Background: Among adults with diabetes, 19-34% will develop a diabetic foot ulcer (DFU), which increases amputation risk and health care costs, and worsens quality of life. Regular physical activity, when increased gradually, may help prevent DFUs. In this mixed-methods study, we examined the feasibility of a low-intensity, technology-based behavioral intervention to increase activity in adults at risk for DFUs. Method: Participants at risk for a DFU (n = 12; 66% female; mean age = 59.9 years) received four in-person exercise and behavioral counseling sessions over 2-3 weeks, supplemented with use of an activity monitor (to track steps) and text messages (to reinforce behavioral strategies) for an added 8 weeks. Pre- and postintervention assessments of accelerometer measured activity, daily mobility, and glycemic control (A1C) were completed. Treatment acceptability was assessed by questionnaire and via key informant interview. Results: The program appears feasible since all but one participant attended all four sessions, all used the activity monitor and all responded to text messages. Treatment acceptability (scale: 1 = very dissatisfied, 5 = extremely satisfied) was high; average item ratings were 4.79 (SD = 0.24). Participants increased their steps by an average of 881.89 steps/day ( d = 0.66). A1C decreased on average by 0.33% ( d = 0.23). Daily mobility did not change. Interview results suggest that participants perceived benefits from the intervention. Participant recommended improvements included providing more physical activity information, addressing pain, and intervention delivery in a podiatry clinic. Conclusion: Individuals at risk for a DFU might benefit from a minimally intensive, technology-based intervention to increase their physical activity. Future research comparing the intervention to usual care is warranted.

a b s t r a c t Available online xxxxPurpose: Pediatric obesity is a serious health problem affecting 1 of 6 children in the U.S. A two-to threefold increased incidence is evident in the last two decades. This study analyzes the outcomes of the ProActive Kids Foundation three-tiered early intervention program to determine the improvement in body composition in overweight and obese youth by incorporating the family along with the pediatric participant. Methods: We analyzed data from 884 overweight (BMI between 85% and 95th percentile) or obese (BMI N 95th percentile) youth (5 to 17 years) in a major metropolitan area in Illinois, to determine body composition improvement from an 8-week intervention between 2010 and 2017. Weight, percent body fat, fat free mass and BMI were analyzed using mixed model analysis, ANCOVA and paired t-test analysis. Results: All measures of weight, percent body fat, fat free mass and BMI improved significantly in pediatric participants. Age, county of residence and time impacted weight, body fat, fat free mass and BMI. Gender did not impact the average change in weight or BMI. Conclusions: The ProActive Kids early intervention program utilizes a targeted approach for the treatment of pediatric obesity during critical developmental ages. By educating parents along with children and adolescents about mental health coaching (lifestyle), nutrition and physical activity, we observed improvements in body composition that have potential to be sustainable. Practice Implications: The ProActive Kids strategy provides a successful model for future treatment and prevention of pediatric obesity.

Physicalinactivity has been a public health problem worldwide for more than a decade. Of those who are physically active, a substantial percentage engage solely in low or very low physical activity (PA) levels. In the last 3 decades, the prevalence of PA in the United States has decreased with approximately 80% of adults not meeting the recommended guidelines for aerobic and muscle strengthening PA. The PA levels of youth have dramatically decreased with 85% of adolescents reporting no PA. Regular PA participation can aid in preventing chronic diseases. A strong inverse dose‐response relationship exists between PA and the incidence of cardiovascular disease, all‐cause and cardiovascular mortality. Moreover, low cardiorespiratory fitness levels are a risk factor for cardiovascular diseases: the leading cause of death and disability globally. Conversely, high amounts of moderate‐to‐vigorous intensity PA at levels 3–5 times recommended in guidelines reduce risk for all cause mortality. Socio‐ecological determinants of PA are essential considerations for promoting across the life course. In health care and community settings, public health nurses have opportunities to promote PA through a socio‐ecological approach across the life course of individuals and diverse populations.

It is well established that exercise improves cardiovascular and all-cause mortality, although an ideal dose of exercise is not known. The physical activity guidelines currently recommend 150 minutes per week of moderate-intensity exercise or 75 minutes of vigorous-intensity activity. Most individuals do not engage in adequate exercise, although a safe upper limit does not exist and a too much exercise hypothesis has recently emerged. This review of the literature analyzes studies that have evaluated exercise dose response on all-cause and cardiovascular mortality for the purpose of determining safe and effective exercise prescriptions. Searches were performed in PubMed and CINAHL between 2010 and 2018 to identify six studies that met inclusion criteria. Moderate-intensity exercise reduced all-cause mortality in five of six studies, whereas low-dose exercise most effectively improved all-cause mortality in three studies, and cardiovascular mortality in one study. Vigorous-intensity exercise or extreme doses demonstrated variable outcomes and remain controversial; two studies found vigorous-intensity exercise beneficial to improve health, two studies discouraged vigorous exercise, and two studies had less conclusive outcomes. It is not surprising that any amount of exercise improves health compared with none at all, with the greatest benefits observed when sedentary individuals began exercising. Low-dose exercise should be recommended to everyone with a goal of meeting the minimal requirements according to guidelines for decreased all-cause and cardiovascular mortality. Additional research to more thoroughly understand exercise dose response and motivate individuals to improve exercise engagement is currently warranted.