Exercise: System-Wide Effects

Transcription

1 Exercise: System-Wide Effects John M. Jakicic, PhD University of Pittsburgh Distinguished Professor and Chair Department of Health and Physical Activity Director Healthy Lifestyle Institute Director Physical Activity and Weight Management Research Center

2 Disclosures Scientific Advisory Board: Weight Watchers International Research Grants Awarded to the University of Pittsburgh National Institutes of Health Weight Watchers International HumanScale

3 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Health-Related Outcomes

4 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes

5 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes

6 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes Body Weight and Adiposity

7 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes Body Weight and Adiposity

8 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes Diet Body Weight and Adiposity

9 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes Diet Body Weight and Adiposity

10 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes Diet Body Weight and Adiposity

11 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Health-Related Outcomes Diet Body Weight and Adiposity

12 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Behavior Health-Related Outcomes Diet Body Weight and Adiposity

13 Pathway for Physical Activity (Exercise) to influence Health Physical Activity Fitness Behavior Health-Related Outcomes Diet Body Weight and Adiposity

14 Key Health Areas of Interest Obesity Cardiovascular Disease Type 2 Diabetes Mellitus

15 Key Health Areas of Interest Obesity

16 Weight Loss Achieved in Behavioral Intervention Programs Percent Weight Loss Months Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic

17 Weight Loss Achieved in Behavioral Intervention Programs Percent Weight Loss Months Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic Jakicic

18 What is the Impact of Physical Activity plus Prescribed Diet in the Management of Body Weight?

19 Effect in Class II and III Obesity Goodpaster et al. JAMA 2010

20 Effect in Class II and III Obesity 2.4 kg (22%) difference in weight loss between groups Goodpaster et al. JAMA 2010

21 What is the Long-Term Impact of Physical Activity in the Management of Body Weight?

22 Dose of Exercise and Long-Term Weight Loss 110 min/wk 175 min/wk 280 min/wk Jakicic, et al. JAMA. 1999

23 Physical activity (0, 6, and 24 months) for categories of 24-month weight loss (N = 170). Physical Activity (kcal/wk) *1500 kcal/wk or 275 min/wk above baseline * P-Values Group Effect = 0.09 Time Effect = <0.001 Group X Time Effect = <0.001 Months <0% Weight Loss (N=54) 0-4.9% Weight Loss (N=33) 5-9.9% Weight Loss (N=36) >=10% Weight Loss (N=47) Jakicic, et al. Arch IntMed. 2008

24 What is the Long-Term Impact of Physical Activity in the Management of Body Weight? OBJECTIVELY MEASURED PHYSICAL ACTIVITY

25 Subjects Grouped based on Weight Loss Achieved and Maintained Non-Loss (n=107, 41%) Late-Loss (n=19, 7%) Non-Maintain (n=45, 17%) Maintain (n=87, 34%) >10% Weight Loss at 6 Months No No Yes Yes >10% Weight Loss at 18 Months No Yes No Yes Jakicic et al. Obesity. 2014

26 % Change in Body Weight by Group P-Values Weight Change Group: < Time: < Weight Change Group X Time: < Percent Weight Change Months NON-LOSS (n=107) LATE-LOSS (n=19) NON-MAINTAIN (n=45) MAINTAIN (n=87) Jakicic et al. Obesity. 2014

27 Change in Moderate-to-Vigorous Intensity Physical Activity (bouts >10 minute in duration) by Weight Loss Pattern P-Values Weight Change Group: < Time: < Weight Change Group X Time: < MET-Minutes per Week Baseline 6 months 12 months 18 months NON-LOSS (n=107) LATE-LOSS (n=19) NON-MAINTAIN (n=45) MAINTAIN (n=87) Jakicic et al. Obesity. 2014

28 Change in Light Intensity Physical Activity by Weight Loss Pattern P-Values Weight Change Group: Time: Weight Change Group X Time: MET-Minutes per Week Baseline 6 months 12 months 18 months NON-LOSS (n=107) LATE-LOSS (n=19) NON-MAINTAIN (n=45) MAINTAIN (n=87) Jakicic et al. Obesity. 2014

29 Weight Variability in Response to Physical Activity

30 Mid-West Exercise Study Responders and Non-responders (Women) W o m e n 1 0 Weight Change (kg) Donnelly et al.

31 Difference in Individual Energy Intake Following Rest and Exercise Difference between Energy Intake for Rest and Exercise (kcal) Consume more following Rest compared to Exercise Consume more following Exercise compared to Rest Adapted from Unick et al. Appetite

32 Potential Mechanisms through which Physical Activity Energy Expenditure Influences and Energy Intake and Body Weight Metabolic Parameters Physical Activity Hunger & Satiety Energy Expenditure Energy Intake Body Weight

33 Key Health Areas of Interest Cardiovascular Disease

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35 Influence of Weight/Body Composition and Fitness on Left Ventricular Mass Dependent Variable Left Ventricular Mass Variable Step Beta S.E. p-value Partial r 2 Intercept Age (years) * Gender (female) * Race (white) * Height (cm) * Weight (kg) < % Body Fat < Mean Arterial Pressure < Fitness (oxygen consumption, L min -1 ) Model r *Indicates these variables were forced in the model during the stepwise regression analysis.

36 Clinical Sites Seattle Boston Minneapolis Providence New York Pittsburgh Philadelphia Denver Baltimore Los Angeles Phoenix Memphis Winston-Salem Birmingham San Antonio Houston Baton Rouge Clinical Site Coordinating Center

37 Physical Activity and Cardiovacular Disease in the Look AHEAD Study Primary and Secondary Outcomes that Occur After Year 1 Baseline Physical Activity Year 1 Physical Activity Year 4 Physical Activity Primary and Secondary Outcomes that Occur After Year 4

38 Physical Activity and Cardiovacular Disease in the Look AHEAD Study Primary and Secondary Outcomes that Occur After Year 1 Baseline Physical Activity Year 1 Physical Activity Year 4 Physical Activity Primary and Secondary Outcomes that Occur After Year 4

39 Physical Activity and Cardiovacular Disease in the Look AHEAD Study Primary and Secondary Outcomes that Occur After Year 1 Baseline Physical Activity Year 1 Physical Activity Year 4 Physical Activity Primary and Secondary Outcomes that Occur After Year 4

40 Change in Physical Activity and CVD Risk in the Look AHEAD Study Outcome Physical Activity Variable 1-Year Hazard Ratio* (based on change in Physical Activity per 100 MET-minutes) 4-Year Hazard Ratio* (based on change in Physical Activity per 100 MET-minutes) Primary** Baseline (0.950, 1.001) (0.906, 0.993) Change at 1 Year (0.985, 1.017) (0.918, 1.000) Secondary Outcome*** Baseline (0.932, 0.997) (0.830, 0.959) Change at 1 Year (0.965, 1.013) (0.844, 0.969) *Fully adjusted model (age, sex, history of CVD, duration of diabetes, diabetes medication use, baseline weight, change in weight *Primary Outcome: (non-fatal MI, stroke, hospitalized angina, CVD death) **Secondary Outcome: (non-fatal MI, stroke, hospitalized angina, CABG/PTCA, hospitalized CHF, carotid endarterectomy, PVD, total mortality) Jakicic, et al. (unpublished)

41 Key Health Areas of Interest Type 2 Diabetes Mellitus

42 4-Year Change in HbA1c by Category of 4-Year Percent Change in Fitness 0.20 P< P< P< Change in HbA1c DSE and ILI Combined DSE ILI >10% decline in fitness 0% to 10% decline in fitness >0% to 10% increase in fitness >10% increase in fitness Missing Fitness at Year 4 Jakicic et al. Diabetes Care. 2013; 36(5):

43 4-Year Change in HbA1c by 4-Year Percent Change in Fitness Adjusted for 4-Year Weight Change. Jakicic et al. Diabetes Care. 2013; 36(5):

44 4-Year Change in HbA1c by 4-Year Percent Change in Fitness Adjusted for Age, Gender, Weight Change and Diabetes Medication Use Jakicic et al. Diabetes Care. 2013; 36(5):

45 Patterns of Physical Activity

46 Continuous vs. Intermittent Bouts of Physical Activity 300 Minutes / week Prescribed Long-Bout Short-Bout Weeks Jakicic et al.intj Obesity1995; 19:

47 Acute Response of Exercise on Insulin Insulin (μu/ml) # REST 10-EX 30-EX FAST 30-MIN 60-MIN 90-MIN 120-MIN Mishler, Jakicic, Goodpaster, Gibbs, Nagle. University of Pittsburgh. Doctoral Dissertation.

48 Sedentary Behavior

49 Benefits of Standing versus Sitting Healy GN, Winkler EAH, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardiometabolic risk biomarkers. European Heart Journal. First published online: 30 July 2015

50 Energy Expenditure Sitting versus Standing (15 minutes) 60 a, b, c ENERGY EXPENDITURE (KCAL) a b c 0 Sitting - television Sitting - computer Standing Walking Activities with the same letter are significantly different at p<0.05 Creasy SA, Rogers RJ, Byard T, Kowalsky R, Jakicic JM. Energy Expenditure during Acute Periods of Sitting, Standing, and Walking. Journal of Physical Activity and Health

51 Wearable Technology

52 0-1 Weight Change (kg) P-Values Group: Time: Group X Time: Months SBWL (N=14) TECH (N=12) EN-TECH (N=13) Rogers RJ, Lang W, Gibbs BB, Davis KK, Burke LE, Kovacs SJ, Portzer LA, Jakicic JM. Comparison of a technology-based system and in-person behavioral weight loss intervention in adults with severe obesity. In Press: Obesity Science and Practice.

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54 Change in Body Weight by Group P-Values Weight Change Group: 0.07 Time: <0.001 Weight Change Group X Time: Weight Change (kg) Months Standard Standard + Wearable Activity Tracker Jakicic et al. JAMA. 2016

55 Concluding Comments

56 New Opportunities at the University of Pittsburgh

57 A national research consortium designed to discover and perform preliminary characterization of the range of molecular transducers (the "molecular map") that underlie the effects of physical activity in humans. The program's goal is to study the molecular changes that occur during and after exercise and ultimately to advance the understanding of how physical activity improves and preserves health. The six-year program is the largest targeted NIH investment of funds into the mechanisms of how physical activity improves health and prevents disease.

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59 Why is MoTrPACImportant? Physical Activity Risk Factors, Fitness, Body Composition, etc. Health Outcome Molecular Pathways / Transducer s

60 University of Pittsburgh Healthy Lifestyle Institute

61 Thank You!