The global epidemic of obesity is staggering in its scope. The World Health Organization (2011) reports that nearly 1.5 billion adults aged 20 years and older and 43 million children younger than 5 years are overweight. The health, societal, and economic impact of obesity on current and future generations is daunting. Obesity is associated with an increased prevalence of serious chronic diseases and con-ditions, including cardiovascular diseases, diabetes mellitus, cancer, musculoskeletal conditions, mental health disorders, and physical function limitations and disability (Abdullah et al., 2011; Alley & Chang, 2007; Deaton et al., 2011; Martin, Freedman, Schoeni, & Andreski, 2010; Wang, McPherson, Marsh, Gortmaker, & Brown, 2011).Obesity among participants 30 to 49 years old in the Framingham Study was associated with a doubling of proba-bility of having a physical function limitation in older age (Peeters, Bonneux, Nusselder, De Laet, & Barendregt, 2004). Available data on direct health care costs estimate that obesity accounts for 74 billion dollars of all health care expenditures in the United States and 33 billion euros in the European Union and 25% of all health expenditures in Canada (Allender, Foster, Scarborough, & Rayner, 2007; Anis et al., 2010; Trasande & Elbel, 2012). An additional 5.5 billion British sterling pounds in health care expenditures associated with obesity are projected by 2050 in the United Kingdom (Trasande & Elbel, 2012; Wang et al., 2011).Physical inactivity and poor dietary habits are the primary contributors to overweight and obesity. Individually, physi-cal inactivity and poor dietary habits increase the risks of developing many chronic diseases and conditions—and these risks are compounded in the presence of obesity (U.S. Department of Health and Human Services, 2008; World Health Organization, 2011, 2012). Physical inactivity and unhealthy dietary habits are highly prevalent in developed and—increasingly so—in developing countries throughout the world (World Health Organization, 2008, 2011).The body of scientific literature about physical activity and diet has grown exponentially over the past decade, demon -strated by the sheer volume of published articles in this and other journals. However, the effectiveness of long-term interventions to promote physical activity has been equivo-cal, but shorter term interventions have shown some success in improving physical activity (Garber et al., 2011). Obesity prevention and treatment programs have been effective in children (Oude Luttikhuis et al., 2009; Waters et al., 2011) but somewhat less so in adults (Appel et al., 2011; Wing & Phelan, 2005). Thus, there remains much to learn about these complex behaviors and how to effectively intervene in diverse settings and populations.This issue of
In Brief LEARNING OBJECTIVE To provide the fitness professional with the current evidence, considerations, and guidelines for providing exercise counseling to women throughout the menopausal transition. Women during all stages of the menopausal transition can benefit from exercise. This article discusses some of the health and psychosocial factors associated with the menopausal transition and how exercise can be helpful in addressing these issues.
Fatiguability and perceived fatigue are common unrelated symptoms in ambulatory individuals with spinal muscular atrophy (SMA). Ratings of perceived exertion (RPE) measures the sense of effort during an activity and has been used as a proxy for fatigue. Relationships between perceived fatigue, fatiguability, and RPE have been described in healthy populations, but the relationship in SMA has not been examined.
It is generally accepted that angina pectoris and, presumably, myocardial ischemia occur at a fixed heart rate-systolic blood pressure product in a given patient. This concept of a fixed threshold has recently been challenged. To evaluate the effects of varying exercise intensity on the ischemic threshold, 33 patients with coronary artery disease and provokable myocardial ischemia, documented by thallium-201 myocardial perfusion imaging, underwent two exercise tests 2 to 7 days apart. A symptom-limited incremental treadmill exercise test was followed by a 20 min submaximal treadmill test at an intensity approximating 70% of the peak heart rate attained during the incremental test. During the incremental exercise test, angina pectoris developed in 16 patients and 17 patients were asymptomatic. At least 0.1 mV of ST segment depression developed in all subjects during the incremental exercise test at a mean exercise duration of 5.3 ± 2.6 min, a rate-pressure product of 19,130 ± 5,735 and oxygen uptake of 19.6 ± 7.0 ml/kg per min. During the submaximal exercise test, 28 (85%) of the 33 patients had significant ST segment depression. Of these patients, 24 (86%) were asymptomatic, including 10 patients who had previously reported anginal symptoms during the incremental test. The average time to onset of 0.1 mV ST segment depression during the submaximal test was 8.1 ± 4.5 min. These changes occurred at a rate-pressure product of 15,250 ± 3,705 and an oxygen uptake of 14.3 ± 5.9 ml/kg per min, and were significantly (p These results demonstrate that myocardial ischemia, whether or not accompanied by angina pectoris, can occur at a lower rate-pressure product and oxygen uptake during submaximal, steady state exercise compared with symptom-limited incremental exercise. It may be concluded that the ischemic threshold varies under different exercise conditions.
The purpose of this study was to identify the population prevalence across the stages of change (SoC) for regular physical activity and to establish the prevalence of people at risk. With support from the National Institutes of Health, the American Heart Association, and the Robert Wood Johnson Foundation, nine Behavior Change Consortium studies with a common physical activity SoC measure agreed to collaborate and share data. The distribution pattern identified in these predominantly reactively recruited studies was Precontemplation (PC) = 5% (± 10), Contemplation (C) = 10% (± 10), Preparation (P) = 40% (± 10), Action = 10% (± 10), and Maintenance = 35% (± 10). With reactively recruited studies, it can be anticipated that there will be a higher percentage of the sample that is ready to change and a greater percentage of currently active people compared to random representative samples. The at-risk stage distribution (i.e., those not at criteria or PC, C, and P) was approximately 10% PC, 20% C, and 70% P in specific samples and approximately 20% PC, 10% C, and 70% P in the clinical samples. Knowing SoC heuristics can inform public health practitioners and policymakers about the population's motivation for physical activity, help track changes over time, and assist in the allocation of resources.
