Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

[Formulae and special characters can only be approximated here. Please see the pdf version of the abstract for an accurate reproduction.] Two randomised controlled trials were conducted to explore the relationship between the consumption of alcoholic beverages and cardiovascular disease risk factors. Study 1 was primarily designed to test the hypothesis that the cardio-protective effect of light alcohol could be mediated, in part, via improvements in endothelial function. Study 1 was also designed to explore the effect of alcohol on both traditional risk factors for cardiovascular disease, such as changes in lipid profile, haemostatic factors and blood pressure, and novel risk factors such as homocysteine, markers of inflammation and oxidative stress. The experimental design of this study also allowed us to determine whether reducing alcohol intake in these moderate-to-heavy drinkers could improvement insulin sensitivity, a component of the metabolic syndrome. In this group of sixteen healthy middle-aged men with a history of moderate to heavy alcohol intake of seven standard drinks per day, reducing intake down to approximately one standard drink per day for four weeks had no beneficial effects on conduit vessel endothelial function as assessed by post-ischaemic brachial artery flow-mediated dilatation, nor were there any detectable changes in soluble E-selectin, endothelin-1 and von Willebrand Factor, which are considered biomarkers of endothelial activation. As this study did not investigate the effect of alcohol on endothelial function in resistance vessels, it cannot exclude the possibility that alcohol may affect endothelial cells resident in that vascular bed. This study does show and confirm, however, that the relationship between alcohol and risk factors for cardiovascular disease is an extremely complex one. On the one hand it demonstrated that alcohol was potentially harmful, increasing blood pressure, plasma F2-isoprostane (oxidative stress), and homocysteine. On the other hand it showed that increasing alcohol intake led to significant reductions in two (i.e. fibrinogen and IL-6) of five inflammatory markers, in addition to improving the HDL-cholesterol profile of these subjects. Although the effects of alcohol on blood pressure, fibrinogen and HDL-cholesterol are not in themselves new, they support our choice of study design and strengthen the argument in favour of accepting the more novel findings of this study, specifically, the lack of effect on endothelial function and insulin sensitivity, and the harmful effect of alcohol in increasing oxidative stress and homocysteine. Study 2 was primarily designed to test the hypothesis that the consumption of red wine may confer greater cardio-protection than beer via improvements in endothelial function. Simultaneously, the study was also designed to determine whether drinking red wine for 4-weeks would have different effects than beer on either traditional risk factors for cardiovascular disease (i.e. blood pressure and lipid profile) or the more novel risk factors, homocysteine and oxidative stress. Using a randomised controlled cross-over study design, Study 2 provides evidence that the regular daily consumption of 4 standard drinks of either beer or red wine does not alter endothelial function, as measured by post-ischaemic flow-mediated vasodilatation of the brachial artery in healthy middle-aged men, nor was there evidence of any beneficial effect of de-alcoholised red wine on brachial artery response. As compliance with drinking protocol was confirmed with increased serum γ-GT and HDL during red wine and beer periods, and increased 24-hr urinary excretion of 4OMGA during red wine and de-alcoholised red wine periods, we are confident that there was excellent compliance with the beverage treatments. Study 2 also provides the first evidence from a carefully controlled intervention study that both red wine and beer elevate blood pressure to a similar degree, with no detectable difference in the magnitude of either treatment. As with endothelial function, there was also no evidence of any beneficial effect of de-alcoholised red wine on blood pressure. In addition, although post hoc analysis found evidence that alcohol increased both plasma homocysteine and urinary excretion of F2-isoprostane and endothelin-1, there was no apparent protective effect conferred from either red wine or de-alcoholised red wine on these cardiovascular risk markers. The results from this study cannot disprove the hypothesis that red wine is more beneficial for cardiovascular health; however, they suggest that if red wine has properties beyond those of beer to confer protection, they are not via any interactions with the nitric oxide regulatory function of the endothelium in conduit vessels nor are they via moderation of the vasopressor, homocysteine-raising, and oxidative stress effects of alcohol. The interpretation of the findings from both intervention studies and their place in the context of our current understanding of the role that alcoholic beverages play in the development and/or prevention of cardiovascular disease are explored in this thesis.

Thesis (Ph. D. (Medical Sciences)) -- University of Limpopo, 2016 / Refer to document / The Belgium Development Co-operation through VLIR-UOS, The University of Limpopo,and The Flemish Universities

Macrophage-derived foam cells play a predominant role in the deposition of arterial plaques during the early stages of atherosclerosis. The deposition of arterial plaques is known to be effected by several factors, including a person’s dietary habits. The consumption of a high-fat (>60% of calories from fat) meal is known to elevate serum LDL and triglycerides, which have been previously implicated in the formation pf foam cells. One limitation of current research models is that it is not possible to directly measure foam cells in vivo. Thus, the purpose of the present study was to validate the use of blood derived monocytes as a proxy measure of foam cells. In order to complete this objective, we evaluated monocyte oxLDL phagocytosis capacity following consumption of a high-fat meal. Eight men and women participated in the present study and venous blood samples were collected prior to the meal, 1-h, 3-h, and 5-h post-meal. Monocytes (CD14+/16- and CD14+/16+) were evaluated for adhesion molecule expression (CD11a, CD11b, and CD18), scavenger R (CD36) expression, and oxLDL phagocytosis using an image-based flow cytometry method developed in our laboratory for this purpose. Data was statistically analyzed for significance using a single-factor ANOVA with repeated measures and a p < 0.05. Consumption of a high-fat meal caused an increase significant increase in the proportion of pro-inflammatory monocytes (CD14+/16+) and a decrease in classic monocytes (CD14+/16-), with the greatest difference occurring at 5 h post prandial (p = 0.038). We also found that pro-inflammatory monocyte expression of adhesion molecules and CD36 increased in a manner that would promote in vivo movement of monocytes into the subendothelial space. Finally, over the course of the 5 h postprandial period, the majority of oxLDL uptake occurred in pro-inflammatory compared to classic monocytes. These results suggest that consuming a high-fat meal increases the potential of monocytes to become foam cells for at least 5 h postprandial.

Thesis (Ph.D. (Health Sciences)) -- University of Limpopo, 2022 / Background: Cardio Vascular Diseases(CVD) are presently the main cause of high mortality rate around the world. In sub-Saharan Africa, CVDs contributes to about 13% of deaths, with 80% deaths being recorded from developing countries. Behavioural and metabolic risk factors contribute to high mortality rate related to development of CVD which self-management strategies and practices could effectively prevent. Objective: To explore and develop ―self-management strategies‖ to prevent the development of CVD among patients living with chronic conditions at Ga Molepo Area clinics in the Limpopo Province, South Africa. Methods: “A mixed method exploratory sequential design study was conducted in four primary health care settings in a rural setting.‖ A semi structured one-on-one interviews were conducted with 43 patients selected by non-probability homogenous purposive sampling for a qualitative strand. Qualitative findings that was obtained with thematic ―Tesch‘s open coding data analysis method guided the quantitative strand‖. A simple random sampling was used to sample 347 respondents for the quantitative strand.Descriptive statistics and chi-square were applied to analyze data from the quantitative strand. ``Results: The qualitative results revealed that there is different self management strategies used by patients living with hypertension and Diabetes Mellitus as risk factors of CVDs. The self-management strategies include engaging in physical activity, eating a healthy balanced diet, drinking a lot of water and adhering to treatment. The quantitative revealed majority of participants(74%) perform mild exercises with 26% performing moderate exercis.On the other hand 7% are having stress and depression and while 7% are smoking.`` Conclusions:The findings indicated that by adopting self-management strategies could be an effective way of preventing the development of CVD which complicates to hypertension and diabetic mellitus .Therefore are encouraged to adhere to strategies adhere to treat,healthy diet and perform mild exercises Recommendations Hence, the government needs to appoint CHW permanently to strengthen the guidelines on the prevention of CVD and also the risk factors that put the communities at risk of developing CVD. Communities need to adhere to preventative strategies ti order prevent CVD. / SPICES Project - (Scaling -up Packages of Interventions for CVD prevention in Europe and sub-Saharan)

published_or_final_version / Sports Science / Master / Master of Science in Sports Science

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

This study evaluated a mandatory fitness assessment and counseling program designed to reduce coronary risk factors related to diet and exercise. The study was conducted at a southwestern graduate level theological institution. There were 19 mandatory and 22 voluntary participants. Each subject initially had either high blood pressure, high percentage body fat, or high total cholesterol. Significant changes were made within both groups regarding body fat percentage and diastolic blood pressure. Total cholesterol levels decreased for the voluntary group only. The mandatory group significantly improved their exercise level, yet still showed a significantly less positive attitude towards exercise. Overall, the fitness assessment and counseling was somewhat beneficial for both the mandatory and voluntary groups.

Persons with serious mental illness (SMI) are in worse physical health compared to persons in the general population and are more likely to develop medical conditions, such as obesity and diabetes, which place them at risk for cardiovascular disease (CVD). There is some evidence that Hispanics with serious mental illness are at greater risk for developing CVD risk factors compared to non-Hispanic Whites with SMI mainly due to health disparities. This study asks the questions: 1) What self-management behaviors do Hispanics with SMI and at risk of CVD engage in or attempt to engage in?, 2) How do measures of self-efficacy and patient activation correspond to self-management behaviors and barriers?, and 3) How do patients’ and stakeholders’ reports of barriers converge or diverge? Self-efficacy theory and social ecology theory were used as theoretical frameworks. Twenty four consumers were recruited from an outpatient mental health clinic. Seventeen stakeholders were recruited through various sites. A convergent mixed methods approach was used. Quantitative measures of self-efficacy and patient activation were compared to qualitative data on self-management behaviors and barriers to healthy living. Additionally, two sets of qualitative data on consumers’ and stakeholders’ perceptions of barriers to healthy living were compared to determine if they converged. Self-management behaviors identified included: healthy eating, seeking medical care, engaging in physical activity, involving others, self-motivation, use of faith, and engaging in structured and unstructured activities. Consumers with high levels of self-efficacy and patient activation tended to engage in more self-management behaviors regularly and perceived fewer barriers. Consumers with the lowest levels of self- efficacy and patient activation engaged in fewer self-management behaviors regularly and encountered more barriers. Consumer and stakeholder perceptions of barriers to healthy living experienced by consumers did converge, with the exception of the following additional barriers which were only identified by stakeholders: lack of health education, lack of formal education, consumer beliefs and fears, and body image. Using an ecological approach, barriers were identified at different environmental levels, often interacting. Overall, self-efficacy and patient activation may have an important influence on self-management behaviors among Hispanics with SMI and at risk for CVD. There is the possibility that barriers may moderate this relationship. Additionally, an ecological approach to understanding barriers to healthy living can be used to locate barriers and develop interventions which address them.

published_or_final_version / Community Medicine / Master / Master of Philosophy