Sandra A. Ham

Bio: Sandra A. Ham is an academic researcher from University of Chicago. The author has contributed to research in topics: Population & Poison control. The author has an hindex of 32, co-authored 77 publications receiving 4217 citations. Previous affiliations of Sandra A. Ham include University of Illinois at Chicago & Centers for Disease Control and Prevention.

Prevalence of physical activity, including lifestyle activities among adults - United States, 2000-2001.

Abstract: Regular physical activity helps prevent obesity, heart disease, hypertension, diabetes, colon cancer, and premature mortality. During 1986--2000, the Behavioral Risk Factor Surveillance System (BRFSS) included questions that measured leisure-time physical activity (primarily exercise or sports-related activities). Previous guidelines for appropriate physical activity to increase cardiorespiratory fitness included participating in vigorous-intensity activity (i.e., > or =20 minutes per day, > or =3 days per week). BRFSS questions used to measure this level of activity were developed a decade before CDC and the American College of Sports Medicine concluded that health-related benefits could accrue from a minimum of 30 minutes of moderate-intensity activity on most days of the week. Various household and transportation-related physical activities and some leisure-time activities, therefore, can be important to measure. In response to expanded activity recommendations designed to include health-related lifestyle activities, new BRFSS physical activity questions have been developed. After cognitive, validity, and reliability testing, the new lifestyle activity questions were used in the 2001 BRFSS. A separate question allowed tracking of physical inactivity during leisure time across years and was used in the 2000 and 2001 BRFSS questionnaires. This report presents data from responses to the 2000 BRFSS leisure-time activity questions and the updated lifestyle activity questions of the 2001 BRFSS to compare overall U.S. and state-specific prevalence estimates for adults who engaged in physical activities consistent with recommendations from both survey years. The findings indicate that even with a more complete measure of physical activity than used previously, the majority of U.S. adults are not physically active at levels that can promote health.

Trends in leisure-time physical inactivity by age, sex, and race/ethnicity - United States, 1994-2004.

Abstract: Physical inactivity is associated with increased risk for certain chronic diseases, including cardiovascular disease, diabetes, and osteoporosis. Despite the benefits of physical activity, more than half of adults in the United States are not regularly active at the recommended levels. Trends in the proportion of adults who achieve the recommended levels of leisure-time physical activity have remained relatively stable over time. However, the proportion of adults from 35 states and the District of Columbia who reported that they did not engage in any leisure-time physical activity declined from 1996 to 2002. To further examine trends in no leisure-time physical activity by population subgroup, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for the period 1994-2004. This report is the first analysis of BRFSS physical-inactivity trends that includes all 50 states and the District of Columbia (DC). State and local health departments should continue to create programs that encourage adults to be physically active during leisure time.

The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (the Diabetes & Aging Study)

Abstract: OBJECTIVE To examine for a legacy effect of early glycemic control on diabetic complications and death. RESEARCH DESIGN AND METHODS This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997–2013, average follow-up 13.0 years, N = 34,737) examined associations between HbA1c RESULTS Compared with HbA1c CONCLUSIONS Among patients with newly diagnosed diabetes and 10 years of survival, HbA1c levels ≥6.5% (≥48 mmol/mol) for the 1st year after diagnosis were associated with worse outcomes. Immediate, intensive treatment for newly diagnosed patients may be necessary to avoid irremediable long-term risk for diabetic complications and mortality.

PEER REVIEWED: Prevalence of Physical Activity in the United States: Behavioral Risk Factor Surveillance System, 2001

Abstract: Introduction The health benefits of regular cardiovascular exercise are well-known. Such exercise, however, has traditionally been defined as vigorous physical activity, such as jogging, swimming, or aerobic dance. Exercise of moderate intensity also promotes health, and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity, such as yard work, housework, or walking for transportation. Until recently, public health surveillance systems have not included assessments of this type of physical activity, focusing on exercise of vigorous intensity. We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults.

Physical activity levels among the general US adult population and in adults with and without arthritis.

Abstract: The health effects of regular physical activity (PA) are well established and include decreased mortality and morbidity related to several common chronic diseases, such as cardiovascular disease, diabetes, and cancer, as well as contributing to improved mental health, physical functioning, and weight control (1–3). Despite this, US adults continue to get inadequate PA (4). In fact, physical inactivity was felt to be such a large public health problem that in 1996 the US Surgeon General released the landmark report Physical Activity and Health: A Report of the Surgeon General (3). This report, as well as an earlier joint report from the Centers for Disease Control and Prevention and the American College of Sports Medicine (CDCACSM) recommend all US adults participate in regular, moderate-intensity, leisure-time PA (2). The CDC-ACSM recommendation specifically states “Every US adult should accumulate 30 minutes or more of moderate intensity activity on most, preferably all, days of the week.” Details of these and other (5) public health recommendations and guidelines for developing and maintaining cardiorespiratory fitness are summarized in Table 1. Monitoring national PA levels is important to define the extent of and to identify trends in physical inactivity, evaluate national health objectives, and to identify subpopulations where interventions should be targeted (6). Populations known to be at risk for physical inactivity include women, ethnic/racial minorities, older persons, disabled persons, overweight/obese persons, and persons with chronic diseases, including cardiovascular disease, diabetes, and arthritis (2,3,6,7). The high prevalence of arthritis in the US (43 million) makes persons with arthritis a large part of the population targeted for PA improvements (8). Participation in PA delays the onset of functional limitation (9,10), prevents obesity (11), and is essential for normal joint health (12,13). In addition, PA has been shown to reduce pain and disability among persons with arthritis and increase their physical performance and self efficacy (14,15). Yet, persons with arthritis often resist PA messages because activity may initially increase pain or because they were told, inappropriately, not to be physically active. The purposes of this study are to 1) describe the sources of data used for surveillance and special studies of PA among persons with arthritis, 2) compare levels of physical inactivity between 3 national health surveys, 3) report the prevalence of PA levels among the general US adult population and among adults with and without self-reported arthritis using data from the Behavioral Risk Factor Surveillance System (BRFSS), and 4) identify areas for future research regarding physical activity and arthritis.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

Abstract: The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.

Physical Activity and Public Health Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

Abstract: Summary—In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995 Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues Key points related to updating the physical activity recommendation were outlined and writing groups were formed A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts Comments were integrated into the final recommendation Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity [I (A)] (Circulation 2007;116:1081-1093)

Heart Disease and Stroke Statistics—2007 Update A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Abstract: 1. About These Statistics…e70 2. Cardiovascular Diseases…e72 3. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris…e89 4. Stroke…e99 5. High Blood Pressure…e111 6. Congenital Cardiovascular Defects…e116 7. Heart Failure…e119 8. Other Cardiovascular Diseases…e122 9. Risk Factor: Smoking/Tobacco Use…e128 10. Risk Factor: High Blood Cholesterol and Other Lipids…e132 11. Risk Factor: Physical Inactivity…e136 12. Risk Factor: Overweight and Obesity…e139 13. Risk Factor: Diabetes Mellitus…e143 14. End-Stage Renal Disease and Chronic Kidney Disease…e149 15. Metabolic Syndrome…e151 16. Nutrition…e153 17. Quality of Care…e155 18. Medical Procedures…e159 19. Economic Cost of Cardiovascular Diseases…e162 20. At-a-Glance Summary Tables…e164 21. Glossary and Abbreviation Guide…e168 Writing Group Disclosures…e171 Appendix I: List of Statistical Fact Sheets: http://www.americanheart.org/presenter.jhtml?identifier=2007 We thank Drs Robert Adams, Philip Gorelick, Matt Wilson, and Philip Wolf (members of the Statistics Committee or Stroke Statistics Subcommittee); Brian Eigel; Gregg Fonarow; Kathy Jenkins; Gail Pearson; and Michael Wolz for their valuable comments and contributions. We would like to acknowledge Tim Anderson and Tom Schneider for their editorial contributions and Karen Modesitt for her administrative assistance. # 1. About These Statistics {#article-title-2} The American Heart Association (AHA) works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS); the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Neurological Disorders and Stroke (NINDS); and other government agencies to derive the annual statistics in this Update. This chapter describes the most important sources and the types of data we use from them. For more details and an alphabetical list of abbreviations, see Chapter 21 of this document, the Glossary and Abbreviation Guide. The surveys used are:

Heart Disease and Stroke Statistics—2008 Update A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Abstract: We thank Drs Robert Adams, Gary Friday, Philip Gorelick, and Sylvia Wasserthiel-Smoller, members of Stroke Statistics Subcommittee; Drs Joe Broderick, Brian Eigel, Kimberlee Gauveau, Jane Khoury, Jerry Potts, Jane Newburger, and Kathryn Taubert; and Sean Coady and Michael Wolz for their valuable comments and contributions. We acknowledge Tim Anderson and Tom Schneider for their editorial contributions and Karen Modesitt for her administrative assistance. View this table: Writing Group Disclosures # Summary {#article-title-2} Each year the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media, the lay public, and many others who seek the …