ObjectiveTo examine the effect of an intensive lifestyle weight loss intervention (ILI) compared to diabetes support and education (DSE) on changes in fitness and physical activity in the Look AHEAD trial.DesignRandomized clinical trial to compare a lifestyle intervention for weight loss with a diabetes support and education condition in individuals with type 2 diabetes.SubjectsData from 4,376 overweight or obese adults with type 2 diabetes (age = 58.7±6.8 years, BMI = 35.8±5.8 kg/m2) who completed one-year of the Look AHEAD trial and had available fitness data were analyzed.InterventionSubjects were randomly assigned to DSE or ILI. DSE received standard-care plus 3 education sessions over the one-year period. ILI included individual and group contact throughout the year, restriction in energy intake, and 175 min/wk of prescribed physical activity.MeasurementsFitness was assessed using a submaximal graded exercise test. Physical activity was assessed via questionnaire in a subset of 2,221 subjects.ResultsChange in fitness was statistically greater in ILI vs. DSE after adjustment for baseline fitness (20.9% vs. 5.7%) (p<0.0001). Multivariate analysis showed that change in fitness was greater in overweight vs. obese Class II and III (p<0.05). Physical activity increased by 892±1694 kcal/wk in ILI vs. 108±1254 kcal/wk in DSE (p<0.01). Changes in fitness (r=0.41) and physical activity (r=0.42) were significantly correlated with weight loss (p<0.0001).ConclusionsThe ILI was effective in increasing physical activity and improving cardiorespiratory fitness in overweight and obese individuals with type 2 diabetes. This effect may add to weight loss in improving metabolic control in patients in lifestyle intervention programs.

BACKGROUND & AIMS Symptoms of Inflammatory Bowel Disease (IBD) include bloody diarrhea, fatigue, abdominal pain and weight loss. Long-term management of remission for most patients requires adherence to taking one or more oral medications daily, in the absence of symptoms. We investigated whether disease characteristics and behavioral characteristics predict adherence to prescribed medical regimes. METHODS Patients 8 to 17.5 years of age, newly diagnosed with IBD as well as a matched cohort previously diagnosed were studied over a 6-month period. Adherence was assessed using medication electronic monitoring devices (MEMS); participants and parents completed questionnaires regarding emotional and behavioral functioning, and biological parameters were monitored. RESULTS Adherence was monitored for 45 newly and 34 previously diagnosed patients. In total, 16,478 patient days (including 12,066 discrete days) were electronically monitored. Overall 70.6% of 5-ASA and 65.4% of 6-MP doses were taken. Only 25% and 15% of older adolescents took at least 80% of their 5-ASA and 6-MP, respectively, compared to about 83% and 64% of 8–11 year-olds. Only age and behavioral issues were statistically linked to rates of adherence. CONCLUSIONS Adherence to commonly prescribed oral medications for IBD is challenging for patients. Screening for emotional and behavioral problems, especially among older adolescents, would be important in identifying patients at risk for poor adherence, who might benefit from interventions. Biological solutions, while critical, when applied without attention to behavioral issues, are not likely to provide the level of therapeutic benefit that can be provided in a combined bio-behavioral approach.

Background Previous investigations have produced mixed findings on whether youth with Inflammatory Bowel Disease (IBD) experience elevated rates of depressive symptoms. Our first aim was to compare self-report of depressive symptoms by youth with IBD to a community sample. The second aim was to examine the relationship between symptoms of depression and measures of disease activity. Methods Item-level responses on the Children's Depression Inventory (CDI) among a sample of 78 youth diagnosed with IBD were compared to responses from a community sample using one-sample t-tests. Particular attention was given to items assessing somatic symptoms of depression given the potential overlap with IBD disease symptoms. The relationship between depressive symptoms and IBD disease activity was evaluated using Spearman's rank correlation coefficients and linear regression. Results Youth with IBD reported lower levels of depressive symptoms compared to the community sample on the CDI Total Score, and similar or lower levels of difficulty on items assessing somatic symptoms. The majority of the sample had inactive or mild disease activity at the time of participation, with 14% experiencing moderate/severe disease activity. Higher ratings of disease activity were related to greater depressive symptoms. Responses on somatic items from the CDI were not differentially related to disease activity. Conclusions As a group, pediatric patients with IBD did not experience clinical levels of depressive symptoms or elevations in depressive symptoms when compared to a community sample. Somatic symptoms of depression do not differentiate youth with IBD experiencing elevations in disease activity from youth experiencing non-somatic symptoms of depression.