Tag: Physical Activity

Exercise shown to curb appetite in diabetes and prediabetes patients
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In a recent study published in the journal Nutrients, researchers evaluated the effects of exercise on appetite in people with type 2 diabetes mellitus (T2DM) or prediabetes.

The global prevalence of T2DM and prediabetes has been steadily growing, with about 537 million people living with diabetes in 2021, compared to 108 million in 1980. Obesity and overweight are major risk factors for diabetes, and weight reduction reduces the risk of diabetes. Therefore, a normal body weight is essential for diabetes prevention and treatment.

Lifestyle interventions and greater physical activity are preferred options for T2DM treatment and prevention. The impact of exercise on energy balance, appetite, and body weight has been studied less in T2DM or prediabetes patients. Thus, a better understanding of the effects of exercise on appetite and its regulation in prediabetes or T2DM patients may improve existing exercise recommendations.

Study: The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Image Credit: Benedek Alpar / Shutterstock

About the study

The present study evaluated how acute and chronic exercise affects appetite and its regulation in T2DM or prediabetes patients. Studies were eligible if they incorporated a bout of acute physical activity or physical training intervention, reported appetite sensation ratings, and compared exercise and non-exercise groups, different exercise regimes, or participants with and without T2DM or prediabetes following the same intervention.

The Cochrane Central Register of Controlled Trials (CINAHL), PubMed, and Web of Science databases were searched for studies. References from included studies were also explored to identify additional studies. Following deduplication, titles/abstracts were screened, and full texts were reviewed.

The following data were extracted: sample size, participants’ age, sex, body mass index (BMI), exercise details, dietary regimens, study duration, medications, appetite ratings, adverse events, and appetite ratings. The risk of bias was assessed using the physiotherapy evidence database scale. The team performed a narrative synthesis of the results.

Findings

Of over 4,000 records identified in database searches, seven studies were included. They were published between 2013 and 23 and included 211 participants. Of these, 183 participants were diagnosed with T2DM and 28 with prediabetes. Two studies examined the effects of chronic exercise on appetite, four evaluated acute exercise, and one investigated both. The quality of evidence for chronic and acute interventions was rated as good.

For assessments of satiety, nausea, hunger, and prospective food consumption, the directions of effects were relatively congruent in acute intervention studies. No study showed a simultaneous increase in satiety and hunger; thus, individual rating scales could be translated into a general trend of appetite. After acute endurance exercise, there was either appetite suppression or no effect for up to 180 minutes following the session.

Two studies measured appetite ratings a day after exercise, and one observed an increase in appetite. Further, two studies investigated resistance exercise; one reported an acute increase in appetite with resistance exercise, whereas the other reported suppressive effects at some time points. In addition, the former study reexamined the acute effects after 12 weeks of training; the results remained unchanged, with no chronic changes in appetite ratings.

Besides, there were no significant changes in appetite hormone levels in the two studies, albeit the feeling of fullness increased at some time points. Likewise, appetite ratings declined, or there was no change following chronic exercise. In a chronic intervention study with 108 participants, satiety increased while hunger decreased in the aerobic endurance and resistance training plus aerobic endurance exercise groups.

In the endurance training group, pre-meal satiety increased; in the combined training group, pre- and post-meal satiety increased after six months. Notably, chronic effects on appetite ratings were inconsistent with changes in appetite hormones. Two acute intervention studies compared participants with and without T2DM.

In one study, there were no differences in appetite ratings between T2DM and non-T2DM groups following exercise. In the other, there were differences in desire to eat and fullness between T2DM and non-T2DM subjects. Further, postprandial fullness declined a day after exercise only in T2DM subjects. No study explicitly reported adverse events.

Conclusions

The study observed that the effects on appetite varied in people with T2DM or prediabetes following acute exercise, whereas appetite ratings declined or were unchanged after chronic exercise. In acute intervention studies, the most consistent finding was increased perceived fullness in T2DM patients after exercise. Overall, the findings provide more evidence for the appetite-reducing effect of (chronic) exercise in prediabetes or T2DM subjects.
Journal reference:

Konitz C, Schwensfeier L, Predel HG, Brinkmann C. The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Nutrients, 2024, DOI: 10.3390/nu16081126, https://www.mdpi.com/2072-6643/16/8/1126
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April 15, 2024
Addressing public health challenges through behavioral interventions

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The concept of “One Health” – which emphasizes the relationship between human, animal, plant and environmental health – has been gaining ground in scientific discussions in recent years. Brazilian and North American researchers developing research using this approach presented their work on Tuesday (April 9th), in Chicago (United States), during FAPESP Week Illinois.

One of the panelists was Eduardo Esteban Bustamante, a professor at the University of Illinois in Chicago. He talked about behavioral interventions that have been tested to promote physical activity and healthy eating – practices that, according to the researcher, Americans still do not adhere to, despite the obvious benefits.

The percentage of Americans meeting nutritional and physical activity recommendations is still very low. Among children aged six to 11, the percentage is 49% for boys and 35% for girls. But as they grow up, these rates get much worse, dropping to 7% and 4%, respectively, in the 16-19 age group, and stagnating at 3% and 2% from the age of 60 onwards.”

Eduardo Esteban Bustamante, Professor, University of Illinois in Chicago

“When it comes to diet, the reality isn’t much better. Just over 10% of American adults over the age of 18 routinely eat fruits and vegetables,” the researcher said.

In an attempt to change this reality, behavioral health intervention programs have been developed and tested across the country. In the last few years alone, more than 3,000 evidence-based physical activity and nutrition interventions have been created in the United States. Of these, around 200 are available in public repositories for use by the public, according to a survey conducted by the researcher.

“These practices are made available on public websites. That way, people can get access to them and follow the instructions correctly to become more active and eat more fruits and vegetables, for example,” Bustamante said.

The problem, however, is that 90% of these scientifically tested physical activity intervention programs in the United States face barriers to dissemination and implementation that limit their potential impact on public health. One of the contributing factors is a lack of alignment with people’s expectations and with the places where they should be implemented, the researcher said.

“I’ve worked with a number of intervention programs, and one of the problems I’ve identified is that we didn’t think about the target audience before we started, and we saw that people weren’t engaged with them. We need to think about how to engage the target audience so that, from the beginning, our interventions fit in and are aligned with their goals,” he said.

“We also need to stop thinking of nutrition and physical activity as medicines that can only benefit health. They’re activities that take place in a context and we can use them to achieve the goals we want, whether they’re health-related or not,” said Esteban.

Based on this finding, the researcher and his collaborators have begun developing and testing new physical activity intervention programs in schools and communities.

For example, one project carried out in collaboration with the University of California Irvine has been using physical activity in schools as a way of learning mathematics. To this end, the basketball court at an educational institution was redesigned to teach children about fractions and decimals.

“The result is that the kids, in addition to getting all the health benefits of doing a physical activity, are learning math in a much more engaging way,” he said.

Another project, implemented in the Chicago Park District, one of the largest and oldest park districts in the United States, has been using sports and recreation to develop communication, emotional and conflict resolution skills in at-risk youths.

“The program works with young people who are in high school. We try to get them jobs during the summer so they can stay in the parks and work during that time, and we encourage them to develop behavioral skills through physical activity,” explained Bustamante.

Multifactorial causes

New approaches to behavioral health interventions are also vital to addressing the diabetes epidemic in the United States, said Marck Rosenblatt, dean of the University of Illinois College of Medicine.

“One in ten people in the United States has diabetes. The causes of this disease are multifactorial. It’s not just because people aren’t taking insulin and medications for hyperglycemia, but also because their diet is inadequate and they don’t exercise,” he said.

“It’ll take a multifaceted approach to address this problem, such as interventions in schools. We’re trying to work with local organizations to try to improve diet quality and encourage physical activity, while at the same time studying the molecular underpinnings of diabetes itself,” said Rosenblatt.

According to the researcher, the social determinants of health are an issue that the Chicago institution and health system have been working hard to understand and intervene in.

“It’s humbling to realize that only around 15% to 20% of a person’s health is related to the solutions we develop in our hospitals and clinics. People’s health is more related to their zip code, which correlates with a number of other factors, such as socioeconomic level, social and community context,” he said.

Environmental risks play a fundamental role in the emergence of degenerative diseases and cancer, emphasized Leandro Colli, professor at the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), supported by FAPESP.

“We know that the cause of cancer is not only genetic. There are also very strong environmental factors. We can intervene in the genetic risk factors, but we also have to look at the environment,” he emphasized.

The researcher is working with collaborators on a project aimed at identifying mutational signatures in cancer patients – a concept that has emerged in recent years whereby it is possible to look at a cell mutation and try to recapitulate its origin and the agents that caused it.

“We’re starting a project in which we’re following a series of patients to try to better understand the risk factors for mutations that lead to cancer, such as tobacco, exposure to solar radiation and the burning of sugar cane in the Ribeirão Preto region,” said Colli.

Source:

São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo)

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April 13, 2024
How diet and hypertension sway risks for heart disease and cancer

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In a recent research review published in Nature Reviews Cardiology, researchers reviewed epidemiological studies on shared mechanisms and modifiable risk factors for cardiovascular disease (CVD) and cancer.

CVD and cancer are leading causes of morbidity and death worldwide, and both illnesses are increasingly understood to be fundamentally linked. Understanding the risk factors and processes that link CVD and cancers allows for the prediction, prevention, and treatment of both, which is critical for advancing the area of cardio-oncology and improving the standard of care.

In the present review, researchers reviewed existing data on the association between CVD and cancer.

Cardiovascular disease and cancer: shared risk factors and mechanisms. Image Credit: ESB Professional / Shutterstock

Shared modifiable factors contributing to cardiovascular disease and cancer risk

Hypertension contributes to CVD and several cancer types, including colorectal, breast, and renal cell cancers. Cancer patients and survivors have higher hypertension rates than healthy individuals. Hyperlipidemia is also associated with atherosclerotic CVD and low-density cholesterol (LDL)–lowering treatment can decrease CVD-related and any-cause deaths. Studies indicate that hyperlipidemia increases breast and colorectal cancer risk.

Obesity, an independent CVD risk factor, exacerbates other risk factors such as diabetes, hypertension, and hyperlipidemia. Diabetes, an established contributory factor for cardiovascular disease, increases colorectal, breast, endometrial, and gallbladder cancer risk. Smoking elevates CVD risk and cancer incidence, increasing cardiovascular morbidities and deaths and malignancies in the upper respiratory organs.

The link between alcohol intake and CVD risk is ambiguous; however, excessive drinking can increase CVD risk. The Mediterranean diet and increased exercise are dose-dependent and significantly related to a lower risk of cardiovascular disease, tumors, and related deaths. Socioeconomic determinants of health (SDOH) measures are strongly related to worsened cardiovascular health and poorer cancer outcomes.

The dysregulation of systems regulating cellular aging, proliferation, metabolism, and damage connect cardiovascular disease and cancer. Oxidative stress in CVD raises noncommunicable disease risk, whereas clonal hematopoiesis causes chronic inflammation, which leads to atherosclerosis and inflammation. Microbial dysbiosis in cancer is associated with increased cell turnover, genotoxic metabolite production, inadequate immune surveillance, and chronic inflammation. Metabolic instability in cancer cells can result in circulating oncometabolites and cardiovascular remodeling. Environmental factors such as diet and medication use can influence dysbiosis. Circulating soluble chemicals are potential mediators of accelerated tumor growth and increased cancer risk in CVD patients.

Epidemiological evidence concerning shared factors increasing CVD and cancer risk

Each 5.0 mmHg decrease in systolic blood pressure (SBP) lowers major adverse cardiovascular events [MACE, hazard ratio (HR) 0.9 without prior CVD; HR 0.9 with prior CVD] risk. A 10-mm Hg drop in SBP lowers CVD [relative risk (RR) 0.8] and any-cause mortality (RR 0.9) risks. Hypertension raises the chance of developing kidney, colorectal, and breast cancers.

Elevated serum triglyceride raises colorectal cancer risk (HR 1.2), but increased high-density cholesterol (HDL) lowers colorectal (adjusted HR 0.8) and breast cancer incidences (RR 0.9). A 5.0 kg/m2 rise in body mass index (BMI) increases CVD risk factor risk, including hypertension, heart failure, ischemic stroke, atrial fibrillation, rectal cancer, and biliary tract cancers with RR values of 1.5, 1.4, 1.4, 1.2, 1.1, and 1.6, respectively. Elevated BMI is also associated with coronary artery diseases (HR, 1.2) and CVD-related deaths (HR, 1.5).

Diabetes mellitus is associated with increased cardiovascular and any-cause deaths (HR 1.2). Smoking raises significant CVD risk (RR 1.6) and related deaths (HR 2.8). Quitting cigarette smoking within five years lowers the incidence of new-onset CVD (HR 0.6). Low-level drinking (1.3–5.0 g of alcohol daily) reduces coronary heart disease-related death risk compared to non-drinkers (RR 0.8); however, drinking >50 g of alcohol daily increases the risk of oropharyngeal, oesophageal, colorectal, laryngeal, and breast cancers.

The Mediterranean diet, which includes olive oil and mixed nuts, lowers the incidence of CVD (HR 0.7). Mediterranean diets reduce the risk of nonfatal MI (RR 0.5), CVD mortality [odds ratio (OR) 0.6], all-cause mortality (OR 0.7), colorectal and breast cancers, and cancer death (RR 0.9). Low cardiorespiratory fitness raises all-cause mortality and CVD events (HR 1.7). High leisure-time physical activity lowers the incidence of 13 malignancies, with the most robust relationships seen in esophageal, lung, and kidney cancers (HR 0.6). The presence of at least one SDOH increases 90-day mortality after heart failure hospitalization (HR 2.8). Three or more SDOHs raise the likelihood of fatal events (CVD HR 1.5) and cancer-related mortality (HR 1.3 for those over 65 years).

Based on the findings, CVD and cancer have a bidirectional link, with shared processes and risk factors producing both conditions. CVD raises the risk of certain types of cancer and cancer-related mortality, whereas cancer raises the risk of certain types of CVD and CVD-related death. Common risk factors include hypertension, high cholesterol, diabetes, obesity, smoking, nutrition, physical activity, and SDOH. Addressing shared risk factors for CVD and cancer has far-reaching public health consequences, as technological discoveries have made cancer a chronic illness, and an increasing population of aging adult survivors may acquire comorbid CVD.

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April 12, 2024
Childhood sedentariness associated with increase in blood insulin concentration, study shows

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An increase in sedentary time from childhood is associated with a significant increase in blood insulin concentration, a new study shows. However, light physical activity could reduce the risk of excess insulin and insulin resistance. The study was conducted in collaboration between the Universities of Bristol and Exeter, and the University of Eastern Finland, and the results were published in the Journal of Clinical Endocrinology and Metabolism.

Based on the University of Bristol’s Children of the 90s data, the study included 792 children followed up from 11 to 24 years of age. At baseline they spent an average of 6 hours per day in sedentary activities, which increased to 9 hours per day during the follow-up. This increase in sedentary time was associated with continuously higher insulin levels in fasting blood, especially among youths with overweight and obesity, whose risk of excess insulin increased by 20%. On the contrary, an average of light physical activity (LPA) of 3-4 hours per day throughout the follow-up decreased the risk of excess insulin by 20%. Higher LPA was also associated with lower insulin resistance.

Participating in moderate-to-vigorous physical activity (MVPA) showed signs of reducing insulin but to a much smaller extent.

Earlier results from the same cohort have linked sedentariness to fat obesity, dyslipidaemia, inflammation, and premature vascular damage. The researchers have also observed a vicious cycle of obesity and worsening insulin resistance.

Light physical activity is now emerging as an effective approach to reversing the deleterious effect of childhood sedentariness. However, whether long-term exposure to LPA from childhood reduces excess glucose, insulin, and insulin resistance has not been examined before. This is because only a few studies have repeatedly measured all these in a large population of healthy youth.

The current study is the largest and the longest follow-up accelerometer-measured movement behaviour and glucose, insulin, and insulin resistance study in the world. The participants wore accelerometer devices on their waists at ages 11, 15, and 24 years for 4-7 days and had fasting glucose and insulin measurements at ages 15, 17, and 24 years. Their fasting blood samples were also repeatedly measured for high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-sensitivity C-reactive protein. Blood pressure, heart rate, smoking status, socio-economic status, and family history of cardiovascular disease were controlled for in the analyses.

Calling a spade a spade, our recent studies have identified childhood sedentariness as a monster that threatens the young population across the globe, no thanks to excessive screen use.”

Andrew Agbaje, award-winning physician and associate professor (docent) of clinical epidemiology and child health, University of Eastern Finland

“Sedentariness should be recognized as one of the twenty-first century independent causes of excess insulin, fat obesity, high lipid levels, inflammation, and arterial stiffness. 3-4 hours of LPA per day is critically important to antagonizing childhood sedentariness. While we await the update of the current World Health Organization’s physical activity guideline, which does not include an LPA recommendation, public health experts, health policymakers, health journalists, pediatricians, and parents should encourage kids to participate in LPA daily.”

Prof. Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Eino Räsänen Fund, Matti and Vappu Maukonen Fund, Foundation for Pediatric Research, and Alfred Kordelin Foundation.

Source:

University of Eastern Finland (UEF Viestintä)

Journal reference:

Agbaje, A. O. (2024). The Interactive Effects of Sedentary Time, Physical Activity, and Fat Mass on Insulin Resistance in the Young Population. The Journal of Clinical Endocrinology and Metabolism. doi.org/10.1210/clinem/dgae135.

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April 9, 2024
How incentives and games encourage exercise
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In a recent study published in the journal Circulation, researchers evaluated the effects of gamification and financial incentives on physical activity in individuals at risk of adverse cardiovascular events.

Higher physical activity is associated with a lower risk of adverse cardiovascular events and improved control of cardiovascular risk factors. By leveraging behavioral economic concepts, such as loss-framing, immediacy, and endowment effects, shorter-term analyses have implemented financial incentives and gamification interventions and observed increased physical activity in patients at risk of or with atherosclerotic cardiovascular disease (ASCVD). Nevertheless, the effect of these interventions over the long term remains unclear.

Study: Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial. Image Credit: Alliance Images / Shutterstock

About the study

In the present study, researchers evaluated the efficacy of financial incentives, gamification, or both to improve physical activity over the long term in individuals at risk of major cardiovascular events. This randomized controlled trial was conducted between May 2019 and January 2024. Eligible participants had ASCVD or a 10-year risk of stroke, myocardial infarction, or cardiovascular death.

Eligible subjects received a wearable device to track their step count. During the two-week run-in period, a baseline step count was established. Subsequently, participants were instructed to set a goal to increase their step count relative to baseline. Next, participants were randomized to attention control, financial incentives, gamification, or financial incentives plus gamification (combination).

The control group received text messages daily for 18 months, inquiring if they had achieved their step goal the previous day. In the gamification arm, participants signed a pre-commitment pledge to reach their step goal. They received 70 points at the beginning of each week. Points were retained if they succeeded in their daily goal; otherwise, 10 points were removed.

Their levels, viz., platinum, gold, silver, bronze, and blue, changed based on points at the end of the week. All participants began at the silver level; blue- or bronze-level participants were restarted at the silver level every eight weeks. Gold- or platinum-level participants were awarded a trophy after the intervention.

On the other hand, the financial incentives group was informed that $14 would be deposited in a virtual account each week. The balance did not change if the goal was achieved; otherwise, $2 was deducted. In the combination arm, participants completed interventions from both arms. After 12 months, interventions were discontinued; however, daily text messages recording the count continued for six additional months (follow-up).

The primary outcome was the change in daily step count from baseline to the end of the intervention. Secondary outcomes were the average changes in daily step count from baseline to follow-up, weekly moderate-to-vigorous physical activity (MVPA) minutes, and the proportion of participant weeks with at least 150 MVPA minutes.

Findings

Overall, 151, 304, 302, and 304 individuals were randomized to control, gamification, financial incentives, and combination arms, respectively. The average age of participants was 66.7 years; 60.5% were female, and 25% were Black. At baseline, the average daily step count was 5081, mean MVPA minutes were 5.8, and the average step count increase was 1867.

In total, 89.8% of participants completed the 18-month study. The control, financial incentives, gamification, and combination groups achieved a mean increase of 1418, 1915, 1954, and 2297 steps from baseline to the intervention period, respectively. The corresponding figures over the follow-up period were 1245, 1576, 1708, and 1831, respectively.

Over the 12-month intervention, compared to the control arm, participants had a greater increase in average daily step count. The combination arm was superior to financial incentives during the intervention period. Weekly MVPA increased by 39.6, 56.6, 54.7, and 65.4 minutes, on average, for control, financial incentives, gamification, and combination arms from baseline to intervention.

Over the follow-up period, weekly MVPA minutes increased by 37.3 for control, 50.7 for gamification, 50.9 for financial incentives, and 57.6 for combination groups. The proportion of participant weeks with at least 150 MVPA minutes was 0.16, 0.24, 0.23, and 0.27 for control, financial incentives, gamification, and combination arms, respectively. The combination group had greater odds of a week with at least 150 minutes of MVPA.

Conclusions

Taken together, interventions with financial incentives, gamification, or both significantly improved physical activity in adults at risk of cardiovascular events compared to attention control over the 12-month intervention. This effect was sustained over the six-month follow-up period after the end of the intervention in the combination group. The combination group also increased weekly MVPA minutes more than the control group. These interventions could be helpful components of strategies aimed at alleviating cardiovascular risks.
Journal reference:

Fanaroff AC, Patel MS, Chokshi N, et al. Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial. Circulation, 2024, DOI: 10.1161/CIRCULATIONAHA.124.069531, https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069531
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April 9, 2024
Consistent walking improves brain function in older adults

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In a recent study published in the journal Scientific Reports, researchers explored how changes in daily step counts and variability affect cognitive function in older adults during a 10-week physical activity intervention.

Study: Association between changes in habitual stepping activity and cognition in older adults. Image Credit: SibRapid / Shutterstock

Background

Aging often leads to cognitive decline, particularly in executive functions and inhibitory control, which are early indicators of conditions like Alzheimer’s disease. Engaging in regular physical activity can reduce or even reverse these declines in older adults. As the population ages, identifying strategies to preserve cognitive function becomes crucial. While structured exercise in controlled settings has been linked to cognitive health, the effects of habitual, daily physical activity on cognition remain underexplored. Further research is needed to clarify the mechanisms linking physical activity patterns to cognitive improvements and to establish customized intervention strategies for diverse aging populations.

About the study

In the present study, 43 older adults were recruited, with 37 completing due to incomplete stepping data. Participants were over 55, able to walk independently, cognitively healthy, and free from significant health issues, though some were on medication. They engaged in a 10-week intervention focused on improving cognitive function through group aerobic and resistance activities, aligning with a dynamic socio-ecological model. Participants committed to a minimum of 150 minutes of moderate-to-vigorous activity weekly, with adherence verified by activity logs.

Activity was monitored with Fitbit devices, requiring consistent wear for accurate step count and variability data. Step count validity and variability (using average real variability, ARV) were assessed, focusing on the day-to-day differences in activity levels.

Physical and cognitive assessments pre- and post-intervention included heart rate, blood pressure, body mass index, a six-minute walk test for aerobic fitness, and a computerized Stroop task for cognitive function. The Stroop task evaluated processing speed, inhibitory control, and cognitive flexibility through different stages, with high accuracy and reaction times recorded.

Data analysis, adhering to normality checks and parametric statistics, modeled step counts and variability non-linearly, assessing changes in physical and cognitive measures via paired t-tests and Analysis of Covariance (ANCOVA), and adjusting for demographic factors. Regression analyses explored the relationship between activity changes and cognitive performance, with statistical significance set at p < 0.05.

Study results

In this study, the majority of participants were female (33 out of 37), and all demonstrated cognitive health with Mini-Mental State Examination (MMSE) scores exceeding 24. Following the intervention, a significant reduction in body mass and body mass index was observed alongside an increase in distance covered during the six-minute walk test (6MWT), indicating physical improvements (all, p < 0.001).

Analysis of stepping data revealed that total step counts increased and day-to-day step variability decreased over the course of the 10-week intervention. These changes were most pronounced at the start and end of the period, with the data fitting best to a cubic model, signifying a non-linear relationship in both total steps taken and in the variability of these steps from day to day. The intervention increased overall physical activity levels, as evidenced by higher step counts while promoting more consistent activity patterns among participants, as shown by reduced variability in day-to-day step counts.

Cognitive outcomes measured through a computerized Stroop task before and after the intervention revealed notable improvements. Specifically, reaction times during the simple naming condition were faster post-intervention, indicating enhanced processing speed. Although the inhibition condition did not significantly improve, the switching condition, which tests cognitive flexibility and is considered the most challenging, exhibited faster completion times post-intervention.

When examining the relationship between changes in physical activity and cognitive performance, the study found no significant association between the increase in total step counts and improvements in reaction time for any of the Stroop task conditions (naming, inhibition, and switching). However, a significant positive association was observed between reductions in day-to-day step variability and faster reaction times in the switching condition.

Conclusions

To summarize, this study confirmed that stabilizing daily step variability, rather than increasing total step count, led to faster reaction times in the Switching task of the Stroop test, indicating improved cognitive flexibility in older adults. This suggests promoting consistent daily physical activity as a potential strategy for enhancing executive function. The Stroop task showed that such cognitive flexibility improvements could significantly lower the risk of cognitive disorders. The findings challenge current physical activity guidelines by suggesting that daily consistency, alongside a high number of steps, may better support cognitive health in older adults. This personalized physical activity intervention increased average step counts, reduced variability, and enhanced cognitive flexibility, indicating its potential as a model for encouraging consistent daily activity among older adults.

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April 9, 2024
Type 2 diabetes patients’ willingness to engage varies

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Type 2 diabetes (T2D) may occur as a result of unhealthy lifestyle habits. People with T2D are often associated with diets with excessive sugar, high alcohol consumption, smoking, and have sedentary habits.

This has sparked much interest in determining the optimal lifestyle changes that could help normalize dysfunctional metabolic pathways in T2D patients.

A recent study in Primary Care Diabetes explores the willingness to engage in various management options for T2D among recently diagnosed patients.

Study: Willingness of people with type 2 diabetes to engage in healthy eating, physical activity and medication taking. Image Credit: urbans/Shutterstock.com

Healthy lifestyle in T2D

Obesity characterizes most T2D patients. As such, most of them show a reduction in their glycated haemoglobin A1c (HbA1c) 0.6–1.2% if they lose 5% or more of their body weight. If this fails to restore glucose levels to normal, medication is initiated, usually metformin, as the first step.

Lifestyle adjustments are key to managing T2D. However, not much is known about how possible it is to achieve these changes. Earlier research revealed that there are several types of barriers to adopting healthy lifestyle habits.

These include beliefs that lifestyle modification is not worthwhile or that medication works just as well or better while being easier to implement. Poverty, ignorance, and lack of adequate support also pose barriers.

The current study aimed to evaluate the level of willingness among recently diagnosed T2D patients towards three types of modifications comprising healthy diet, adequate physical exercise, and proper use of medications.

About the study

The researchers used an online survey to assess patient factors among recently diagnosed type 2 diabetes patients living in either the Netherlands or in the UK.

The mean age was 57 years, over half were on metformin as part of T2D treatment, and one in three lived in the UK.

What did the study show?

There were 67 patients included in the survey. About half of them reported their willingness to use any of the three management options, in contrast to 6% who rejected all three.

A healthy diet was an acceptable option for three out of four of the participants. The same proportion was willing to perform physical exercise and medication, respectively.

People who were more willing to exercise or take medications were more likely to have a higher combined score for all three areas: their capability, opportunity, and motivation to make lifestyle changes.

Factors like educational level, body mass index (BMI), smoking or drinking, eating habits, or exercise levels, were not found to be independently associated with willingness to change lifestyle patterns.

Diet

Patients in the Netherlands were significantly more favorable towards the adoption of a healthy diet. UK patients often thought poorly of the recommended diets.

A doctor’s recommendation was more often found to underpin those patients who showed greater willingness to eat healthy compared with the other group.

Interestingly, both willing and unwilling groups believed in the effectiveness of a healthy diet in managing weight and blood glucose levels, as well as similar hindrances vs. facilitating factors.

Healthy eating was often opposed by beliefs that the recommended diet was not suitable for the patient, usually because they had other illnesses as well.

Thus, individual beliefs about what comprises a healthy diet must be specifically asked for and addressed when prescribing such an approach.

Exercise

Especially with respect to exercising, people who were ready to take it up believed it was a feasible option compared to those who were unwilling. The former also perceived more positive outcomes compared to the latter.

Barriers like poor motivation and the difficulty of exercising in hot surroundings and sticking to it when away from home were more likely to be unwilling to exercise.

Those who expressed willingness to exercise were more likely to have companions and to find it easier, as well as feeling better while exercising.

Both groups showed the same beliefs regarding the efficacy of exercise in managing T2D and in overall health and weight management.

Medication

People willing to take medication were more likely to believe that medication helps reduce blood glucose and to have acquaintances who were helped by medication.

Conversely, unwillingness was associated with beliefs that without a reminder, medication intake would be low or that there were significant side effects.

Conclusions

People who have recently been diagnosed with type 2 diabetes are often encouraged to change lifestyle habits, including their eating patterns and physical activity, and to begin medication.

The vast majority are willing to use any of these options to manage their condition. This may be in part because they have not had time to experience any negative outcomes of these management choices.

Only half of the patients were willing to use all three approaches to manage their diabetes.

“Most of the recently diagnosed patients not willing to manage T2D with medication were willing to engage in healthy eating or physical activity. Nonetheless, a substantial proportion was not willing to engage in both healthy eating and physical activity.”

Compliance with healthy eating or exercise patterns does not seem to be influenced by their beliefs about the available management options.

Country-wise variability was observed in the degree of willingness to follow dietary recommendations.

The presence of obstacles, irrespective of willingness to use one or more approaches indicates that “willingness to engage in something does not guarantee successful implementation and tailored support should be part of personalized diabetes care.”

This is shown to be essential for helping T2D patients achieve good diabetic control, beginning with the approach most agreeable to the patient.

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April 8, 2024
Burdock roots outshine dandelion in antidiabetic potential study
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In a recent study published in the journal Plants, researchers from Latvia analyzed and compared the chemical compounds in the roots of dandelion (Taraxacum officinale) and burdock (Arctium lappa) for their potential antidiabetic properties. They found that while burdock exhibited higher values for total phenolic content (TPC), tannin content, and α-amylase activity compared to dandelion, dandelion had higher total polysaccharide (TP) content. In vivo studies are warranted to confirm these findings and the antidiabetic potential of these plants.

Study: Antidiabetic Properties of the Root Extracts of Dandelion (Taraxacum officinale) and Burdock (Arctium lappa). Image Credit: KatMoys / Shutterstock

Background

Type 2 diabetes mellitus (T2DM) accounts for a majority of diabetes cases globally and is associated with various risk factors, including genetic predisposition, poor diet, and lack of physical activity, leading to insulin resistance and hyperglycemia-associated complications. Given the drawbacks and expenses of conventional hypoglycemic drugs, there is a growing interest in herbal medicine for diabetes management. Preclinical studies highlight the potential of edible plants for blood sugar control and offer promising alternatives with apparent efficacy and low toxicity.

Dandelion and burdock, traditional medicinal plants belonging to the Asteraceae family, are rich in diverse phytochemicals with potential health benefits. They contain phenolic acids, coumarins, and polysaccharides, exhibiting various biological activities, suggesting their potential role in managing complex conditions like T2DM. The present study aimed to investigate the potential antidiabetic properties of chemical compounds in dandelion and burdock roots by assessing their effects on blood sugar levels and antioxidant capabilities.

About the study

Dandelion and burdock roots were collected from two distinct rural regions in Latvia and processed according to standardized methods. While dandelion roots were sourced from “Vecpiebalga” and “Kaļķis,” burdock roots were collected near “Viļani” and “Būdiņas.” The roots were washed, dried, and ground into a powder for extraction. Ethyl alcohol extracts (AE) and lyophilizate extracts (LE) were prepared from the powdered roots, and both extraction methods were analyzed comparatively. Analysis of the extracts included determination of inulin content, TPC, tannin level, and TP.

Preparation of ethyl alcohol and lyophilizate extracts.

Additionally, antioxidant activities were assessed using the DPPH (short for 2,2-diphenyl-1-picrylhydrazyl) assay, and hypoglycemic properties were assessed based on α-amylase activity. Trolox was used as a standard solution for constructing the standard curve in the antioxidant activity analysis. Half maximal inhibitory concentration (IC50) was determined for Trolox and compared with that of dandelion and burdock. Similarly, in the hypoglycemic activity analysis, acarbose was used as the standard solution.

Liquid chromatography-mass spectrometry (LC-MS) was employed for qualitative analysis of the chemical components. Statistical analysis involved means and standard errors, analysis of variance, and the Mann–Whitney U test.

Results and discussion

The results of specific color-change-based chemical tests revealed the presence of inulin and the absence of starch in burdock and dandelion roots. Significant differences were observed in TPC between alcohol-based and lyophilizate extraction methods, with burdock showing higher TPC, particularly in LE. Dandelion roots showed negligible tannin content, while burdock roots exhibited low but detectable levels, with LE showing slightly higher values. However, no significant difference was found in terms of TPC and tannin obtained from samples of the two different Latvian rural regions in the study.

Further, dandelion root extract showed higher values of TP compared to burdock root extract. No statistically significant differences were found in the TP between the two plants. Comparatively, LE exhibited significantly higher antioxidant activity compared to AE. Burdock LE outperformed Trolox, while dandelion AE showed the least favorable outcome.

None of the plant extracts matched the IC50 of acarbose, with LE of burdock showing the most favorable outcomes and the AE of dandelion demonstrating the least favorable results. LE consistently showed significantly higher values compared to AE within the same plant samples.

Diverse chemical compounds were found in root extracts, including amino acids, phenolic acids, and alkaloids, among others. Specific compounds like chlorogenic acid, phenylalanine, and valine were found in all the extracts, while others like caffeic acid and oleanolic acid were exclusive to burdock, and salicylic acid glucoside and protocatechuic acid were unique to dandelion. Burdock showed a wider array of unique compounds than dandelion, indicating its richer chemical profile.

In the future, exploring additional compounds present in the roots and replicating tests with various solvents could provide further insights. Animal and human studies would be crucial to confirm these findings and explore the potential clinical applications of these compounds.

Conclusion

In conclusion, the present study found burdock root to be better than dandelion regarding its chemical composition and potential therapeutic activity. However, more research is needed to confirm the effectiveness of the two plants individually and in combination with other drugs for managing diabetes and other chronic ailments.
Journal reference:

Antidiabetic Properties of the Root Extracts of Dandelion (Taraxacum officinale) and Burdock (Arctium lappa). Zolotova D. et al., Plants, 13(7):1021 (2024), DOI: 10.3390/plants13071021, https://www.mdpi.com/2223-7747/13/7/1021
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April 8, 2024
Lancet study reveals alarming global obesity trends in 2022
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New study released by the Lancet shows that, in 2022, more than 1 billion people in the world are now living with obesity. Worldwide, obesity among adults has more than doubled since 1990, and has quadrupled among children and adolescents (5 to 19 years of age). The data also show that 43% of adults were overweight in 2022.

The study also shows that even though the rates of undernutrition have dropped, it is still a public health challenge in many places, particularly in South-East Asia and sub-Saharan Africa.

Countries with the highest combined rates of underweight and obesity in 2022 were island nations in the Pacific and the Caribbean and those in the Middle East and North Africa.

Malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight and obesity. Undernutrition is responsible for half of the deaths of children under 5 and obesity can cause noncommunicable diseases such as cardiovascular diseases, diabetes and some cancers.

WHO has contributed to the data collection and analysis of this study. The full dataset is now also disseminated through the Global Health Observatory.

“This new study highlights the importance of preventing and managing obesity from early life to adulthood, through diet, physical activity, and adequate care, as needed,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies. Importantly, it requires the cooperation of the private sector, which must be accountable for the health impacts of their products”.

Obesity is a complex chronic disease. The causes are well understood, as are the interventions needed to contain the crisis, which are backed by strong evidence. However, they are not implemented. At the World Health Assembly in 2022 Member States adopted the WHO Acceleration plan to stop obesity, which supports country-level action through 2030. To date, 31 governments are now leading the way to curb the obesity epidemic by implementing the plan.

The core interventions are:
- actions to support healthy practices from day 1, including breastfeeding promotion, protection and support;
- regulations on the harmful marketing of food and beverages to children;
- school food and nutrition policies, including initiatives to regulate the sales of products high in fats, sugars and salt in proximity of schools;
- fiscal and pricing policies to promote healthy diets;
- nutrition labelling policies;
- public education and awareness campaigns for healthy diets and exercise;
- standards for physical activity in schools; and
- integration of obesity prevention and management services into primary health care.
There are significant challenges in implementing policies aimed at ensuring affordable access to healthy diets for all and creating environments that promote physical activity and overall healthy lifestyles for everyone. Countries should also ensure that health systems integrate the prevention and management of obesity into the basic package of services.”

Dr. Francesco Branca, Director of WHO’s Nutrition and Food Safety Department and one of the co-authors of the study

Addressing undernutrition requires multisectoral action in agriculture, social protection and health, to reduce food insecurity, improve access to clean water and sanitation and ensure universal access to essential nutrition interventions.

Source:

The World Health Organization
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April 1, 2024
Trial shows blood pressure drops with less sitting

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In a recent study published in JAMA Network Open, researchers investigated whether reducing sitting time could effectively improve blood pressure (BP) among older adults.

Study: Sitting Time Reduction and Blood Pressure in Older Adults. Image Credit: insta_photos/Shutterstock.com

Background

Sedentary behavior is associated with adverse health outcomes such as cardiovascular disease, type 2 diabetes, low physical function, and death. Moderate to moderate activity can benefit older adults’ cognitive, physical, functional, and emotional health; however, their compliance with physical activity is poor, with most of them sitting for much of the day.

Identifying modifiable variables is critical to improving cardiometabolic fitness in older individuals. Short-term experimental investigations demonstrate that lowering sitting duration reduces blood pressure, particularly in hypertensive individuals.

About the study

In the present randomized controlled trial, researchers evaluated the impact of sitting time reduction on BP readings in the geriatric population.

The team conducted the Healthy Aging Resources to Thrive (HART) trial primarily remotely at the state level during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic between January 2019 and November 2022.

Participants included adult Kaiser Permanente Washington (KPWA) care recipients, enrolled for at least a year, aged between 60 and 89 years, sitting for ≥6.0 hours daily, and a body mass index (BMI) ranging between 30 and 50 kg/m2.

The researchers excluded palliative, long-term, or hospice care recipients, those with cancer, deafness or considerable hearing impairment, degenerative disorders such as dementia, or adverse mental health conditions in the previous two years, diagnosed using the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) codes.

The team randomized the participants in a 1:1 ratio to the sedentary behavior reduction intervention (I-STAND) or healthy living control conditions for six months.

The intervention group received ten health enhancement contacts, sedentary time reduction targets, and a fitness tracker. The controls received ten health training contacts to establish broad healthy living objectives that excluded physical activity and sedentary behavior.

The primary study outcome was sitting duration recorded at study initiation, three months, and six months, using accelerometers for a week at every time point. The researchers monitored systolic BP (SBP) and diastolic BP (DBP) at study initiation and after six months.

The exploratory outcomes included changes in accelerometer standing and walking time, daily step count, number of sitting bouts of ≥30 minutes, mean sitting bouts’ duration, time to perform five chair stands from the Short Physical Performance Battery, and changes in hypertension medication classes.

The researchers performed linear regression modeling for analysis, with study covariates such as age, sex, race, ethnicity, residence county, physical function, retirement status, diabetes, and hypertension.

They also performed a sensitivity analysis, separately analyzing data obtained before and during coronavirus disease 2019 (COVID-19).

Results

The researchers randomized 283 individuals to the I-STAND intervention (n=140) and control (n=143) groups. The mean participant age was 69 years, 186 (66%) were female, and the mean BMI was 35 kg/m2.

At study initiation, 52% (n=147) suffered from hypertension, and 69% (n=97) consumed one or more antihypertensive medications. Accelerometer awake time was nearly 16 hours daily over a week of wear in the study groups.

The team noted sedentary time reduction in favor of the I-STAND intervention, with an average difference of 31 minutes per day at three months and 32 minutes per day at six months.

The intervention group had a considerably higher mean drop in SBP (3.5 mm Hg) after six months. However, DBP changes were not significantly different across the study groups (0.3 mm Hg).

The sensitivity analysis showed similar results. The study found six major adverse events in both the I-STAND intervention group (two cancer diagnoses, one emergency department admission, two hospitalizations, and one fall) and the control group.

However, there were no adverse events associated with the trial. They found no significant intergroup variations in BMI, waist circumference, or body weight.

The study found that standing time rose while sitting bouts’ duration and extended sitting bouts were reduced after six months, favoring the intervention group. Changes in antihypertensive drug classes in both groups were not significant.

Women had significantly lower diastolic blood pressure than men, but the impact was minor. Participants in suburban and rural locations demonstrated minor improvements in diastolic blood pressure, supporting the research intervention.

Conclusion

The study findings revealed that lowering sitting time may be successfully provided remotely, resulting in considerable blood pressure decreases. The intervention, which involved 283 older individuals, decreased sitting duration by >30 minutes per day and SBP by about 3.5 mm Hg.

The findings indicate that sitting time reduction by standing more and taking more frequent breaks may be a unique lifestyle option for decreasing blood pressure that is simpler for older individuals with chronic diseases to implement into their everyday lives.

Possible physiological causes for SBP decreases include frequent interruptions to the bent arterial posture, which may enhance blood flow and vascular shear stress.

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March 29, 2024