Health and Human Sciences Theses and Dissertations

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https://hdl.handle.net/1805/1639

This collection contains theses and dissertations for the Therapeutic Outcomes Research Program and the Department of Nutrition & Dietetics.

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Beet-ing Muscle Dysfunction and Exercise Intolerance in Pulmonary Hypertension
(2019-10) Long, Gary Marshall; Coggan, Andrew R.; Brown, Mary Beth; Lahm, Tim; Avin, Keith; Arnold, Brent
Background: Pulmonary Hypertension (PH) is a devastating disease characterized by pulmonary arterial remodeling, right ventricular dysfunction and ultimately right heart failure. Increased emphasis has been given to skeletal muscle dysfunction in PH, and to its implication in the severe exercise intolerance that is a hallmark of the condition. In this dissertation, skeletal muscle blood flow was measured via the microsphere technique at rest and during exercise (Aim 1), with an acute dose of dietary nitrate via beetroot juice (BRJ) gavage used to determine if supplementation could improve muscle blood flow and alter energetics (Aim 2). VO2max, voluntary running and grip strength tests were used to determine the effect of disease on performance, and to test for an ergogenic effect of BRJ vs. placebo (PL) in healthy and PH rats (Aim 3). Methods: A prospective, randomized, counterbalanced, placebo-controlled trial was used to examine the aforementioned aims across four groups; PH rats (induced with monocrotaline, MCT, 60mg/kg, s.q., 4 weeks) supplemented with BRJ (MCT BRJ, n=9); PH rats supplemented with placebo (MCT PL, n=9); healthy control rats (vehicle, s.q.) supplemented with BRJ (CON BRJ, n=8); healthy control rats supplemented with placebo (CON PL, n=9). Results: Monocrotaline induced a severe PH phenotype evidenced by increased RV wall thickness, RV hypertrophy, RVSP and reduced cardiac output and stroke volume compared to controls (p=<0.001). MCT rats demonstrated lower muscle blood flow at rest, and more prominently during exercise compared to controls (p=0.007-0.047), regardless of supplementation. MCT rats displayed a greater reliance on anaerobic metabolism, demonstrated by increased blood lactate accumulation (p=<0.001), and this was significantly related to reduced blood flow during exercise (r=-0.5879, p=0.001). BRJ supplementation resulted in increased plasma nitrate and nitrite compared to PL (p=<0.001), but at the skeletal muscle level, only nitrate was increased after BRJ. BRJ did not have a significant effect on blood flow, with no improvement during exercise shown vs. PL. Similarly, BRJ did not significantly improve exercise function in MCT or CON rats. Conclusion: MCT rats demonstrated a reduction in muscle blood flow, with BRJ supplementation not resulting in improved flow or exercise performance.
Contributing Factors for Opioid Misuse Among U.S. Adolescents
(2019-10) Hurse, Deidre N.; Arnold, Brent; Altenburger, Peter; Goering, Elizabeth; Saha, Chandan; Agho, Augustine
The United States is amidst an opioid overdose epidemic. Even with significant gaps in surveillance data on opioid-related deaths, the problem is undeniable and requires a systemic response. Despite the dangerous effects of opioid misuse, pathways that lead to opioid abuse for young people is understudied. This study sought to understand factors related to opioid misuse among youth. An exploratory approach used data from both quantitative and qualitative sources. The convergent parallel mixed method design used secondary data from a biannual school-based survey and three oral interviews. While opioid misuse is not limited to heroin, the 2013, 2015, and 2017 Youth Risk Behavior Surveillance Survey (YRBS) was used to determine associations between predictor variables and heroin use. Oral interviews added the perspective of adolescent users and were inclusive of persons that misused prescription and other forms of opioids. The synchronization of data analysis allowed observations to impact the study direction unilaterally. Opioid misuse for youth was related to experiences, access, and divergent substance use. Traumatic stressors, such as physical dating violence and sexual dating violence, had the most substantial relationship with heroin misuse. Findings confirmed that ease of access had a relationship with misuse. It is unclear if opioid misuse was a result of polysubstance use. However, the study identified that divergent substance use was correlated with opioid misuse in this population. The study findings support the use of early intervention before high school. Prevention must be inclusive of primary, secondary, and tertiary approaches. Future prevention for youth can be enhanced by addressing resilience from trauma, reducing access to opioids and addressing alcohol, and substance use among youth. Adopting a framework that acknowledges the root causes of misuse, can mitigate the impact of the opioid crisis and save lives.
The Effectiveness of Robot-Assisted, Task-Specific Ankle Training in Improving Deficits Across the Three Domains of the ICF in Children with Cerebral Palsy (CP)
(2018-11) Alotaibi, Madawi H.; Arnold, Brent; Altenburger, Peter; Munk, Niki; Dierks, Tracy
Cerebral Palsy (CP) is considered to be the leading cause of motor disability among children. Children with CP present with multiple physical impairments including decreased strength and range of motion (ROM), increased spasticity, and poor balance and coordination. These impairments often lead to limitations in ankle motor control that impacts balance and gait function, which puts children at a higher risk for developing other problems. In recent studies, robotic devices have been developed to address poor motor control of the upper and lower extremities. Aim: The aim of this study is to investigate the extent to which the robot-assisted, taskspecific ankle trainer improve deficits across the three domains of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Method: This is a quasi-experimental, single group, repeated measure design with four time-testing points through a set training session/protocol. A convenience sample of 5 children with CP were enrolled in the study. All children received 6-weeks of ankle robot training that included two 45-60 minute sessions per week, for a total of 12 sessions. Data from Tardieu Scale of spasticity, Boyd and Graham selective motor control, Pediatric Balance Scale, goniometer, hand held dynamometer, gait mat analysis, accelerometer, LIFE-H for children questionnaires, ultrasound, and robotic evaluation were collected at the different time points (1 week and 1 month pre training and 1 week and 1 month post training). Descriptive statistics and repeated measure (ANOVA) were used with SPSS software for data analysis. Results: All participants showed improvement in 1. Body Function and Structures (ROM, tone, strength, balance, ankle control and performance, and muscle architecture), 2. Activity (gait and activity counts) and 3. Participations over the course of the study. Conclusion: The results revealed the potential of robot-assisted, task-specific ankle training to improve motor performance and capacity at the body function, activity and participation level. Training appeared to have a lasting impact as most gains were maintained one month following training.
Impact of a multimedia educational tool incorporating theoretical and mixed methods on the fruit and vegetable intakes of middle school children
(2017-12-11) Whelan, JoAnne Louise; Arnold, Brent; Ernst, Judith; Staten, Lisa; Magee, Paula
In the United States, over 30 percent of children are categorized as overweight or obese. Comorbid conditions, such as cardiovascular disease and other health complications related to obesity, are also on the rise. This public health issue is often related to disproportionate dietary intake and lack of physical activity. Efforts that promote fruits and vegetables (F/V) as preferred food choices over high fat and high sugar foods may help combat the increasing incidence of overweight and obesity. Other benefits from F/V include prebiotics or fiber that helps to create and maintain a healthy microbiota, which is now recognized as essential for long-term positive health outcomes. Many children, however, fall short in consuming the recommended daily amounts of F/V servings, and therefore, lack key nutrients such as vitamins, minerals, phytonutrients and fiber. This study is a pilot, quasi-experimental design that provides information related to the importance of eating F/V to children, ages 11-12 years, who attend a parochial school in Indianapolis, Indiana. The data from this study describe the amounts of F/V servings in home-prepared school lunches. The primary aim of this study is to determine if eight interactive multimedia lessons and activities delivered to one group of students (intervention) and a single lesson delivered to a different group of students in the same school and grade (control), affects the amount of lunch F/V servings, student knowledge, attitude, and self-efficacy/perception. This baseline data will contribute to the design and implementation of a health curriculum for middle school age students. Focus groups, adapted validated assessment tools as well as the on-site observation of F/V servings brought in lunches and consumed at lunch are compared between both groups to document any effects of the instruction. The results show that a statistically significant change in knowledge occurred within the intervention group following the implementation of this F/V education series. Favorable findings, with a positive upward trend in relative amounts of F/V, were identified and more research in this area is warranted.
Virtual Reality: Its Effects on Physical Activity Intensity and Pain Sensitivity
(2020-12) Evans, Eric Joseph; Naugle, Kelly; Arnold, Brent; Kaleth, Anthony; Naugle, Keith
The ability of virtual reality (VR) active games to elicit moderate-to-vigorous physical activity (MVPA) has yet to be fully understood. Also, whether VR combined with physical activity could have a greater pain reducing effect compared to non-active VR distraction remains unknown. The purpose of this study was to evaluate the effects of commercial VR active games on physical activity intensity levels, enjoyment, and pain sensitivity in young health adults. Thirty-six (18 males, 18 females) participants completed four study sessions, with each devoted to playing one VR game for fifteen minutes. The games included Beat Saber, Holopoint, Hot Squat, and Relax Walk VR. Levels of physical activity reached during VR gameplay were measured with percentage of heart rate reserve (%HRR), ratings of perceived exertion (RPE), and accelerometry. Enjoyment was measured with a visual analog scale and the Physical Activity Enjoyment Scale following each gaming session. Pressure pain thresholds (PPT’s) of the dominant forearm and ipsilateral thigh were conducted before and after VR gameplay. The primary outcome measures were analyzed with mixed model ANOVAs. The %HRR and RPE results showed that only Hot Squat consistently elicited moderate intensity activity. Accelerometry data showed that Hot Squat and Holopoint elicited higher whole body and lower body intensity levels than Beat Saber and Relax Walk VR. For enjoyment, Beat Saber and Holopoint were rated higher than Hot Squat and Relax Walk VR. Results for pressure pain thresholds (PPT’s) showed 1) an overall acute hypoalgesic effect on the forearm and thigh following all VR games, and 2) an enhanced hypoalgesic effect (combining MVPA and VR distraction) on the thigh following Hot Squat. Overall, results from this study suggest that active VR games can elicit varying degrees of physical activity intensity levels in young healthy adults, with Hot Squat eliciting moderate intensity activity. Thus, active VR games could be an alternative and enjoyable mode of obtaining physical activity. This study also showed that active VR games can elicit an acute hypoalgesic effect, with the effect potentially exacerbated with greater movement during gameplay.

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