Final

1. What are the minimum PA recommendations for Weight Management (weight loss and weight loss maintenance)?

At least 300 minutes of moderate intensity aerobic activity a week 60 min a day, 5 days a week

1. Be able to calculate BMI given a person's height (inches) and weight (lb). Also, be able to calculate a person's weight (lbs), given their height and BMI.

BMI= wgt (kg) / hgt (m)^2 154lbs / 2.2= 70 kg (5'10") 70 in x .0254 = 1.778 meters 70 kg / 1.778 m^2 70 kg /3.1613 m= 22.14 OR 704.5 x wgt (lb) / hgt (in) / hgt (in)1 OR 704.5 x wgt (lbs) / hgt (in)^2

1. What are the 3 major factors that account for total energy expenditure (TEE)?

Basal Metabolic Rate (metabolism) BMR Thermic Effect of Food (TEF) we produce heat when we eat. Physical Activity (most variable)

Define normal weight obesity.

Combination of normal BMI and increased Body Fat % Men: BMI < 25 & BF% > 25% Women: BMI < 25 & BF% > 32% (35%)

1. What happens to the relationship between TV viewing time and mortality when MVPA is controlled?

Controlling for MVPA did not negate the hazards of prolonged sitting

1. Name five foods that are VERY LOW in energy density, other than broth or gelatin.

Cucumber Lettuce Tomato Mushroom Broccoli Strawberries Grapefruit Green beans Winter squash Carrots Apple

1. What is an allele?

Different variants at any particular site in the genome are called alleles

1. In general, describe the relationship between all-cause mortality and fitness in men, according to Blair's study.

Dose response Low fit was 1.82 relative risk compared to high fit

1. What is the general relationship between TV viewing time and obesity? Why is this the case?

Dose-response relationship - more TV viewing time= higher obesity = lower VO2 max

1. Why is it important for a kcal-cutting diet to be healthy, as well as effective?

Eating unhealthy foods to lose weight is like smoking to lose weight, it works but increases risk of disease

1. In general, describe the relationship between all-cause mortality and fitness in women.

Even stronger in women for a dose response (4, 3, 2, 1)

1. What words and concepts do the acronyms FITT and SITT stand for? Explain.

FITT- Exercise: Frequency, Intensity, Time, Type SITT- Sedentary Behavior Frequency, Interruptions, Time, Type Sedentary Behavior Frequency- number of bouts of sitting Interruptions- getting up from couch or chair Time- duration of sitting bouts Type- mode of sedentary behavior (watching tv, driving, etc.)

1. What is the general relationship between fatigue and lack of PA?

Fatigue does not mean a person has had adequate exercise- could be from not exercising - emotional stress can make you feel tired, depression causes fatigue.

1. What are the most commonly used cut-points to define obesity using BF%?

Fit = < 15% (men) < 23% (women) (this is from Wilmore 1986) Obesity= 25% (men) 32% (35%) (women) (from Lohman 1992)

1. What do the results from the Shengxu and Li investigations tell us about the relationship between actual genetic differences in adults and risk of obesity?

Genetics account for less than 3%

1. If an adult wanted even greater benefits from PA (the most benefits), what is the recommendation? Greater than 300/150 mod/vigorous

Greater than 300/150 mod/vigorous

1. If adults want to lose weight, what must they do, given the study by Thomas (2014)?

Have to strictly adhere to the diet

1. Why is BMI limited in its ability to distinguish risk in older adults?

In older people, more LBM is good, but more body fat is bad (BMI does not distinguish) (normal wight obesity, where you are normal weight but have a lot of fat)

1. Recognize the factors that are improved by regular PA that relate to daily function?

Increased Physical fitness (aerobic capacity) Increased muscular strength Greater functional capacity (perform more work and play with less fatigue) Improved cognitive function later in life Enhanced quality of life

1. What were the general findings of the large prospective study from Finland?

Intense activity was lower in risk than moderate which was lower than low activity (dose-response)

1. What was unique regarding the DESIGN of the study by Donnelly? Why couldn't subjects exaggerate their reports of physical activity?

It was SUPERVISED and in LARGE amounts of PA.

1. The genetic and obesity study by Shengxu found 17 genetic factors that related to obesity, but these 17 factors together accounted for only _____ % of the differences in BMI and waist circumference?

Less than 1%

1. Compared to BMI, is the relationship between mortality and measurement of body fat % more or less J-shaped?

Less, it is more of a linear relationship.

1. What is the DOUBLE benefit of eating low energy dense foods?

Low energy dense foods not only contain fewer calories (so you can eat more of them) they also tend to be the healthiest foods, reducing risk of death and premature death.

1. How much PA (minimum) is recommended by the U.S. Guidelines for weight management, including weight loss and maintenance of weight loss?

Minimum of 150 minutes per week (moderate intensity) Greater than or equal to 300 min/week for weight management, including weight loss and maintenance of weight loss.

1. What are the muscle-strengthening recommendations for adults?

Moderate or high intensity and involve all major muscle groups on 2 or more days per week

1. Define each moderate and vigorous PA using METs.

Moderate- 3 to 5.9 METS (5 or 6 on a 0-10 scale) Vigorous- 6 or more (7 or higher on a 0-10 scale)

1. What is unique about the relationship between TV viewing time and morality across the different levels of MVPA? Explain.

More MVPA, the lower the mortality rate- but within each category, there is still a dose-response relationship with TV viewing. (Even active people who watch a lot of TV are more likely to die than active people who don't)

1. On average, how many hours of TV watching do American adults spend per day?

More than 4 hours

1. Did subjects in the Ello-Martin and Rolls study need to count calories? Were they required to eat a specific number of calories? Explain briefly.

Neither- they ate ad libitum- one group encouraged to eat less fat, the other encouraged to reduce fat and increase fruits and veggies

1. Name six foods that are LOW in energy density.

Oatmeal Mayo (fat free) Cottage cheese (fat free) Grapes Vegetarian chili Black beans Green peas Banana Yogurt (fat free) Baked potato with skin Tuna (canned) Rice, white, long grain

1. In the review by Wing, regarding weight loss, how beneficial was adding an exercise program to a calorie-cutting diet? Explain.

Only 2 out of 13 exercise studies showed additional weight loss benefits compared to diet alone

1. What two general factors strongly affect insulin resistance?

PA and weight

1. What are the relationships between age, income, gender, race, and education and PA?

PA tends to decrease with: Age Income (poverty) Gender (female) Race (black and American Indian) Education (low education) Region (South)

1. Define physical activity (PA), exercise, cardiorespiratory fitness, MET, and MET-minutes.

Physical Activity- body movement produced by skeletal muscles that result in energy expenditure Exercise- subset of a physical activity. A volitional, planned, structured, repetitive physical activity aimed at improvement or maintenance of physical fitness or health Cardiorespiratory fitness- the ability of the circulatory and respiratory systems to supple oxygen during sustained physical activity. Ability to perform sustained physical works. Usually expressed as a maximal oxygen uptake. How strong is the heart MET- (metabolic equivalent) energy requirement of an activity expressed as a multiple of RMR (3METS = 3 x RMR) Resting metabolic rate = 1 MET Walking is typically a 3 MET activity Jogging is typically a 10 METS activity MET-Minutes- if a person does a 4 MET activity for 30 minutes, they have performed 120 MET- minutes of activity

1. In the study by Poppitt & Prentice, what was the relationship between fat intake and prevalence of obesity? What would likely explain this relationship?

Positively correlated- more fat= higher prevalence of obesity

1. What were the general findings of the Harvard Study?

Risk of death was higher for those who got too little physical activity and too high (either under 500 kcal or over 3500 kcal) Basically risk of all-cause mortality went down the more active you were

1. What are some other health/disease outcomes or conditions that are related to sedentary time, besides mortality?

Sedentary time is associated with waist circumference, blood glucose, and triglycerides. Unhealthy cardio-metabolic health profile

1. Describe the research conducted to determine the actual or objective levels of American adult PA compared to self-reported levels.

Self-report vs accelerometers Average report was 325 minutes moderate per week, when in reality it was 45 min

1. What are the strategies recommended for interrupting and reducing time spent sitting?

Stand and take a break from computer of desk work every 30 min. Take "standing breaks" during long meetings. Stand during phone calls. Walk to colleague's desk rather than email or phoning. Using a height-adjustable desk to allow transitions between standing and sitting. Minimize TV watching Conduct meetings as you walk around the building.

1. What was unique about the methods used in the Lipid Research Clinics Study by Ekelund?

Subjects were all apparently healthy at baseline Submaximal treadmill test at baseline (shows how fit people really are) Divided into quartiles

1. What happens when adults are covertly served meals over about one week that are high in fat (60%), moderately high fat (40%) or low in fat (20%)? Explain generally.

The 60% fat balance was way increased 40% increased a little 20% fat decreased Because people still tend to eat the same amount, despite how much fat or how filling

1. Which group of subjects lost the most weight? Did they eat more or less food than the other study group? How can this be. Explain?

The reduced fat and fruits and veggies lost more weight The RF+ FV group ate more food- less energy dense foods

1. What was unique about subjects in the Harvard study who engaged in extreme amounts of PA?

Their risk for all-cause mortality was higher than the trend should have shown

1. Why were the subjects in the Ello-Martin study able to lose substantial amounts of weight without trying to cut kcal? Explain.

They reduced fat and increased low energy dense foods

1. What did the study by Tucker (2016) show about PA and kcal intake?

Those that exercised more (in the upper quartile), ate 1200 kcals more in a week than those in the lowest quartile. (170 kcals more per day)

1. Define the principle of progression.

To continue to the next level of fitness, regular increases in overload are necessary

1. Why does exercise not result in significant weight loss?

Unless daily cardio is done, little is lost from exercise. It is also so easy to overeat and gain back everything burned in exercise. (studies show that exercise alone doesn't produce weight loss) Probably due to insufficient quantity of exercise and or non-compliance to the exercise program.

1. Give some examples of specific activities that fit the Vigorous Activity level.

Walking 3.75 mph on a 5% grad= 6.5 METS Jogging at 10 min mile pace (6 mph) on a level grade= 10 METS Walking 3.75 mph at 12.5% grade= 10 METS

1. If a person is trying to lose weight, but they are not having success, what is likely the problem?

When a person is not losing weight, it is almost always because that the person is not creating a meaningful deficit (even if they are sure they are). Remember, the more overweight a person is, the larger the error made in estimating energy intake.

1. Why do people often give up when their diet is not working?

When people are not losing meaningful amounts of weight each week (ie, at least ½ lb per week and preferably 1 full lb per week), they almost always get discouraged and quit. Significant weight loss early on is critical! Success begets success.

1. What is the association between work and exercise?

Work: exercise is work, physical work. The more we work (exercise), the easier it is to work (and play)

1. Were the results of Ekelund's study dose-response? How many times greater was the risk of death in the Poorly fit (lowest quartile) compared to those in the Very Good category (upper quartile)?

Yes very. Relative risk was 8.5 in the poor compared to the very good category.

1. Be able to set up, interpret, and use the NIH Body Weight Planner app. Practice using it.

do

1. When plant foods (carbs) with a lot of water are consumed, along with high fiber foods, how many kcal per gram does carbohydrate provide?

less than 1 kcal per gram

1. Where is fiber found in the diet?

plants

1. In the literature, what is the BEST predictor of weight loss by successful dieting?

weight lost in first 6-12 weeks

1. Be able to recognize the simple and important tips to follow when helping a client with an exercise program?

· Get physician approval · Begin easy, progress slowly (slower for obese) · Exercise with a partner if having trouble doing it alone · Monitor mileage or exercise duration every day on the calendar (exercise log) · Be sure your client understands that exercise is work · Benefits are dose response- more you put in, the more you get out

1. Overweight and obesity increase risk for many diseases. What diseases are "caused" by excess body weight and body fat (ie, obesity)? Understand, in a basic way, what each disease is.

· High blood pressure & Hypertension · Dyslipidemia (bad cholesterol profile) HDL, LDL, triglycerides · osteoarthritis · coronary heart disease · stroke · gallbladder disease · Type 2 Diabetes · Complications with pregnancy and delivery · Sleep apnea · Infertility · Nonalcoholic fatty liver disease · Pancreatitis · Cataracts · Respiratory disease (flu and pneumonia) · Many cancers (particularly endometrial (endometrium is the lining of the uterus), breast, prostate, and colon) · Social discrimination · Emotional distress · All-cause mortality, decreased life expectancy

1. What are the health problems that children suffer from when they are overweight/obese?

· Hypercholesterolemia · Elevated blood pressure · Insulin resistance

1. What are four limitations that reduce the likelihood of physical activity producing weigh loss?

· Increased food consumption is likely. · Fatigue (can't go for hours and hours) · Time restraints (an hour to walk 3-4 miles) · Injury (more of an issue for high mileage and obese) · Difficult for the obese to exercise · Overall low energy expenditure for the amount of work (humans are quite efficient) · May compensate for the extra work by being less active during other parts of the day

1. Theoretically, why should individuals lose body fat as a result of strength training? Why don't adults typically lose much body weight or fat as a result of strength training? Explain.

· Strength training should increase muscle mass, and thus increase RMR, and increase total energy expenditure, and decrease body fat. (it also increases free living physical activity which increases energy expenditure and also increases fat oxidation, which increases body fat) · Most people don't, because it takes a LOT of strength training to raise RMR enough to change anything- diet is the key to produce a lean body. · Strength training prevents the loss of Lean Body Mass, large amounts of strength training increase it, but the typical program for strength training does not result in a lean body or the loss of body fat.

1. What specific health problems and diseases are substantially more common in less active adults compared to active adults?

- Heart disease (CHD) - Stroke - cancers (particularly colon and breast) - Diabetes - Osteoporosis - Depression

1. What are the 3 major factors that contribute to the energy density of food?

- fat -fiber -water (moisture) in the food

1. Which intermediate health problems are decreased or increased by regular PA?

- increased HDL - increased Fat Free Mass (muscle) Decreased: - LDL - Triglycerides - Blood pressure - Insulin resistance - Body weight and body fat (abdominal fat)

1. After 12 months of exercising (a lot), how much FAT was lost by the women? How about the men? Do you think the participants should have lost more weight/fat than they did? Why didn't they lose more weight/fat? Think logically.

-1.9 kg women fat loss -3 kg men fat loss Yes, they probably overate to compensate for their added exercise routine

we use average error (not minimal error), how much do obese women underestimate their kcal intake per day, on average?

-1000 kcal per day

1. What are two serious health problems that Mr. Butler has because of his severe obesity?

-diabetes -high blood pressure -LDL cholesterol

1. Define LOW energy dense foods (kcal per gram).

.6- 1.5 kcal per gram

1. What is the definition of a VERY LOW energy dense food (How many kcal per gram)?

0 to .6 calories per gram

1. How does sitting offset the benefits associated with walking, quantitatively?

1 hour of sitting per day offsets the benefits associated with 15 minutes of walking per day.

What 3 factors are necessary for a weight management strategy to be successful?

1) Effective 2) Healthy 3) (Sustainable)

1. Which 5 factors lead to CVD that are indirectly caused by obesity?

1) Higher LDL levels 2) Lower HDL & higher triglycerides 3) Physical inactivity 4) Higher blood pressure 5) Insulin resistance (Type II diabetes)

1. Be able to recognize commonalities associated with successful weight loss among those in the national weight registry.

1) Low fat intake (24% of total) 2) High dietary restraint (control) 3) Low calorie intake (less than 1400 a day) 4) Fast food less than once a week 5) Strong focus on smaller portion size 6) Infrequent snacking 7) 44% weighed themselves daily 8) Abundant physical activity 9) Eat the same foods regularly with almost no splurging on weekends or holidays 10) Average caloric expenditure through exercise (2,800 calories)

Rank the five body composition measurement methods according to their precision and accuracy.

1. DEXA is the best! 1.3% (not pts) 2. Plethysmography (Bod Pod) 2.5% (not pts) 3. Hydro densitometry (hydrostatic weighing) 5-6% (not pts) 4. bioelectrical impedance 3-4% points 5. skinfold (lots of error)

1. In the Miller review on physical activity and weight loss, how much did subjects lose, on average, by dieting (restricting kcal)? How much more did they lose when an exercise program was included with their diet?

10.7 kg (23.5 lbs) 11 kg with exercise (so like 1 more kg or less than a lb.) (24.2 lbs.)

1. When using Percent Sedentary Time to predict mortality, for adults 50+ yrs of age, how many times greater is the risk of mortality for those in the 4th Quartile of Percent Sedentary Time compared to those in the 1st Quartile (rounded to the nearest whole number)?

11.9 relative risk

1. According to the CALERIE study, how accurate/precise is energy intake (kcal), when calculated using the Body Weight Planner/Simulator, for predicting weight loss over 12 weeks? How about after 24 weeks?

12 weeks: R=.99 24 weeks: R=.98

1. Over approximately 7 months, how much weight did the average "Biggest Loser" lose? Why is this important to know?

128 lbs

1. Recognize the key points associated with the Harvard Alumni Study. How was the study conducted, in general?

17,000 Harvard male alumni. Paffenbarger followed them for 16 years (1986) At baseline- self reported activity levels (caloric expenditure) everything they did active Results were consistent throughout different levels of blood pressure, smoking, weight gained, heredity, etc.

1. In a representative sample of American adults (NHANES), which quartiles show greater Light Intensity activity than Sedentary activity (Q1, Q2, Q3, Q4)? Are there any quartiles that show more moderate or vigorous activity than Sedentary? Explain.

1st quartile is the only one No- the majority of the day is either sedentary or light activity.

1. Instead of 4 kcal per gram of carbohydrate, how many kcal are there in carbohydrate when fiber is included in the diet?

2-3 kcal

1. How much greater was the risk of death in the men who had Low Fitness levels and Low BP, compared to men who had High Fitness levels and High BP?

2.5 times greater for low fitness and low blood pressure

1. How long does it take a small individual (121 lbs) to burn enough kcal by walking to compensate for eating a piece of chocolate cake and drinking a glass of milk?

3 hours 15 min causal walking

1. In the huge study by Hu, published in the New England Journal of Medicine, how much greater is the risk of CVD mortality among women who have never smoked, who are obese, compared to normal weigh women?

3 times more for those who were obese

1. In a similar study by Li, what percentage of the differences in BMI could be accounted for by genetic factors?

3%

1. For additional benefits, what are the recommendations in minutes of Moderate and Vigorous PA, considered individually and combined?

300 min moderate intensity a week OR 150 vigorous OR combination

1. How much lower is the fitness level of Frequent TV viewers compared to Moderate or Infrequent TV viewers? Why would this be the case?

32.6 max VO2 for frequent TV compared to 36 VO2 for infrequent and moderate TV viewing

1. In the Hu study, what is the relationship between obese women who participate in < 1 hr per week of activity compared to normal weight women who participate in 3.5 hrs or more of activity per week? (rounded to the nearest tenth)

4.7 times the risk of mortality

What is the average BF% in the U.S. among adult women?

41% for women

1. How many kcal did the women burn each exercise session, on average? How much weight did the women lose, on average? Why didn't they lose more weight? Think logically.

438+88kcal per session Weight remained stable Overeating after exercising- think that because they are working out they can eat more- gain the weight

1. In the review by Wing, regarding weight loss, how beneficial was exercising without cutting kcal (in kg)?

6 of 10 trials showed an effect, but it was only a 1-2 kg effect (difference) on average as opposed to no treatment Effects tend to be dose response- the more you exercise, the better weight loss was affected

1. In the McTiernan study, how many days per week and how much time was spent exercising by the subjects? Would you consider this a lot of exercise?

60 min, 6 days per week YES, it's a lot

1. Specifically, what percentage of adults self-report that they meet the US guidelines (for moderate to vigorous PA, MVPA) compared to the percentage who actually meet the guidelines while wearing accelerometers?

60% self-report 8% accelerometer

1. In the average adult, what percentage of total caloric expenditure is accounted for by a person's resting metabolism?

60-70% total expenditure

1. On average, how many kcal did the men burn EACH exercise session? How much weight did the men lose over 16 months?

667+ 116 kcal per session 6% of their weight (5.2+4.7 kg)

1. For risk of death, what is considered "even risk" or "break even risk" regarding hours of Sedentary time per day: 6½ hrs of sedentary time, 7½ hrs, 8½ hrs, 9½ hrs, 10½ hrs, 12½ hrs or 14½ hrs?

7.5 hours

1. Rounded to the nearest whole number, in the Blair study, how much greater was the risk of CVD death in the Low fitness group (lowest quintile) compared to the High fitness group (top 2 quintiles) in men?

8 times greater for low fitness group

What percentage of type II diabetics are obese when they are diagnosed?

80-85%

1. When eating the same amount of food (504 grams, not counting water and fiber) when comparing the HIGH fat diet to the LOW fat diet, what is the kcal intake difference? Would a difference of over 800 kcal make a difference if someone was trying to manage their weight?

825, YES

1. Judged objectively, how many minutes per day are spent in MVPA by the average adult?

9

1. How many grams of carbohydrate (or protein) can one eat to equal the kcal provided by 4 grams of dietary fat?

9 grams

1. Rounded to the nearest whole number, in the Blair study, how much greater was the risk of CVD death in the Low fitness group (lowest quintile) compared to the High fitness group (top 2 quintiles) in women?

9 times greater for low fitness

1. When controlled, what two variables negate the TV viewing time and fitness relationship?

Accelerometer PA and Body Fat %

1. What consequence or implication does the objective above have? (TV time and mortality

Activity levels do not counter the effects of sitting- means that although PA is important, you still need to not be sedentary the rest of the day

1. Define the law of adaptation and the principle of overload. Give a few examples.

Adaptation: The body's structures and functions respond to the stresses and strains placed upon them by becoming stronger or weaker (adaptation occurs in BOTH directions) like having a cast on a leg Use it or lose it! The heart is the most important muscle of the body Overload: the stress placed on the body when physical activity is greater than usual in amount or intensity Too much overload= injury A little overload= no improvement No overload= steady decline

1. What was unique about the methods used by Blair in his study?

Also used treadmill test instead of questionnaire 10,000 men, 3,000 women for 8 years Max treadmill test used to index fitness (duration on a treadmill) speed increases until you can't continue Subjects divided into quintiles (20% in each group) Chronic disease free at baseline