Sedentariness - Disease Cure PDF

HOW ‘WE’ HAVE STOPPED MOVING, CONSEQUENCES & CURES BACKGROUND ¡ Physical inactivity (PI) in North America (NA) is associated with morbidity-mortality ¡ 50 – 80% of North American adults are not active enough to gain health benefits ¡ PI is associated with increased incidences of cardiovascular disea...

HOW ‘WE’ HAVE STOPPED MOVING, CONSEQUENCES & CURES BACKGROUND ¡ Physical inactivity (PI) in North America (NA) is associated with morbidity-mortality ¡ 50 – 80% of North American adults are not active enough to gain health benefits ¡ PI is associated with increased incidences of cardiovascular diseases (9.9%); stroke (6.5%); hypertension (2.2%); Type 2 diabetes (5.9%); bladder cancer (2.9%); breast cancer (3.6%), colon cancer (3.9%) ¡ Estimated healthcare costs attributable to PI in Canada were $2.1 billion (1999) and $2.4 billion (2009) and higher (Arraiz et al., 1992; Knight, 2012;Villeneuve et al., 1998; Centers for Disease Control and Prevention [CDC], n.d.; Statistics Canada, 2021; Piercy et al., 2018; Katzmarzyk et al., 2022; Katzmarzyk et al., 2020) ¡ More effective physical activity (PA) interventions (are critical) to reduce excess disease & costs ¡ Observed stabilizations of sedentariness levels suggest novel methods are needed ¡ We provide a select sedentary subpopulation a customized intervention to increase PA adoption RESEARCH QUESTION – APPLICABLE TO ONE SUBPOPULATION BUT SUBPOPULATION CUSTOMIZATION IS APPLICABLE TO ALL ¡ Does an online PA-promoting Christian-based cognitive behavioural therapy (C-CBT) intervention (with Fitbit monitoring), targeted at religious Christians & structured around conscientiousness-grit, grace and stewardship show efficacy vs wait list controls? AIMS & OBJECTIVES ¡ A. RCT assessment of whether an online Christian-based CBT-PA intervention is more effective than the wait list control condition, in increased PA assessed by self-report (IPAQ), Fitbit (online) tracked steps & BMI ¡ B. Assess whether engagement with online CCBT (operationalized as (a) workbooks completed, (b) text messages exchanged, (c) phone sessions completed) predicts increased PA HYPOTHESES ¡ A. The CCBT intervention is more effective than wait list control condition in increased PA as assessed by self-report (IPAQ), Fitbit (online) tracked steps & changes in body mass index (BMI) ¡ B. Engagement with online CCBT ¡ a) online workbooks completed ¡ b) online text messages exchanged ¡ c) phone sessions completed ¡ All in combination predict increased PA WHY NOW? VS. LATER? ¡ Multiple demographic variables within the Christian subpopulation are associated with sedentariness & excess weight ¡ Effective interventions enable role modelling for others ¡ Role modelling can influence close-knit faith communities (any close-knit community) ¡ Wearable devices (eg. Fitbits) support effective PA interventions & role-modelling (Dodor, 2012; Kim et al., 2003; Schlundt et al., 2008;Tomlinson, 2011) SCIENTIFIC BACKGROUND (1) ¡ Conscientiousness is significantly correlated (r=.30, p=.02) with + health outcomes ¡ Church-attenders appear to more conscientious than secular individuals (p <.01) ¡ When conscientious individuals do not obtain sufficient PA, we predict a sensitization to its absence & motivation to address this ‘gap’ Like ‘peeling’ an onion… the outer layers (are subjects most ready to adopt walking exercise) The readier-to-adopt individuals will role model for those ‘less ready’ (Edmonds et al., 2015; Kloet & Galen, 2011) SCIENTIFIC BACKGROUND (2) ¡ Past RCTs indicate that when religious CBT is compared to standard CBT in Christians, depression effects are greater ¡ The affinity between Christian faith and Christian CBT-orientation will contribute to increased intervention efficacy SCIENTIFIC BACKGROUND (3) ¡ Grit predicts higher stages of change re: intentions to exercise ¡ Grit is defined as perseverance & passion for long-term goal achievement (Duckworth et al., 2007) ¡ More grit will contribute to more healthy exercise sustained for longer periods Grit & Myth of Sisyphus: "The struggle itself towards the heights is enough to fill a man's heart." PROPOSED TRIAL DESIGN ¡ Online, 2-arm RCT ¡ Random assignment to: (1) CCBT or (2) wait list control ¡ Recruitment through CloudResearch (online platform) ¡ Outcomes measured at baseline, post-intervention (4 months), and 6 months ¡ Semi-structured interview at 6 month follow-up INCLUSION CRITERIA ¡ (1) 25 to 55 years old ¡ (2) self-identification as a regular church attendee ¡ (3) willingness to complete the Big Five Inventory questionnaire (John & Srivastava, 1999) ¡ (4) Big Five Inventory questionnaire scores that are 1 SD > the mean score typically derived in most published studies ¡ (5) willingness to receive & wear a loaned Fitbit in daytime hours on a daily basis for the duration of the 16 week intervention ¡ (6) BMI between 27 & 33 ¡ (7) fluent in English ¡ (8) approval from a primary care physician for initiating graded-incremental walking exercise routines ¡ (9) ability to walk 30 minutes without significant self-identified pain &/or orthopedic dysfunction EXCLUSION CRITERIA ¡ (1) Past or present diagnosis of Bipolar Disorder, Borderline Personality Disorder, Obsessive-Compulsive Disorder, Schizophrenia, Substance Abuse/Addiction in the past three months; suicidal ideation or attempted suicide in the past six months ¡ (2) individuals with a self-reported co-morbid illness or condition that is negatively affected by walking exercise ¡ (3) individuals who report walking 20 minutes per day (on average) or more PRIMARY OUTCOMES ¡ PA: International Physical Activity Questionnaire (IPAQ) ¡ Steps: Fitbit Versa 2 ¡ Estimates can be made through analyses of periods of non-wear & missing data strategies that reduce nonadherence-based inaccuracies (Dang et al,, 2023) ¡ IPAQ can help identify outliers & Fitbit adherence failures SECONDARY OUTCOMES ¡ Body Mass Index (BMI) ¡ Depression (Patient Health Questionnaire-9) ¡ Anxiety (General Anxiety Disorder-7) ¡ Religious Engagement (Duke University Religion Index) ¡ Pain (Brief Pain Inventory) ¡ Quality of Life (EuroQol-5 Dimension) ¡ Grit (12 item Grit Scale) EXPERIMENTAL INTERVENTION ¡ Christian-based Cognitive Behavioural Therapy (C-CBT) via NexJ Connected Wellness (NCW) for 16 weeks ¡ Online workbooks combined with 1 hourly weekly navigation-coaching (phone + text messages) from a health coach trained in C-CBT ¡ Key intervention features: ¡ Christian CBT content focused on health stewardship in increasing physical activity ¡ Fitbit loan combined with daily monitoring of steps ¡ Feedback provided (about steps taken) through text messaging WAIT LIST CONTROL ¡ Fitbit loan but no counseling, text messaging, online content INTERVENTION STANDARDIZATION ¡ Intervention structure follows a multi-modal online intervention effective with major depressive disorder & T2D (both trials resulted in improved physical activity levels) (Ritvo et al., 2021; Wayne et al., 2015) ¡ Current studies build on prior intervention effectiveness ESSENCE OF CCBT FOR PA PROMOTION ¡ Emphasizing grace-stewardship balance ¡ Yes, the body is an amazing collection of resources ¡ Yes, the body is replenishing resources ¡ But without caretaking (exercise), disease ensues GRACE-STEWARDSHIP BALANCE ¡ There is grace in replenishing resources and being good stewards of our bodies and health through healthy exercise Replenishing resources Healthy exercise AEROBIC EXERCISE LENGTHENS TELOMERES / REDUCES STRESS IN FAMILY CAREGIVERS: RCT -- PUTERMAN ET AL., 2018 Caregivers of ill family members are often sedentary & highly stressed Observational reports suggest accelerated cellular aging, as indicated by shorter telomere lengths A test of aerobic exercise effects focused on changes in telomerase levels (primary outcome) & telomere lengths (secondary outcome) in inactive caregivers WHY NOT JUST INVESTIGATE COMPREHENSIVE LIFESTYLE INTERVENTION? Aerobic exercise (AE) is a ‘health behaviour’ that can elicit increased adherence (in multiple modalities) over time Direct & replicable associations can be evaluated between AE & telomere outcomes There may be more direct associations between AE & telomeres than between diet (alone), meditationyoga (alone) & group tx. (alone) We may learn more from singular intervention studies than from multi-modal studies - by comparing specific effects on telomere length A way to remember ‘telomeres’….He not busy being born is busy dying PUTERMAN ET AL., 2018 - STRENGTH 1 - EXCELLENT EXERCISE ADHERENCE Exercise program started with 3 x’s 20-min. sessions of self-chosen activities/wk at low moderate intensity - 40% of heart rate reserve established from their CardioPulmonary Exercise Test [CPET] This increased to 4–5 x’s 30-minute sessions/wk at upper moderate intensity by week 9 Maintained for the remaining 15 of 24 overall weeks. All participants rec’d free gym memberships at a YMCA, accessed fitness videos & wore accelerometers during workouts (wGT3X-BT Monitor™) & heart rate monitors gauge targeted heart rates. Every Sunday, participants uploaded data to the Actilife™ cloud, & on Monday their coach emailed a progress report summarizing daily activity for the prior week. NON-ADHERENCE REMEDIATION Participants who did not reach goals rec’d a 10-minute call using motivational interviewing methods (Miller and Rollnick, 2013) & 5 text messages during week with exercise reminders. Waitlist controls (WCs) The WCs were not PA monitored with actigraphs but self reported exercise via L-CAT (Kiernan et al., 2013) and stress via Perceived Stress Scale (Cohen et al., 1983) monthly. After study, WCs received free gym memberships & personalized fitness programs 81% of participants completed > 80% of assigned exercise during study. Mean of 3.5 sessions/wk & 39.9 min duration / session 73% of participants performed ≥100% of target exercise. No significant baseline between-group differences in activity levels, as reported with the L- CAT, (t (66)= − 0.73) Participants randomized to exercise arm were exercising significantly more than WCs & at mean levels that met CDC recommendations Participants randomized to the aerobic exercise arm (N=34) were 4 years younger (p < 0.01) and more likely to be female (88.-3% vs 73.5%) than those assigned to the control arm (N=34). * = statistical significance DISCUSSION POINTS - 1 1 - Leukocyte telomere lengths appeared significantly longer after AE in inactive, highly stressed adults; WCs showed insignificant shortenings in leukocyte telomere lengths But… effects can’t be attributed to changes in telomerase levels in PBMCs (the primary outcome measure), or changes in the %s of circulating white blood cell subtypes, given the absence of changes in PBMC’s telomerase enzyme activity. DISCUSSION POINTS - 2 2- Despite non-significant changes in telomerase levels in PBMC, several explanations exist for length changes: A) Long-term exercise reduces % of senescent immune cell subsets in circulation (Silva et al., 2016; Timmerman et al., 2008), & senescent cells have the shortest telomere lengths (Lin et al., 2016; Merino et al., 2011). Therefore, telomere lengthening after AE may result from redistributed immune cell subpopulations & corresponding subsets within circulation. DISCUSSION POINTS - 2B B) Telomerase enzyme activity is not independently linked to the regulation of telomere length The telomerase enzyme is recruited to the ends of telomeres by the shelterin complex (6 proteins that regulate telomere configuration under resting conditions & respond to cellular replication) Human studies suggest aerobically fit adults express elevated mRNA levels of the shelterin complex under resting conditions (Denham et al., 2016; Werner et al., 2009). Elongation of telomere lengths observed in the AE group may reflect the improved capacity of the shelterin complex to recruit telomerase to the ends of telomeres within leukocytes, independent of telomerase activity regulation Pe DISCUSSION POINTS - 3C Persistent exposures of leukocytes to pro-inflammatory proteins & elevated oxidative stress elicit damage to telomeres & associated mechanisms (von Zglinicki, 2002; Jurk et al., 2014) & serve as an underlying contributor to shorter telomeres Regular participation in aerobic exercise exerts powerful antiinflammatory & anti-oxidant effects (Gleeson et al., 2011; Boccatonda et al., 2016; Pedersen and Saltin, 2015) Elongation of leukocyte telomeres observed in the AE group may have resulted from reduced inflammation & oxidative stress. INTERPRETATION Lifestyle changes significantly increased telomerase activity & consequently telomere maintenance in human immune-system cells. Given this finding in a pilot study, the increases in telomerase activity are a significant association rather than inferring causation. Associations can be two-way: a correlation between x & y could mean x influences or causes y - or y influences or causes x - or both - or neither as another variable or set of variables might be causing x & y to change in ways that are correlated & appear linked DISARRAY IN EXERCISE PROMOTION RESEARCH ¡ What is the exercise mode with least need for ‘preparation’..’expense’? PRIORITIZATION OF INTERVENTION STRATEGIES ¡ You will have index cards with slots for (10) linear analog scale responses ¡ |--------------------------------------------------------------------------------| 1 3 5 7 ¡ We supply questions to trigger responses (if you choose to respond) 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION & DISCUSSION ? ¡ 1. Walking is unavoidable and readily extended in duration & distance ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 What issues are a high priority for presentation and discussion? ¡ 2. Walking is healthy and sedentariness (beyond a specific threshold) is biodegrading ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION AND DISCUSSION? ¡ 3. Walking is part of stewardship & greenhouse gas reduction & a way of contributing to reducing global warming & extreme weather patterns ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION AND DISCUSSION? 4. Walking together is a way of building newer and older relationships ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION AND DISCUSSION? 5. Walking is a way of improving heart health ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION AND DISCUSSION? 6. Walking is a way of improving mitochondrial health and increasing energy and vitality ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION AND DISCUSSION? 7. Walking is a way of improving mood. ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10 WHAT ISSUES ARE A HIGH PRIORITY FOR PRESENTATION AND DISCUSSION? 8. Walking is a way of exploring and valuing community ¡ |-------------------------------------------------------------------| 1 2 3 4 5 6 7 8 9 10