Objective-To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors. overweight/obese) participated in a cohort-randomized trial comparing assessments + intervention (worksite A) with assessments only (worksite B) for 1 year. All participants received personal health reports containing their assessment results. The intervention was designed to promote physical activity and favorable dietary patterns using pedometers, healthy snack cart, WeightWatchers® meetings, group exercise classes, seminars, team competitions, and participation rewards. Outcomes included BMI, body composition, blood pressure, fitness, lipids, and Framingham 10-year coronary heart disease risk. Methods-InResults-123 participants, aged 45 ± 9 yr, with BMI 32.9 ± 8.8 kg/m 2 completed 1 year. Improvements (P ≤ 0.05) were observed at both worksites for fitness, blood pressure, and total-, HDL-, and LDL-cholesterol. Additional improvements occurred at worksite A in BMI, fat mass, Framingham risk score, and prevalence of the metabolic syndrome; only the changes in BMI and fat mass were different between worksites.Conclusion-A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors, but many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.

To test the effect of diet on the short-term lipid response to exercise, fourteen moderately trained (VO2max: 50.2 +/- 6.7 ml/kg/min), healthy men (mean age: 28 +/- 4 years) were alternately fed a high fat (60 +/- 6.7% fat) and a high carbohydrate (63 +/- 3.2% carbohydrate) isoenergetic diet for 2 weeks in a randomized crossover design. During the last 4 days of the treatments, fasting total cholesterol, triglyceride, HDL-cholesterol, and HDL3-cholesterol were measured the day before, and again immediately, 24 hr, and 48 hr after exercise (4190 kJ, 70% VO2max). LDL-cholesterol and HDL2-cholesterol were calculated. Lipid concentrations were adjusted for plasma volume changes after exercise. A 2 (diet) x 4 (time) ANOVA with repeated measures revealed no significant interaction between the diet and exercise treatments. Furthermore, diet alone did not influence lipid concentrations in these trained men. Exercise resulted in an increase in HDL-C (10.7%) and HDL3-C (8.5%) concentrations and a concomitant fall in triglyceride (-25%) and total cholesterol (-3.5%). Thus, we conclude that diet composition does not affect the short-term changes in blood lipids and lipoproteins that accompany a single session of aerobic exercise in moderately trained men.

We quantified the moderate-to-vigorous physical activity (MVPA, heart rate ≥140 bpm) of urban public elementary school children on school days with and school days without physical education (PE) class by using continuous heart rate monitoring. The heart rate of 81 students (93.8% black) in grades 3 and 5 was recorded in 15-second intervals. On the basis of 575 school-day observations (mean 7.1 days/student), students accumulated 44.4 (standard deviation [SD], 34.4) minutes of MVPA on days with PE and 30.6 (SD, 29.9) MVPA minutes on days without PE (P < .001). School policies should promote daily PE to help children in under-resourced areas achieve the recommended 60 minutes per day of MVPA.

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Small changes in lifestyle behaviors and adiposity within a healthy cohort of young adults significantly influenced cardiometabolic indices during their graduate career.

Treadmill exercise capacity in resting metabolic equivalents (METs) and stress hemodynamic, electrocardiographic (ECG), and myocardial perfusion imaging (MPI) responses are independently predictive of adverse clinical events. However, limited data exist for arm ergometer stress testing (AXT) in patients who cannot perform leg exercise because of lower extremity disabilities. We sought to determine the extent to which AXT METs, hemodynamic, ECG, and MPI responses to arm exercise add independent incremental value to demographic and clinical variables for prediction of all-cause mortality, myocardial infarction (MI), or late coronary revascularization, individually or as a composite. A prospective cohort of 186 patients aged 64 ± 10 (SD) yr, unable to perform lower extremity exercise, underwent AXT MPI for clinical reasons between 1997 and 2002, and were followed for 62 ± 23 mo, to an endpoint of death or 12/31/2006. Average annual rates were 5.4% for mortality, 2.2% for MI, 2.5% for late coronary revascularization, and 8.0% for combined events. After adjustment for age and clinical variables, AXT METs [P < 0.05; hazard ratio (HR) = 0.59; confidence interval (CI) = 0.35-0.84] and abnormal MPI (P < 0.01; HR = 2.48; CI = 2.15-2.81) were independently predictive of mortality. A positive AXT ECG (P < 0.05; HR = 2.61; CI = 2.13-3.10) was predictive of MI. Death and MI combined were prognosticated by METs (P < 0.05; HR = 0.63; CI = 0.41-0.85), MPI (P < 0.05; HR = 1.77; CI = 1.49-2.05), and a positive AXT ECG (P < 0.05; HR = 1.86; CI = 1.55-2.17). In conclusion, for high risk older patients who cannot perform leg exercise because of lower extremity disabilities, AXT METs are as important as MPI for prediction of mortality alone and death and MI combined, and a positive AXT ECG prognosticates MI alone and death and MI combined.

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Valuable prognostic and clinical information from treadmill exercise testing (GXT) includes exercise capacity (METs), heart rate, and electrocardiographic (ECG) responses. However, little or no prognostic data are available for arm ergometer stress testing (AXT). To determine whether AXT variables predict survival, myocardial infarction (MI), or coronary revascularization (CVASC), we performed AXT from 1997 to 2002 in 359 patients, mean age 63 +/− 11 (SD) years, referred for clinical reasons but unable to perform GXT, and followed for 63 +/− 24 months, during which 98 deaths occurred (27%). Average annual mortality, MI, CVASC, and combined adverse event rates were 5.2%, 1.7%, 2.2%, and 7.1%, respectively. Student’s t-tests were used to assess differences between outcome groups. Cox regression models were employed to determine hazard ratios (HR) and 95% confidence intervals (CI). Kaplan-Meier survival models were used to compare survival curves among AXT groups. AXT METs was highly predictive of survival after adjustment for age and beta blocker treatment (p < 0.001; when stratified by tertiles; death HR 0.47, CI 0.22– 0.71 middle vs. lowest; HR 0.61, CI 0.28 – 0.94 highest vs. middle). A greater delta (peak-rest) heart rate was associated with survival (p = 0.0003) and/or event-free outcome as were faster % age-predicted peak heart rate (death HR 0.58, CI 0.36 – 0.80 for >70% vs.> 70%), higher exercise systolic blood pressure (SBP) (p = 0.002) and peak heart rate x SBP product (PRPP) (p = 0.0006). A positive (+) AXT ECG was observed in 22% of deaths and 10% of survivors, 27% of MI and 12% with no MI, and 32% of CVASC versus 11% with no CVASC. A+AXT ECG was a powerful predictor of adverse outcome, even after accounting for peak heart rate, peak SBP and PRPP (death HR 2.2, CI 1.94 –2.43; MI HR 2.9, CI 2.48 –3.30; CVASC HR 4.1, CI 3.73– 4.43; combined events HR 2.8, CI 2.55–2.98). Sensitivity, specificity, positive and negative predictive values of a +AXT ECG in prognosticating adverse outcomes ranged from 22–31%, 88 –92%, 18 – 61%, and 62–92%, respectively. Thus, in veterans who are older and have more comorbidities than most other study populations based on adverse event rates, AXT is an alternative to GXT for predicting clinical outcome in patients with lower extremity disabilities.