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Exercise dose, exercise adherence, and associated health outcomes in the TIGER study.

ABSTRACT: To effectively evaluate activity-based interventions for weight management and disease risk reduction, objective and accurate measures of exercise dose are needed. This study examined cumulative exercise exposure defined by HR-based intensity, duration, and frequency as a measure of compliance with a prescribed exercise program and a predictor of health outcomes.One thousand one-hundred fifty adults (21.3 ± 2.7 yr) completed a 15-wk exercise protocol consisting of 30 min·d, 3 d·wk, at 65%-85% maximum HR reserve. Computerized HR monitor data were recorded at every exercise session (33,473 valid sessions). To quantify total exercise dose, duration for each session was adjusted for average exercise intensity (%HR reserve) to create a measure of intensity minutes for each workout, which were summed over all exercise sessions to formulate an HR physical activity score (HRPAS). Regression analysis was used to examine the relation between HRPAS and physiological responses to exercise training. Compliance with the exercise protocol based on achievement of the minimum prescribed HRPAS was compared with adherence defined by attendance.On the basis of HRPAS, 868 participants were empirically defined as compliant, and 282 were noncompliant. HRPAS-based and attendance-based classifications of compliance and adherence differed in approximately 9% of participants. Higher HRPAS was associated with significant positive changes in body mass (P < 0.001), body mass index (P < 0.001), waist and hip circumferences (P < 0.001), percent body fat (P < 0.001), systolic blood pressure (P < 0.011), resting HR (P < 0.003), fasting glucose (P < 0.001), and total cholesterol (P < 0.02). Attendance-based adherence was associated with body mass, hip circumference, percent body fat, resting HR, and cholesterol (P < 0.05).The HRPAS is a quantifiable measure of exercise dose associated with improvement in health indicators beyond that observed when adherence is defined as session attendance.

SUBMITTER: Miller FL

PROVIDER: S-EPMC3867583 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Exercise dose, exercise adherence, and associated health outcomes in the TIGER study.

Miller Fred L FL O'Connor Daniel P DP Herring Matthew P MP Sailors Mary H MH Jackson Andrew S AS Dishman Rodney K RK Bray Molly S MS

Medicine and science in sports and exercise 20140101 1

<h4>Purpose</h4>To effectively evaluate activity-based interventions for weight management and disease risk reduction, objective and accurate measures of exercise dose are needed. This study examined cumulative exercise exposure defined by HR-based intensity, duration, and frequency as a measure of compliance with a prescribed exercise program and a predictor of health outcomes.<h4>Methods</h4>One thousand one-hundred fifty adults (21.3 ± 2.7 yr) completed a 15-wk exercise protocol consisting of ...[more]

PMID: 23793231

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Project description:BackgroundThe majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence, the impact on patient outcomes is unclear. We compared clinical outcomes and medication adherence with FDC therapy versus multipill combination therapy in a real-world setting using linked clinical and administrative databases.Methods and findingsWe conducted a population-based retrospective cohort study of 13,350 individuals 66 years and older in Ontario, Canada with up to 5 years of follow-up. We included individuals who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) plus one thiazide diuretic. High-dimensional propensity score matching was used to compare individuals receiving FDC versus multipill therapy. The primary outcome was a composite of death or hospitalization for acute myocardial infarction (AMI), heart failure, or stroke. We conducted 2 analyses to examine the association between adherence and patient outcomes. First, we performed an on-treatment analysis to determine whether outcomes differed between groups while patients were on treatment, censoring patients when they first discontinued treatment, defined as not receiving medications within 150% of the previous days' supply. Second, we conducted an intention-to-treat analysis that followed individuals allowing for breaks in treatment to quantify the difference in drug adherence between groups and assess its impact on clinical outcomes. As expected, there was no significant difference in the primary outcome between groups in the on-treatment analysis (HR 1.06, 95% CI 0.86-1.31, P = 0.60). In the intention-to-treat analysis, the proportion of total follow-up days covered with medications was significantly greater in the FDC group (70%; IQR 19-98) than in the multipill group (42%, IQR 11-91, P < 0.01), and the primary outcome was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; HR 0.89, 95% CI 0.81-0.97, P < 0.01). The main limitations of this study were the lack of data regarding cause of death and blood pressure measurements and the possibility of residual confounding.ConclusionsAmong older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence.

Project description:Abstract Objectives Our primary objective is to determine how mood response to exercise is influenced by genetic variation, controlling for exercise quantity and quality. Methods The Training Interventions and Genetics of Exercise Response (TIGER) Study is a prospective cohort study, in which sedentary subjects (18–35y, <30 min/wk for 30d prior to enrollment) participated in a 15-week program, exercising within a prescribed (65–85% maximum heart rate reserve) target heart rate zone for 3 d/wk. Before and after each exercise session, a subset of subjects (n = 247) completed a 10 cm visual analog scale (VAS: 0–100) for four mood states: fatigue, tension, depression, and hunger. Multiple linear regression was performed to examine the association between variation in DRD2, BDNF, and FTO genes and change in mood state following exercise, controlling for gender, exercise duration, and intensity. Results Exercise was associated on average with reduced feelings of fatigue (−3.18 ± 16.37), tension (−3.85 ± 12.97), and depression (−5.12 ± 8.20), and increased feelings of hunger (6.06 ± 10.54). Carriers of the major allele (A) in rs1362570 for the FTO gene experienced greater reductions in tension following exercise (AA or AG: −5.19 ± 1.08 vs GG: −1.16 ± 1.24, P < 0.02, respectively). Homozygotes for the major allele (A) in rs1799978 for the DRD2 gene displayed reduced feelings of tension in response to exercise, while those with one or more minor alleles reported increased tension (AA: −4.69 ± 0.89 vs AG or GG: + 2.25 ± 2.16, P < 0.005). Homozygotes for the major alleles in rs151948, rs1362570, and rs1799978 (for BDNF, FTO, & DRD2 genes, respectively) served as strong predictors for changes in feelings of tension following exercise, controlling for gender and exercise parameters (P < 0.001). Subjects with one or more minor alleles (A) in rs1800498 for DRD2 gene displayed greater increases in hunger in response to exercise (AA or AG: 7.17 ± 0.85 vs GG: 3.96 ± 1.09, P < 0.03). Conclusions Specific gene polymorphisms, exercise intensity, duration, and gender may influence, in part, the variable mood response to exercise. Funding Sources Funding for this research was provided by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health Grant.

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Exercise dose, exercise adherence, and associated health outcomes in the TIGER study.

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Exercise dose, exercise adherence, and associated health outcomes in the TIGER study.

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