Cardiometabolic Health and Weight Management Chair: John Jakicic - - PowerPoint PPT Presentation

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Cardiometabolic Health and Weight Management Chair: John Jakicic - - PowerPoint PPT Presentation

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Meeting 5 Cardiometabolic Health and Weight Management Chair: John Jakicic Members: Wayne Campbell, Loretta DiPietro, Russ Pate, Linda Pescatello, Ken Powell Cardiometabolic Health and Weight Management Subcommittee October 17 -20, 2017

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Meeting 5

Cardiometabolic Health and Weight Management Chair: John Jakicic

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Members: Wayne Campbell, Loretta DiPietro, Russ Pate, Linda Pescatello, Ken Powell

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SLIDE 2

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Experts and Consultants

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  • Consultant:

– Ronald J. Sigal, M.D., M.P.H.

University of Calgary

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SLIDE 3

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Subcommittee Questions

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  • 1. What is the relationship between physical

activity and prevention of weight gain?

  • 2. In people with normal blood pressure or pre-

hypertension, what is the relationship between physical activity and blood pressure?

  • 3. In adults without diabetes, what is the

relationship between physical activity and incidence of type 2 diabetes?

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SLIDE 4

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Question #2

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In people with normal blood pressure or pre- hypertension, what is the relationship between physical activity and blood pressure?*

a. Is there a dose-response relationship? If yes, what is the shape of the relationship? b. Does the relationship vary by age, sex, race/ethnicity, socio- economic status, weight status, or resting blood pressure level? c. Does the relationship vary based on: frequency, duration, intensity, type (mode), or how physical activity is measured?

  • Source of evidence to answer question:

– SR/MA/Existing Report

*Subquestions a, b, and c were addressed during the July meeting

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SLIDE 5

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Key Findings: Physical Activity and Blood Pressure

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  • There were 8 meta-analyses of randomized

clinical control trials that examined the blood pressure response to physical activity among sedentary adults with prehypertension and normal blood pressure [Carlson, 2014; Cornelissen, 2011, 2013b; Corso, 2016; Fagard 2007; MacDonald, 2016; Murtagh, 2015].

– 5 of the meta-analyses included adults with prehypertension [Cornelissen, 2011, 2013b; Corso, 2016; MacDonald, 2016; Murtagh, 2015]. – 7 of the meta-analyses included adults with normal blood pressure [Casonatto, 2016; Carlson, 2014; Cornelissen, 2011, 2013b; Corso, 2016; Fagard 2007; MacDonald, 2016].

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Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Key Findings: Physical Activity and Blood Pressure

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  • In the 5 meta-analyses involving adults with prehypertension, 5

reported a statistically significant reduction in systolic blood pressure and 4 reported a statistically significant reduction in diastolic blood pressure.

  • In the 7 meta-analyses involving adults with normal blood pressure 3

reported a statistically significant reduction and 1 reported a statistically significant rise in systolic blood pressure; and 6 reported a statistically significant reduction in diastolic blood pressure

  • The magnitude of the reductions ranged from 2 to 5 mmHg for

systolic blood pressure and 1 to 4 mmHg for diastolic blood pressure.

  • The magnitude of these blood pressure reductions may be sufficient

to reduce the: – Resting blood pressure of some samples with prehypertension into normotensive ranges. – Risk of coronary heart disease 4 percent to 5 percent and stroke by 6 percent to 8 percent among adults with prehypertension and normal blood pressure

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SLIDE 7

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Key Findings: Physical Activity and Blood Pressure

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  • In a meta-analysis among 136,846 adults initially

free of hypertension at baseline (i.e., those with normal blood pressure) Huai et al. [2013] reported:

– 11.4% adults developed hypertension after an average

  • f 10 years (2 to 45 years) of follow up.

– “High” amounts of leisure-time physical activity (i.e., volume and/or intensity) were associated with a 19% lower risk of hypertension compared to the reference group engaging in “low” leisure-time physical activity (RR 0.81 [95% CI 0.76-0.85]). – Moderate amounts of recreational physical activity were associated with a 11 percent decreased risk of hypertension compared to lower amounts of recreational physical activity (RR 0.89 [95% CI, 0.85-0.94]). – No significant associations were found with occupational and commuting physical activity and incident hypertension.

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SLIDE 8

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Conclusion Statement

24

  • Strong evidence demonstrates that

physical activity reduces blood pressure among adults with prehypertension and normal blood pressure. PAGAC Grade: Strong

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SLIDE 9

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Committee Discussion

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In people with normal blood pressure or pre-hypertension, what is the relationship between physical activity and blood pressure?

a. Is there a dose-response relationship? If yes, what is the shape of the relationship? b. Does the relationship vary by age, sex, race/ethnicity, socio-economic status, weight status, or resting blood pressure level? c. Does the relationship vary based on: frequency, duration, intensity, type (mode), or how physical activity is measured?

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Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Question #3

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In adults without diabetes, what is the relationship between physical activity and the incidence of type 2 diabetes?

a. Is there a dose-response relationship? If yes, what is the shape of the relationship? b. Does the relationship vary by age, sex, race/ethnicity, socio-economic status, or weight status? c. Does the relationship vary based on: frequency, duration, intensity, type (mode), and how physical activity is measured?

  • Source of evidence to answer question:

– SR/MA/Existing Report

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SLIDE 11

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Analytical Framework

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Systematic Review Question

In adults without diabetes, what is the relationship between physical activity and the incidence of type 2 diabetes?

Target Population Adults, ages 18 and older Comparison Adults who participate in varying levels of physical activity, including no reported physical activity Intervention/Exposure All types and intensities of physical activity including lifestyle activities, leisure activities, and sedentary behavior Endpoint Health Outcomes Key Definitions

Non-diabetic/normal: Having an A1C below 5.7%, fasting blood glucose less than 100 mg/dL, and an OGTT 2 hour blood glucose lower than 140 mg/dL.

Type 2 diabetes

Prediabetes: Having an A1C of 5.7%–6.4%, or fasting blood glucose of 100–125 mg/dl,

  • r and/or an OGTT 2 hour blood glucose of 140 mg/dL–199 mg/dL with fasting blood

glucose <126 mg/dL. Diabetes: Having an A1C of 6.5% or higher, fasting blood glucose of 126 mg/dL or higher, and/or an OGTT 2 hour blood glucose of 200 mg/dL or higher.

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Search Results: High-Quality Reviews1

1 Reviews include systematic reviews, meta-analyses, and pooled analyses.

28 Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

n

  • ti

a c fi ti n e d I PubMed database searching N = 972 Cochrane database searching N = 123 CINAHL database searching N = 29 Records after duplicates removed N = 1020 g n i n e e r c S Titles screened N = 1020 Excluded based on title N = 747 Excluded based on abstract N = 222 ty i l i b i g i El Abstracts screened N = 273 Full text reviewed N = 53 Excluded based on full text N = 41 d e d u l c n I Articles included N = 12

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Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Description of the Evidence

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  • 12 reviews

– Type of review

  • 7 Meta-analyses
  • 4 Systematic reviews
  • 1 pooled analysis

– Study designs included in the reviews

  • 10 reviews with only cohort studies
  • 1 review with cohort and experimental studies
  • 1 review with cohort, experimental, and case-control

studies

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SLIDE 14

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Description of the Evidence

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  • Studies per review:

– Range of 2 - 81, median 8.5

  • Total # subjects per review (8 reviews):

– Range of 4500 - ~300,000, median 140,000 subjects

  • Age of subjects:

– Average age (3 studies): 50, 50, and 52 years

  • f age
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SLIDE 15

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Description of the Evidence

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  • Physical activity

– Mostly leisure-time MVPA – 4/12 included other domains: transportation,

  • ccupational, household
  • Dose-response

– 5 meta-analyses provided point estimates for 3+ volumes of physical activity

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SLIDE 16

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Key Findings

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  • All 12 reviews reported an inverse

relationship between volume of physical activity and risk of incident type 2 diabetes.

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SLIDE 17

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Key Findings

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  • High versus low risk estimates, 4

reviews and 1 systematic review:

0.45 (0.31, 0.77) 0.53 (0.40, 0.70) 0.58 (no 95% CI) 0.65 (0.59, 0.71) 0.83 (0.76, 0.90)

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SLIDE 18

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Point estimates and dose-response estimates for relationsh p i between MVPA and incidence of type 2 diabetes, 10 systemat reviews

0.4 0.5 0.6 0.7 0.8 0.9 1 0 MET-hr/wk 5 MET-hr/wk 10 MET-hr/wk15 MET-hr/wk20 MET-hr/wk25 MET-hr/wk30 MET-hr/wk

Wahid Huai CloostermansA AuneLTPA Kyu

Relative risk of incidence of T2D

Dose-response curves from 5 meta-analyses

inverted rescaled

ic

Draft Key Findings

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SLIDE 19

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Key Findings

35

  • One systematic review and one meta-

analysis presented information regarding the effect of weight status on the relationship between physical activity and type 2 diabetes.

  • No evidence of effect modification
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SLIDE 20

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Conclusion Statement

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  • Strong evidence demonstrates an

inverse relationship between volume of moderate to vigorous physical activity and incidence of type 2 diabetes. PAGAC Grade: Strong

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SLIDE 21

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Conclusion Statement

37

  • Strong evidence demonstrates the

existence of an inverse, curvilinear dose-response relationship between volume of physical activity and incidence of type 2 diabetes, with a decreasing slope at higher levels of physical activity. PAGAC Grade: Strong

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SLIDE 22

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Conclusion Statement

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  • Moderate evidence indicates that the

inverse relationship between volume of physical activity and risk of type 2 diabetes does not vary by weight status. PAGAC Grade: Moderate

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SLIDE 23

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Conclusion Statement

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  • Limited evidence suggests that the relationship between

higher volume of physical activity and lower incidence of type 2 diabetes is not influenced by age, sex, or race

  • ethnicity. PAGAC Grade: Limited
  • Insufficient evidence is available to determine if the

relationship between physical activity and the incidence of type 2 diabetes varies by socioeconomic status. PAGAC Grade: Grade not assignable

  • Insufficient evidence exists to determine whether the

relationship between physical activity and the incidence of type 2 diabetes varies by the frequency, intensity, duration,

  • r type of physical activity, or how physical activity is
  • measured. PAGAC Grade: Grade not assignable
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SLIDE 24

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Draft Research Recommendations

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  • Determine the value of different types

(e.g., strength, alternative) and intensities (e.g., light, vigorous) of physical activity on the incidence of type 2 diabetes.

  • Determine whether the relationship

between physical activity and risk of type 2 diabetes varies by age, sex, race/ethnicity, and socio-economic status.

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SLIDE 25

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

Committee Discussion

41

In adults without diabetes, what is the relationship between physical activity and the incidence of type 2 diabetes?

  • a. Is there a dose-response relationship? If yes,

what is the shape of the relationship?

  • b. Does the relationship vary by age, sex,

race/ethnicity, socio-economic status, or weight status?

  • c. Does the relationship vary based on:

frequency, duration, intensity, type (mode), and how physical activity is measured?

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SLIDE 26

Cardiometabolic Health and Weight Management Subcommittee • October 17-20, 2017

  • Final edits to Q1 document (including tables)
  • Final edits to Q2 document (including tables)
  • Final edits to Q3 document (including tables)

– Initial review by Anne Rodgers

  • Integration of full document for final report

Next Steps

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