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Background Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one’s ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants’ perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms. Methods Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants. Results Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED. Conclusion This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies.

Chronic widespread musculoskeletal pain (CMP) is a primary condition of Veterans who were deployed to the Persian Gulf War. The mechanisms that underlie CMP in these Veterans are unknown and few efficacious treatment options exist. This study tested the effects of 16 weeks of resistance exercise training (RET) on gray matter (GM) volume and white matter (WM) microstructure in Gulf War Veterans (GWVs) with CMP compared to GWV waitlist controls (WLC). Fifty-four GWVs were randomly assigned to 16 weeks of RET (  = 28) or WLC (  = 26). Training involved 10 resistance exercises to involve the whole body, was supervised and individually tailored, and progressed slowly to avoid symptom exacerbation. Outcomes assessed at baseline, 6, 11 and 17 weeks and 6- and 12-months post-intervention included GM volume (voxel-based morphometry), WM microstructure (diffusion tensor imaging), pain [short form McGill Pain Questionnaire (SF-MPQ) and 0-100 visual analog scale (VAS)], fatigue (0-100 VAS), and mood (Profile of Mood States). Muscular strength was assessed at baseline, 8 and 16 weeks, and training volume was tracked throughout the 16-week intervention. Primary analyses used linear mixed effects models with Group, Time, and the Group*Time interaction as fixed factors and subject and slope as random factors to test the differential effects of RET and WLC on brain structure and symptoms. All neuroimaging analyses used the False Discovery Rate to correct for multiple comparisons at an alpha of 0.05. Strength increased significantly across the trial for the RET group (  < 0.001). There were significant Group*Time interaction effects for pain ratings (SF-MPQ total;  < 0.01) and the Profile of Mood States total mood disturbance score (  < 0.01). There were no Group or Group*Time effects for GM volume or WM microstructure. There were no significant associations between strength, symptoms, and brain structure (  > 0.05). Sixteen weeks of low-to-moderate intensity RET (i) improved musculoskeletal strength and (ii) did not exacerbate symptoms, but (iii) was insufficient to alter brain structure in GWVs with CMP.

Background: Older adults spend most of their day in sedentary behavior (SB) (i.e., prolonged sitting), increasing risk for negative health outcomes, functional loss, and diminished ability for activities of daily living. The purpose of this study was to develop and pilot test an intervention designed to reduce SB in older adults that could be translated to communities. Methods: Two pilot studies implementing a 4-week SB intervention were conducted. SB,physical function, and health-related quality of life were measured via self-report and objective measures. Participants (N=21) completed assessments pre- and post-intervention (studies 1 and 2) and at follow-up (4-weeks post-intervention; study 2). Due to the pilot nature of this research, data were analyzed with Cohen’s d effect sizes to examine the magnitude of change in outcomes following the intervention. Results: Results for study 1 indicated moderate (d=0.53) decreases in accelerometry-obtained total SB and increases (d=0.52) in light intensity physical activity post-intervention. In study 2,there was a moderate decrease (d=0.57) in SB evident at follow-up. On average SB decreased by approximately 60 min/d in both studies. Also, there were moderate-to-large improvements in vitality (d=0.74; study 1) and gait speed (d=1.15; study 2) following the intervention. Further,the intervention was found to be feasible for staff to implement in the community. Conclusion: These pilot results informed the design of an ongoing federally funded randomized controlled trial with a larger sample of older adults from underserved communities. Effective,feasible, and readily-accessible interventions have potential to improve the health and function of older adults.

Abstract Background Pain modulation is a critical function of the nociceptive system that includes the ability to engage descending pain control systems to maintain a functional balance between facilitation and inhibition of incoming sensory stimuli. Dysfunctional pain modulation is associated with increased risk for chronic pain and is characteristic of fibromyalgia (FM). Catastrophizing is also common in FM. However, its influence on pain modulation is poorly understood. Objective To determine the role of catastrophizing on central nervous system processing during pain modulation in FM via examining brain responses and pain sensitivity during an attention-distraction paradigm. Methods Twenty FM patients and 18 healthy controls (CO) underwent functional magnetic resonance imaging while receiving pain stimuli, administered alone and during distracting cognitive tasks. Pain ratings were assessed after each stimulus. Catastrophizing was assessed with the Pain Catastrophizing Scale (PCS). Results The ability to modulate pain during distraction varied among FM patients and was associated with catastrophizing. This was demonstrated by significant positive relationships between PCS scores and pain ratings (P < 0.05) and brain responses in the dorsolateral prefrontal cortex (P < 0.01). Relationships between catastrophizing and pain modulation did not differ between FM and CO (P > 0.05). Conclusions FM patients with higher levels of catastrophizing were less able to distract themselves from pain, indicative of catastrophizing-related impairments in pain modulation. These results suggest that the tendency to catastrophize interacts with attention-resource allocation and may represent a mechanism of chronic pain exacerbation and/or maintenance. Reducing catastrophizing may improve FM symptoms via improving central nervous system regulation of pain.

While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. Regression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=-.49, P=.01) and lack of previous experience with pedometers (beta=-.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity. ClinicalTrials.gov NCT03837366; https://clinicaltrials.gov/ct2/show/NCT03837366.

Abstract Introduction Physical activity (PA) is associated with brain health in older adults. However, it is unknown whether the current physical activity recommendations (PAR) impart substantive benefit. The objective of this study was to compare temporal lobe volumes between older adults who met PAR and those who did not. Methods Ninety-one enrollees from the Wisconsin Registry for Alzheimer's Prevention wore an accelerometer for seven consecutive days to quantify their PA behaviors and underwent a T-1 anatomic magnetic resonance imaging scan. Participants were categorized as either having met PAR or not based on the US Department of Health and Human Services recommendations of 150 minutes of moderate-to-vigorous physical activity per week. Results Participants who met PAR possessed significantly greater inferior (η2 P  = .050) and anterior (η2 P  = .055) temporal lobe volumes compared with those who did not ( P  < .05). Discussion Individuals at-risk for AD experience accelerated rates of brain atrophy. These results suggest that regular engagement in PA at or above PAR could attenuate this decline.

Health coaching is a common approach for promoting lifestyle changes, but little is known about the effectiveness of different delivery methods. The purpose of this study was to evaluate the effectiveness of in-person versus online health coaching when used as part of a facilitated behavior change program. To increase translatability, the study used a naturalistic design that enabled participants to self-select the coaching delivery method (Group) as well as the target behavior (diet, physical activity, or weight management). Regardless of group, participants were provided with a behavior-based monitoring device and guided to use it by the health coach. A sample of 92 adults participated and 86 completed pre–post evaluations to assess behavior change strategies and posttest outcome measurements for their specific goal. Two-way (Group × Time) analyses of variance were used to evaluate changes in behavioral strategies. Intent-to-treat regression analyses were used to compare postintervention outcomes for groups. The in-person group had significantly higher Healthy Eating Index scores than the online group (p > .05), but nonsignificant group differences were observed for those targeting physical activity or weight change (p < .05). The results support the use of health coaching for promoting behavior change and suggest that online coaching may be equally effective as in-person methods.

To begin to elucidate the mechanisms underlying the benefits of exercise for chronic pain, we assessed the influence of exercise on brain responses to pain in fibromyalgia (FM). Complete data were collected for nine female FM patients and nine pain-free controls (CO) who underwent two functional neuroimaging scans, following exercise (EX) and following quiet rest (QR). Brain responses and pain ratings to noxious heat stimuli were compared within and between groups. For pain ratings, there was a significant (p < 0.05) Condition by Run interaction characterized by moderately lower pain ratings post EX compared to QR (d = 0.39–0.41) for FM but similar to ratings in CO (d = 0.10–0.26), thereby demonstrating that exercise decreased pain sensitivity in FM patients to a level that was analogous to pain-free controls. Brain responses demonstrated a significant within-group difference in FM patients, characterized by less brain activity bilaterally in the anterior insula following QR as compared to EX. There was also a significant Group by Condition interaction with FM patients showing less activity in the left dorsolateral prefrontal cortex following QR as compared to post-EX and CO following both conditions. These results suggest that exercise appeared to stimulate brain regions involved in descending pain inhibition in FM patients, decreasing their sensitivity to pain. Thus, exercise may benefit patients with FM via improving the functional capacity of the pain modulatory system.

Introduction Cardiorespiratory fitness (CRF) has been shown to be related to brain health in older adults. In individuals at risk for developing Alzheimer's disease (AD), CRF may be a modifiable risk factor that could attenuate anticipated declines in brain volume and episodic memory. The objective of this study was to determine the association between CRF and both hippocampal volume and episodic memory in a cohort of cognitively healthy older adults with familial and/or genetic risk for Alzheimer's disease (AD). Methods Eighty‐six enrollees from the Wisconsin Registry for Alzheimer's Prevention participated in this study. Participants performed a graded maximal exercise test, underwent a T‐1 anatomical magnetic resonance imaging scan, and completed the Rey Auditory Verbal Learning Test (RAVLT). Results There were no significant relationships between CRF and HV or RAVLT memory scores for the entire sample. When the sample was explored on the basis of gender, CRF was significantly associated with hippocampal volume for women. For men, significant positive associations were observed between CRF and RAVLT memory scores. Summary These results suggest that CRF may be protective against both hippocampal volume and episodic memory decline in older adults at risk for AD, but that the relationships may be gender specific. In this cross‐sectional study, cardiorespiratory fitness (CRF) was significantly associated with hippocampal volume for women. For men, significant positive associations were observed between CRF and episodic memory scores. These results suggest that CRF may be protective against both hippocampal volume and episodic memory decline in older adults at risk for AD, but that the relationships may be gender specific.