Objective The objective of this article is to evaluate near-infrared spectroscopy (NIRS), a non-invasive technique to assess tissue oxygenation and mitochondrial function, as a diagnostic tool for statin-associated muscle symptoms (SAMS).Methods We verified SAMS in 39 statin-treated patients (23 women) using a double-blind, placebo-controlled, cross-over protocol. Subjects with suspected SAMS were randomised to simvastatin 20 mg/day or placebo for 8 weeks, followed by a 4-week no treatment period and then assigned to the alternative treatment, either simvastatin or placebo. Tissue oxygenation was measured before and after each statin or placebo treatment using NIRS during handgrip exercise at increasing intensities of maximal voluntary contraction (MVC).Results 44% (n=17) of patients were confirmed as having SAMS (11 women) because they reported discomfort only during simvastatin treatment. There were no significant differences in percent change in tissue oxygenation in placebo versus statin at all % MVCs in all subjects. The percent change in tissue oxygenation also did not differ significantly between confirmed and unconfirmed SAMS subjects on statin (−2.4% vs −2.4%, respectively) or placebo treatment (−1.1% vs −9%, respectively). The percent change in tissue oxygenation was reduced after placebo therapy in unconfirmed SAMS subjects (−10.2%) (p≤0.01) suggesting potential measurement variability.Conclusions NIRS in the forearm cannot differentiate between confirmed and unconfirmed SAMS, but further research is needed to assess the usability of NIRS as a diagnostic tool for SAMS.Trial registration number NCT03653663.

Background: Firefighters have a high prevalence of cardiovascular disease. The poor heart health of firefighters is implicated in their increased risk of sudden cardiac death (SCD). Exercise maybe protective against SCD partially due to the immediate blood pressure (BP) reductions of 5-8 mmHg following exercise, termed postexercise hypotension (PEH) Objectives: To examine PEH under ambulatory conditions after a maximal cardiopulmonary exercise test (CPET) among career firefighters Methods: Firefighters (n = 19) completed a maximal CPET and non-exercise control (CONTROL) in random order on separate non-workdays and left the laboratory instrumented to an ambulatory BP (ABP) monitor. Ambulatory systolic BP (ASBP), diastolic BP (ADBP), and heart rate (AHR) were recorded at hourly intervals over 19hr. The ambulatory rate pressure product (ARPP) was calculated as ASBPxAHRx10-3 at each hourly interval. Repeated measures ANCOVA tested if the ABP, AHR, and ARPP responses differed after CPET vs CONTROL over 19hr Results: Firefighters were middle-aged (39.5 f 8.9 yr), overweight (29.2 f 4.0 kg/m2) men with elevated BP (123.1 f 9.6/79.8 f 10.4 mmHg), while resting HR (67.7 f 11.3 bpm) and RPP (8.4 f 1.7mmHg*bpm*10-3) were in normal ranges. ASBP (16.6 f 5.7 mmHg) and ADBP (3.1 f 4.6 mmHg) increased after the CPET vs CONTROL over 19hr (ps<0.01), as did AHR (9.4 f 7.9 bpm, p = 0.02) and ARPP (2.5 f 1.1mmHg*bpm*10-3, p < 0.01). Conclusions: Unexpectedly, the firefighters exhibited postexercise hypertension rather than PEH. The increases in ABP and AHR we observed indicated a sustained increase in cardiac demand. Further investigation is needed to confirm our findings and determine whether the adverse hemodynamic responses we observed contribute to the high prevalence of SCD that firefighters experience on the job.

Postexercise hypotension (PEH), or the immediate decrease in blood pressure (BP) lasting for 24 h following an exercise bout, is well-established; however, the influence of exercise training on PEH dynamics is unknown. This study investigated the reliability and time course of change of PEH during exercise training among adults with hypertension. PEH responders (n = 10) underwent 12 weeks of aerobic exercise training, 40 min/session at moderate-to-vigorous intensity for 3 d/weeks. Self-measured BP was used to calculate PEH before and for 10 min after each session. The intraclass correlation coefficient (ICC) and Akaike Information Criterion (AIC) determined PEH reliability and goodness-of-fit for each week, respectively. Participants were obese (30.6 ± 4.3 kg∙m−2), middle-aged (57.2 ± 10.5 years), and mostly men (60%) with stage I hypertension (136.5 ± 12.1/83.4 ± 6.7 mmHg). Exercise training adherence was 90.6 ± 11.8% with 32.6 ± 4.2 sessions completed. PEH occurred in 89.7 ± 8.3% of these sessions with BP reductions of 9.3 ± 13.1/3.2 ± 6.8 mmHg. PEH reliability was moderate (ICC ~0.6). AIC analysis revealed a stabilization of maximal systolic and diastolic BP reductions at 3 weeks and 10 weeks, respectively. PEH persisted throughout exercise training at clinically meaningful levels, suggesting that the antihypertensive effects of exercise training may be largely due to PEH. Further studies in larger samples and under ambulatory conditions are needed to confirm these novel findings.

OBJECTIVE:Weight stigma induces cardiovascular health consequences for people with obesity. How stigma affects cardiovascular reactivity in individuals with both obesity and hypertension is not known.METHODS:In a randomized experiment, we assessed the influence of two video exposures, depicting either weight stigmatizing (STIGMA) or non-stigmatizing (NEUTRAL) scenes, on cardiovascular reactivity [resting blood pressure (BP), heart rate (HR), ambulatory BP (ABP), and ambulatory HR (AHR)], among women with obesity and high BP (HBP; n=24) or normal BP (NBP; n=25). Systolic ABP reactivity was the primary outcome. Laboratory BP and HR were measured before/during/following the videos, and ABP and AHR were measured over 19 hours (10 awake hours, 9 sleep hours) upon leaving the laboratory. A repeated measures ANCOVA tested differences in BP and HR changes from baseline in the laboratory and over ambulatory conditions between the two groups after each video, controlling for body mass index, baseline BP and HR.RESULTS:Laboratory SBP/DBP increased 5.5+7.3/2.4+8.8mmHg more in women with HBP than NBP following the STIGMA versus NEUTRAL video (Ps<0.05). For the primary outcome, ABP increased more in HBP than NBP over sleep (SBP/DBP=4.2+20.6/4.7+14.2mmHg; Ps<0.05) following the STIGMA versus NEUTRAL video, as did HR during sleep (7.5+15.7bpm more in HBP than NBP; P<0.05).CONCLUSIONS:Weight stigma increases cardiovascular reactivity among women with obesity and HBP in the laboratory and under ambulatory conditions.CLINICAL TRIAL REGISTRATION:Registered at ClinicalTrials.gov (Identifier: NCT04161638).

Because data are scarce, we examined the relationship between postexercise hypotension (PEH) and heart rate variability (HRV) before and after aerobic exercise training among adults with hypertension. Participants completed a 12 w aerobic training program. Before and after training, they performed a peak graded exercise stress test (GEST) and nonexercise control (CONTROL) and were left attached to an ambulatory BP monitor. Prior to CONTROL, HRV was measured supine for 5 min using a 12-lead electrocardiogram (ECG). The participants (n = 18) were middle-aged (52.1 ± 11.7 y) and 50% men with hypertension (131.7 ± 9.8/85.9 ± 8.5 mmHg) and obesity (30.0 ± 3.7 kg·m−2). Before training, ambulatory systolic BP (ASBP) and diastolic ABP (ADBP) decreased by 3.2 ± 2.1 mmHg and 2.5 ± 1.5 mmHg, respectively, from baseline after the GEST versus CONTROL (p < 0.05). After training, ASBP tended to decrease by 3.5 ± 2.2 mmHg (p = 0.055) and ADBP decreased by 1.7 ± 2.5 mmHg (p = 0.001) from baseline after the GEST versus CONTROL. Before training, HRV high frequency (HFms2) (β = −0.441), age (β = 0.568), and resting SBP (β = 0.504) accounted for 66.8% of the ASBP response (p = 0.001), whereas the low frequency (LF)/HF ratio (β = 0.516) and resting DBP (β = 0.277) accounted for 35.7% of the ADBP response (p = 0.037). After training, the standard deviation of NN intervals (SDNN) (β = −0.556), age (β = 0.506), and resting SBP (β = 0.259) accounted for 60.7% of the ASBP response (p = 0.004), whereas SDNN (β = −0.236) and resting DBP (β = 0.785) accounted for 58.5% of the ADBP response (p = 0.001). Our preliminary findings show that adults with hypertension and parasympathetic suppression (i.e., lower SDNN and HFms2 and higher LF/HF) may elicit PEH to the greatest degree independent of training status versus adults with parasympathetic predominance, suggesting that resting HRV may be an important determinant of PEH.

Postexercise hypotension (PEH) is the immediate reduction in blood pressure (BP) after an acute exercise persisting for 24 hr. We have suggestive evidence autonomic activity as measured by heart rate variability (HRV) may influence PEH that requires confirmation. PURPOSE:To better establish the relationship between PEH and HRV before and after aerobic training among adults with hypertension. METHODS: Participants completed a moderate to vigorous intensity aerobic training program for 40-50 min/session, 3 d/wk for 12 wk. Before and after training, they performed a peak graded exercise stress test (GEST) and non-exercise control (CONTROL) session leaving the laboratory attached to an ambulatory BP monitor for 19 hr. HRV was measured in the supine position for 5 min using a 12-lead electrocardiogram prior to CONTROL. RESULTS: Participants were middle-aged (52.1 ± 11.7 yr) men (n = 9) and women (n = 9) with hypertension (131.7 ± 9.8 mmHg/85.9 ± 8.5 mmHg) and obesity (body mass index [BMI] 30.0 ± 3.7 kg.m-2). Before training, ambulatory systolic BP (ASBP) decreased 3.2 ± 2.1 mmHg (p = 0.016), and diastolic ABP (ADBP) decreased 2.5 ± 1.5 mmHg (p = 0.015) from baseline during the day following GEST versus CONTROL. After training, ASBP tended to decrease 3.5 ± 2.2 mmHg (p = 0.055), and ADBP decreased 1.7 ± 2.5 mmHg (p < 0.001) from baseline during the day following GEST versus CONTROL. Before training, HRV high frequency (HFms2) (β = 0.441), age (β = -0.568), and resting SBP (β = -0.504) accounted for 66.8% of the variance in ASBP (p < 0.001), whereas the low frequency (LF)/HF ratio (β = -0.516) and resting DBP (β = -0.277) accounted for 35.7% of the variance in ADBP during the day (p = 0.037). After training, the standard deviation of NN intervals (SDNN) (β = 0.556), age (β = -0.506), and resting SBP (β = -0.259) accounted for 60.7% of the variance in ASBP (p = 0.004), whereas SDNN (β = 0.236) and resting DBP (β = -0.785) accounted for 58.5% of the variance in ADBP during the day (p = 0.001). CONCLUSIONS: Adults with hypertension and parasympathetic predominance, as reflected by higher SDNN and HFms2 and lower LF/HF at rest, elicited PEH to a greater extent independent of training status compared to adults with sympathetic predominance. Our results highlight resting autonomic activity is an important determinant of PEH that should be explored further.

Caffeine has beneficial effects on firefighter job performance reducing fatigue and improving psychomotor vigilance. However, excessive caffeine intake may raise blood pressure (BP) following a bout of acute exercise among adults with elevated BP. The influence of caffeine intake on the ambulatory BP (ABP) response to vigorous physical exertion among firefighters has not been studied. In this sub-study we conducted secondary statistical analyses from a larger clinical trial (NCT04514354) that included examining the influence of habitual caffeine intake, and cardiometabolic biomarkers shown to influence BP, on the ABP response following a bout of sudden vigorous exertion over 19 h among firefighters. Previously, we found high amounts of calcium and sodium intake raised BP following a bout of acute exercise among adults with elevated BP. Thus, other secondary aims were to examine the influence of habitual calcium and sodium intake, and cardiometabolic biomarkers have shown to influence BP, on the ABP response following sudden vigorous exertion over 19 h among firefighters. Firefighters (n = 15) completed a Food-Frequency Questionnaire assessing habitual dietary intake over the past year. They randomly completed a maximal graded exercise stress test (GEST) and non-exercise CONTROL on separate non-workdays leaving the laboratory wearing an ABP monitor for 19 h. Prior to and immediately after the GEST, fasting venous blood was collected to measure lipid-lipoproteins, c-reactive protein, and blood glucose. Height and weight were taken to calculate body mass index. Repeated measures ANCOVA tested if the ABP response differed after GEST vs. CONTROL. Linear mixed models examined the relationships among caffeine, calcium, sodium, cardiometabolic biomarkers, and the ABP response following GEST vs. CONTROL. Firefighters were middle-aged (40.2 ± 9.5 year), overweight (29.0 ± 3.9 kg/m2) men with elevated BP (124.1 ± 10.3/79.6 ± 11.5 mmHg) who consumed 542.0 ± 348.9 mg of caffeine/day, about ~50% more than the dietary reference intake. Unexpectedly, systolic ABP was higher by 18.0 ± 6.7 mmHg and diastolic ABP by 9.1 ± 5.4 mmHg (ps < 0.01) over 19 h following GEST vs. CONTROL. We found 24% of the variance in the adverse ABP response to maximal physical exertion was explained by caffeine intake, and when combined with c-reactive protein, non-high-density lipoprotein-cholesterol, body mass index, blood glucose, and resting heart rate, up to 74% of the variability in the ABP response was explained. Additionally, we found calcium (ps < 0.001) and sodium (p < 0.0001) intake each explained up to 24% of the ABP response. Further investigation is needed in a larger, more diverse sample of firefighters to better establish how caffeine contributes to the adverse BP response to strenuous physical exertion.

Postexercise hypotension (PEH) is the decrease in blood pressure (BP) resulting from a single bout of exercise persisting for up to 24 hr. Studies that have explored the reproducibility of PEH mostly did so in the laboratory under acute experimental conditions. The reproducibility of PEH during an exercise training program is unknown. PURPOSE: To determine the reliability of the appearance of PEH during a 12-week aerobic exercise training program performed for 3 sessions per week at moderate intensity among adults with hypertension. METHODS: Prior to beginning exercise training, the subjects (n = 10) were determined to be PEH responders, defined as a > 2 mmHg decrease in 24-hr ambulatory BP following a maximal graded exercise stress test compared to a non-exercise control session. We measured BP with a home BP monitor for 10 minutes pre- and post-exercise for each session. The appearance of PEH for a given exercise session was defined as a decrease in BP post- vs pre-exercise. RESULTS: Subjects on average were obese (30.6 ± 4.3 kg/m2), middle-aged (57.2 ± 10.5 yr) men (60%) and women with stage I hypertension (136.5 ± 12.1/83.4 ± 6.7 mmHg). The average number of exercise sessions completed was 32.6 ± 4.2 for an overall exercise adherence rate of 90.6 ± 11.8%. Of the exercise sessions completed, PEH occurred in 89.7 ± 8.3% of them. CONCLUSION: PEH occurred after ~90% of the exercise sessions over 12-weeks of exercise training. The high consistency by which PEH was elicited, among initially sedentary adults with hypertension who were PEH responders, reinforces the clinical importance of PEH as antihypertensive lifestyle therapy. Further studies with larger sample sizes are needed to confirm our promising findings.

Firefighters have a high prevalence of cardiovascular disease and its risk factors compared to the general population. The poor heart health of firefighters is implicated in their increased risk of sudden cardiac death (SCD) accounting for nearly 50% of all on-duty fatalities. Exercise may confer protective benefits against SCD in part due to the immediate blood pressure (BP) reductions of 5-8 mmHg following exercise, termed postexercise hypotension (PEH). PURPOSE: To examine the time course of PEH under ambulatory conditions after a maximal cardiopulmonary graded exercise stress test (GEST) among career firefighters. METHODS: Firefighters (n = 19) completed a maximal GEST and a non-exercise control (CONTROL) in random order on separate nonwork days and left the laboratory attached to an ambulatory BP (ABP) monitor for 19 hr. Ambulatory systolic BP (ASBP), diastolic BP (ADBP), and heart rate (AHR) were recorded at hourly intervals over 19 hr. The ambulatory rate pressure product (ARPP), an indicator of cardiac demand, was calculated as ASBPxAHRx10-3 at each hourly interval over 19 hr. Repeated measures ANCOVA tested if the ABP, AHR, and ARPP responses differed after GEST vs CONTROL over 19 hr. RESULTS: Firefighters were middle-aged (39.5 ± 8.9 yr), overweight (29.2 ± 4.0 kg/m2) men with elevated resting BP (123.1 ± 9.6/79.8 ± 10.4 mmHg), while resting HR (67.7 ± 11.3 bpm) and RPP (8.4 ± 1.7 mmHg*bpm*10-3) were in normal ranges. ASBP (16.6 ± 5.7 mmHg) and ADBP (3.1 ± 4.6 mmHg) increased after the GEST vs CONTROL over 19 hr (ps < 0.01), as did AHR (9.4 ± 7.9 bpm, p = 0.02) and ARPP (2.5 ± 1.1 mmHg*bpm*10-3, p < 0.01). CONCLUSION: Unexpectedly, the firefighters exhibited postexercise hypertension rather than PEH. The increases in ABP and AHR we observed resulted in a sustained increase in cardiac demand. Further investigation is needed to confirm our findings and determine whether the adverse hemodynamic responses we observed contribute to the high prevalence of SCD that firefighters experience on the job.

Abstract Racial and ethnic minority populations in the US experience greater cumulative disease burden, as well as social and economic barriers, stressors, and limited advocacy/access to culturally informed healthcare. This increased risk burden is expected to be associated with an increased risk for delirium during acute care encounters. Previous studies on health disparity and delirium are limited and report equivocal findings regarding delirium incidence, possibly related to sample bias or non-validated measures. Risk for delirium during acute care in health disparity populations (HDP) that include Black African Americans (BAA) and Hispanic-Latinx (HL) has not been systematically studied using validated measures. We conducted a retrospective analysis utilizing our delirium program (ADAPT) registry that systematically assessed all hospitalized patients through their entire hospital stay for the years 2018-2019 (36K patients, 80% NHW, 11% HL, 9% BAA). The Confusion Assessment Method (CAM and CAM-ICU) and Richmond Agitation Sedation Scale (RASS) were used as screening assessments to identify delirium. We know from previous studies that negative CAM results in our environment have high specificity. The incidence of delirium between populations was compared using a chi-square test. Delirium incidence was higher in HDP (BAA combined with HL) compared to NHW in 71-80yo (16.0% vs 12.6%, p=0.003). Delirium incidence was not different in all other age groups compared; <65yo (p=0.191), 61-70yo (p=0.223), 81-90yo (p=0.644). Understanding the association, or lack thereof, between health disparities, ethnic and race-based risks for delirium is expected to provide important insights into more focused delirium assessment, prevention and mitigation strategies in these populations.

Previously we found high calcium intake (CA) negatively impacted the immediate blood pressure (BP) reductions that occur after a single bout of exercise, or post-exercise hypotension (PEH), among overweight, middle-aged men with hypertension. Firefighters (FF) have a disproportionately high risk of sudden cardiac death on the job partially due to a high prevalence of hypertension and poor nutrition. PURPOSE: To examine the influence of CA on PEH following a bout of vigorous intensity exercise in FF. METHODS: FF (n = 15) completed a non-exercise control (CONTROL) and peak graded exercise stress test (GEST) in random order on different non-work days. FF left the laboratory attached to an ambulatory BP (ABP) monitor for 19 hr. CA was assessed with the National Health and Nutrition Examination Survey food-frequency questionnaire. Repeated measures ANCOVA tested if ABP differed after GEST vs CONTROL by CA group divided by the median as high (1087.9 ± 325.9 mg) and low (558.1 ± 143.4 mg) with baseline BP as a covariate. Mixed models examined the relationships between CA and the ABP response after GEST vs CONTROL. RESULTS: FF were overweight (29.0 ± 3.9 kg/m2), middle-aged (40.2 ± 9.5 yr) men with elevated resting BP (124.1 ± 10.3/79.6 ± 11.5 mmHg). Among the total sample, systolic ABP (ASBP) (18.0 ± 6.7 mmHg, p = 0.001) and diastolic ABP (ADBP) (9.1 ± 5.4 mmHg, p = 0.003) increased after the GEST vs CONTROL over 19 hr, with trending interactions for CA group*condition for ASBP (p = 0.088) and ADBP (p = 0.059). The interactions revealed ASBP increased 26.3 ± 12.2 mmHg in HighCA after GEST vs CONTROL (p = 0.010) over 19 hr, but was not different in LowCA (p > 0.05). In contrast, ADBP increased 11.9 ± 6.8 mmHg in LowCA after GEST versus CONTROL (p = 0.025) over 19 hr, but was not different in HighCA (p > 0.05). CA accounted for 23.7% (p = 0.0005) and 22.8% (p = 0.001) of the variance in the ASBP and ADBP response, respectively. DISCUSSION: CA explained up to 24% of the increase in the ABP response after GEST vs CONTROL. HighCA augmented the increase in ASBP by 17.0 ± 15.0 mmHg versus LowCA; whereas LowCA augmented the increase in ADBP by 5.2 ± 11.0 mmHg versus HighCA. Further investigation is needed in a larger sample of FF to better establish the influence CA has on their adverse ABP response to vigorous physical exertion.

Describe how a playgroup model may be used to engage families and promote health behaviors in early childhood. Optimizing health behaviors in early childhood may help prevent obesity. The Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup is a 10-week program to promote healthy diet and activity habits among toddlers (12-36 months) from families with low-incomes. This process evaluation determined facilitators and barriers (F/Bs) of recruitment and retention, acceptability, and perceived impact of the FUNPALs Playgroup program. 50 families with toddlers were recruited from underserved communities and randomly assigned to the FUNPALs Playgroup (n=24) or a dose matched health education control group (n=26). Recruitment advertisements were distributed via Facebook and the community. Recruitment F/Bs were collected via self-report at screening. Program acceptability was assessed with a satisfaction survey. Retention F/Bs and perceived impact were assessed via focus group (FG). FGs were recorded and analyzed via rapid coding procedure (Neal et al., 2015). Results. The sample was multiethnic and multiracial. Most popular recruitment methods were Facebook (n=21), friends (n=6), and pediatricians' offices (n=6). Common reasons for enrolling were to socialize with other families (n=25) and each other (n=9), and to learn about parenting (n=9). Satisfaction surveys showed parents found the program fun and interesting. Retention rate was 90%. Per FGs, families attended playgroup because families enjoyed it and children could socialize. Per FGs, the FUNPALs Playgroup helped families buy healthier foods, try new foods, understand activity recommendations for toddlers, and adopt positive parenting skills. The FUNPALs Playgroup may be a feasible and acceptable method for optimizing health behavior development among toddlers.

There are well-established sex differences in central hemodynamic and cardiac adaptations to endurance exercise; however, controversial evidence suggests that excessive endurance exercise may be related to detrimental cardiovascular adaptations in marathoners. To examine left ventricle (LV) structure, LV function, 24-h central hemodynamics and ventricular–vascular coupling in male and female marathoners and recreationally active adults. 52 marathoners (41 ± 5 years, n = 28 female, completed 6 ± 1 marathons/3 years) and 49 recreationally active controls (42 ± 5 years, n = 25 female) participated in the study. Three-Dimensional Echocardiography (3DE) was used to measure LV mass index and LV longitudinal (LS) circumferential (CS), area (AS), and radial strain (RS). An ambulatory blood pressure (BP) cuff was used to measure 24-h central hemodynamics (BP, pulse wave velocity, PWV, wave reflection index, RIx). Hemodynamic and 3DE measures were combined to derive the ratio of arterial elastance (Ea) to ventricular elastance (Elv) as a global measure of ventricular–vascular coupling. There were no sex or group differences in LS, CS, AS, and RS (p > 0.05). Females marathoners had similar aortic BP (116 ± 9 vs. 113 ± 1 mmHg), and PWV (5.9 ± 0.5 vs. 5.9 ± 1.1 m/s) compared to female controls but lower aSBP (116 ± 9 vs. 131 ± 10 mmHg) and PWV (5.9 ± 0.5 vs. 6.2 ± 0.5 m/s) compared to male marathoners (p < 0.05). Female marathoners had lower Ea/Elv than female controls (0.67 ± 0.20 vs. 0.93 ± 0.36) and male marathoners (0.67 ± 0.20 vs. 0.85 ± 0.42, p < 0.05). Women that have completed multiple marathons do not have reduced LV function or increased aortic stiffness and may have better ventricular–vascular coupling compared to male marathoners and their female untrained counterparts.

Objective: To examine postexercise hypotension (PEH) after a maximal cardiopulmonary stress test (GEST) as well as heart rate variability (HRV), a surrogate marker of sympathovagal balance, as it relates to PEH among career firefighters with hypertension. Materials and Methods: Firefighters (n=5) who were middle-aged (40.6±6.2yr) and overweight (28.1±3.9kg.m-2) men with high BP (Systolic 126.4±9.5mmHg/Diastolic 85.6±5.9mmHg) and normal resting HR (71.1±11.2bpm) randomly performed a GEST and non-exercise control (CONTROL) session followed by attachment to ambulatory BP (ABP) and HR monitors for 19hr. Systolic (ASBP) and diastolic (ADBP) ABP, and HRV low (LF) and high (HF) frequency were recorded at hourly intervals over awake (11hr), sleep (8hr), and 19hr. Repeated measure analysis of variance (ANOVA) tested if BP and HRV differed over time and between experimental conditions. Multivariate regression tested the relationship between HRV and BP responses. Results: Compared to CONTROL, after the GEST ASBP significantly increased over awake (21.7±3.4mmHg, p=0.003) and 19hr (15.8±2.2mmHg, p=0.002), and exhibited a statistically trending increase over-sleep (7.9±2.9mmHg, p=0.055). Compared to CONTROL, after the GEST ADBP showed a statistically trending increase over awake (8.8±3.9 mmHg, p=0.091), sleep (8.2±4.3mmHg, p=0.134), and 19hr (8.6±3.5mmHg, p=0.072). Compared to CONTROL, after the GEST LF/HF significantly increased over awake (1.9±0.5, p=0.015), and displayed a statistically trending increase over 19hr (0.8±0.5 p=0.155). LF/HF statistically tended to explain up to 59.3% of the variance in the SBP response over 19hr (r:-0.77, p=0.068) and significantly explained 84.5% of the variance in the DBP response over awake (r:-0.92, p=0.014). Conclusion: Sudden vigorous exertion evoked postexercise hypertension as opposed to PEH among firefighters with elevated BP. Reasons for these unexpected findings are not clear but may reside in a compensatory baroreflex response to sympathetic predominance as reflected by higher LF/HF due to either increased sympathetic or decreased parasympathetic modulation.

ObjectivesWe compared the health benefits of two different Tai Chi interventions tailored for improving blood pressure (BP) (PRESSURE) or balance (BALANCE).Designrandomized controlled trial.SettingCommunity dwelling older adults (≥60yr) practiced Tai Chi at the fitness center of a continuous care community.InterventionsWe tailored PRESSURE to emphasize breathing techniques and mental relaxation and BALANCE to emphasize movement principles that challenged balance. Subjects were randomized to PRESSURE (n = 12), BALANCE (n = 13), or CONTROL (n = 10). Tai Chi was practiced 3 sessions/wk, 60 min/session for 12 wk. CONTROL performed normal daily activities.Main outcome measuresWe compared the change in cardiometabolic health, balance, and functional fitness between groups with ANCOVA using baseline values, age, and body mass index as covariates.ResultsSubjects were physically active, Tai Chi naive (97.1 %), white, mostly female (82.9 %), and older (78.9 ± 5.7 yr) with resting systolic BP (SBP) of 126.5 ± 14.4 mmHg and diastolic BP of 69.3 ± 8.4 mmHg. PRESSURE significantly improved Chair Sit-to-Stand Test (CSTS) (1.0 ± 1.8 vs.−0.6 ± 0.8times/30s,p = 0.03) versus CONTROL, and gait speed (12.8±43.3 vs.−24.1±22.4cm/sec, p = 0.02) versus BALANCE. Meanwhile, BALANCE significantly improved Single Leg Stance Test (5.4±18.0 vs.−8.2±10.3 s, p = 0.049) and CSTS (1.0±1.7 vs.−0.6±0.8times/30s, p = 0.03), and tended to lower SBP (-4.2±16.0 vs. 3.5±8.3mmHg, p = 0.052) versus CONTROL.ConclusionWithin 3 months, Tai Chi improved several health outcomes independent of the type of practice among physically active, Tai Chi naive older adults. Therefore, healthcare and exercise professionals may recommend Tai Chi to physically active older adults without specifying the type of practice.

In a recent systematic review, we reported evidence that exercise and nutrition professionals stigmatize their patients due to their weight in 81% of 31 studies. Being weight stigmatized is associated with adverse cardiovascular health consequences for unclear reasons; but may be due to the heightened cardiovascular reactivity that accompanies obesity and hypertension. PURPOSE: We examined the influence of two video exposures, one containing scenes of weight stigma (STIGMA) and the other non-stigmatizing neutral (NEUTRAL) scenes, on cardiovascular reactivity assessed by resting and ambulatory blood pressure (ABP) and heart rate (HR), among women with obesity and high blood pressure (HBP; n=24) or normal BP (NBP; n=25). METHODS: Women completed a screening visit and two randomized visits which involved watching a 10-min STIGMA and NEUTRAL video exposure. Laboratory BP and HR were measured before, during, and after the videos. ABP and HR were measured upon leaving the laboratory for the awake (10hr), sleep (9hr), and 19hr. A repeated measures ANCOVA tested the difference in BP and HR changes from baseline between the BP groups after STIGMA vs NEUTRAL controlling for BMI and baseline BP and HR in the laboratory and over ambulatory conditions. RESULTS: Women with HBP (systolic/diastolic BP [SBP/DBP]= 122.9 ±13.6/73.5 ±11.2mmHg) were 37.5±9.1yr and obese (Body Mass Index [BMI] = 37.8 ± 6.1kg•m2); women with NBP (SBP/DBP=106.9±7.4/65.0±7.1mmHg) were 34.1±8.9yr and obese (BMI= 33.6±4.9kg•m2). Laboratory SBP/DBP increased 5.5+7.3/2.4+8.8mmHg more in HBP than NBP after STIGMA vs NEUTRAL (Ps<0.05), with no difference in HR (P>0.05). ABP increased more in HBP than NBP over sleep (SBP / DBP= 4.2 + 20.6/4.7 + 14.2mmHg; Ps<0.05) and 19hr (SBP / DBP =0.9+15.2/0.4+10.8 mmHg; Ps<0.05) after STIGMA vs NEUTRAL. During sleep, HR increased 7.5+15.7bpm more in HBP than NBP after STIGMA vs NEUTRAL (P<0.05). CONCLUSION: Exposure to a weight stigma video resulted in greater cardiovascular reactivity in women with obesity and HBP than NBP in the laboratory and under ambulatory conditions, most notably during sleep. Our findings reveal the importance of educating health professionals about weight stigma, and its immediate, yet persistent adverse cardiovascular health effects, and developing interventions to mitigate weight stigma.

Describe the relationships among parent feeding practices, the home environment and diet among toddlers.