Rachele M Pojednic

All Publications

• Assessing Health Behaviors as Predictors of Psychological Resilience and BMI in a National and Small Military College Sample. Healthcare (Basel, Switzerland) Blodgett, K., Pojednic, R. 2025; 13 (22)

  Abstract

  Objective: Assess potential associations between the health behaviors, resilience, and body mass index (BMI) of first-year students and compare these metrics between students at a small military college and a representative national sample. Methods: Cross-sectional data were collected via an online survey administered by the American College Health Association (ACHA) during the fall of 2022 from first-year students at a senior military college (n = 77) and first-year college students who completed the NCHA-III (n = 7644). Results: Military college students had significantly higher levels of weekly vigorous physical activity and strength training than the national sample. Vigorous physical activity, strength training, and better sleep significantly predicted improved psychological resilience and BMI values in the national sample. No behaviors predicted psychological resilience or BMI in the military college sample. Conclusions: Health behaviors like physical activity and sleep may improve resilience and body weight in civilian college students. However, combining military training with college life appears to have less impact on the relationship between health behaviors and resilience.

  View details for DOI 10.3390/healthcare13222877

  View details for PubMedID 41302264

  View details for PubMedCentralID PMC12652307

• Weight loss and body composition after compounded semaglutide treatment in a real world setting. Diabetes, obesity & metabolism Chun, E., , Rivera, D., Reyna, K., Legere, H., Joseph, R., Pojednic, R. 2025

  Abstract

  Clinical trials have shown efficacy of semaglutide for weight loss, but further study is needed in less controlled environments including impacts on body composition.This retrospective study included individuals who participated in a weight management programme at a commercial wellness studio receiving once-weekly compounded semaglutide/cyanocobalamin injections from June 2023 to January 2024. Once-weekly semaglutide/cyanocobalamin injected subcutaneously starting at 0.25 mg/0.125 mg and titrated to a maximum dose of 2.4 mg/0.24 mg. The primary endpoint was weight loss at 3 months, with secondary analyses including weight loss percentage, weight loss by body mass index (BMI) class and body composition changes including changes in total fat mass, lean body mass, skeletal muscle mass and trunk adiposity.A total of 94 individuals were analysed (81F/13M), age in years mean (SD) = 46.57 (10.60). After 3 months, average weight loss was 4.11 (2.77) kg or 4.57% (2.96%). Individuals lost fat mass (2.67 (2.37) kg) and trunk fat mass (1.10 (1.36) kg), while also losing small amounts of lean mass (1.43 (1.41) kg) and skeletal muscle mass (0.88 (0.81) kg). As a proportion of total weight, fat mass decreased while lean muscle mass and skeletal muscle mass increased.This study demonstrates that meaningful weight loss is achievable on semaglutide/cyanocobalamin outside of a closely controlled environment. In addition, body composition improved with losses in fat mass and gains in overall proportion of lean muscle and skeletal muscle.

  View details for DOI 10.1111/dom.16162

  View details for PubMedID 39776038

• The Perceived Effectiveness of Cannabidiol on Adult Women with Inflammatory Bowel Disease. Medicina (Kaunas, Lithuania) Portman, A., Bukovich, E., Bissex, J., Flanagan, M., Pojednic, R. 2024; 60 (12)

  Abstract

  Background and Objectives: In this study we analyzed the perceived effectiveness of cannabidiol (CBD) in adult women with inflammatory bowel disease (IBD). Materials and Methods: We conducted an online cross-sectional survey which assessed disease severity and quality of life (QOL) in women with IBD (Crohn's disease and ulcerative colitis) who used CBD versus those who did not. The survey included: the Harvey-Bradshaw Index, Partial Mayo Score, Short Inflammatory Bowel Disease Questionnaire, Bristol Stool Scale, and the Prime Screen Short Food Frequency Questionnaire. CBD utilization practices were also examined. STROBE reporting outcomes were followed. Statistical methods included Pearson and Spearman's correlations and chi-square analyses. Results: Seventy-one (n = 71) women were included. Twenty-five (n = 25) were CBD users and forty-six (n = 46) were past/never users. Most current users ingested CBD once per day (40%), acquired CBD from a dispensary (56%), and utilized an oral tincture (40%) at a dose of 25 mg or less (56%). There was no statistical association between CBD use and disease severity, quality of life (QOL), fecal consistency, or food intake. However, CBD users reported decreases in IBD-related pain and nausea (76% and 64%, respectively), and improvement in appetite (60%). Overall, disease severity and QOL were inversely correlated (past/never users: p = 0.000, r = -0.544; current users: p = 0.042, r = -0.427). Conclusions: Women with IBD who use CBD insignificantly trended toward improved disease-related symptoms, appetite, and QOL compared to non-users. Disease severity and QOL were inversely associated, regardless of CBD use. These preliminary outcomes indicate the need for further research on CBD use in women with IBD.

  View details for DOI 10.3390/medicina60122059

  View details for PubMedID 39768938

  View details for PubMedCentralID PMC11680051

• The Perceived Effectiveness of Cannabidiol on Adult Women with Inflammatory Bowel Disease MEDICINA-LITHUANIA Portman, A., Bukovich, E., Bissex, J., Flanagan, M., Pojednic, R. 2024; 60 (12)

  View details for DOI 10.3390/medicina60122059

  View details for Web of Science ID 001384805000001

• Whole-Body Cryotherapy Reduces Systemic Inflammation in Healthy Adults: Pilot Cohort Study. Interactive journal of medical research Chun, E., Joseph, R., Pojednic, R. 2024; 13: e60942

  Abstract

  Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease-related inflammation. In addition, the long-term durability of W-BC effect is unknown.This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides.Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at -110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw.The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (-0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (-0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and <5.7%) and was not clinically significant. There was no association between W-BC and LDL cholesterol, HDL cholesterol, or triglycerides (P>.10), although LDL trended lower over the time period examined (P=.07).These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose.

  View details for DOI 10.2196/60942

  View details for PubMedID 39576692

• Intensive, Real-Time Data Collection of Psychological and Physiological Stress During a 96-Hour Field Training Exercise at a Senior Military College: Feasibility and Acceptability Cohort Study. JMIR formative research Pojednic, R., Welch, A., Thornton, M., Garvey, M., Grogan, T., Roberts, W., Ash, G. 2024; 8: e60925

  Abstract

  BACKGROUND: Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters.OBJECTIVE: This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX).METHODS: A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured.RESULTS: A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices.CONCLUSIONS: This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery.

  View details for DOI 10.2196/60925

  View details for PubMedID 39422988

• Critical Action Steps to Take as a Certified Exercise Professional in a Rapidly Evolving Healthcare Market ACSMS HEALTH & FITNESS JOURNAL Mendola, N., Pojednic, R. 2024; 28 (5): 61-65

  View details for DOI 10.1249/FIT.0000000000000987

  View details for Web of Science ID 001298993800010

• Dietary Supplementation on Physical Performance and Recovery in Active-Duty Military Personnel: A Systematic Review of Randomized and Quasi-Experimental Controlled Trials. Nutrients Harlow, J., Blodgett, K., Stedman, J., Pojednic, R. 2024; 16 (16)

  Abstract

  Warfighters, often called tactical athletes, seek dietary supplementation to enhance training and recovery. Roughly 69% of active-duty US military personnel have reported consuming dietary supplements. The objective of this systematic review was to examine the impact of dietary supplements on muscle-related physical performance and recovery in active-duty military personnel.Randomized controlled trials and quasi-experimental controlled trials of oral dietary supplementation in active-duty military members were examined. A protocol was registered (PROSPERO CRD42023401472), and a systematic search of MEDLINE and CINAHL was undertaken. Inclusion criteria consisted of studies published between 1990-2023 with outcomes of muscle performance and recovery among active-duty military populations. The risk of bias was assessed with the McMaster University Guidelines and Critical Review Form for Quantitative Studies.Sixteen studies were included. Four were conducted on protein or carbohydrate; four on beta-alanine alone, creatine alone, or in combination; two on mixed nutritional supplements; two on probiotics alone or in combination with beta hydroxy-beta methylbutyrate calcium; and four on phytonutrient extracts including oregano, beetroot juice, quercetin, and resveratrol. Ten examined outcomes related to physical performance, and six on outcomes of injury or recovery. Overall, protein, carbohydrate, beta-alanine, creatine, and beetroot juice modestly improved performance, while quercetin did not. Protein, carbohydrates, beta-alanine, probiotics, and oregano reduced markers of inflammation, while resveratrol did not.Nutrition supplementation may have small benefits on muscle performance and recovery in warfighters. However, there are significant limitations in interpretation due to the largely inconsistent evidence of ingredients and comparable outcomes. Thus, there is inadequate practical evidence to suggest how dietary supplementation may affect field performance.

  View details for DOI 10.3390/nu16162746

  View details for PubMedID 39203882

• The Healthspan Project: A Retrospective Pilot of Biomarkers and Biometric Outcomes after a 6-Month Multi-Modal Wellness Intervention HEALTHCARE Chun, E., Crete, A., Neal, C., Joseph, R., Pojednic, R. 2024; 12 (6)

  Abstract

  Wellness-centric proactive healthcare is increasingly sought after, with individuals frequently embracing complementary modalities to achieve this goal. In this six-month study, healthy adult participants (n = 25) received specific therapies, including whole-body cryotherapy, infrared sauna, and photobiomodulation, along with guidance on physical activity, diet, and alcohol intake. Serum biomarkers were measured for all participants, while a subset also received biometric assessments for body composition (n = 10) and heart rate variability (n = 7). Over the course of the study (mean (SD) follow-up days = 174 (130)), participants exhibited significant improvements in health. LDL cholesterol (-9.77 (15.43) md/dL) and hsCRP (-1.75 (2.66) mg/L) decreased significantly (p < 0.05). HbA1c increased slightly (p < 0.05), but the effect size was small (0.12 (0.13)%). The body composition subset lost overall body weight (-3.29 (3.75) kg), primarily body fat, while preserving lean muscle mass (p < 0.05). Heart rate variability increased for those with existing cardiovascular risk factors (p < 0.05). In conclusion, participation in the multimodal Healthspan protocol is associated with substantial improvements in health-related biomarkers and biometrics.

  View details for DOI 10.3390/healthcare12060676

  View details for Web of Science ID 001193501400001

  View details for PubMedID 38540640

  View details for PubMedCentralID PMC10970491

• Exercise professional education, qualifications, and certifications: a content analysis of job postings in the United States FRONTIERS IN SPORTS AND ACTIVE LIVING Pojednic, R., O'Neill, D. P., Flanagan, M. G., Bartlett, A., Carter, B., Kennedy, M. A. 2024; 6: 1338658

  Abstract

  Growth in the field of clinical exercise science and the potential impacts on overall health and wellbeing have driven the need for qualified, clinically trained, exercise professionals. And yet, it is not well understood what specific credentials employers are seeking when hiring exercise professionals.The purpose of the study was to examine the qualification requirements for professionals seeking employment in exercise science, exercise physiology, kinesiology or equivalent fields.Search platforms Indeed.com and USAJobs.gov were examined within a two week period in 2022. Search terms included "Exercise Physiology", "Exercise Science", "Exercise Professional", "Exercise Prescription", "Exercise Specialist", and "Kinesiology".A total of n = 739 jobs were retrieved and n = 615 jobs were included: Exercise Science (n = 227), Kinesiology (n = 210), Exercise Physiology (n = 91), Exercise specialist (n = 53), and Exercise prescription (n = 32). Over 70% of the jobs analyzed required a bachelor's degree with the remainder requiring various levels of education. The primary certification required was personal trainer (n = 94), followed by strength and conditioning specialist (n = 33), clinical exercise physiologist (n = 26), group exercise (n = 17), exercise specialist (n = 10), and exercise physiologist (n = 5). Four job focus areas were determined: academic teaching and research, general fitness and worksite wellness, athletic performance and rehabilitation, clinical exercise specialist all with varying levels of degree and certification requirements.Job postings related to exercise related professions are varied across the United States with wide-ranging education, credentialing and certification requirements. These findings indicate the timely need for outreach to employers to highlight changing credentialing requirements due to evolving accreditation standards.

  View details for DOI 10.3389/fspor.2024.1338658

  View details for Web of Science ID 001153649600001

  View details for PubMedID 38313216

  View details for PubMedCentralID PMC10835791

• The Cadet Athlete Physical Training Intervention (CAPTI): A 16-week Periodized Program to Remediate Underdeveloped Tactical Athletes at a Senior Military College. International journal of exercise science Thornton, M. T., Welch, A. S., Caulfield, S., Pojednic, R. M. 2024; 17 (4): 1083-1091

  Abstract

  Approximately half of military recruits fail the Army Physical Fitness Test (APFT), and 70% of all injuries in the US military are musculoskeletal in nature. The purpose of this study was to investigate whether underdeveloped musculoskeletal and cardiovascular fitness levels and subsequent APFT scores of senior military college cadets could be improved by a novel, evidence-based Cadet Athlete Physical Training Intervention (CAPTI) compared to the current Remedial Physical Training program (RPT). Cadets failing the APFT (total score < 180, or < 60 in scored sit-ups, pushups or run time, respectively) participated in a 16-week remedial training program including either CAPTI (periodized full body calisthenic and varied-technique cardiovascular training, along with mobility training and mental health and wellbeing sessions), or a traditional, event-specific remedial training program (RPT). CAPTI was randomly assigned to one of three battalions, while the others received RPT. One hundred and thirty-eight cadets (n = 70 CAPTI, n = 68 RPT) participated in the study. After training, 82.9% (n = 58) of CAPTI passed the APFT compared to 27.9% (n = 19) of RPT. Paired t-tests demonstrated significant improvement (p < 0.01) for CAPTI in total APFT scores (42 ± 31.5 points), sit-ups (13.8 ± 9.4) pushups (6.5 ± 11) and run time (83 ± 123s). In RPT, significant improvements (p < 0.01) were noted in total APFT scores (16 ± 27.8), sit-ups (3.3 ± 6.7) pushups (3.69 ± 8.0) and run time (43 ± 127s). Between-group analyses demonstrated CAPTI had significantly higher improvements compared to RPT in APFT total score (p < 0.01) and sit-ups (p < 0.01). Higher perceived program enjoyment was also demonstrated for CAPTI when compared to RPT (P < 0.01). The CAPTI program could help address the military's physical readiness and musculoskeletal injury problem by incorporating evidence-based, wellness-focused, periodized training as part of a remedial physical training model.

  View details for PubMedID 39258122

• Nutrition Interventions on Muscle-Related Components of Sarcopenia in Females: A Systematic Review of Randomized Controlled Trials CALCIFIED TISSUE INTERNATIONAL Thornton, M., Sim, M., Kennedy, M. A., Blodgett, K., Joseph, R., Pojednic, R. 2024; 114 (1): 74-81

  Abstract

  Sarcopenia is a skeletal muscle disease categorized by low muscle strength, muscle quantity or quality, and physical performance. Sarcopenia etiology is multifaceted, and while resistance training is widely agreed upon for prevention and treatment, disease progression is also highly related to poor diet. The incidence of sarcopenia appears sex-specific and may be increased in females, which is problematic because dietary quality is often altered later in life, particularly after menopause. Identifying effective nutrition or supplementation interventions could be an important strategy to delay sarcopenia and related comorbidities in this vulnerable population. This systematic review examined randomized controlled trials (RCTs) of nutrition strategies on muscle-related components of sarcopenia in middle-aged and older females. A protocol was registered (PROSPERO CRD42022382943) and a systematic search of MEDLINE and CINAHL was undertaken. RCTs from 2013 to 2023 that assessed nutrition-only interventions on muscle mass, muscle strength, and physical function in female participants were included. Fourteen RCTs were included based on selection criteria. Study designs and interventions were heterogeneous in supplementation type and amount, age, and duration. Six RCTs reported beneficial effects of protein, Vitamin D, Vitamin D and Magnesium (Mg), and fish oil on muscle protein synthesis, muscle strength, and/or muscle function. Eight studies that examined various protein interventions, VitD alone, Mg alone, and dairy derivatives did not demonstrate any effect. Exercise appeared to modulate results in several studies. Nutrition interventions alone are likely to have a limited but positive effect on muscle-related components of sarcopenia in females. Current evidence suggests that a combination of dietary intervention and exercise is likely to be key to preventing and treating sarcopenia in middle aged and older females and there is a need for well-designed nutrition based studies in this population.

  View details for DOI 10.1007/s00223-023-01157-1

  View details for Web of Science ID 001121900600001

  View details for PubMedID 38043101

  View details for PubMedCentralID 2886201

• The Perceived Effect Of Cannabidiol On Indicators Of Muscle Recovery In Active Adult Women Flanagan, M., Pojednic, R. LIPPINCOTT WILLIAMS & WILKINS. 2023: 92-93

  View details for Web of Science ID 001158156600206

• Physical Fitness Predicted Future Warfighters' Leadership Performance During Training, But Heart Rate Variability Did Not Thornton, M., Grogan, T., Welch, A., Klepper, B., Harlow, J., Blodgett, K., Pojednic, R. LIPPINCOTT WILLIAMS & WILKINS. 2023: 930

  View details for Web of Science ID 001158156603094

• Performance Medicine: a novel and needed paradigm for proactive health care FRONTIERS IN SPORTS AND ACTIVE LIVING Joseph, R. J. J., Pojednic, R. M. M. 2023; 5: 1156645

  Abstract

  Performance Medicine is an emerging clinical practice that holds immense promise for advancing preventive health. To date, however, the concept remains imprecise, disorganized, and commercialized. The purpose of this perspective article is to define characteristics, core tenets, and practice standards to help build a common framework. We define performance broadly as "one's capacity to bring energy and attention to what matters most in a given moment". Performance Medicine, therefore, is predicated on the thesis that the critical practices that enhance one's daily wellbeing simultaneously increase both lifespan and healthspan. As a clinical practice, Performance Medicine is proactive and preventive. It focuses on the immediate and actionable strategies to address one's physical, mental, and emotional capabilities every day. The practice employs a values-centered approach that begins with a discovery process to elucidate the client's deeply held beliefs about their health status, life mission and goals, vision for optimal wellbeing, and motivations for change. Subsequent diagnostics and therapies combine evidence-based practices from multiple medical specialties including internal medicine, sports medicine, obesity medicine, integrative medicine, and others. This is complemented by the most recent scientific advancements in nutrition, exercise physiology, sleep, and recovery. The Performance Medicine prescription incorporates a personalized combination of lifestyle-based behavior change practices, evidence-based diagnostics and risk reduction therapies, ongoing monitoring, and community support. Finally, the iterative and incremental process towards enhanced and sustained health is guided and supported by a trusted partnership between the client and a team of expert practitioners and coaches.

  View details for DOI 10.3389/fspor.2023.1156645

  View details for Web of Science ID 001042062600001

  View details for PubMedID 37547820

  View details for PubMedCentralID PMC10401041

• A 16-week Periodized Program To Remediate Underdeveloped Tactical Athletes At A Senior Military College Thornton, M., Welch, A., Caulfield, S., Phillips, E., Pojednic, R. LIPPINCOTT WILLIAMS & WILKINS. 2022: 673

  View details for Web of Science ID 000888056603046

• Physician Nutrition Advice and Referrals to Registered Dietitians AMERICAN JOURNAL OF LIFESTYLE MEDICINE Pojednic, R., Phillips, E., Shehadeh, A., Muller, A., Metallinos-Katsaras, E. 2023; 17 (6): 847-854

  Abstract

  This study aims to examine the frequency and content of healthcare providers' nutrition recommendations and referrals Registered Dietitian Nutritionists (RDN).Physicians, physician assistants, nurses, and other providers (> 18 years of age) currently practicing primarily in the United States received an email survey that assessed dietary recommendations for diabetes, hypertension, dyslipidemia, overweight/obesity, and general wellbeing, frequency and comfort level of providing nutrition advice, and RDN referrals. Chi-square and Student's t-tests were used for analysis.154 physicians (61%), registered nurses/nurse practitioners/physician assistants (19.5%), and other providers (19.5%) were included. Those with nutrition education gave nutrition advice more than those without for some, but not all, conditions (P = .01). The Mediterranean diet was most frequently recommended, except for hypertension. The DASH diet was recommended to 47.7% of patients with hypertension. More providers gave dietary advice than referred to RDNs. Dietary advice was associated with RDN referrals for diabetes (P = .01) and wellbeing (P = .05). Providers with an RDN in their practice provided advice for diabetes more than those without (P = .01).Healthcare providers gave nutrition recommendations consistent with evidence-based guidance. RDN referrals occur in conjunction with dietary recommendations, not as replacement.

  View details for DOI 10.1177/15598276221092304

  View details for Web of Science ID 000800563400001

  View details for PubMedID 38511118

  View details for PubMedCentralID PMC10948933

• The Benefits of Physical Activity for People with Obesity, Independent of Weight Loss: A Systematic Review INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Pojednic, R., D'Arpino, E., Halliday, I., Bantham, A. 2022; 19 (9)

  Abstract

  Purposeful weight loss continues to be the primary focus for treating obesity. However, this strategy appears to be inadequate as obesity rates continue to rise and a myriad of benefits of physical activity that affect multiple health outcomes related to obesity and associated comorbidities are not integrated into treatment strategies. There are emerging correlational data in individuals with obesity that demonstrate physical activity can be beneficial to many critical health markers, independent of weight loss or changes in BMI. This systematic review investigates interventional studies that examine health markers, independent of weight loss, in individuals with obesity. Fourteen studies were identified that utilized a variety of physical activity interventions with primary endpoints that included cellular, metabolic, systemic and brain health outcomes. The review of the literature demonstrates that for individuals with obesity, there are both small-scale and large-scale physiologic benefits that occur with increased physical activity of various modalities. Focusing on these benefits, rather than a narrow focus of weight loss alone, may increase physical activity behavior and health for individuals with obesity.

  View details for DOI 10.3390/ijerph19094981

  View details for Web of Science ID 000794796300001

  View details for PubMedID 35564376

  View details for PubMedCentralID PMC9102424

• Vitamin D deficiency associated with risk of prediabetes among older adults: Data from the National Health and Nutrition Examination Survey (NHANES), 2007-2012 DIABETES-METABOLISM RESEARCH AND REVIEWS Pojednic, R. M., Trussler, E. M., Navon, J. D., Lemire, S. C., Siu, E. C., Metallinos-Katsaras, E. S. 2022; 38 (3): e3499

  Abstract

  To examine the association between vitamin D (25(OH)D) deficiency and risk of prediabetes in Americans 50+ years of age.This was a cross-sectional analysis of NHANES (2007-2012) subjects aged 50+ years, free of kidney/liver diseases and diabetes. Prediabetes was defined as: HbA1c level 5.7%-6.4%, or fasting plasma glucose level 100-125 mg/dL, or Oral Glucose Tolerance Test result 140-199 mg/dL, with no laboratory value in the diabetic range. The comparison group had normal glucose tolerance (NGT) with no marker in the prediabetes/diabetes range. Total serum 25(OH)D levels were deficient at <50 nmol/L, insufficient 50-75 nmol/L, and sufficient >75 nmol/L. Logistic regression included strata, cluster and weight variables. Models were adjusted for body mass index (BMI), ethnicity, age and gender.The final sample was 2286 adults, predominantly White (80.4%) and female (56.6%), with a mean age of 62.3 years. Within the sample, 1387 had prediabetes (59.1%) and 899 were NGT (40.9%). Individuals classified within a lower serum vitamin D category were more likely to have prediabetes (p = 0.03). Those with 25(OH)D deficiency were more likely to have prediabetes compared to 25(OH)D sufficient individuals (crude OR = 1.48, 95% CI 1.15-1.91), and this association remained significant after adjustment for ethnicity, BMI, age and gender (aOR = 1.39, 95% CI 1.02-1.89). There was no effect modification by BMI, gender or ethnicity.Vitamin D status was associated with risk of prediabetes in this sample of Americans 50+ years of age. Future research should seek to understand the potential mechanistic relationship between vitamin D and prediabetes.

  View details for DOI 10.1002/dmrr.3499

  View details for Web of Science ID 000705220800001

  View details for PubMedID 34590783

• Physicians' Perceptions of the Registered Dietitian Are Evolving The Importance of the RD on the Health Care Team and Order Writing Privileges TOPICS IN CLINICAL NUTRITION Pojednic, R., Gale, D., McFarland, M., Prelack, K. 2021; 36 (3): 213-223

  View details for DOI 10.1097/TIN.0000000000000255

  View details for Web of Science ID 000666866300004

• Identifying elements for a comprehensive paediatric cardiac rehabilitation programme CARDIOLOGY IN THE YOUNG Curran, T., Gauthier, N., Duty, S. M., Pojednic, R. 2020; 30 (10): 1473-1481

  Abstract

  The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.

  View details for DOI 10.1017/S1047951120002346

  View details for Web of Science ID 000612802200016

  View details for PubMedID 32778199

• Key Steps to Implementing Physical Activity into Health Professional Training Programs CURRENT SPORTS MEDICINE REPORTS Pojednic, R., Stoutenberg, M. 2020; 19 (10): 396-398

  View details for DOI 10.1249/JSR.0000000000000756

  View details for Web of Science ID 000596037000004

  View details for PubMedID 33031203

• Move It or Lose It: Summarizing Peer-reviewed Evidence for Practicing What You Preach CURRENT SPORTS MEDICINE REPORTS Bowersock, A. H., Jaworski, C. A., Pojednic, R. 2020; 19 (8): 286-289

  Abstract

  Physically active health care providers are more likely to provide physical activity (PA) counseling to their patients, but barriers in PA counseling exist. Common barriers include knowledge, time constraints, lack of reimbursement, as well as lack of personal habits. This article will summarize evidence-based knowledge regarding provider PA habits as a means of improving rapport, compliance, and empathy for patients when prescribing PA. Clinical pearls for successful PA counseling scenarios also will be discussed.

  View details for DOI 10.1249/JSR.0000000000000735

  View details for Web of Science ID 000561249700004

  View details for PubMedID 32769664

• Identifying Key Physical Activity Categories and Topics to Include in Health Professional Training Programs TEACHING AND LEARNING IN MEDICINE Stoutenberg, M., Powell, B. J., Busignani, P. J., Bowersock, A. H., Pojednic, R. 2020; 32 (4): 362-370

  Abstract

  Phenomenon: Healthcare is an important sector in promoting physical activity (PA). However, few health professional training programs include PA, nor does standardized guidance exist on implementing it in the curriculum. This study aimed to consolidate health professional expert opinion on key PA categories and topics that should be included in the curriculum of health professional training programs. Approach: A three-round, modified e-Delphi process examined the opinions of 73 experts from seven health professions (clinical nutrition, exercise physiology, medicine, nursing, occupational therapy, physical therapy, physician assistants). In Round 1, panelists reported importance, ranked, and scored five broad PA categories, and responded to open-ended prompts for additional categories. In Round 2, panelists received summary feedback, re-ranked and re-scored PA categories, and suggested key PA topics within the five categories. In the final round, panelists viewed, ranked, and scored the PA topics. Findings: Expert panelists felt that all PA categories were important, with Health Behavior Change ranking the highest (98.7%) followed by Cellular and Systemic Implications of Exercise, Clinical Exercise Physiology, and PA and Public Health. The Administrative Aspects of Integrating PA into Health Systems ranked least important (48.0%). A consensus on the key PA categories was considered reached after two rounds. Five to eight specific PA topics were generated within each PA category and ranked in order of importance. Insights: These findings highlight several key PA categories and topics that can serve as a foundation for a diverse number of health professional training programs.

  View details for DOI 10.1080/10401334.2020.1730183

  View details for Web of Science ID 000517393600001

  View details for PubMedID 32107937

• The association between Vitamin D deficiency and risk of pre-diabetes among older adults Trussler, E., Navon, J., Pojednic, R., Metallinos-Katsaras, E. CAMBRIDGE UNIV PRESS. 2020: E348

  View details for DOI 10.1017/S0029665120002967

  View details for Web of Science ID 000546638800281

• Translating Urban Walkability Initiatives for Older Adults in Rural and Under-Resourced Communities INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Klann, A., Linh Vu, Ewing, M., Fenton, M., Pojednic, R. 2019; 16 (17)

  Abstract

  The built environment can promote physical activity in older adults by increasing neighborhood walkability. While efforts to increase walkability are common in urban communities, there is limited data related to effective implementation in rural communities. This is problematic, as older adults make up a significant portion of rural inhabitants and exhibit lower levels of physical activity. Translating lessons from urban strategies may be necessary to address this disparity. This review examines best practices from urban initiatives that can be implemented in rural, resource-limited communities. The review of the literature revealed that simple, built environment approaches to increase walkability include microscale and pop-up infrastructure, municipal parks, and community gardens, which can also increase physical activity in neighborhoods for urban older adults. These simple and cost-effective strategies suggest great potential for rural communities.

  View details for DOI 10.3390/ijerph16173041

  View details for Web of Science ID 000487037500036

  View details for PubMedID 31443359

  View details for PubMedCentralID PMC6747272

• Association Between Menstrual Dysfunction, Bone Stress Injuries and Risk for Disordered Eating in Female Collegiate Athletes Bugbee, M., Wilson, S., Pojednic, R. LIPPINCOTT WILLIAMS & WILKINS. 2019: 733-734

  View details for DOI 10.1249/01.mss.0000562690.77872.e2

  View details for Web of Science ID 000481662802667

• Implementation of the Exercise Prescription LIFESTYLE MEDICINE, 3RD EDITION Pojednic, R. M., Loveland, C. R., Jones, S. edited by Rippe, J. M. 2019: 147-152

  View details for Web of Science ID 000569702400012

• Improved Access to and Impact of Registered Dietitian Nutritionist Services Associated with an Integrated Care Model in a High-Risk, Minority Population JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS Warner, M. F., Miklos, K. E., Strowman, S. R., Ireland, K., Pojednic, R. M. 2018; 118 (10): 1951-1957

  Abstract

  Integrated health care models create opportunities for registered dietitian nutritionists (RDNs) to provide nutrition-related care and engage in multidisciplinary teams to improve clinical outcomes. While benefits of integrated care (IC) have been reported, little is known about the impact of the RDN within an IC model.Our primary objective was to identify whether IC vs traditional care (TC) increases the number of RDN patient visits. Our secondary objective was to evaluate clinical outcomes of patients seeing an RDN vs not, regardless of care model.This was a retrospective cohort study.Patients were aged 3 to 94 years and from a patient-centered medical home in Boston, MA.We measured 3-month total and average number of patients seen by the RDN in TC vs IC. Changes in adult hemoglobin A1c, weight, and pediatric body mass index (measured as kg/m2) among high-risk patients seen by an RDN compared to patients not seen by an RDN.Data were obtained from electronic medical records and analyzed utilizing Mann-Whitney U test, analysis of covariance, and paired sample t tests.The RDN saw 145 patients (137 adult, 8 pediatric) in the TC model compared to 185 patients (135 adult, 50 pediatric) in the IC model. Mean number of patients seen per session was 3.20 in the TC model vs 4.63 in the IC model (P=0.004). Adult hemoglobin A1c within-group differences decreased by 0.42%±1.49% (P=0.007) for patients seen by an RDN and decreased 0.15%±1.47% (P=0.012) for patients not seen by an RDN. Adult weight within-group differences decreased 1.0±7.2 kg (P=0.15) for patients seen by a RDN and increased 0.1±5.6 kg (P=0.70) for patients not seen by a RDN. Pediatric BMI showed no change between or within groups.The IC model increased 3-month total number of patients seen by an RDN. High-risk patients who saw an RDN had a significant decrease in hemoglobin A1c.

  View details for DOI 10.1016/j.jand.2018.05.004

  View details for Web of Science ID 000445432100013

  View details for PubMedID 30029962

• Bridging the gap between clinicians and fitness professionals: a challenge to implementing exercise as medicine BMJ OPEN SPORT & EXERCISE MEDICINE Pojednic, R., Bantham, A., Arnstein, F., Kennedy, M. A., Phillips, E. 2018; 4 (1): e000369

  Abstract

  Health clubs (HC) and personal trainers (PT) are traditional outlets for the promotion of physical activity (PA) and exercise programming. As physicians are increasingly being called on to write exercise prescriptions for their patients, this study sought to investigate the level of integration between the healthcare and fitness systems.An internet study was designed with five domains to understand physicians': (1) overall perception of HC, (2) appropriateness and recommendation of HC and PT to their patients, (3) attitude regarding specific aspects of HC, (4) support of patient participation in HC sponsored exercise and (5) elements of HC that physicians would like to know for referral.An electronic survey was sent to members of two mailing lists of primary care and sports medicine specialty physicians during 2011-2012.On a Likert scale of 1-10 412 physicians reported being familiar with HC (8.9±2.1), indicated a favourable view of HC (7.9±2.2), and believe HC to be an appropriate venue for their patients (7.5±2.3). However, physicians only recommend HC to 41%±28% of their patients and PT for only 21%±21.6% of patients. Physicians ranked expense and convenience as the most problematic elements of HC (8.1±2.1 and 6.3±2.5, respectively). 72% of physicians indicated cost as most concerning when recommending a specific HC.HC and PT are a significant implementation system for the promotion of physical activity, yet physicians are concerned with several elements of HC and are not adequately relying on this partnership to promote physical activity to their patients.

  View details for DOI 10.1136/bmjsem-2018-000369

  View details for Web of Science ID 000596798200077

  View details for PubMedID 30364472

  View details for PubMedCentralID PMC6196940

• Practice patterns, counseling and promotion of physical activity by sports medicine physicians JOURNAL OF SCIENCE AND MEDICINE IN SPORT Pojednic, R. M., Polak, R., Arnstein, F., Kennedy, M. A., Bantham, A., Phillips, E. M. 2017; 20 (2): 123-127

  Abstract

  This study examined sports medicine physicians with an established interest in physical activity to investigate attitudes surrounding exercise, physical activity and patient-counseling behavior. The degree to which physicians' personal knowledge of physical activity and related resources, involvement with common activities, and perceived barriers were assessed.An internet survey was designed in four domains: (1) counseling behavior, (2) tools and resources, (3) appropriateness of common physical activities for patients and (4) barriers.The survey was sent to 3570 members of two electronic mailing lists - Institute of Lifestyle Medicine, Boston, MA and The American College of Sports Medicine. Surveys were emailed during 2011-2012 and analyzed in 2013-2014. Each survey contained 39 questions.The response rate of the surveys was 16%. Of 412 physicians, 74% regularly recommended physical activity, 66% talked about exercise with patients, and 49% included as a vital sign. Only 26% of physicians provided a written exercise prescription. ACSM's Exercise is Medicine® (37%) was the most popular resource. Walking, followed by aerobic activity, strength training and cycling were the most recommended forms of activity and were associated with physicians' personal experiences. The most potent inhibitor was time.Physicians with an interest in exercise and physical activity recognize the importance of recommending and counseling patients on exercise and physical activity. Physician counseling was associated with personal familiarity with physical activity. Increasing knowledge and experience with exercise, physical activity and counseling behavior is an important component to encourage physical activity assessment and promotion by sports medicine physicians.

  View details for DOI 10.1016/j.jsams.2016.06.012

  View details for Web of Science ID 000398327200004

  View details for PubMedID 27460911

• A parallel curriculum in lifestyle medicine CLINICAL TEACHER Pojednic, R., Frates, E. 2017; 14 (1): 27-31

  Abstract

  Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours such as diet, physical activity or weight control, despite the prediction by the World Health Organization that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. This gap in patient-clinician dialogue is perhaps the result of a lack of structured training in medical school surrounding the components of lifestyle medicine.Although Harvard Medical School does have a required course in nutrition, there are no requirements for the other components of lifestyle medicine, including physical activity, behaviour change and self-care.Since 2009 Harvard Medical School has addressed this absence in the curriculum by developing a student-led, faculty member-advised, parallel curriculum in lifestyle medicine. Medical student participants were invited to take part in anonymous questionnaires between 2009 and 2013, which gathered data about personal ability and attitude in counselling patients on lifestyle behaviours, as well as subjective data on the curriculum content and applications to effective medical practice. Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours IMPLICATION: Each year, students have pointed to a lack of lifestyle medicine knowledge because of a gap in the traditional curriculum surrounding topics such as physical activity, nutrition and behaviour-change strategies, and indicated that the inclusion of this knowledge and these skills was an important component of medical education. Although participation is currently voluntary, this is the first such curriculum of this type and addresses a critical gap in undergraduate medical education.

  View details for DOI 10.1111/tct.12475

  View details for Web of Science ID 000392740100005

  View details for PubMedID 26639320

• The Effect of Physical Activity on Child Development Peabody, S., Pojednic, R., Carson, S. H., Kennedy, M., Bevans, K., Tavares, E. M., Phillips, E. M. ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. 2017: A111-A112

  View details for Web of Science ID 000401115400180

• The effect of before school physical activity on child development: A study protocol to evaluate the Build Our Kids Success (BOKS) Program CONTEMPORARY CLINICAL TRIALS Pojednic, R., Peabody, S., Carson, S., Kennedy, M., Bevans, K., Phillips, E. M. 2016; 49: 103-108

  Abstract

  Most childhood physical activity interventions focus on reducing childhood obesity with varying success, indicating that body mass index (BMI) may be a limited marker of health in children. To better understand overall childhood health and wellbeing, this study is investigating BOKS (Build Our Kids Success), an established ongoing before-school physical activity program, to evaluate students' physical health, mental health, cognitive capacity, and academic performance.The study is a non-randomized controlled trial with 26 elementary and middle schools in 3 Massachusetts communities, including first through eighth grade (aged 5-14) students, their parents, and teachers. Data collection is occurring during the 2015-2016 school year. Physical fitness is being assessed via 400m run and anthropometrics via height and weight measures (BMI). Psychosocial outcomes are being assessed via student, parent, and teacher survey and include nutrition, daily activities, emotional and relationship scales, bullying and victimization, vitality and energy, student engagement, stress, positive affect, self-efficacy and life satisfaction. Academic performance is reported by grades. Statistical methods include a psychometric evaluation of study measures, Pearson correlations, Student's t-tests, ANOVA/ANCOVA and multivariate linear regression including multilevel modeling analyses to account for the hierarchical organization of the data.This study is investigating a before school physical activity program on parameters of physical health, mental health, cognitive capacity, and academic performance by employing a novel triad approach, correlating the input of the child, parent, and teacher. Outcomes will evaluate the effectiveness of a before school physical activity program in elementary and middle schools and potentially provide valuable information for schools looking to institute innovative physical activity programs.

  View details for DOI 10.1016/j.cct.2016.06.009

  View details for Web of Science ID 000381543800014

  View details for PubMedID 27339866

• Lifestyle Medicine Education AMERICAN JOURNAL OF LIFESTYLE MEDICINE Polak, R., Pojednic, R. M., Phillips, E. M. 2015; 9 (5): 361-367

  Abstract

  The actual causes of premature adult deaths, the preponderance of noncommunicable chronic diseases, and their associated costs are related to unhealthy behaviors, such as poor nutrition, physical inactivity, and tobacco use. Although recommended as the first line of prevention and management, providers often do not provide behavioral change counseling in their care. Medical education in lifestyle medicine is, therefore, proposed as a necessary intervention to allow all health providers to learn how to effectively and efficiently counsel their patients toward adopting and sustaining healthier behaviors. Lifestyle medicine curricula, including exercise, nutrition, behavioral change, and self-care, have recently evolved in all levels of medical education, together with implementation initiatives like Exercise is Medicine and the Lifestyle Medicine Education (LMEd) Collaborative. The goal of this review is to summarize the existing literature and to provide knowledge and tools to deans, administrators, faculty members, and students interested in pursuing lifestyle medicine training or establishing and improving an LMEd program within their institution.

  View details for DOI 10.1177/1559827615580307

  View details for Web of Science ID 000446738000007

  View details for PubMedID 26413038

  View details for PubMedCentralID PMC4561845

• Lifestyle Medicine Curricula: An Initiative to Include Lifestyle Medicine in Our Nation's Medical Schools ACADEMIC MEDICINE Pojednic, R. M., Trilk, J., Phillips, E. M. 2015; 90 (7): 840-841

  View details for DOI 10.1097/ACM.0000000000000744

  View details for Web of Science ID 000357093500007

  View details for PubMedID 26414051

• Vitamin D receptor protein is associated with interleukin-6 in human skeletal muscle ENDOCRINE Pojednic, R. M., Ceglia, L., Lichtenstein, A. H., Dawson-Hughes, B., Fielding, R. A. 2015; 49 (2): 512-520

  Abstract

  Vitamin D is associated with skeletal muscle physiology and function and may play a role in intramuscular inflammation, possibly via the vitamin D receptor (VDR). We conducted two studies to examine (1) whether serum 25-hydroxyvitamin D (25OHD) and/or intramuscular VDR protein concentrations are associated with intramuscular interleukin-6 (IL-6) and/or tumor necrosis factor-α (TNFα); and (2) whether 16-week supplementation with vitamin D3 alters intramuscular IL-6 and/or TNFα. Potential-related signaling pathways were also examined. Muscle biopsies of 30 older, mobility-limited adults were obtained at baseline. A subset of 12 women were supplemented with either 4,000 IU/day of vitamin D3 (N = 5) or placebo (N = 7), and biopsies were repeated at 16 weeks. Serum 25OHD was measured, and intramuscular VDR, IL-6, and TNFα gene expressions and protein concentrations were analyzed. Baseline serum 25OHD was not associated with intramuscular IL-6 or TNFα gene expression or protein concentration. Baseline intramuscular VDR protein concentration, adjusted for baseline serum 25OHD, was positively associated with intramuscular IL-6 gene expression (n = 28; p = 0.04), but negatively associated with intramuscular IL-6 protein (n = 18; p = 0.03). Neither intramuscular IL-6 nor TNFα gene expression was different between placebo (n = 7) or vitamin D3 supplementation groups (n = 5) after 16 weeks (p = 0.57, p = 0.11, respectively). These data suggest that VDR is a better predictor than serum 25OHD concentration of intramuscular IL-6 gene and protein expressions. A similar relationship was not observed for TNFα expression. Further, supplementation with 4,000 IU vitamin D3 per day does not appear to affect intramuscular IL-6 or TNFα gene expression after 16 weeks.

  View details for DOI 10.1007/s12020-014-0505-6

  View details for Web of Science ID 000355230500025

  View details for PubMedID 25510525

  View details for PubMedCentralID PMC4447580

• Physical Activity Assessment and Promotion: Physicians' Practice Patterns Suggest Gains And Promising Opportunities For Improvement Phillips, E. M., Pojednic, R. M., Navaie, M., Polak, R., Bantham, A., Kennedy, M. A., Arnstein, F., Solomon, D. J. LIPPINCOTT WILLIAMS & WILKINS. 2015: CP509

  View details for DOI 10.1249/01.mss.0000478205.55241.9b

  View details for Web of Science ID 000415220900014

• Effects of 1,25-Dihydroxyvitamin D₃ and Vitamin D₃ on the Expression of the Vitamin D Receptor in Human Skeletal Muscle Cells CALCIFIED TISSUE INTERNATIONAL Pojednic, R. M., Ceglia, L., Olsson, K., Gustafsson, T., Lichtenstein, A. H., Dawson-Hughes, B., Fielding, R. A. 2015; 96 (3): 256-263

  Abstract

  Vitamin D receptor (VDR) expression and action in non-human skeletal muscle have recently been reported in several studies, yet data on the activity and expression of VDR in human muscle cells are scarce. We conducted a series of studies to examine the (1) effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on VDR gene expression in human primary myoblasts, (2) effect of 16-week supplementation with vitamin D3 on intramuscular VDR gene expression in older women, and (3) association between serum 25-hydroxyvitamin D (25OHD) and intramuscular VDR protein concentration in older adults. Human primary myoblasts were treated with increasing concentrations of 1,25(OH)2D3 for 18 h. A dose-dependent treatment effect was noted with 1 nmol/L of 1,25OH2D3 increasing intramuscular VDR mRNA expression (mean fold change±SD 1.36±0.33; P=0.05). Muscle biopsies were obtained at baseline and 16 weeks after vitamin D3 supplementation (4,000 IU/day) in older adults. Intramuscular VDR mRNA was significantly different from placebo after 16 weeks of vitamin D3 (1.2±0.99; -3.2±1.7, respectively; P=0.04). Serum 25OHD and intramuscular VDR protein expression were examined by immunoblot. 25OHD was associated with intramuscular VDR protein concentration (R=0.67; P=0.0028). In summary, our study found VDR gene expression increases following treatment with 1,25OH2D3 in human myoblasts. 25OHD is associated with VDR protein and 16 weeks of supplementation with vitamin D3 resulted in a persistent increase in VDR gene expression of vitamin D3 in muscle tissue biopsies. These findings suggest treatment with vitamin D compounds results in sustained increases in VDR in human skeletal muscle.

  View details for DOI 10.1007/s00223-014-9932-x

  View details for Web of Science ID 000350676500008

  View details for PubMedID 25479835

  View details for PubMedCentralID PMC4429607

• Including lifestyle medicine in undergraduate medical curricula MEDICAL EDUCATION ONLINE Phillips, E., Pojednic, R., Polak, R., Bush, J., Trilk, J. 2015; 20

  View details for DOI 10.3402/meo.v20.26150

  View details for Web of Science ID 000349345100001

• Innovation in diabetes care: improving consumption of healthy food through a "chef coaching" program: a case report. Global advances in health and medicine Polak, R., Dill, D., Abrahamson, M. J., Pojednic, R. M., Phillips, E. M. 2014; 3 (6): 42-8

  Abstract

  Nutrition therapy as part of lifestyle care is recommended for people with type 2 diabetes. However, most people with diabetes do not follow this guideline. Changing eating habits involves obtaining knowledge and building practical skills such as shopping, meal preparation, and food storage. Just as fitness coaches use their specific knowledge base in fitness to enhance the effectiveness of their coaching, credentialed chefs trained as health coaches might combine their culinary expertise with coaching in order to improve clients' food choices and lifestyles. This report documents the case of a 55-year-old white male physician, single and living alone, who was recently diagnosed with type 2 diabetes and reported chronic stress, sedentary behavior, and unhealthy eating habits. He participated in a chef coaching program of 8 weekly one-on-one 30-minute coaching sessions via Skype delivered by a chef trained as a health coach. During the first five meetings, the patient's goals were primarily culinary; however, with his success in accomplishing these goals, the patient progressed and expanded his goals to include other lifestyle domains, specifically exercise and work-life balance. At the end of the program, the patient had improved both his nutritional and exercise habits, his confidence in further self-care improvement, and his health parameters such as HgA1c (8.8% to 6.7%; normal <6.5%). We conclude that chef coaching has the potential to help people with diabetes improve their practical culinary skills and implement them so that they eat better and, further, has the potential to help them improve their overall self-care. We intend to further develop chef coaching and assess its potential as we learn from its implementation.

  View details for DOI 10.7453/gahmj.2014.059

  View details for PubMedID 25568831

• The Emerging Biomolecular Role of Vitamin D in Skeletal Muscle EXERCISE AND SPORT SCIENCES REVIEWS Pojednic, R. M., Ceglia, L. 2014; 42 (2): 76-81

  Abstract

  In this review, we summarize current evidence for a direct effect of vitamin D on skeletal muscle. A number of studies identify the receptor for 1,25-dihydroxyvitamin-D3 (vitamin D receptor (VDR)) and the enzyme CYP27B1 (1-α-hydroxylase) in muscle. We hypothesize that vitamin D acts on myocytes via the VDR, and we examine proposed effects on myocyte proliferation, differentiation, growth, and inflammation.

  View details for DOI 10.1249/JES.0000000000000013

  View details for Web of Science ID 000333169900006

  View details for PubMedID 24508736

  View details for PubMedCentralID PMC4369924

• Longitudinal Decline of Neuromuscular Activation and Power in Healthy Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Clark, D. J., Pojednic, R. M., Reid, K. F., Patten, C., Pasha, E. P., Phillips, E. M., Fielding, R. A. 2013; 68 (11): 1419-1425

  Abstract

  Weakness contributes to the decline of physical function that occurs with aging. Contradictory findings have been reported as to whether neuromuscular activation is impaired with aging, and the extent to which it contributes to weakness. The present study uses a longitudinal design to assess how potential age-related change of neuromuscular activation affects strength, power, and mobility function.Participants included 16 healthy older adults who were healthy and high functioning at baseline. Strength was measured by leg press one repetition maximum. Power production was measured during a maximal effort rapid leg press movement with resistance set to 70% of the one repetition maximum. During the same movement, neuromuscular activation was quantified as the rate of rise of the quadriceps surface electromyogram (rate of electromyogram rise). Thigh muscle cross-sectional area was measured by computed tomography. Mobility function was assessed by the Short Physical Performance Battery.The time between baseline and follow-up testing was almost 3 years. Between these time points, rate of electromyogram rise decreased 28% (p = .004) and power decreased 16.5% (p = .01). There was a trend for reduced anterior thigh muscle cross-sectional area (3%, p = .05), but no change in posterior thigh muscle cross-sectional area (p = .84), one repetition maximum strength (p = .72), or Short Physical Performance Battery score (p = .17). Loss of power was strongly associated with reduction in the rate of electromyogram rise (R (2) = .61, p < .001), but not with reduction of anterior thigh muscle cross-sectional area (p = .83).The present findings suggest that voluntary neuromuscular activation declines with advancing age, contributes to a reduction in power production, and precedes the decline of mobility function.

  View details for DOI 10.1093/gerona/glt036

  View details for Web of Science ID 000325996800012

  View details for PubMedID 23676250

  View details for PubMedCentralID PMC3805299

• Effects of alkali supplementation and vitamin D insufficiency on rat skeletal muscle ENDOCRINE Ceglia, L., Rivas, D. A., Pojednic, R. M., Price, L., Harris, S. S., Smith, D., Fielding, R. A., Dawson-Hughes, B. 2013; 44 (2): 454-464

  Abstract

  Data on the independent and potential combined effects of acid-base balance and vitamin D status on muscle mass and metabolism are lacking. We investigated whether alkali supplementation with potassium bicarbonate (KHCO3), with or without vitamin D3 (± VD3), alters urinary nitrogen (indicator of muscle proteolysis), muscle fiber cross-sectional area (FCSA), fiber number (FN), and anabolic (IGF-1, Akt, p70s6k) and catabolic (FOXO3a, MURF1, MAFbx) signaling pathways regulating muscle mass. Thirty-six, 20-month-old, Fischer 344/Brown-Norway rats were randomly assigned in a 2 × 2 factorial design to one of two KHCO3-supplemented diets (± VD3) or diets without KHCO3 (± VD3) for 12 weeks. Soleus, extensor digitorum longus (EDL), and plantaris muscles were harvested at 12 weeks. Independent of VD3 group, KHCO3 supplementation resulted in 35 % lower mean urinary nitrogen to creatinine ratio, 10 % higher mean type I FCSA (adjusted to muscle weight), but no statistically different mean type II FCSA (adjusted to muscle weight) or FN compared to no KHCO3. Among VD3-replete rats, phosphorylated-Akt protein expression was twofold higher in the KHCO3 compared to no KHCO3 groups, but this effect was blunted in rats on VD3-deficient diets. Neither intervention significantly affected serum or intramuscular IGF-1 expression, p70s6k or FOXO3a activation, or MURF1 and MAFbx gene expression. These findings provide support for alkali supplementation as a promising intervention to promote preservation of skeletal muscle mass, particularly in the setting of higher vitamin D status. Additional research is needed in defining the muscle biological pathways that are being targeted by alkali and vitamin D supplementation.

  View details for DOI 10.1007/s12020-013-9976-0

  View details for Web of Science ID 000325360800026

  View details for PubMedID 23666769

  View details for PubMedCentralID PMC4435679

• Skeletal muscle vitamin D receptor associated with serum 25-hydroxyvitamin D Pojednic, R. M., Ceglia, L., Lichtenstein, A., Dawson-Hughes, B., Fielding, R. FEDERATION AMER SOC EXP BIOL. 2013

  View details for Web of Science ID 000319883500657

• The specific contributions of force and velocity to muscle power in older adults EXPERIMENTAL GERONTOLOGY Pojednic, R. M., Clark, D. J., Patten, C., Reid, K., Phillips, E. M., Fielding, R. A. 2012; 47 (8): 608-613

  Abstract

  The purpose of this study is to examine the relative importance of the force-based and velocity-based measures of muscle performance to explain inter-individual differences in power production capability and functional task performance. Participants included seventy-nine men and women: middle-aged healthy adults (MH: 40-55years), older healthy adults (OH: 70-85years), and older adults with mobility limitations (OML: 70-85years). Muscle power at 180°/s, isometric maximal torque, and maximal contraction velocity at 40% 1RM were measured during unilateral leg extension. The Short Physical Performance Battery (SPPB) was used to differentiate between healthy and mobility limited older adults. Functional task performance was assessed using multiple chair rise and stair climb tests. Leg extensor force (torque), but not maximal contraction velocity, was significantly associated with muscle power in MH. Both torque and velocity were significantly associated with muscle power in OH. Maximal velocity, but not torque, was associated with power in OML. Maximal velocity demonstrated an association with multiple chair rise time and stair climb time in OML, but not MH or OH. It is concluded that movement velocity is an increasingly important determinant of maximal power output with advancing age. Furthermore, movement velocity is also a critical component of functional task performance with aging and may contribute to functional deficits. These findings help to explain why the rate-dependent variable power has emerged as a critical component of both assessment and rehabilitation of muscular performance and physical function in older adults.

  View details for DOI 10.1016/j.exger.2012.05.010

  View details for Web of Science ID 000306106500009

  View details for PubMedID 22626972

  View details for PubMedCentralID PMC3778449