Abstract The objective of this study was to examine the dietary intake profiles of first-time parents, second-time parents, and couples without children; once during pregnancy, then at 6- and ...12-months postpartum. This was an observational, longitudinal, cohort study. Participants were a community-based sample of 153 couples aged 25 to 40 years. Data were collected between 2007 and 2011. Dietary intake was recorded using 3-day dietary recall. Hierarchical linear modeling was used to compare the dietary intakes of groups (ie, parent, sex, and couple days) over time. Percentage of participants per group meeting recommended daily dietary guidelines was also analyzed, as were variables that influenced meeting overall recommended guidelines using a multivariate analysis of variance. First-time mothers had higher overall energy, fat, sugar, fruit, and milk intake compared with women without children, and longitudinally first-time mothers decreased their fruit intake. Second-time mothers had higher overall energy, fat, sugar, and fruit intake compared with nonparent women, and longitudinally second-time mothers increased their meat intake. First-time fathers had overall higher bread intake compared with second-time fathers and men without children, and first-time fathers consumed less sugar than second-time fathers. Longitudinally, first-time fathers increased their fiber intake. At any stage of data collection, from pregnancy to 12-months postpartum, only 2% to 16% of all mothers met recommended overall daily dietary guidelines. The only variable investigated that influenced meeting overall daily dietary guidelines at baseline was parent status.
Abstract The health benefits of regular physical activity are irrefutable; virtually everyone can benefit from being active. The evidence is overwhelming with risk reductions of at least 20%-30% for ...more than 25 chronic medical conditions and premature mortality. Even higher risk reductions (ie, ≥ 50%) are observed when objective measures of physical fitness are taken. International physical activity guidelines generally recommend 150 minutes per week of moderate- to vigorous-intensity physical activity. A critical review of the literature indicates that half of this volume of physical activity might lead to marked health benefits. There is compelling evidence to support health promotion strategies that emphasize that health benefits can be accrued at a lower volume and/or intensity of physical activity. Public health policies are needed that reduce the barriers to physical activity participation such that everyone can reap the benefits of physical activity. It is also important to highlight that sedentary time (particularly sitting time) carries independent health risks. The simple message of “move more and sit less” likely is more understandable by contemporary society and is formed on the basis of a strong body of evidence. For practitioners who work directly with clients, it is recommended that an individualized prescription (dosage) that takes into consideration the unique characteristics and needs of the client is provided. Physical activity or exercise promotion should not be done in isolation; it should be part of an integrated approach to enhance healthy lifestyle behaviours.
Abstract Krassioukov A, Warburton DE, Teasell R, Eng JJ, Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of autonomic dysreflexia after spinal cord ...injury. Objective To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD). Data Sources A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD. Study Selection Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded. Data Extraction Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers. Data Synthesis Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E2 ). Conclusions A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from noncontrolled trials, and more rigorous trials are required.
Abstract Background Recently, high intensity interval training has been advocated for the rehabilitation of persons living with heart failure (HF). Home-based training is more convenient for many ...patients and could augment compliance. However, the safety and efficacy of home-based interval training remains unclear. Methods We evaluated the safety and efficacy of a supervised home-based exercise program involving a combination of interval and resistance training. Measures of aerobic power, endurance capacity, ventilatory threshold, and Quality of Life in forty patients with heart failure (HF), were taken at baseline and after 12-weeks. Patients were matched and randomized to either control (CTL; n = 20) or experimental (EXP; n = 20) conditions. The EXP group underwent a 12-week high intensity interval and resistance training program while the CTL maintained their usual activities of daily living. Results In the EXP, we found a significant improvement in aerobic power, endurance capacity, ventilatory threshold, and Quality of Life. There were no significant changes in CTL. Conclusions We have shown that a home-based cardiac rehabilitation program involving interval and resistance training is associated with improved aerobic capacity and Quality of Life in patients with HF. This research has important implications for the treatment of HF.
Although several investigations have demonstrated that prolonged aerobic exercise results in decreased left ventricular (LV) function, few have examined the impact of an acute bout of high-intensity ...exercise on right ventricular (RV) and LV systolic and diastolic function. Cardiac magnetic resonance imaging with tagging was used to study the impact of high-intensity interval exercise on biventricular function in 9 endurance-trained (ET; V o2 max 69 ± 7 ml/kg/min) and 9 normally active (NA; V o2 max 44 ± 9 ml/kg/min) men. Subjects underwent baseline cardiac magnetic resonance imaging assessments (pre) and then performed an average of 14 1-minute intervals at 97 ± 11% (NA) and 99 ± 6% (ET) of peak power output, separated by 2 minutes of recovery at 21 ± 6% (NA) and 21 ± 9% (ET) of peak power output. After exercise, 2 cardiac magnetic resonance imaging assessments (post 1 at 6.2 ± 2.6 minutes and post 2 at 38.4 ± 3.8 minutes) were completed. RV and LV ejection fractions, twist, basal and apical rotation rates, rate of untwisting, circumferential strain, and timings were examined. No significant change in RV and LV ejection fractions, twist, untwisting rate, or strain after exercise occurred in the NA group. In the ET group, RV ejection fraction (pre 56 ± 4%, post 1 54 ± 4%, post 2 54 ± 3%) and LV ejection fraction (pre 62 ± 4%, post 1 59 ± 4%, post 2 58 ± 4%) were decreased at post 1 and post 2, while untwisting rate, apical rotation rate, and circumferential strain were decreased at post 2 (all p values <0.05). In conclusion, biventricular systolic and diastolic dysfunction occurred after 14 minutes of high-intensity exercise in ET athletes, a phenomenon not observed in NA subjects.
Abstract Background This systematic review sought to evaluate critically the health benefits of physical activity among persons with atrial fibrillation (AF). AF is increasing in Western society. ...While health benefits of physical activity are well established, benefits of physical activity among individuals with AF are not clearly identified. Methods Literature was retrieved systematically through searching electronic databases (MEDLINE, EMBASE, Cochrane), cross-referencing, and drawing on the authors' knowledge. Identified original research articles evaluated health benefits of physical activity among persons with AF or effects of physical activity on AF incidence. From 1056 individual citations, 36 eligible articles were identified. Results Moderate-intensity physical activity was found to improve exercise capacity, quality of life, and the ability to carry out activities of daily living among persons with AF (n = 6). Increased incidence of AF was not associated with physical activity among the general population (n = 2), although long-term vigorous endurance exercise may be associated with increased incidence of AF (n = 7), and greater risks may be associated with high-intensity physical activity among those with AF (n = 2). Moderate-intensity physical activity among individuals with AF does not adversely alter training outcomes, functional capacity, morbidity, or mortality compared with those in sinus rhythm (n = 12). Physical activity may improve management and treatment of AF (n = 6) and, among at-risk populations, may reduce incidence of AF (n = 3). Conclusions In conclusion, moderate-intensity physical activity should be encouraged among persons with or at risk of AF. Further research is needed.
Abstract Cardiovascular and renal disease are highly prevalent in Canada's Aboriginal population even though rates of cardiovascular disease are falling in the rest of the country. High and rising ...prevalence rates of diabetes must be addressed to impact significantly on global cardiovascular and renal risk. Type 2 diabetes is occurring in Aboriginal youth, putting them at greater risk of long-term complications. The reasons for the sudden upswing in diabetes rates in the past 60 years are a result in large part to social determinants of health, which for Aboriginal people include the multigenerational effects of colonization and consequences of the residential school system. Addressing cardiovascular and renal risk therefore requires the knowledge and skills to implement clinical practice guideline–based interventions, the ability to create culturally safe chronic disease management programs in partnership with Aboriginal communities, and advocacy across sectors for improvements in the social determinants of health.
Abstract Cardiometabolic risk is a growing concern in Western society in which rates of cardiovascular disease, diabetes, and obesity are on the rise. Aboriginal populations currently experience ...unequal burdens of these chronic conditions. However, limited information regarding the experience of cardiometabolic risk among Métis populations is available. This review sought to evaluate the cardiometabolic risk experience among Métis populations in Canada. Canada's Métis population currently experiences greater burdens of chronic conditions including metabolic syndrome, diabetes, obesity, and cardiovascular disease than that of the non-Aboriginal population. Métis populations also experience poorer life expectancy, education, and employment attainments, and reduced access to health care services compared with non-Aboriginal populations. Interventions addressing the deficiencies in sociodemographic, lifestyle, and social determinants among the Métis population might help combat rising experiences of chronic diseases faced by these people. Though the burden of chronic conditions, sociodemographic, lifestyle challenges, and social determinants of health among Métis populations are generally less than that of First Nations populations, Métis people experience these health challenges and influencing factors are generally more similar to that of First Nations than non-Aboriginal peoples. Subsequently, Métis populations need to be included in plans and strategies to reduce chronic conditions among Aboriginal populations. In conclusion, Métis populations experience greater burden of cardiometabolic risk and its components than the general Canadian population.
Limited research has been done on integrating cooking and exercise classes into the routine care of chronic kidney disease (CKD) patients. The main purpose of the research was to determine whether ...the addition of these services would slow the progression of certain CKD parameters.
The study evaluated 5 endpoints, at baseline, 6 months, and 12 months: urinary protein, blood pressure, urinary sodium, glomerular filtration rate, and total cholesterol between 2 groups (control group receiving CKD standard care and experimental group receiving standard care plus cooking and exercise classes). Eighty percent of the experimental group was hypothesized to improve in 4 out of the 5 endpoints versus ≤50% in the control group with a P-value of 0.05. An overall difference of 30% was anticipated between the 2 groups. The research also compared self-efficacy and health status outcomes using a self-management questionnaire.
Forty randomly assigned patients participated in the study (17 controls and 23 experimental). In the control group, 2 of 17 people improved in at least 4 of the 5 endpoints. In the experimental group, 14 of 23 people improved in at least 4 of the 5 endpoints.
Sixty-one percent of experimental subjects showed improvements in 4 of 5 endpoints, showing a significant difference overall when compared with the control group (12% improved in 4 out of 5 endpoints). In looking at the trend in qualitative measures from the comparison of the self-management questionnaire, the overall trend showed more improved answers with the experimental group versus the control group.
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