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Cardiometabolic-Health Related Risk Factors and Physical Function with Aging: Targets for Lifestyle Intervention

Napoleone, Jenna Marie (2021) Cardiometabolic-Health Related Risk Factors and Physical Function with Aging: Targets for Lifestyle Intervention. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Maintaining optimal physical function with age is critical for quality of life and health. Modifiable risk factors (e.g., cardiometabolic, lifestyle and behavioral) have shown to contribute to declining physical function in late-life adults, yet less is known about how earlier midlife risk factors impact mid- and late-life functional performance.This dissertation examined associations of (1) maintenance session attendance impact on weight loss (WL) success in a lifestyle intervention (DPP-GLB) in adults with prediabetes and/or metabolic syndrome (MetS; n=238; mean age=62 years; 76% women), (2) objective physical function changes among GLB Moves participants randomized to an intervention with physical activity (DPP-GLB) or sedentary behavior (GLB-SED) goals vs. 6-month control and 12-month pre-post (n=305; 79% women), and (3) changes in the number of components of MetS across midlife with objective physical performance in early late life women from the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% Black, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Regression analyses were applied (1: logistic and multinomial; 2: mixed models; and 3: linear and latent class modeling). Attending maintenance sessions and meeting the 6-month WL goal was associated with meeting the 12-month 5% WL goal, with Medicare eligible adults being more successful (OR=3.03, 95%CI:1.58-5.81). DPP-GLB and GLB-SED were effective at improving function with clinically meaningful changes (GLB-DPP: +0.05±0.17, GLB-SED: +0.06±0.16 m/s faster gait; GLB-DPP: -0.17±2.7, GLB-SED: -0.55±2.2 secs faster chair stands); those with lower initial function improved more (+0.09 faster gait in DPP-GLB, +0.07 in GLB-SED). Midlife MetS groups (≥3 components) were related to worse early late life 40-ft walk (β:-0.08; 95% CI:-0.13, -0.03), gait speed (β:-0.09; 95% CI:-0.15, -0.02), SPPB (β:-0.79; 95% CI: -1.15, -0.44), and chair stands (β:0.69; 95% CI: 0.09, 1.28), but no difference in stair climb. This dissertation provides valuable information to Medicare-DPP providers and characterize clinical and behavioral modifiable risk factors for functional decline in mid-to-early late life, to tailor preventive strategies to compress years of morbidity related to the onset of disability in late-life. Thus, the goal is to help older adults maintain independence with aging and live longer, healthier lives by intervening earlier in midlife.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Napoleone, Jenna Mariejmn82@pitt.edujmn820000-0002-0271-5937
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee CoChairKriska, Andrea M.kriskaa@edc.pitt.edukriskaa
Committee CoChairStrotmeyer, Elsa S.strotmeyere@edc.pitt.edustrotmeyere
Committee MemberBoudreau, Robert M.BoudreauR@edc.pitt.eduboudreaur
Committee MemberMiller, Rachel G.millerr@edc.pitt.edumillerr
Committee MemberRockette-Wagner, Bonnybjr26@pitt.edubjr26
Committee MemberBrach, Jennifer S.jbrach@pitt.edujbrach
Date: 12 May 2021
Date Type: Publication
Defense Date: 21 April 2021
Approval Date: 12 May 2021
Submission Date: 29 April 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 183
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: older adults, physical function, lifestyle intervention
Date Deposited: 12 May 2021 19:51
Last Modified: 12 May 2023 05:15

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