Showing papers by "Michael A. Babyak published in 2011"

Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study.

Abstract: OBJECTIVE To examine a 1-year follow-up of a 4-month, controlled clinical trial of exercise and antidepressant medication in patients with major depressive disorder (MDD). METHODS In the original study, 202 sedentary adults with MDD were randomized to: a) supervised exercise; b) home-based exercise; c) sertraline; or d) placebo pill. We examined two outcomes measured at 1-year follow-up (i.e., 16 months post randomization): 1) continuous Hamilton Depression Rating Scale score; and 2) MDD status (depressed; partial remission; full remission) in 172 available participants (85% of the original cohort). Regression analyses were performed to examine the effects of treatment group assignment, as well as follow-up antidepressant medication use and self-reported exercise (Godin Leisure-Time Exercise Questionnaire), on the two outcomes. RESULTS In the original study, patients receiving exercise achieved similar benefits compared with those receiving sertraline. At the time of the 1-year follow-up, rates of MDD remission increased from 46% at post treatment to 66% for participants available for follow-up. Neither initial treatment group assignment nor antidepressant medication use during the follow-up period were significant predictors of MDD remission at 1 year. However, regular exercise during the follow-up period predicted both Hamilton Depression Rating Scale scores and MDD diagnosis at 1 year. This relationship was curvilinear, with the association concentrated between 0 minute and 180 minutes of weekly exercise. CONCLUSION The effects of aerobic exercise on MDD remission seem to be similar to sertraline after 4 months of treatment; exercise during the follow-up period seems to extend the short-term benefits of exercise and may augment the benefits of antidepressant use. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00331305.

Systolic Blood Pressure, Socioeconomic Status, and Biobehavioral Risk Factors in a Nationally Representative US Young Adult Sample

Abstract: In the National Longitudinal Study of Adolescent Health, a US longitudinal study of >15 000 young adults, we examined the extent to which socioeconomic status is linked to systolic blood pressure (SBP) and whether biobehavioral risk factors mediate the association. More than 62% of the participants had SBP >120 mm Hg and 12% had SBP >140 mm Hg. More than 66% were classified as at least overweight (body mass index >25 kg/m(2)), with >36% meeting criteria for at least class I obesity (body mass index >30 kg/m(2)). Multivariate models showed that higher household income and being married were independently associated with lower SBP. Higher body mass index, greater waist circumference, smoking, and higher alcohol intake were each independently associated with higher SBP. Meditational analyses suggested that higher education level was associated with lower SBP by way of lower body mass, smaller waist circumference, and lower resting heart rate. When these indirect effects were accounted for, education was not significantly associated with SBP. In contrast, household income remained associated with SBP even with control for all of the covariates. Results reinforce current public health concerns about rates of obesity and high blood pressure among young adults and suggest that disparities in education level and household income may play an important role in the observed decrements in health. Identifying modifiable mechanisms that link socioeconomic status to SBP using data from a large representative sample may improve risk stratification and guide the development of effective interventions.

The DASH Diet and Insulin Sensitivity

Abstract: Lifestyle modifications, including adoption of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, weight loss in individuals who are overweight or obese, and physical activity, are effective in the prevention and treatment of hypertension. A healthy lifestyle may also have beneficial effects on metabolic abnormalities, such as insulin resistance, that are associated with high blood pressure. This review examines the independent and combined effects of the DASH diet and weight loss plus exercise on blood pressure and insulin sensitivity, with a focus on recently published results from the ENCORE study. Our data suggest that the DASH eating plan alone lowers blood pressure in overweight individuals with higher than optimal blood pressure, but significant improvements in insulin sensitivity are observed only when the DASH diet is implemented as part of a more comprehensive lifestyle modification program that includes exercise and weight loss.

Association of vascular health and neurocognitive performance in overweight adults with high blood pressure.

Abstract: The relationship between vascular health--including flow-mediated dilation (FMD) and intima medial thickness (IMT)--and neurocognitive performance was examined in a sample of 124 sedentary, middle-aged adults with high blood pressure (systolic blood pressure, SBP, 130-159 mmHg or diastolic blood pressure, DBP, 85-99 mmHg) who were overweight or obese (body mass index 25.0-39.99 kg/m²). Patients completed a neuropsychological test battery, including measures of executive function and psychomotor speed, and measures of IMT and FMD were obtained. Hierarchical multiple regression analyses were used to investigate the association between vascular measures and neurocognitive performance after controlling for demographic factors and cerebrovascular risk factors. Higher levels of FMD predicted better executive function (b = 0.90, p = .045). Greater IMT tended to be associated with slower psychomotor speed (b = -0.82, p = .084), with the effect attenuated after controlling for FMD. Impaired FMD is associated with worse neurocognitive functioning among overweight adults with high blood pressure.

Positive emotion is associated with 6-year change in functional status in individuals aged 60 and older

Abstract: Analyses examined both positive emotion (PE) at baseline and change in PE from baseline to follow up as predictors of change in functional status (FS). Initial models examined baseline PE, and change in PE, as predictors of change in FS adjusted for baseline PE, negative emotion (NE), FS, and age and gender. Final models included additional adjustments for frequency of social contact, marital status, body mass index, smoking status, drinking behavior, and comorbidity at baseline. Baseline PE was a predictor of change in FS, adjusted for NE, age, and gender (p = 0.033). Additional covariates reduced the effect of baseline PE as a predictor of change in FS (p = 0.115). Change in PE was a significant predictor of change in FS – increases in ratings of PE over time were associated with less decline in FS (p = 0.001). The association for change in PE remained significant in the fully adjusted model (p = 0.004). Results replicate our prior findings.