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CORK Bibliography: Exercise

41 citations. January 2011 to present

Prepared: March 2012

Astorino TA; Martin BJ; Schachtsiek L; Wong K; Ng K. Minimal effect of acute caffeine ingestion on intense resistance training performance. Journal of Strength and Conditioning Research 25(6): 1752- 1758, 2011. (42 refs.)

Astorino, TA, Martin, BJ, Schachtsiek, L, Wong, K, and Ng, K. Minimal effect of acute caffeine ingestion on intense resistance training performance. J Strength Cond Research 25(6): 1752-1758, 2011-The primary aim of the study was to determine the efficacy of acute caffeine intake to enhance intense resistance training performance. Fourteen resistance-trained men (age and body mass = 23.1 +/- 1.1 years and 83.4 +/- 13.2 kg, respectively) who regularly consumed caffeine ingested caffeine (6 mg.kg(-1)) or placebo 1 hour before completion of 4 sets of barbell bench press, leg press, bilateral row, and barbell shoulder press to fatigue at 70-80% 1-repetition maximum. Two minutes of rest was allotted between sets. Saliva samples were obtained to assess caffeine concentration. The number of repetitions completed per set and total weight lifted were recorded as indices of performance. Two-way analysis of variance with repeated measures was used to examine differences in performance across treatment and sets. Compared to placebo, there was a small but significant effect (p < 0.05) of acute caffeine intake on repetitions completed for the leg press but not for upper-body exercise (p > 0.05). Total weight lifted across sets was similar (p > 0.05) with caffeine (22,409.5 +/- 3,773.2 kg) vs. placebo (21,185.7 +/- 4,655.4 kg), yet there were 9 'responders' to caffeine, represented by a meaningful increase in total weight lifted with caffeine vs. placebo. Any ergogenic effect of caffeine on performance of fatiguing, total-body resistance training appears to be of limited practical significance. Additional research is merited to elucidate interindividual differences in caffeine-mediated improvements in performance.

Asthana A; Piper ME; McBride PE; Ward A; Fiore MC; Baker TB et al. Long-term effects of smoking and smoking cessation on exercise stress testing: Three-year outcomes from a randomized clinical trial. American Heart Journal 163(1): 81-U110, 2012. (40 refs.)

Background The long-term effects of smoking and smoking cessation on markers of cardiovascular disease (CVD) prognosis obtained during treadmill stress testing (TST) are unknown. The purpose of this study was to evaluate the long-term effects of smoking cessation and continued smoking on TST parameters that predict CVD risk. Methods In a prospective, double-blind, randomized, placebo-controlled trial of 5 smoking cessation pharmacotherapies, symptom-limited TST was performed to determine peak METs, rate-pressure product (RPP), heart rate (HR) increase, HR reserve, and 60-second HR recovery, before and 3 years after the target smoking cessation date. Relationships between TST parameters and treatments among successful abstainers and continuing smokers were evaluated using multivariable analyses. Results At baseline, the 600 current smokers (61% women) had a mean age of 43.4 (SD 11.5) years and smoked 20.7 (8.4) cigarettes per day. Their exercise capacity was 8.7 (2.3) METs, HR reserve was 86.6 (9.6)%, HR increase was 81.1 (20.9) beats/min, and HR recovery was 22.3 (11.3) beats. Cigarettes per day and pack-years were independently and inversely associated with baseline peak METs (P < .001), RPP (P < .01, pack-years only), HR increase (P < .05), and HR reserve (P < .01). After 3 years, 168 (28%) had quit smoking. Abstainers had greater improvements than continuing smokers (all P b.001) in RPP (2,055 mm Hg beats/min), HR increase (5.9 beats/min), and HR reserve (3.7%), even after statistical adjustment (all P < .001). Conclusions Smokers with a higher smoking burden have lower exercise capacity, lower HR reserve, and a blunted exercise HR response. After 3 years, TST improvements suggestive of improved CVD prognosis were observed among successful abstainers.

Birzniece V; Nelson AE; Ho KKY. Growth hormone and physical performance. (review). Trends in Endocrinology and Metabolism 22(5): 171- 178, 2011. (86 refs.)

There has been limited research and evidence that GH enhances physical performance in healthy adults or in trained athletes. Even so, human growth hormone (GH) is widely abused by athletes. In healthy adults, GH increases lean body mass, although it is possible that fluid retention contributes to this effect. The most recent data indicate that GH does not enhance muscle strength, power, or aerobic exercise capacity, but improves anaerobic exercise capacity. In fact, there are adverse effects of long-term GH excess such that sustained abuse of GH can lead to a state mimicking acromegaly, a condition with increased morbidity and mortality. This review will examine GH effects on body composition and physical performance in health and disease.

Brant WO; Myers JB; Carrell DT; Smith JF. Male athletic activities and their effects on semen and hormonal parameters. Physician and Sportsmedicine 38(3): 114- 120, 2010. (54 refs.)

Infertility is generally defined as the inability to conceive a pregnancy or the failure to do so within a reasonable period (typically 12 months). Approximately 85% of couples conceive a first pregnancy within 12 months. The prevalence of infertility has increased over the past 10 years, with approximately 10 million affected couples in the United States. Roughly 40% to 50% of infertility is either due to, or is contributed by, a male factor. Given how common the condition is, men and their partners are understandably concerned and interested in identifying and eliminating risk factors for male infertility. This article reviews the available literature on various aspects of male infertility related to athletic pursuits. These include the effects of exercise on semen parameters, hormonal axes, and testicular health. Due to the prevalence and particular relevance of anabolic steroid use by athletes and the impact of steroid use on fertility, this topic is also reviewed.

Buchowski MS; Meade NN; Charboneau E; Park S; Dietrich MS; Cowan RL et al. Aerobic exercise training reduces cannabis craving and use in non-treatment seeking cannabis-dependent adults. PLoS ONE 6(3): article e17465, 2011. (38 refs.)

Background: Cannabis dependence is a significant public health problem. Because there are no approved medications for this condition, treatment must rely on behavioral approaches empirically complemented by such lifestyle change as exercise. Aims: To examine the effects of moderate aerobic exercise on cannabis craving and use in cannabis dependent adults under normal living conditions. Design: Participants attended 10 supervised 30-min treadmill exercise sessions standardized using heart rate (HR) monitoring (60-70% HR reserve) over 2 weeks. Exercise sessions were conducted by exercise physiologists under medical oversight. Participants: Sedentary or minimally active non-treatment seeking cannabis-dependent adults (n = 12, age 25 +/- 63 years, 8 females) met criteria for primary cannabis dependence using the Substance Abuse module of the Structured Clinical Interview for DSM-IV (SCID). Measurements: Self-reported drug use was assessed for 1-week before, during, and 2-weeks after the study. Participants viewed visual cannabis cues before and after exercise in conjunction with assessment of subjective cannabis craving using the Marijuana Craving Questionnaire (MCQ-SF). Findings: Daily cannabis use within the run-in period was 5.9 joints per day (SD = 3.1, range 1.8-10.9). Average cannabis use levels within the exercise (2.8 joints, SD = 1.6, range 0.9-5.4) and follow-up (4.1 joints, SD = 2.5, range 1.1-9.5) periods were lower than during the run-in period (both P <.005). Average MCQ factor scores for the pre- and post-exercise craving assessments were reduced for compulsivity (P = .006), emotionality (P = .002), expectancy (P = .002), and purposefulness (P = .002). Conclusions: The findings of this pilot study warrant larger, adequately powered controlled trials to test the efficacy of prescribed moderate aerobic exercise as a component of cannabis dependence treatment. The neurobiological mechanisms that account for these beneficial effects on cannabis use may lead to understanding of the physical and emotional underpinnings of cannabis dependence and recovery from this disorder.

Chwastiak LA; Rosenheck RA; Kazis LE. Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psycosomatics 52(3): 230-236, 2011. (41 refs.)

Background: Increased cardiovascular morbidity and mortality have been reported across a number of chronic psychiatric illnesses. Interventions to decrease cardiovascular risk have focused on single health behaviors. Objective: To evaluate the co-occurrence of multiple poor health behaviors that increase cardiovascular risk among veterans with psychiatric diagnoses. Methods: Using data from the 1999 Large Health Survey of Veterans (n = 501,161), multivariate logistic regression was used to evaluate the associations between current smoking, no regular exercise, and obesity with each of six Axis I diagnoses. Results: There were statistically increased odds of co-occurrence of obesity, current tobacco use, and no regular exercise among veterans with each of the psychiatric diagnoses, with the exception of drug use disorders (which was not significantly different from 1). The highest odds were among veterans with schizophrenia, PTSD, and bipolar disorder [OR (95% CI) of 1.37 (1.29, 1.45); 1.26 (1.20, 1.32); and 1.19 (1.11, 1.25), respectively]. The OR for depression was not significant after adjustment for medical comorbidity. Conclusions: Veterans with psychiatric illnesses, and particularly those with schizophrenia, PTSD, and bipolar disorder, are much more likely to have multiple poor health behaviors that increase their cardiovascular risk. Interventions to decrease cardiovascular risk among veterans with serious mental illness need to target multiple health behaviors.

Ciccolo JT; Dunsiger SI; Williams DM; Bartholomew JB; Jennings EG; Ussher MH et al. Resistance training as an aid to standard smoking cessation treatment: A pilot study. Nicotine & Tobacco Research 13(8): 756-760, 2011. (18 refs.)

Introduction: Research indicates that exercise may be helpful for smoking cessation; however, the majority of studies have focused only on women and only on aerobic exercise. This pilot study explored the use of resistance training (RT) (i.e., weight lifting) as an adjunctive strategy for quitting smoking for both men and women. Methods: A sample of 25 smokers received a brief smoking cessation counseling session and the nicotine patch prior to being randomized into a 12-week RT or contact control (CC) group. Assessments were conducted at baseline, 3-month, and at a 6-month follow-up. Results: Participants (52% female) averaged 36.5 years (SD = 12.0) of age and 19.1 years (SD = 12.0) of smoking. At the 3-month assessment, objectively verified 7-day point prevalence abstinence (PPA) rates were 46% for the RT group and 17% for CC; prolonged abstinence rates were 16% and 8%, respectively. At the 6-month assessment, objectively verified 7-day PPA rates were 38% for the RT group and 17% for CC; prolonged abstinence rates were 15% and 8%, respectively. Mean body weight decreased 0.6 kg (SD = 1.7) in the RT group and increased 0.6 kg (SD = 2.8) in the CC group. Mean body fat decreased 0.5% (SD = 1.8) in the RT group and increased 0.6% (SD = 0.7) in the CC. Conclusions: This is the first study reporting on the use of a RT program as an aid to smoking cessation treatment. The findings suggest that such a program is feasible as an adjunctive treatment for smoking cessation. An adequately powered trial is warranted.

Cohen-Mansfield J; Kivity Y. The relationships among health behaviors in older persons. Journal of Aging and Health 23(5): 822-842, 2011. (60 refs.)

Objective: To examine the relationships among health behaviors in older persons and whether they form related groups of behaviors. Method: Health behaviors (physical activity, alcohol use, nutrition, weight stability, and smoking) were analyzed using factor analysis in two representative samples of two cohorts of Israeli older persons aged 75 to 94. Data collection was conducted during 1989-1992 for the first cohort (N = 1,200) and during 2000-2002 for the second (N = 421). Results: Four factors of health behaviors were found mostly unrelated: (a) physical activity and weight stability, (b) alcohol use, (c) smoking, and (d) nutrition. Discussion: The analysis enables identification of underlying health-behavior dimensions in an understudied population. Furthermore, the findings have important implications for health-promotion policy, indicating that prevention and health-promotion programs for older persons should target each health behavior, and not assume that the practice of any health behavior implies a healthy overall lifestyle in this population.

de Preux LB. Anticipatory ex ante moral hazard and the effect of Medicare on prevention. Health Economics 20(9, special issue): 1056-1072, 2011. (31 refs.)

This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.

Doonan RJ; Scheffler P; Yu A; Egiziano G; Mutter A; Bacon S et al. Altered arterial stiffness and subendocardial viability ratio in young healthy light smokers after acute exercise. PLoS ONE 6(10): e26151, 2011. (53 refs.)

Background: Studies showed that long-standing smokers have stiffer arteries at rest. However, the effect of smoking on the ability of the vascular system to respond to increased demands (physical stress) has not been studied. The purpose of this study was to estimate the effect of smoking on arterial stiffness and subendocardial viability ratio, at rest and after acute exercise in young healthy individuals. Methods/Results: Healthy light smokers (n = 24, pack-years = 2.9) and non-smokers (n = 53) underwent pulse wave analysis and carotid-femoral pulse wave velocity measurements at rest, and 2, 5, 10, and 15 minutes following an exercise test to exhaustion. Smokers were tested, 1) after 12h abstinence from smoking (chronic condition) and 2) immediately after smoking one cigarette (acute condition). At rest, chronic smokers had higher augmentation index and lower aortic pulse pressure than non-smokers, while subendocardial viability ratio was not significantly different. Acute smoking increased resting augmentation index and decreased subendocardial viability ratio compared with non-smokers, and decreased subendocardial viability ratio compared with the chronic condition. After exercise, subendocardial viability ratio was lower, and augmentation index and aortic pulse pressure were higher in non-smokers than smokers in the chronic and acute conditions. cfPWV rate of recovery of was greater in non-smokers than chronic smokers after exercise. Non-smokers were also able to achieve higher workloads than smokers in both conditions. Conclusion: Chronic and acute smoking appears to diminish the vascular response to physical stress. This can be seen as an impaired 'vascular reserve' or a blunted ability of the blood vessels to accommodate the changes required to achieve higher workloads. These changes were noted before changes in arterial stiffness or subendocardial viability ratio occurred at rest. Even light smoking in young healthy individuals appears to have harmful effects on vascular function, affecting the ability of the vascular bed to respond to increased demands.

Du F; Qiukui H; Birong D; Changquan H; Hongmei W; Yanling Z et al. Association of osteoporotic fracture with smoking, alcohol consumption, tea consumption and exercise among Chinese nonagenarians/centenarians. Journal of Nutrition, Health & Aging 15(5): 327-331, 2011. (37 refs.)

To observe the association of osteoporotic fracture with habits of smoking, alcohol consumption, tea consumption and exercise among very old people. A cross sectional study conducted in Dujiangyan Sichuan China. 703 unrelated Chinese nonagenarians and centenarians (67.7(1% women, mean age 93.48 years) resident in Dujiangyan. Medical history of osteoporosis and the statement of fracture and habits (current and former) of smoking, alcohol consumption, tea consumption and exercise were collected. In women, subjects with current or former habit of alcohol consumption had significantly higher prevalence osteoporotic fracture than those without this habit; but subjects with former habit of exercise had significantly lower prevalence osteoporotic fracture than those without tills habit. However, in men, there was no significant difference in prevalence of these habits between subjects with and without osteoporotic fracture. After adjust for age, gender, sleep habits educational levels, religion habits and temperament, we found that former habit of alcohol consumption had a significant odds ratio (OR=2.473 95% CI (1.074, 5.526)) for osteoporotic fracture. In summary, among nonagenarians and centenarians, among habits (current and former) of smoking, alcohol consumption, tea consumption and exercise, there seems to be significant association of osteoporotic fracture only with current or former habits of alcohol consumption, former habit of exercise. The habit of alcohol consumption might be associated with a greater risk of osteoporotic fracture, but the former habit of exercise might be associated with a lower risk of osteoporotic fracture.

Ganio MS; Johnson EC; Klau JF; Anderson JM; Casa DJ; Maresh CM et al. Effect of ambient temperature on caffeine ergogenicity during endurance exercise. European Journal of Applied Physiology 111(6): 1135- 1146, 2011. (54 refs.)

It is well established that caffeine ingestion during exercise enhances endurance performance. Conversely, the physiological and psychological strain that accompanies increased ambient temperature decreases endurance performance. Little is known about the interaction between environmental temperature and the effects of caffeine on performance. The purpose of this study was to compare the effects of ambient temperature (12 and 33 degrees C) on caffeine ergogenicity during endurance cycling exercise. Eleven male cyclists (mean +/- SD; age, 25 +/- 6 years; (V) over dotO(2max); 58.7 +/- 2.9 ml kg(-1) min(-1)) completed four exercise trials in a randomized, double blind experimental design. After cycling continuously for 90 min (average 65 +/- 7% (V) over dotO(2max)) in either a warm (33 +/- 1 degrees C, 41 +/- 5% rh) or cool (12 +/- 1 degrees C, 60 +/- 7%rh) environment, subjects completed a 15-min performance trial (PT; based on total work accumulated). Subjects ingested 3 mg kg(-1) of encapsulated caffeine (CAF) or placebo (PLA) 60 min prior to and after 45 min of exercise. Throughout exercise, subjects ingested water so that at the end of exercise, independent of ambient temperature, their body mass was reduced 0.55 +/- 0.67%. Two- way (temperature x treatment) repeated-measures ANOVA were conducted with alpha set at 0.05. Total work (kJ) during the PT was greater in 12 degrees C than 33 degrees C [P < 0.001, eta(2) = 0.804, confidence interval (CI): 30.51-62.30]. When pooled, CAF increased performance versus PLA independent of temperature (P = 0.006, eta(2) = 0.542 CI: 3.60-16.86). However, performance differences with CAF were not dependent on ambient temperature (i.e., non-significant interaction; P = 0.662). CAF versus PLA in 12 and 33 degrees C resulted in few differences in other physiological variables. However, during exercise, rectal temperature (T-re) increased in the warm environment (peak T-re; 33 degrees C, 39.40 +/- 0.45; 12 degrees C, 38.79 +/- 0.42 degrees C; P < 0.05) but was not different in CAF versus PLA (P > 0.05). Increased ambient temperature had a detrimental effect on cycling performance in both the CAF and PLA conditions. CAF improved performance independent of environmental temperature. These findings suggest that caffeine at the dosage utilized (6 mg/kg body mass) is a, legal drug that provides an ergogenic benefit in 12 and 33 degrees C.

Gonzalez AM; Walsh AL; Ratamess NA; Kang J; Hoffman JR. Effect of a pre-workout energy supplement on acute multi-joint resistance exercise. Journal of Sports Science and Medicine 10(2): 261-266, 2011. (38 refs.)

The effect of a pre-workout energy supplement on acute multi-joint resistance exercise was examined in eight resistance-trained college-age men. Subjects were randomly provided either a placebo (P) or a supplement (S: containing caffeine, taurine, glucuronolactone, creatine, beta-alanine, and the amino acids; leucine, isoleucine, valine, glutamine and arginine) 10 minutes prior to resistance exercise. Subjects performed 4 sets of no more than 10 repetitions of either barbell squat or bench press at 80% of their pre-determined 1 repetition-maximum (1RM) with 90 seconds of rest between sets. Dietary intake 24 hours prior to each of the two training trials was kept constant. Results indicate that consuming the pre-workout energy drink 10 minutes prior to resistance exercise enhances performance by significantly increasing the number of repetitions successfully performed (p = 0.022) in S (26.3 +/- 9.2) compared to P (23.5 +/- 9.4). In addition, the average peak and mean power performance for all four sets was significantly greater in S compared to P (p < 0.001 and p < 0.001, respectively). No differences were observed between trials in subjective feelings of energy during either pre (p = 0.660) or post (p = 0.179) meaures. Similary, no differences between groups, in either pre or post assessments, were observed in subjective feelings of focus (p = 0.465 and p = 0.063, respectively), or fatigue (p = 0.204 and p = 0.518, respectively). Results suggest that acute ingestion of a high-energy supplement 10 minutes prior to the onset of a multi-joint resistance training session can augment training volume and increase power performance during the workout.

Gouzi F; Prefaut C; Abdellaoui A; Vuillemin A; Molinari N; Ninot G et al. Evidence of an early physical activity reduction in chronic obstructive pulmonary disease patients. Archives of Physical Medicine and Rehabilitation 92(10): 1611-1617, 2011. (45 refs.)

Objective: To compare the lifetime pattern of physical activity (PA) in chronic obstructive pulmonary disease (COPD) patients and sedentary healthy subjects (SHS) using a PA questionnaire with a lifetime period of recall (Quantification de l'Activite Physique [QUANTAP] system), and to compare the pattern of PA reduction in COPD patients with the onset of breathlessness and other relevant clinical events in this disease (diagnosis, first rehabilitation, onset of smoking). Design: Cross-sectional comparative study. Settings: Outpatient university hospital and inpatient pulmonary rehabilitation center. Participants: COPD patients (n=129; mean age +/- SD, 61 +/- 10y; forced expiratory volume in Is, 57 +/- 23%) and SHS (n=29; mean age +/- SD, 61 +/- 5y; <150min.wk(-1) of moderate-vigorous PA). Interventions: Not applicable. Main Outcome Measures: Lifetime PA was compared in COPD patients and SHS using the QUANTAP system. The patients with COPD and SHS underwent pulmonary function, exercise, and quadriceps endurance testing. The current PA level was assessed with a triaxial accelerometer and the Voorrips questionnaire. The age at the onset of breathlessness was also recorded. Results: Accelerometry showed no significant difference between patients and SHS (in vector magnitude units, 136 +/- 56 vs 135 +/- 47; P=.95). Within the past 15 years, the cumulated PA level was not different for each 5-year period. Then, from the period of 16 to 40 years ago, it was systematically higher in patients compared with SHS (in metabolic equivalent/y(-1); median [interquartile range], 6973 [5400-12,207] vs 4248 [3545-5919]; P<.05). The COPD patients reduced their PA earlier than the SHS (45y vs 55y; P<.01), and the PA was dropped before the onset of breathlessness (45y vs 49y; P<.001). Conclusions: The observation of an early PA reduction, preceding the onset of breathlessness, suggests the implication of prior pathologic mechanisms in the PA reduction of COPD patients. [Note: Presented at the Annual Congress of the European-Respiratory-Society, September 12-16, 2009, Vienna, Austria

Grier TL; Morrison S; Knapik JJ; Canham-Chervak M; Jones BH. Risk factors for injuries in the U.S. Army Ordnance School. Military Medicine 176(11): 1292-1299, 2011. (40 refs.)

Objective: To investigate risk factors for time-loss injuries among soldiers attending U.S. Army Ordnance School Advanced Individual Training. Methods: Injuries were obtained from an injury surveillance system. A health questionnaire provided data on age, race, rank, current self-reported injury and illness, and tobacco use. Fitness data was obtained from operations office. Results: Cumulative time-loss injury incidence was 31% for men and 54% for women. For men, higher risk of injury was associated with race, a current self-reported injury, smoking before entering the Army, lower sit-up performance, and slower 2-mile run times. For women, higher risk of injury was associated with race, a current self-reported injury, and slower 2-mile run times. Conclusion: Smoking cessation and fitness training before entry are potential strategies to reduce injuries among soldiers in the Ordnance School.

Hayes DK; Fan AZ; Smith RA; Bombard JM. Trends in selected chronic conditions and behavioral risk factors among women of reproductive age, behavioral risk factor surveillance system, 2001-2009. Preventing Chronic Disease 8(6): a120, 2011

Some potentially modifiable risk factors and chronic conditions cause significant disease and death during pregnancy and promote the development of chronic disease. This study describes recent trends of modifiable risk factors and controllable chronic conditions among reproductive-aged women. Data from the 2001 to 2009 Behavioral Risk Factor Surveillance System, a representative state-based telephone survey of health behavior in US adults, was analyzed for 327,917 women of reproductive age, 18 to 44 years. We calculated prevalence ratios over time to assess trends for 4 selected risk factors and 4 chronic conditions, accounting for age, race/ethnicity, education, health care coverage, and individual states. From 2001 to 2009, estimates of 2 risk factors improved: smoking declined from 25.9% to 18.8%, and physical inactivity declined from 25.0% to 23.0%. One risk factor, heavy drinking, did not change. From 2003 to 2009, the estimates for 1 risk factor and 4 chronic conditions worsened: obesity increased from 18.3% to 24.7%, diabetes increased from 2.1% to 2.9%, high cholesterol increased from 10.3% to 13.6%, asthma increased from 13.5% to 16.2%, and high blood pressure increased from 9.0% to 10.1%. All trends were significant after adjustment, except that for heavy drinking. Among women of reproductive age, prevalence of smoking and physical inactivity improved, but prevalence of obesity and all 4 chronic conditions worsened. Understanding reasons for the improvements in smoking and physical activity may support the development of targeted interventions to reverse the trends and help prevent chronic disease and adverse reproductive outcomes among women in this age group.

Public Domain

Hildebrandt T; Lai JK; Langenbucher JW; Schneider M; Yehuda R; Pfaff DW. The diagnostic dilemma of pathological appearance and performance enhancing drug use. (review). Drug and Alcohol Dependence 114(1): 1-11, 2011. (146 refs.)

Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement: (2) significant body image disturbance: (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

Hildebrandt T; Langenbucher JW; Lai JK; Loeb KL; Hollander E. Development and validation of the appearance and performance enhancing drug use schedule. Addictive Behaviors 36(10): 949-958, 2011. (89 refs.)

Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic-androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes the development and psychometric evaluation of the Appearance and Performance Enhancing Drug Use Schedule (APEDUS) which is a semi-structured interview designed to assess the spectrum of drug use and related features of APED use. Eighty-five current APED using men and women (having used an illicit APED in the past year and planning to use an illicit APED in the future) completed the APEDUS and measures of convergent and divergent validity. Inter-rater agreement, scale reliability, one-week test-retest reliability, convergent and divergent validity, and construct validity were evaluated for each of the APEDUS scales. The APEDUS is a modular interview with 10 sections designed to assess the core drug and non-drug phenomena associated with APED use. All scales and individual items demonstrated high inter-rater agreement and reliability. Individual scales significantly correlated with convergent measures (DSM-IV diagnoses, aggression, impulsivity, eating disorder pathology) and were uncorrelated with a measure of social desirability. APEDUS subscale scores were also accurate measures of AAS dependence. The APEDUS is a reliable and valid measure of APED phenomena and an accurate measure of the core pathology associated with APED use. Issues with assessing APED use are considered and future research is considered.

Hildebrandt T; Yehuda R; Alfano L. What can allostasis tell us about anabolic-androgenic steroid addiction? Development and Psychopathology 23(3, special issue): 907-919, 2011. (109 refs.)

Anabolic-androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction follow the traditional framework of drug abuse and dependence, which suggest that harmful use occurs as a result of the drug's ability to hijack the motivation-reward system. However, AASs, unlike typical drugs of abuse, are not used for acute intoxication effects or euphoria. Rather, AASs are used to affect the body through changes to the musculoskeletal system and the hypothalamic-pituitary-gonadal axis as opposed to stimulating the reward system. We offer an allostatic model of AAS addiction to resolve this inconsistency between traditional drug addiction and AAS addiction. This allostatic framework provides a way to (a) incorporate exercise into AAS misuse, (b) identify where AAS use transitions from recreational use into a drug problem, and (c) describe individual differences in vulnerability or resilience to AASs. Implications for this model of AAS addiction are discussed.

Horn K; Dino G; Branstetter SA; Zhang JJ; Noerachmanto N; Jarrett T et al. Effects of physical activity on teen smoking cessation. Pediatrics 128(4): E801-E811, 2011. (51 refs.)

OBJECTIVE: To understand the influence of physical activity on teen smoking-cessation outcomes. METHODS: Teens (N = 233; 14-19 years of age) from West Virginia high schools who smoked >1 cigarette in the previous 30 days were included. High schools with >300 students were selected randomly and assigned to brief intervention (BI), Not on Tobacco (N-O-T) (a proven teen cessation program), or N-O-T plus a physical activity module (N-O-T + FIT). Quit rates were determined 3 and 6 months after baseline by using self-classified and 7-day point prevalence quit rates, and carbon monoxide validation was obtained at the 3-month follow-up evaluation. RESULTS: Trends for observed and imputed self-classified and 7-day point prevalence rates indicated that teens in the N-O-T + FIT group had significantly higher cessation rates compared with those in the N-O-T and BI groups. Effect sizes were large. Overall, girls quit more successfully with N-O-T compared with BI (relative risk [RR]: >infinity) 3 months after baseline, and boys responded better to N-O-T + FIT than to BI (RR: 2-3) or to N-O-T (RR: 1-2). Youths in the N-O-T + FIT group, compared with those in the N-O-T group, had greater likelihood of cessation (RR: 1.48) at 6 months. The control group included an unusually large proportion of participants in the precontemplation stage at enrollment, but there were no significant differences in outcomes between BI and N-O-T (z = 0.94; P = .17) or N-O-T + FIT (z = 1.12; P = .13) participants in the precontemplation stage. CONCLUSIONS: Adding physical activity to N-O-T may enhance cessation success, particularly among boys.

Ip EJ; Barnett MJ; Tenerowicz MJ; Perry PJ. The Anabolic 500 Survey: Characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy 31(8): 757-766, 2011. (34 refs.)

Study Objective. To contrast the characteristics of two groups of men who participated in strength-training exercise those who reported anabolic-androgenic steroid (AAS) use versus those who reported no AAS use. Design. Analysis of data from the Anabolic 500, a cross-sectional survey. Participants. Five hundred six male self-reported AAS users (mean age 29.3 yrs) and 771 male self-reported nonusers of AAS (mean age 25.2 yrs) who completed an online survey between February 19 and June 30, 2009. Measurements and Main Results. Respondents were recruited from Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Data were collected on demographics, use of AAS and other performance-enhancing agents, alcohol and illicit drug use, substance dependence disorder, other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses, and history of sexual and/or physical abuse. Most (70.4%) of the AAS users were recreational exercisers who reported using an average of 11.1 performance-enhancing agents in their routine. Compared with nonusers, the AAS users were more likely to meet criteria for substance dependence disorder (23.4% vs 11.2%, p<0.001), report a diagnosis of an anxiety disorder (10.1% vs 6.1%, p=0.010), use cocaine within the past 12 months (11.3% vs 4.7%, p<0.001), and report a history of sexual abuse (6.1% vs 2.7%, p=0.005). Conclusion. Most of the AAS users in this study were recreational exercisers who practiced polypharmacy. The AAS users were more likely than nonusers to meet criteria for substance dependence disorder, report a diagnosis of an anxiety disorder, report recent cocaine use, and have a history of sexual abuse. The information uncovered in this study may help clinicians and researchers develop appropriate intervention strategies for AAS abuse.

Jose KA; Blizzard L; Dwyer T; McKercher C; Venn AJ. Childhood and adolescent predictors of leisure time physical activity during the transition from adolescence to adulthood: A population based cohort study. International Journal of Behavioral Nutrition and Physical Activity 8(e-article 54), 2011. (46 refs.)

Background: Few studies have investigated factors that influence physical activity behavior during the transition from adolescence to adulthood. This study explores the associations of sociodemographic, behavioral, sociocultural, attitudinal and physical factors measured in childhood and adolescence with physical activity behavior during the transition from adolescence to adulthood. Methods: Childhood and adolescent data (at ages 7-15 years) were collected as part of the 1985 Australian Health and Fitness Survey and subdivided into sociodemographics (socioeconomic status, parental education), behavioral (smoking, alcohol, sports diversity, outside school sports), sociocultural (active father, active mother, any older siblings, any younger siblings, language spoken at home), attitudinal (sports/recreational competency, self-rated health, enjoyment physical education/physical activity, not enjoying school sports) and physical (BMI, time taken to run 1.6 km, long jump) factors. Physical activity between the ages 15 and 29 years was reported retrospectively using the Historical Leisure Activity Questionnaire at follow-up in 2004-2006 by 2,048 participants in the Childhood Determinants of Adult Health Study (CDAH). Australia's physical activity recommendations for children and adults were used to categorize participants as persistently active, variably active or persistently inactive during the transition from adolescence to adulthood. Results: For females, perceived sports competency in childhood and adolescence was significantly associated with being persistently active (RR = 1.88, 95% CI = 1.39, 2.55). Smoking (RR = 0.31 CI = 0.12, 0.82) and having younger siblings (RR = 0.69 CI = 0.52, 0.93) were inversely associated with being persistently active after taking physical and attitudinal factors into account. For males, playing sport outside school (RR = 1.47 CI = 1.05, 2.08), having active fathers (RR = 1.25 CI = 1.01, 1.54) and not enjoying school sport (RR = 4.07 CI = 2.31, 7.17) were associated with being persistently active into adulthood. Time taken to complete the 1.6 km run was inversely associated with being persistently active into adulthood (RR = 0.85 CI = 0.78, 0.93) after adjusting for recreational competency. Conclusions: Perceived sports competency (females) and cardiorespiratory fitness, playing sport outside school and having active fathers (males) in childhood and adolescence were positively associated with being persistently active during the transition from adolescence to adulthood.

Julius BR; Ward BA; Stein JH; McBride PE; Fiore MC; Colbert LH. Ambulatory activity associations with cardiovascular and metabolic risk factors in smokers. Journal of Physical Activity & Health 8(7): 994-1003, 2011. (48 refs.)

Background: We examined the association between ambulatory activity and biological markers of health in smokers. Methods: Baseline data from 985 subjects enrolled in a pharmacologic smoking cessation trial were examined. Body size, blood pressure, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), total and small LDL particles, LDL size, high density lipoprotein cholesterol, triglycerides (TG), C-reactive protein (CRP), creatinine, fasting glucose, and hemoglobin A1c were assessed in relation to pedometer-assessed ambulatory activity, as was the odds of metabolic syndrome and CRP > 3 mg/L. Effect modification by gender was examined. Results: Only waist circumference was lower with greater steps/day in the men and women combined (P(trend) < 0.001). No other significant relationships were noted in men, while women with >= 7500 steps/day had lower weight, BMI, CRP, TG, total, and small LDL particles compared with those with < 7500 steps/day. These women also had 62% and 43% lower odds of metabolic syndrome and elevated CRP, respectively, compared with the less active women. Adjustment for BMI attenuated all the associations seen in women. Conclusions: Greater ambulatory activity is associated with lower levels of metabolic and cardiovascular risk factors in female smokers which may, in part, be mediated by a reduction in BMI.

Korhonen T; Goodwin A; Miesmaa P; Dupuis EA; Kinnunen T. Smoking cessation program with exercise improves cardiovascular disease biomarkers in sedentary women. Journal of Women's Health 20(7): 1051-1064, 2011. (64 refs.)

Background: Several cardiovascular disease (CVD) biomarkers sensitive to tobacco exposure have been identified, but how tobacco use cessation impacts them is less clear. We sought to investigate the effects of a smoking cessation program with an exercise intervention on CVD biomarkers in sedentary women. Methods: This is a cohort study on a subsample of a 2 x 2 factorial randomized controlled trial (RCT) (exercise setting: home vs. facility; level of exercise counseling: prescription only vs. prescription and adherence counseling) conducted January 2004 through December 2007. The analyses were completed in October 2010. In the greater Boston area, 130 sedentary female smokers aged 19-55 completed a 15-week program. All participants received nicotine replacement therapy (transdermal patch) and brief behavioral counseling for 12 weeks. They all received an exercise prescription on a moderate intensity level. All exercise interventions lasted for 15 weeks, from 3 weeks precessation until 12 weeks postcessation. Main outcome measures. were selected CVD biomarkers hypothesized to be affected by smoking cessation or exercise measured at baseline and 12 weeks postcessation. Results: Independent of tobacco abstinence, improvement was seen in inflammation (white blood cells [WBC]), prothrombotic factor (red blood cells [RBC]), and cardiovascular fitness level (maximum oxygen consumption [Vo(2)max]). This suggests that even if complete abstinence is not achieved, reduction in tobacco exposure and increase in exercise can improve the cardiovascular risk profile. A significant decrease was seen for total cholesterol and the total cholesterol high-density lipoprotein cholesterol (HDL-C): ratio only among the abstainers. The heart rate was reduced among all participants, but this decrease was more profound among abstainers. A significant weight gain and body mass index (BMI) increase were observed among abstainers and those who relapsed. We also found an increase in hemoglobin A1c (Hb A1c), although significant only when the groups were combined. Conclusions: A smoking cessation intervention including exercise reduced tobacco-induced cardiovascular damage selectively within 3 months.

Kwan MY; Cairney J; Faulkner GE; Pullenayegum EE. Physical activity and other health-risk behaviors during the transition into early adulthood: A longitudinal cohort study. American Journal of Preventive Medicine 42(1): 14-20, 2012. (37 refs.)

Background: Research consistently demonstrates that physical activity declines with age. However, such declines do not occur linearly. The transition into early adulthood is one period in which disproportionate declines in physical activity have been evident, but much of our understanding of such declines among young adults has been based on either cross-sectional data or prospective studies that focus exclusively on college/university students. Purpose: The purpose of the current study was to use multilevel modeling to discern patterns of physical activity based on gender and educational trajectory among a nationally representative cohort of Canadian adolescents (N=640; ages at baseline, 12-15 years). Examinations of smoking and binge drinking also were conducted as a basis for comparison. Methods: Drawn from seven cycles of the National Population Health Survey (NPHS), participants were interviewed every 2 years from 1994-1995 to 2006-2007; data analysis was conducted in 2010. Results: Overall, there was a 24% decrease in physical activity (equivalent to 1 MET/day) across the 12-year period. A significant three-way time X gender X educational trajectory interaction (coefficient= -0.189, SE=0.09, p<0.05) emerged in the physical activity analysis; main effects in time(2) (coefficient= -0.114, SE=0.01, p<0.01) and time(3) (coefficient=0.028, SE=0.01, p<0.01) were significant for binge drinking and smoking, respectively. Conclusions: Physical activity decline was evident during young adults' transition into early adulthood, with declines being steepest among men who entered a college/university. Although there were increases in several health-risk behaviors during adolescence, individuals tend to grow out of binge drinking and smoking as they mature.

Lee CD; Sui XM; Hooker SP; Hebert JR; Blair SN. Combined impact of llfestyle factors on cancer mortality in men. Annals of Epidemiology 21(10): 749-754, 2011. (28 refs.)

PURPOSE: The impact of lifestyle factors on cancer mortality in the U.S. population has not been thoroughly explored. We examined the combined effects of cardiorespiratory fitness, never smoking, and normal waist girth on total cancer mortality in men. METHODS: We followed a total of 24,731 men ages 20-82 years who participated in the Aerobics Center Longitudinal Study. A low-risk profile was defined as never smoking, moderate or high fitness, and normal waist girth, and they were further categorized as having 0, 1, 2, or 3 combined low-risk factors. RESULTS: Over an average of 14.5 years of follow-up, there were a total of 384 cancer deaths. After adjustment for age, examination year, and multiple risk factors, men who were physically fit, never smoked, and had a normal waist girth had a 62% lower risk of total cancer mortality (95% confidence interval [CI], 45%-73%) compared with men with no low-risk factors. Men with all 3 low-risk factors had a 12-year (95% CI, 8.6-14.6) longer life expectancy compared with men with no low-risk factors. Approximately 37% (95% CI, 17%-52%) of total cancer deaths might have been avoided if the men had maintained all 3 low-risk factors. CONCLUSIONS: Being physically fit, never smoking, and maintaining a normal waist girth is associated with lower risk of total cancer mortality in men.

Lenz TL; Gillespie N. Transdermal patch drug delivery interactions with exercise. Sports Medicine 41(3): 177-183, 2011. (20 refs.)

Transdermal drug delivery systems, such as the transdermal patch, continue to be a popular and convenient way to administer medications. There are currently several medications that use a transdermal patch drug delivery system. This article describes the potential untoward side effects of increased drug absorption through the use of a transdermal patch in individuals who exercise or participate in sporting events. Four studies have been reported that demonstrate a significant increase in the plasma concentration of nitroglycerin when individuals exercise compared with rest. Likewise, several case reports and two studies have been conducted that demonstrate nicotine toxicity and increased plasma nicotine while wearing a nicotine patch in individuals who exercise or participate in sporting events compared with rest. Healthcare providers, trainers and coaches should be aware of proper transdermal patch use, especially while exercising, in order to provide needed information to their respective patients and athletes to avoid potential untoward side effects. Particular caution should be given to individuals who participate in an extreme sporting event of long duration. Further research that includes more medications is needed in this area.

Lisha NE; Martens M; Leventhal AM. Age and gender as moderators of the relationship between physical activity and alcohol use. Addictive Behaviors 36(9): 933-936, 2011. (19 refs.)

Objective: Understanding moderators of the relationship between physical activity (PA) and alcohol use is important for clarifying the mechanisms underlying these behaviors and informing health promotion interventions. This study examined age and gender as two candidate moderators of the PA-alcohol use link. Method: As part of a correlational, cross-sectional population-based study of US 34,653 adults, participants were administered surveys assessing demographics, alcohol use, moderate and vigorous PA, and other characteristics. Composite indices of the frequency and quantity of alcohol use and PA were utilized in analyses. Results: Age moderated the association between past-year vigorous PA and alcohol use (ps <=.01). Vigorous PA was positively associated with alcohol use in individuals under 50 years of age (ps <=.05), but not in individuals over 50 years of age (ps >= 0.05). Gender moderated the association between past-year moderate PA and alcohol use (ps<.001). The relation was stronger in males (beta=.72) than in females (beta=.41). Each of the findings remained significant even when controlling for demographics, psychiatric variables, and other potential confounds. Conclusion: Among the American population of adults, age appears to moderate the relationship between vigorous PA and alcohol use, whereas gender appears to moderate the relationship between moderate PA and alcohol use. These findings shed light on the underlying mechanisms that may account for increased alcohol use in exercisers and may have clinical implications for alcohol screening and interventions in adults

Lv J; Liu QM; Ren YJ; Gong T; Wang SF; Li LM. Socio-demographic association of multiple modifiable lifestyle risk factors and their clustering in a representative urban population of adults: a cross-sectional study in Hangzhou, China. International Journal of Behavioral Nutrition and Physical Activity 8(e-article 40), 2011. (76 refs.)

Background: To plan long-term prevention strategies and develop tailored intervention activities, it is important to understand the socio-demographic characteristics of the subpopulations at high risk of developing chronic diseases. This study aimed to examine the socio-demographic characteristics associated with multiple lifestyle risk factors and their clustering. Methods: We conducted a simple random sampling survey to assess lifestyle risk factors in three districts of Hangzhou, China between 2008 and 2009. A two-step cluster analysis was used to identify different health-related lifestyle clusters based on tobacco use, physical activity, fruit and vegetable consumption, and out-of-home eating. Multinomial logistic regression was used to model the association between socio-demographic factors and lifestyle clusters. Results: A total of 2016 eligible people (977 men and 1039 women, ages 18-64 years) completed the survey. Three distinct clusters were identified from the cluster analysis: an unhealthy (UH) group (25.7%), moderately healthy (MH) group (31.1%), and healthy (H) group (43.1%). UH group was characterised by a high prevalence of current daily smoking, a moderate or low level of PA, low FV consumption with regard to the frequency or servings, and more occurrences of eating out. H group was characterised by no current daily smoking, a moderate level of PA, high FV consumption, and the fewest times of eating out. MH group was characterised by no current daily smoking, a low or high level of PA, and an intermediate level of FV consumption and frequency of eating out. Men were more likely than women to have unhealthy lifestyles. Adults aged 50-64 years were more likely to live healthy lifestyles. Adults aged 40-49 years were more likely to be in the UH group. Adults whose highest level of education was junior high school or below were more likely to be in the UH group. Adults with a high asset index were more likely to be in the MH group. Conclusions: This study suggests that Chinese urban people who are middle-aged, men, and less educated are most likely to be part of the cluster with a high-risk profile. Those groups will contribute the most to the future burden of major chronic disease and should be targeted for early prevention programs.

Meyer C; Taranis L. Exercise in the eating disorders: Terms and definitions. (editorial). European Eating Disorders Review 19(3, special issue): 169- 173, 2011. (55 refs.)

Mnatzaganian G; Ryan P; Norman PE; Davidson DC; Hiller JE. Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men. Arthritis and Rheumatism 63(8): 2523-2530, 2011. (48 refs.)

Objective. To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men. Methods. A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs). Results. Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (>= 48 years of smoking) were 42-51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70-74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19-2.24]). Adjusting for Deyo-Charlson Index or Elixhauser's comorbidity measures did not eliminate these associations. Conclusion. Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis.

Nettle D. Large differences in publicly visible health behaviours across two neighbourhoods of the same city. PLoS ONE 6(6): e21051, 2011. (25 refs.)

Background: There are socioeconomic disparities in the likelihood of adopting unhealthy behaviours, and success at giving them up. This may be in part because people living in deprived areas are exposed to greater rates of unhealthy behaviour amongst those living around them. Conventional self-report surveys do not capture these differences in exposure, and more ethological methods are required in order to do so. Methodology/Principal Findings: We performed 12 hours of direct behavioural observation in the streets of two neighbourhoods of the same city which were similar in most regards, except that one was much more socioeconomically deprived than the other. There were large differences in the publicly visible health behaviours observed. In the deprived neighbourhood, we observed 266 more adults smoking (rate ratio 3.44), 53 more adults drinking alcohol (rate ratio not calculable), and 38 fewer adults running (rate ratio 0.23), than in the affluent neighbourhood. We used data from the Health Survey for England to calculate the differences we ought to expect to have seen given the individual-level socioeconomic characteristics of the residents. The observed disparities between the two neighbourhoods were considerably greater than this null model predicted. There were also different patterns of smoking in proximity to children in the two neighbourhoods. Conclusions/Significance: The differences in observed smoking, drinking alcohol, and physical activity between these two neighbourhoods of the same city are strikingly large, and for smoking and running, their magnitude suggests substantial area effects above and beyond the compositional differences between the neighbourhoods. Because of these differences, individuals residing in deprived areas are exposed to substantially more smoking and public drinking, and less physical activity, as they go about their daily lives, than their affluent peers. This may have important implications for the initiation and maintenance of health behaviours, and the persistence of health inequalities.

O'Brien KS. Commentary on Terry-McElrath & O'Malley (2011): Bad sport: Exorcizing harmful substances and other problems. (editorial). Addiction 106(10): 1866-1867, 2011. (18 refs.)

O'Brien CP; Gastfriend DR; Forman RF; Schweizer E; Pettinati HM. Long-term opioid blockade and hedonic response: Preliminary data from two open-label extension studies with extended-release naltrexone. American Journal on Addictions 20(2): 106-112, 2011. (36 refs.)

The emergence of extended-release naltrexone (XR-NTX) raises the opportunity to explore the role of endorphin blockade on hedonic response during long-term alcohol dependence treatment. A hedonic survey was administered to 74 alcohol dependent patients treated for an average of 3.5 years with nearly continuous month-long intramuscular XR-NTX. The paper-and-pencil, one-time survey asked patients about the degree of pleasure they experienced in the past 90 days with drinking alcohol, sex, exercise and other daily activities. The data revealed lower pleasure ratings for alcohol than for sex, exercise and 10 other common activities. Mean responses to drinking alcohol and gambling were significantly lower than to listening to music, sex, reading, being with friends, eating good food, eating spicy food, and playing video/card games. This effect was independent of XR-NTX dose or duration. Although this exploratory study lacked baseline data, a comparison group or control for the impact of patient discontinuation, the data indicate the feasibility of examining long-term hedonic response in recovery. The differential hedonic ratings suggest that, in patients who persist with long-term continuous therapy, XR-NTX may selectively inhibit the pleasure associated with drinking alcohol, compared to a variety of other activities.

Peltzer K. Leisure time physical activity and sedentary behavior and substance use among in-school adolescents in eight African countries. International Journal of Behavioral Medicine 17(4): 271- 278, 2011. (35 refs.)

Background Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases. In high income countries, studies have measured school population level physical activity and substance use, but comparable data are lacking from most African countries. Purpose: To study the relationship between self-reported leisure time physical activity frequency and sedentary behavior and alcohol, tobacco, and other drug use behaviors among school children. Method A cross-sectional survey was conducted with the total sample of 24,593 school children aged 13 to 15 years from nationally representative samples from eight African countries. Univariate and multivariate analyses were conducted to assess the relationship between physical activity frequency, six measures of alcohol, tobacco, and other drug use, socioeconomic status, and mental health variables. Results: In all, only 14.2% of the school children were frequently physically active (5 days and more in a week, at least 60 min/day) during leisure time; this was significantly higher among boys than girls. Ugandan and Kenyan school children were most physically active (17.7% and 16.0%, respectively), and Zambian and Senegalese the least (9.0% and 10.9%, respectively). Frequency of alcohol consumption and higher socioeconomic status were significantly associated with leisure time physical activity, while tobacco, illicit drug use, and mental health variables were not. Leisure time sedentary behavior of five and more hours spent sitting on a usual day were highly associated with all substance use variables. Conclusion: These findings suggest that leisure time physical activity frequency is associated with frequency of alcohol use and not with tobacco and illicit drug use, and leisure time sedentary behavior is highly associated with alcohol, tobacco, and drug use among adolescents.

Ruthig JC; Marrone S; Hladkyj S; Robinson-Epp N. Changes in college student health: Implications for academic performance. Journal of College Student Development 52(3): 307- 320, 2011. (52 refs.)

This study investigated the longitudinal associations of health perceptions and behaviors with subsequent academic performance among college students. Multiple health perceptions and behaviors were assessed for 203 college students both at the beginning and end of an academic year. Students' academic performance was also measured at the end of the year. Separate regression analyses were conducted for men and women to examine changes in health perceptions and behaviors as predictors of year-end performance. Significant gender differences were found for initial health symptoms, perceived stress, exercise, and nutrition. After controlling for prior achievement, increased binge drinking negatively predicted female students' academic performance and feelings of success; increased tobacco use negatively predicted male students' performance. Male and female college students appear to differ in the ways that their health changes over an academic year as well as how such changes impact their later academic performance. Implications for devising health promotion programs that specifically target male and female college students' health risks are discussed.

Scarborough P; Bhatnagar P; Wickramasinghe KK; Allender S; Foster C; Rayner M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: An update to 2006-07 NHS costs. Journal of Public Health 33(4): 527-535, 2011. (40 refs.)

Background: Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 199293. Methods: Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 200607. Results: In 200607, poor diet-related ill health cost the NHS in the UK 5.8 billion. The cost of physical inactivity was 0.9 billion. Smoking cost was 3.3 billion, alcohol cost 3.3 billion, overweight and obesity cost 5.1 billion. Conclusion: The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Shaw I; Shaw BS; Brown GA. Concurrent training and pulmonary function in smokers. International Journal of Sports Medicine 32(10): 776-780, 2011. (39 refs.)

This study compared the effects of aerobic, resistance and concurrent aerobic and resistance training on pulmonary function and cardiorespiratory endurance in at-risk smokers. 50 sedentary, male smokers with pulmonary function impairments at risk for developing chronic lung diseases were randomly assigned to an aerobic (AerG; n = 12), resistance (ResG; n = 13), concurrent (ConG; n = 13) or non-exercising control (NexG; n = 12) group for 16 weeks. AerG subjects performed 45 min of aerobic exercise at 60% HR max, ResG subjects performed 8 resistance exercises at 60 % 1-RM for 3 sets, 15 repetitions while ConG subjects performed both aerobic and resistance exercises. ANOVA revealed no significant difference between the groups in their pre-/post-test changes for FEV(1)/FVC ratio (AerG: -4.13 %; ResG: -2.13%; ConG: -0.56%); FEF-50 (AerG: -4.59%; ResG: -7.62%; ConG: 5.76%), FEF-75 (AerG: -2.36%; ResG: -7.62%; ConG: 10.71%) and FEF 25 -75 (AerG: -3.53%; ResG: -6.43%; ConG: 7.63%). Significant differences were found between the groups in their pre-/post-test changes for FVC (AerG: 8.05%; ResG: 7.22%; ConG: 11.55%), FEV(1) (Aer: 9.60%; ResG: 5.13%; ConG: 12.10%), PEF (AerG: 11.29%; ResG: 7.49%; ConG: 20.18%), PIF (AerG: 24.80%; ResG: 19.41%; ConG: 28.15%), IVC (AerG: 9.04%; ResG: 6.21%; ConG: 16.35%), FEF-25 (AerG: 5.88%; ResG: 5.37%; ConG: 11.88%) and cardiorespiratory fitness (AerG: 25.44%; ResG: 11.59%; ConG: 22.83%). Post-hoc analysis revealed concurrent and aerobic training were equally effective at improving PIF and cardiorespiratory fitness with concurrent training most effective at improving FVC, FEV(1), PEF, IVC and FEF-25. This suggests synergy between aerobic and resistance exercise in preventing or reducing the detrimental effects of smoking while gaining the unique benefits of each mode of exercise.

Sokka T; Pincus T. Poor physical function, pain and limited exercise: Risk factors for premature mortality in the range of smoking or hypertension, identified on a simple patient self-report questionnaire for usual care. BMJ Open 1: e-000070, 2011. (38 refs.)

Objective: To analyse poor physical function, pain, limited exercise and smoking, assessed in a patient-friendly self-report questionnaire format that has been completed by every patient at every visit over 20-30+/-14years in the authors' and other usual care settings, to predict 5-year mortality in a general older population. Methods: An extended version of a Multidimensional Health Assessment Questionnaire was mailed to 2000 subjects in Finland, identified as a randomly selected control cohort for a rheumatoid arthritis cohort. The questionnaire included queries concerning baseline physical function, pain, exercise and smoking status, identical to the clinic version, as well as age and 25 medical conditions. Five-year survival was analysed according to descriptive statistics, Kaplan-Meier curves and Cox regressions. Results: The questionnaire was returned by 1523 subjects (76%). Five-year survival was 94% in all subjects, 98% in subjects with no disease or no acutely life-threatening disease, and 17% in subjects with an acutely life-threatening disease. Hazard ratios (HRs) for 5-year mortality were 3.5 for poor physical function, 2.2 for pain, 5.2 for limited exercise and 4.6 for smoking (p<0.01); 5-year survivals were 93%, 97%, 93% and 95%, respectively, compared with 91% for hypertension. Each of the four patient history variables predicted mortality at higher levels in subjects who reported no versus one or more acutely life-threatening conditions. Conclusions: Poor physical function, pain, limited exercise and smoking can be assessed systematically on a simple standard Multidimensional Health Assessment Questionnaire, to identify potentially modifiable risk factors for premature mortality in the infrastructure of usual medical care and health maintenance.

Terry-McElrath YM; O'Malley PM. Substance use and exercise participation among young adults: Parallel trajectories in a national cohort-sequential study. Addiction 106(10): 1855-1865, 2011. (60 refs.)

Aims This study examined the extent to which the trajectory of participation in sports, athletics or exercising (PSAE) covaried with substance use in early adulthood controlling for team sports participation using parallel process latent growth curve modeling. Design, setting and participants: Analysis of data collected from a series of panel studies using a cohort-sequential design. Specifically, the analyses used longitudinal data from 11 741 individuals from the graduating classes of 1986-2001, first surveyed as seniors in American high schools. Up to four additional follow-up surveys were administered to age 26 years. Data were collected using in-school and mailed self-administered questionnaires. Measurements: Level of PSAE, past-30-day alcohol, cigarette and marijuana use frequency and any past-30-day use of illicit drugs other than marijuana (IOTM) were the main processes of interest. Self-reported race/ethnicity, college status at age 19/20 years, parental education, gender and team sports participation during high school were included as covariates. Findings: Results indicate that higher initial levels of PSAE related to lower initial substance use prevalence rates other than alcohol, and lower initial prevalence rates of substance use then corresponded with lower substance use rates throughout early adulthood. Further, as individuals increased PSAE levels throughout early adulthood, the frequency of their use of cigarettes, marijuana and IOTM correspondingly decreased. Conclusions: Increased participation in sports, athletics or exercising (PSAE) is related to significantly lower substance use frequency at modal age 18 and through significantly and negatively correlated growth trajectories through early adulthood. Encouraging PSAE among adolescents and early adults may relate to lower substance use levels throughout early adulthood.

Torabi MR; Tao R; Jay SJ; Olcott C. A cross-sectional survey on the inclusion of tobacco prevention/cessation, nutrition/diet, and exercise physiology/fitness education in medical school curricula. Journal of the National Medical Association 103(5): 400-406, 2011. (49 refs.)

Chronic diseases are currently the major cause of death and disability worldwide. Addressing the main causes of chronic diseases from a preventive perspective is imperative for halting a continual increase in premature deaths. Physicians occupy a unique position to assist individuals with chronic disease prevention. Hence, medical school is an opportunity to prepare physicians for preventive interventions with patients at risk for developing chronic diseases. This study asserts that education on chronic disease prevention that targets tobacco cessation/prevention, nutrition/diet, and exercise physiology/fitness is a key aspect of medical school curricula. However, many US medical schools do not include all 3 components in their curricula. This study investigates the extent to which medical school curricula include the above 3 areas. Two methods were utilized for the study: (1) a cross-sectional survey was given to the associate dean of academic affairs of 129 US medical schools and (2) relevant data were retrieved from the Association of American Medical Colleges. Findings support the notion that medical schools are in need of increased curricula covering tobacco prevention/cessation, nutrition/diet, and exercise physiology/fitness. Results indicate that exercise physiology/fitness was the area receiving the least attention in medical schools. Ultimately, this study's purpose was to provide a basis for determining whether inclusion of these 3 subjects in medical school curricula has any significant effect on training future doctors to meet the needs of growing numbers of individuals with chronic disease.