Introduction Prolonged sedentary behavior is an independent risk factor for many negative health outcomes. Although many employers have begun introducing sit–stand desks as means of reducing ...employee’s occupational sitting time, few studies have examined the impact of prolonged access to such desks on sitting/standing time or cardiometabolic outcomes. The present study compared occupational sedentary/physical activity behaviors and cardiometabolic biomarkers among employees with long-term access to traditional sitting and sit–stand desks. Methods This study used a naturalistic, cross-sectional study design. Occupational sedentary and physical activity behaviors and cardiometabolic health outcomes were collected in a controlled laboratory between February and June 2014. Data were analyzed in September 2014. Adults working in full-time sedentary desk jobs who reported having either a sit–stand desk ( n =31) or standard sitting desk ( n =38) for a minimum of 6 months were recruited. Results Employees with sit–stand desks sat less ( p =0.02) and stood more at work ( p =0.01) compared with employees with sitting desks. Significant inverse correlations were observed between several occupational physical activity outcomes (walking time, steps at work) and cardiometabolic risk factors (systolic blood pressure, weight, lean mass, BMI) over the entire sample. Conclusions Employees with long-term access to sit–stand desks sat less and stood more compared with employees with sitting desks. These findings hold public health significance, as sit–stand desks represent a potentially sustainable approach for reducing sedentary behavior among the large, growing number of sedentary workers at increased risk for sedentariness-related pathologies.
Chronic obstructive pulmonary disease (COPD) phenotyping can help define clusters of patients with common characteristics that relate to clinically meaningful outcomes. In this review, we describe 7 ...clinically meaningful COPD phenotypes that can be identified by primary care physicians as well as specialists and that have specific management and prognostic implications: (1) asthma-COPD overlap phenotype, (2) frequent exacerbator phenotype, (3) upper lobe-predominant emphysema phenotype, (4) rapid decliner phenotype, (5) comorbid COPD phenotype, (6) physical frailty phenotype, and (7) emotional frailty phenotype.
Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of ...sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied.
To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity.
Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV
% predicted=50.8±20.5). Participants had sleep and physical activity continuously monitored using a multisensor activity monitor for a median of 6 days. Linear mixed effects models were applied to investigate the factors associated with sleep impairment and the association between nocturnal sleep and patients' subsequent daytime physical activity.
Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01).
There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions.
Cognitive dysfunction has been demonstrated in chronic obstructive pulmonary disease (COPD), but studies are limited to cross-sectional analyses or incompletely characterized populations.
We examined ...longitudinal changes in sensitive measures of executive function in a well-characterized population of patients with severe COPD.
This study was performed on patients enrolled in the National Emphysema Treatment Trial. To assess executive function, we analyzed trail making (TM) A and B times at enrollment in the trial (2,128 patients), and at 12 (731 patients) and 24 months (593 patients) after enrollment, adjusted for surgery, marriage status, age, education, income, depression, PaO2, PaCO2, and smoking. Associations with survival and hospitalizations were examined using Cox regression and linear regression models.
The average age of the patients was 66.4 years, and the average FEV1 was 23.9% predicted. At the time of enrolment, 38% had executive dysfunction. Compared with those who did not, these patients were older, less educated, had higher oxygen use, higher PaCO2, worse quality of life as measured by the St. George's Respiratory Quotient, reduced well-being, and lower social function. There was no significant change over 2 years in TM A or B times after adjustment for covariables. Changes in TM B times were modestly associated with survival, but changes in TM B-A times were not. Changes in TM scores were not associated with frequency of hospitalization. Lung function, PaO2, smoking, survival, and hospitalizations were not significantly different in those with executive dysfunction.
In this large population of patients with severe emphysema and heavy cigarette smoking exposure, there was no significant decline over 2 years in cognitive executive function as measured by TM tests. There was no association between executive function impairment and frequency of hospitalization, and there was a possible modest association with survival. It is plausible that cerebrovascular comorbidities explain previously described cognitive pathology in COPD.
Background Individuals who have metastatic cancer experience substantial physical and psychological distress (e.g., pain, depression, anxiety) from their disease and its treatment compared to ...patients with less advanced disease. As the burden of symptoms varies over time, ecological momentary assessment (EMA) may be used to better understand patients’ symptom trajectories, complimenting traditional longitudinal data collection methods. However, few have used EMA in patients with metastatic disease. The current study adds to the existing literature by exploring interrelated, common cancer-related symptoms of pain, anxiety, and depression and use of cannabis-based products, opioid medications, other (nonopioid) pain medications, and medications for anxiety or depression. Methods An eight-day prospective observational feasibility study was conducted among 50 patients with metastatic cancer recruited from seven solid cancer clinics at The Ohio State University Comprehensive Cancer Center. Participants completed a week of interval-contingent mobile EMA, administered daily at 9 a.m., 3 p.m., and 8 p.m., and a comprehensive interviewer-administered questionnaire on Day 8. Participants were queried on their symptom burden and management strategies (i.e., use of medications and cannabis). We considered EMA to be feasible if a priori retention (80%) and adherence goals (75%) were met. Results Seventy-nine percent of eligible patients contacted enrolled in the study ( n = 50 of 63). Among those enrolled, 92% were retained through Day 8 and 80% completed >90% of EMAs, exceeding a priori objectives. Participants’ average pain, anxiety, and depressive symptoms across the week of EMA ranged from 1.7 to 1.8 (1 to 5 scale). Symptoms varied little by day or time of administration. On Day 8, significant proportions of participants reported past-week use of medications and cannabis for symptom management. Conclusions Participants exceeded a priori adherence and retention objectives, indicating that mobile EMA is feasible among metastatic cancer patients, addressing a gap in the existing literature and informing future research. Restricting eligibility to participants with a minimum cutoff of symptom burden may be warranted to increase observations of symptom variability and provide opportunities for future health interventions. Future research is needed to test the acceptability and quality of data over a longer study period in this patient population.
Cognitive impairment is increasingly being found to be a common comorbidity in chronic obstructive pulmonary disease (COPD). This study sought to understand the relationship of comprehensively ...measured cognitive function with COPD severity, quality of life, living situation, health care utilization, and self-management abilities.
Subjects with COPD were recruited from the outpatient pulmonary clinic. Cognitive function was assessed using the Montreal Cognitive Assessment (MOCA). Self-management abilities were measured using the Self Management Ability Score 30. Quality of life was measured using the Chronic Respiratory Disease Questionnaire. Pearson correlation was used to assess the bivariate association of the MOCA with other study measures. Multivariate analysis was completed to understand the interaction of the MOCA and living situation on COPD outcomes of hospitalization, quality of life, and self-management ability.
This study included 100 participants of mean age 70±9.4 years (63% male, 37% female) with COPD (mean FEV1 forced expiratory volume in 1 second percentage predicted 40.4±16.7). Mean MOCA score was 23.8±3.9 with 63% of patients having mild cognitive impairment. The MOCA was negatively correlated with age (r=-0.28, P=0.005) and positively correlated with education (r=+0.24, P=0.012). There was no significant correlation between cognitive function and exacerbations, emergency room (ER) visits, or hospitalizations. There was no association between the MOCA score and self-management abilities or quality of life. We tested the interaction of living situation and the MOCA with self-management abilities and found statistical significance (P=0.017), indicating that individuals living alone with higher cognitive function report lower self-management abilities.
Cognitive impairment in COPD does not appear to be meaningfully associated with COPD severity, health outcomes, or self-management abilities. The routine screening for cognitive impairment due to a diagnosis of COPD may not be indicated. Living alone significantly affects the interaction between self-management abilities and cognitive function.
Abstract Context Palliative services have historically been offered to terminal patients with cancer, but much less so in other chronic illnesses such as chronic obstructive pulmonary disease (COPD) ...because of difficulties in predicting the trajectory to death. Objectives The goal of this study was to determine if the change over time of the key parameters (trajectory) in patients with severe COPD can independently predict short-term mortality. Methods We analyzed data from 1218 patients with severe COPD. Multivariate models for trajectory change were used to forecast mortality at 12 months. Results Changes in several variables by defined cutpoints increase significantly and independently the odds of dying in 12 months. The earliest and strongest predictors were the decrease in gait speed by 0.14 m/s or six-minute walk by 50 m (odds ratio OR 4.40, P < 0.0001). Alternatively, if six-minute walk or gait speed were not used, change toward perceiving a very sedentary state using a single question (OR 3.56, P = 0.0007) and decrease in maximal inspiratory pressure greater than 11 cm H2 O (OR 2.19, P = 0.0217) were predictive, followed by change toward feeling upset or downhearted (OR 2.44, P = 0.0250), decrease in room air resting partial pressure of oxygen greater than 5 mm Hg (OR 2.46, P = 0.0156), and increase in room air resting partial pressure of carbon dioxide greater than 3 mm Hg (OR 2.8, P = 0.0039). Change over time models were more discriminative (higher c-statistics) than change from baseline models. Conclusion The changes in defined variables and patient-reported outcomes by defined cutpoints were independently associated with increased 12-month mortality in patients with severe COPD. These results may inform clinicians when to initiate end-of-life communications and palliative care.
Background
Sexual minority men are disproportionately affected by HIV. Medical advances in HIV treatment have extended life expectancy, and as this group ages, medical and psychological challenges ...become more prominent. Older people with HIV experience a higher incidence of cancer and other comorbidities; these burdens along with sexual minority stress can strain coping resources and diminish health-related quality of life. Interventions such as cognitive behavioral stress and self-management (CBSM) can mitigate some of this burden; however, no manualized, eHealth-based interventions have focused on the unique needs of sexual minority men living with HIV and cancer.
Objective
This study aims to refine and finalize a web-based, CBSM-based intervention to meet the unique needs of this population, including sexual health, comanagement of 2 chronic conditions, and coping with sexual minority stress.
Methods
This mixed methods study used a previously completed qualitative phase (n=6) to inform the development of a web-based platform and intervention called SmartManage. The pilot phase study (n=50) involved randomization (1:1) into either 10 sessions of adapted CBSM or an attention control health promotion. Both conditions used the SmartManage platform, a web-based eHealth program designed to deliver CBSM and health promotion content and host live groups. Feasibility and acceptability (eg, rates of participant engagement and retention) were the primary outcomes.
Results
Participant-related activities are expected to be completed by November 2022, and results are expected to be submitted for publication by February 2023.
Conclusions
We hypothesize that participants would find the intervention acceptable (compared with engagement and retention rates observed in similar CBSM studies). We also hypothesize that participants receiving the SmartManage intervention would have reduced symptom burden and improved health-related quality of life before and after treatment compared with those who do not.
International Registered Report Identifier (IRRID)
DERR1-10.2196/37822
To describe cardiorespiratory, strength, muscular endurance, and flexibility fitness outcomes in a sample of adolescents who are Hispanic aged 11 to 15 years with overweight or obesity, stratified by ...age and sex.
The sample included 280 adolescents (mean age: 13.0 ± 0.83 years, mean body mass index percentile: 94.6). Anthropometric measures included height, weight, body mass index percentile, and waist and hip circumference. Fitness measures included handgrip strength, sit-ups in 60 seconds, sit-and-reach test, and 6-minute walk test. We report mean scores for each fitness outcome measure and correlation coefficients with anthropometric measures.
Mean handgrip was 23.7 ± 6.48 kg, sit-and-reach test was 25.3 ± 8.13 cm, average sit-ups in 60 seconds were 19.4 ± 9.28, and 6-minute walk distance was 1960 ± 271 ft. Males outperformed females in all tests except sit-and-reach test.
Compared with published fitness values of healthy weight adolescents, our sample of adolescents who are Hispanic with overweight/obesity living in southern Florida is unconditioned in terms of cardiorespiratory fitness, strength, muscular endurance, and flexibility.
A self-management intervention is a personalized approach to individuals aiming to engage individuals in a behavior change to develop skills to live better with their condition. Self-management ...involves an iterative process between participants and providers in which goals are formulated and feedback is given. All respiratory societies advocate self-management as part of chronic care because it may improve quality of life and health-care utilization. Self-management is an integral part of pulmonary rehabilitation. Self-management interventions usually involve education and exercise prescription, and that is an asset of current programs; however, recent reports indicate that effective strategies for motivation and a behavior change focus are often missed. A recent systematic review on self-management urges the need for a specific aspect and characteristic of self-management interventions: iterative interactions between participants and health-care professionals competent in using behavior change practices to elicit participants' motivation, confidence, and competence to develop skills to better manage their disease. A recent review of self-care intervention in chronic disease states that the major deficits found in self-care interventions included a lack of attention and/or innovation to the psychological consequences of chronic illness, technology, and behavior change techniques to help patients manage symptoms. There is a need for exploration of mechanisms to explain the relationships between both anxiety and depression, and adherence to treatment in COPD. The latter is particularly appropriate for pulmonary rehabilitation, for which greater adherence is needed. This report aims to introduce basic aspects of behavior change and a proposed roadmap to introduce behavior change into pulmonary rehabilitation and chronic care programs.
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