The relationship between sleep and physical activity is an area of growing scientific interest, particularly in the context of older adults. The importance of examining long sleep duration and its influence on physical activity in this demographic becomes increasingly relevant given rising healthcare costs. This dissertation aims to investigate this intricate relationship via secondary analysis by examining the effects of moderate time-in-bed (TIB) restriction (60 minutes per night)) on various intensities of physical activity (sedentary, light, moderate, vigorous, moderate-vigorous physical activity) in older adults classified as long sleepers and average duration sleepers. It was hypothesized that moderate TIB restriction would result in differential changes in physical activity levels across various intensities, with long sleepers exhibiting increased physical activity and average sleepers displaying decreased activity, potentially influenced by alterations in TST (total sleep time) and SE (sleep efficiency). Utilizing a randomized controlled trial design, this study examined the effect of treatment changes in objectively measures activity (waist actigraphy) and subjects physical activity levels as measured by the Godin Leisure-Time Exercise Questionnaire . Eligible participants were long sleepers (sleeping > 9 hours per night) and average sleepers (sleeping 7-9 hours per night). Both types of sleepers were either randomized to TIB restriction or asked to maintain their average sleep patterns. Mean TIB restriction compared with baseline was 39.5 minutes in average sleepers and 52.9 minutes in long sleepers randomized to TIB restriction . Contrary to the original hypothesis, no significant effect of TIB restriction was observed across all physical activity levels in either long sleepers or average sleepers. However, a notable association was found between increased sleep efficiency (+0.09% [SD = ± 4.64%]) and light physical activity (±31 minutes [SD = ± 104.81, R=0.445, P < 0.007]) in long sleepers undergoing TIB restriction. While this study presents several methodological limitations, including its nature as a secondary analysis and the less-than-intended achievement of TIB restriction, it adds a valuable layer to the existing body of research on sleep and physical activity in older adults. The findings suggest that moderate TIB restriction may not be sufficiently impactful to change behavior in physical activity levels, thus highlighting the need for more nuanced, targeted research in this domain.

ABSTRACT

Background. College students’ modifiable health behaviors, including unhealthful eating patterns, predispose them to risk for future cardiometabolic conditions.

Purpose. This novel 8-week randomized control parallel-arm study compared the effects of a daily 18-hour Time-Restricted Feeding protocol vs. an 8-hour fast on diet quality in college students. Secondary outcomes were resting morning blood pressure, biomarkers of glucose regulation, biomarkers of lipid metabolism, and anthropometric measures.

Methods. Eighteen healthy college students (age = 23 ± 4 years; BMI = 23.2 ± 2.3 kg/m2; MET = 58.8 ± 32.9 min/wk) completed this study. Participants were randomized to a daily 18-hour fasting protocol (Intervention; n = 8) or a daily 8-hour fasting protocol (Control; n = 10) for eight weeks. One ‘cheat’ day was permitted each week. Outcomes were measured at weeks 0 (baseline), 4, and 8. A non-parametric Mann Whitney U test was used to compare the week 4 change from baseline between groups. Statistical significance was set at p≤0.05.

Results. Diet quality (p = 0.030) and body weight (p = 0.016) improved from baseline to week 4 for the INV group in comparison to the CON group. The data suggest these improvements may be related to reductions in snacking frequency and increased breakfast consumption. Fasting blood glucose and hip circumference tended to improve for the INV group in comparison to the CON group (p = 0.091 and p = 0.100). However, saturated fat intake tended to increase in the INV group in comparison to the CON group (p = 0.064). Finally, there were no treatment differences between groups (p>0.05) for the 4-week change in total calories, dietary vitamin C, added sugars, resting systolic blood pressure, resting diastolic blood pressure, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein (LDL) cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, waist circumference, or MET.

Conclusion. These data, although preliminary, suggest that the 18-hour fasting protocol was effective for improving diet quality and reducing weight in comparison to the 8-hour fasting protocol in healthy college students. Future intervention trials will need to confirm these findings and determine the long-term relevance of these improvements for health outcomes.

Osteosarcopenia is a newly formed term that combines the symptoms of osteoporosis and sarcopenia together because of their concurrent appearances in life. They are both age-related, debilitating conditions that affect older adults’ skeleton and musculoskeletal system. Osteoporosis specifically targets the cells of the bone and make them weak and porous. Sarcopenia attacks the skeletal muscles and deteriorates the muscle fibers, decreasing mass and strength. Both diseases put sedentary elders at high risk of sustaining fractures and proneness to fall. The manifestation of one condition typically leads to the other because of their obvious physical attachments as well as their direct chemical crosstalk. The onset of osteosarcopenia is subtle coinciding with age related processes that become greatly exacerbated and accelerated when coupled with chronic inactivity. Thus, a critical intervention for managing the disability associated with osteosarcopenia is physical activity. While some pharmacological treatments or supplements are known to have positive results in stemming further bone loss, regular participation in moderate-intensity exercises is considered the most effective treatment for attenuating further bone and muscle loss.

Background: Exercise is Medicine (EIM) is a health promotion strategy for addressing physical inactivity in healthcare. However, it is unknown how to successfully implement the processes.

Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.

Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.

Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.

Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.

Obesity and arthritis are risk factors for falls. Little is known about the effects of weight loss on balance in people with arthritis. The Group Lifestyle Balance (GLB) ProgramTM is an evidence-based, lifestyle change program for weight loss in individuals with prediabetes but it hasn’t been evaluated in people with arthritis. The purpose of this pilot study was to evaluate the effectiveness of an adapted version of the GLB on balance outcomes among overweight (Body Mass Index (BMI) >27) individuals with arthritis. A single-group, quasi- experimental design was used to examine the effects of the adapted GLB program on measures of balance and function. All participants (N=17) received the GLB program and completed the following assessments at baseline, 12 weeks and six months: the Timed-Up-and-Go (TUG), 10 Meter gait speed, Fullerton Advanced Balance Scale (FAB) and the Activity Based Confidence survey (ABC). Repeated measures analysis of variance (ANOVAs) were used to examine changes over time in SPSS Version 24. Participants (mean age = 71.7 years) were primarily female (82%), white (94%), and college educated (94%). There was a linear (F1=14.82, p=.002) and quadratic (F1=7.20, p=.017) effect of time for the TUG. There was a linear effect of time on the FAB (F1=7.10, p=.017), and on both the customary (F1=5.44, p=.033) and fast walking pace (F1=7.59, p=.014) 10-meter gait speed assessments. There were no significant changes on the ABC. The Group Lifestyle Balance program may be an effective way to improve balance and function among overweight and obese individuals with arthritis.

Female college veterans face a host of struggles both personally and academically. Research that focuses primarily on female veterans’ wellness needs as they transition into civilian life is limited and this population is woefully understudied in comparison to male veterans. The purpose of this study was to describe and explore some of the wellness needs of female college veterans making the transition from military service to college/civilian life. Twelve hundred and thirty female veterans from a University Veterans Center were sent a recruitment email where 125 successfully completed a life satisfaction (Frisch, 1994), physical activity (Craig et al., 2003), resilience (Connor & Davidson, 2003), and a five-facet mindfulness (Baer et al., 2008) questionnaire. The means for this population were: Quality of life (M= 37.8), Resilience (M= 70.5), Physical Activity MET minutes (M= 4,605), and Five-facet mindfulness (M= Observing 3.50, Describing = 3.38, Acting with Awareness M= 3.02, Non-Judging of Inner Experience M= 2.98, Non-reactivity to Inner Experience M= 3.06). Resilience was significantly (p <0.01) and positively correlated to all five domains of mindfulness (range r = 0.332 – 0.534) and was negatively associated with Quality of Life (QOL) (r= -0.204). Vigorous Activity minutes and Total Met Minutes were both positively associated with QOL (r= 0.300 and r= 0.199 respectively). This population of female veterans self-reported to have very low/low life satisfaction, low resilience, and high physical activity levels. The behaviors and traits reported in these female college veterans provide important information for developing resources and potential interventions in the future.

Most American children consume less than the recommend amount of fruits and vegetables (F&V), 74% and 84%, respectively. Eating too few F&V in childhood is associated with increased risk of cardiovascular disease, hypertension, respiratory symptoms, and some cancers later in life. Adequate F&V consumption favorably impacts antioxidant status, gut flora, mood, and cognitive functioning. Nutrients such as vitamin C and fiber are only naturally occurring in plant foods. For many children, school lunches are an important source of F&V. This pilot study assessed the feasibility of providing condiments to increase children’s consumption of salad bar F&V in an elementary school cafeteria at lunchtime. The trial site was a single Title 1 elementary school in a large, urban district in the greater Phoenix metropolitan area. Taste tests were conducted on three convenience samples of children in grades 3 – 7, aged 8 – 12 years (n=57) to identify the most popular condiment flavors. The five highest rated flavors were made available daily at a “flavor station” in the school’s lunchroom for three consecutive weeks during the Fall 2018 semester. Descriptive and inferential statistics were used to analyze data. A cost analysis was conducted for capital outlays related to the flavor station. School employee perceptions of F&V and the flavor station were assessed via posttest online surveys. Peanut butter was rated the best tasting condiment by children and was the only condiment that increased in popularity throughout the intervention. Overall, daily F&V consumption increased 17 g per child. There was a linear increase in F&V consumption during the study (r=0.986; P=0.014). As a proportion of the total F&V selected, F&V waste decreased by nearly 3%. The average daily cost of providing the flavor station was $0.09 per student. Sixty-five percent of school staff felt that the flavor station should continue at their school. Peanut butter is an affordable, nutrient-dense food that accommodates the USDA Food and Nutrition Service meal patterns and nutrition standards, and thus, is a viable strategy for increasing F&V consumption and decreasing F&V waste. The results herein inform the development of future interventions to improve the palatability of F&V for children.

Diabetes mellitus (DM) is a disease characterized by chronically elevated levels of glucose in the bloodstream. Glucose is a form of sugar that is used as fuel by the body’s cells. Blood glucose levels are usually tightly controlled and regulated through a negative feedback system. When this system fails, however, glucose can accumulate in the bloodstream. This system failure typically results from insufficient insulin release due to malfunctioning pancreatic beta cells or the body has developed a resistance to insulin. Excessive glucose accumulation contributes to chronic inflammation and the hardening of blood vessels in the body. This inflammation contributes to a multitude of debilitating health issues such as neuropathy, nephropathy, retinopathy, renal failure, and/or gangrene of the limbs. Additionally, DM is the 7th leading cause of death in the United States and its treatment comes with a significant economic deficit. While there is currently no cure, pharmaceuticals, dietary modification, physical activity, and weight control are the four main approaches for DM intervention and control. These four approaches each operate to regulate glucose using different biological pathways in order to reduce and regulate blood glucose levels. These pathways include improving insulin sensitivity and correcting pancreatic beta cell function. The purpose of this paper will be to provide an overview of type II diabetes mellitus (T2DM) as well as to review the physiological mechanisms involved with glucose control and finally to discuss the use and effectiveness of the main interventional approaches used with the treatment of T2DM: pharmaceuticals, dietary control, physical activity and weight control.

Individuals fluent in sign language who have at least one deaf parent are considered native signers while those with non-signing, hearing parents are non-native signers. Musculoskeletal pain from repetitive motion is more common from non-natives than natives. The goal of this study was twofold: 1) to examine differences in upper extremity (UE) biomechanical measures between natives and non-natives and 2) upon creating a composite measure of injury-risk unique to signers, to compare differences in scores between natives and non-natives. Non-natives were hypothesized to have less favorable biomechanical measures and composite injury-risk scores compared to natives. Dynamometry was used for measurement of strength, electromyography for ‘micro’ rest breaks and muscle tension, optical motion capture for ballistic signing, non-neutral joint angle and work envelope, a numeric pain rating scale for pain, and the modified Strain Index (SI) as a composite measure of injury-risk. There were no differences in UE strength (all p≥0.22). Natives had more rest (natives 76.38%; non-natives 26.86%; p=0.002) and less muscle tension (natives 11.53%; non-natives 48.60%; p=0.008) for non-dominant upper trapezius across the first minute of the trial. For ballistic signing, no differences were found in resultant linear segment acceleration when producing the sign for ‘again’ (natives 27.59m/s2; non-natives 21.91m/s2; p=0.20). For non-neutral joint angle, natives had more wrist flexion-extension motion when producing the sign for ‘principal’ (natives 54.93°; non-natives 46.23°; p=0.04). Work envelope demonstrated the greatest significance when determining injury-risk. Natives had a marginally greater work envelope along the z-axis (inferior-superior) across the first minute of the trial (natives 35.80cm; non-natives 30.84cm; p=0.051). Natives (30%) presented with a lower pain prevalence than non-natives (40%); however, there was no significant difference in the modified SI scores (natives 4.70 points; non-natives 3.06 points; p=0.144) and no association between presence of pain with the modified SI score (r=0.087; p=0.680). This work offers a comprehensive analysis of all the previously identified UE biomechanics unique to signers and helped to inform a composite measure of injury-risk. Use of the modified SI demonstrates promise, although its lack of association with pain does confirm that injury-risk encompasses other variables in addition to a signer’s biomechanics.

Obesity is becoming more prevalent in the United States and is a result of a several of factors, including an individual's genetics, environment, and societal influences. Of the most important, however, when managing weight is the balance between energy expenditure and energy intake. One's total energy expenditure is constituted of four main components: resting metabolic rate (RMR), thermic effect of food, non-exercise thermogenesis, and exercise thermogenesis. The most prominent of these is RMR, which accounts for about 60-70% of an individual's total energy expenditure.

Differences in RMR amongst individuals is dependent on a multitude of variables including height, adiposity, age, body mass, training status, and of most importance, fat-free mass (FFM). Research shows that the greater the body size, the greater the RMR. This positive association between height and body mass with RMR is attributed to more massive organ systems needed in order to meet the greater metabolic demands of a bigger individual. Research also supports that age is negatively associated with RMR. This is mostly due to sarcopenia, or the loss of muscle mass. The most important determinant of RMR, however, is FFM. Unlike body mass, FFM only accounts for metabolically active tissues including muscle, bone, blood, and all organs. Fat-free mass has been reported to account for up to 80% of the variance in RMR. Resistance training is shown to increase FFM, which results in increases in RMR. However, there are several elements to a successful, progressive resistance training protocols that result in increases in muscular strength and hypertrophy. Strength and hypertrophy gains result in a greater oxidative capacity of muscle, and consequentially a greater RMR. The most influential factor in muscular strength and hypertrophic resistance training is intensity. Moderate intensity programs are recommended for the nonathletic adult population for safety purposes. An intensity 4 of about 80% 1 RM is appropriate for increases in FFM. Training protocols lasting at least three months and that incorporate whole-body exercises have the greatest effects on FFM and RMR. Most studies show that increases in FFM of 1-2 kg are necessary increase RMR by about 3-8%. Interestingly, RT can produce similar increases in RMR and FFM in obese and overweight populations in leaner individuals. Implementing resistance training has been shown to be an effective method in managing weight and increasing both RMR and FFM.