Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiologybased literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes. E vidence is accumulating that sedentary behavior might be associated with increased cardiovascular-specific and overall mortality. Insufficient physical activity predicts premature cardiovascular disease (CVD) mortality and disease burden, such that the United States and other developed countries have issued physical activity guidelines, but these guidelines are specific to physical activity and do not include sedentary behavior.1 Sedentary behavior guidelines to reduce the risk of chronic diseases for adults have been developed in some countries, but they are broadly stated and nonquantitative. For example, Australia and the United Kingdom have public health guidelines stating that adults should minimize the amount of time spent being sedentary (sitting) for extended periods.2,3 Such broad public health guidelines for adults are likely appropriate, because evidence is still accumulating regarding the strength of the association, the evidence for causation (including understanding mechanisms), and the support for dose-response relationships that demonstrate sedentary behavior to be an independent risk factor for adverse health outcomes. Although at one time, excess sedentary behavior was considered to be at one end of the continuum of physical activity such that a person with no moderateto-vigorous physical activity (MVPA) was considered "sedentary," consensus is building that sedentary behavior is distinct from lack of MVPA. Even the word "sedentary," derived from the Latin "sedentarius" and defined as "sitting, remaining in one place," connotes a different set of behaviors than non-MVPA. 4 Thus, researchers studying MVPA, physical inactivity, and sedentary behavior are now viewing these behaviors as separate entities with their own unique determinants and health consequences. CLiniCAL STATEMEnTS And GUidELinESThis American Heart Association science advisory summarizes the existing evidence about sedentary behavior as a potential risk factor for CVD and...

Endometrial ablation is a less invasive treatment for menorrhagia than is hysterectomy, and it preserves the uterus. This randomized controlled trial was undertaken to assess 10-year outcomes for 2 established methods of endometrial ablation in 120 women with heavy dysfunctional ablation who were enrolled in the years 1993 to 1995. Sixty-one of them were treated by endometrial coagulation and 59 by endometrial resection. All of these women would have undergone hysterectomy had ablation not been an option. Excluded from the study were women younger than 35 years, those whose uterus was more than twice the normal size or had a cavity depth exceeding 12 cm, and those for whom pelvic pain was a major problem.Only one death, from infection, was related to the initial treatment. Two-thirds of patients had had a single ablation when followed up 2 years after treatment, and the figure after 10 years was 63%. Twenty-six women had had a hysterectomy within 10 years of endometrial ablation. The likelihood of this happening was substantially greater in women less than 40 years of age than in older women (43% vs. 18%). In all, 78% of women had avoided major surgery. The major indications for hysterectomy were bleeding and lower abdominal pain. Only 7% of women still had episodic bleeding 10 years after initial treatment. None of them was more than 45 years of age. On a scale of 0 ("not satisfied") to 100 ("very satisfied"), the overall degree of satisfaction with the outcome of treatment was 84. Nearly 95% of women would recommend the same treatment.The investigators believe that endometrial ablation is an excellent way of treating heavy dysfunctional bleeding. In the present series, if a woman required no further intervention within 2 years of ablation, the chance of having a hysterectomy within 10 years after initial treatment was only 6%. GYNECOLOGY Volume 62, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe first established treatment for anovulatory women having polycystic ovarian syndrome (PCOS) who failed to respond to medical treatment was laparoscopic ovarian wedge resection. Since then, the risk of adhesion formation has prompted the development of less invasive surgical procedures such as ovarian wedge resection by minilaparotomy. This study compared the risk of adhesion formation in 37 anovulatory infertile women with PCOS who had failed to respond to clomiphene citrate and who had ovarian wedge resection by minilaparotomy (group I), and 39 others who underwent laparoscopic ovarian electrodrilling (group II). All participants had a second-look laparoscopy 1 week after the initial procedure. Adhesion formation was assessed using the American Fertility Society classification. The 2 treatment groups were similar demographically and with respect to serum gonadotropin levels.Three women in group II (7.7%) had periovarian adhesions. In contrast, 81% of group I women had periovarian adhesions, and 54% and 46%, respectively, had intra-abdominal and uterine adhesions. Adhesions at all 3 sites were Operative Gyneco...

Context Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately. Objective To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. Design, Setting, and Participants Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. Intervention Participants were randomly assigned to follow the Atkins (n=77), Zone (n=79), LEARN (n=79), or Ornish (n=76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Main Outcome Measures Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. Results Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (PϽ.05). Mean 12-month weight loss was as follows: Atkins, −4.7 kg (95% confidence interval [CI], −6.3 to −3.1 kg), Zone, −1.6 kg (95% CI, −2.8 to −0.4 kg), LEARN, −2.6 kg (−3.8 to −1.3 kg), and Ornish, −2.2 kg (−3.6 to −0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Conclusions In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss. Trial Registration clinicaltrials.gov Identifier: NCT00079573

Objective-To test a 2-year community-and family-based obesity prevention intervention for low-income African-American girls.Design-Randomized controlled trial with follow-up measures scheduled at 6, 12, 18 and 24 months.Setting-Low-income areas of Oakland, CA.Participants-261 8-10 year old African-American girls and their parents/caregivers. Interventions-Families were randomized to two-year, culturally-tailored interventions: (1) after school Hip-Hop, African and Step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education. Main Outcome Measure-Body mass index (BMI) change. Results-Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [−.18, .27] kg/m 2 per year). Among secondary outcomes, fasting total cholesterol (−3.49 [−5.28, −1.70] mg/dL per year), LDL-cholesterol (−3.02 [−4.74, −1.31] mg/dL per year), incidence of hyperinsulinemia (Relative Risk 0.35 [0.13, 0.93]), and depressive symptoms (−0.21 [−0.42, −0.001] per year) fell more among girls in the dance and screen time reduction intervention.In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P=.02) and/or those whose parents/guardians were unmarried (P<.01).Conclusions-A culturally-tailored after-school dance and screen time reduction intervention for low-income, preadolescent African-American girls did not significantly reduce BMI gain compared to health education, but produced potentially clinically important reductions in lipids,

Substantially increasing preschoolers' outdoor free play time did not increase their physical activity levels.

Background: Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce. Objective: We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success. Design: Secondary analysis was performed using data from 181 free-living overweight/obese women (mean ± s.d. age ¼ 43 ± 5 years, body mass index ¼ 31 ± 4 kg m À2 ) participating in a 1-year randomized clinical trial (the A TO Z study) comparing popular weight loss diets (Atkins, Zone and Ornish). Participants' dietary adherence was assessed as the difference between their respective assigned diet's recommended macronutrient goals and their self-reported intake. Association between dietary adherence and 12-month weight change was computed using Spearman's correlations. Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests. Results: Within each diet group, adherence score was significantly correlated with 12-month weight change (Atkins, r s ¼ 0.42, P ¼ 0.0003; Zone, r s ¼ 0.34, P ¼ 0.009 and Ornish, r s ¼ 0.38, P ¼ 0.004). Twelve-month weight change in the most vs least adherent tertiles, respectively, was À8.3±5.6 vs À1.9±5.8 kg, P ¼ 0.0006 (Atkins); À3.7±6.3 vs À0.4±6.8 kg, P ¼ 0.12 (Zone) and À6.5 ± 6.8 vs À1.7 ± 7.9 kg, P ¼ 0.06 (Ornish). Conclusions: Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

This pilot study examined the effects of a teacher-taught, locomotor skill (LMS)-based physical activity (PA) program on the LMS and PA levels of minority preschooler-aged children. Eight low-socioeconomic status preschool classrooms were randomized into LMS-PA (LMS-oriented lesson plans) or control group (supervised free playtime). Interventions were delivered for 30 min/day, five days/week for six months. Changes in PA (accelerometer) and LMS variables were assessed with MANCOVA. LMS-PA group exhibited a significant reduction in during-preschool (F (1,16) = 6.34, p = .02, d = 0.02) and total daily (F (1,16) = 9.78, p = .01, d = 0.30) percent time spent in sedentary activity. LMS-PA group also exhibited significant improvement in leaping skills, F (1, 51) = 7.18, p = .01, d = 0.80). No other, significant changes were observed. The implementation of a teacher-taught, LMS-based PA program could potentially improve LMS and reduce sedentary time of minority preschoolers.

The impact of additional structured outdoor playtime on preschoolers' physical activity (PA) level is unclear. The purpose of this pilot study was to explore the effects of increasing structured outdoor playtime on preschoolers' PA levels. Eight full-day classrooms (n 0134 children) from two preschool programmes were randomised into a treatment (STRUCT, n 04) or control (CON, n 04) condition. Both groups received an additional 30 minutes of outdoor playtime three days per week for four weeks. The STRUCT intervention consisted of previously tested structured outdoor playtime activities/games. The CON intervention consisted of free outdoor playtime. Children were individually recruited (n075) for the objective assessment of PA levels. The PA levels of 67 children (age, 4.190.8 years; STRUCT, n038; CON, n 029) were assessed at baseline and during week four for seven consecutive days using Actigraph accelerometers. Data were analysed using mixed-model analysis of variance. Time spent in vigorous PA significantly increased during the 30-minute intervention time for the STRUCT group compared with the CON group (group )time interaction: F(1, 36) 04.91, p00.04). Compared with baseline, a significant increase was observed in the STRUCT group's time spent engaged in moderate-to-vigorous PA (MVPA) during the intervention time, but this increase was not significant compared with the CON group (baseline: STRUCT, 1.792.0 min; CON, 1.992.4 min; week four: STRUCT, 4.993.1 min; CON, 3.392.5 min). Compared with the CON group, the STRUCT group spent a significantly greater percentage of time engaged in MVPA and a