Shirit Kamil-Rosenberg | U.S. Department of Veterans Affairs (original) (raw)

Papers by Shirit Kamil-Rosenberg

Archives of Physical Medicine and Rehabilitation, Dec 1, 2022

Medicine and Science in Sports and Exercise, Sep 1, 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

Purpose: Cardiorespiratory fitness (CRF) has recently been recognized as a risk factor for mortal... more Purpose: Cardiorespiratory fitness (CRF) has recently been recognized as a risk factor for mortality, but it is not routinely measured in clinical settings. The purpose of this study was to assess a nonexercise method to estimate CRF (eCRF) and its association with mortality in a clinically referred population. Methods: A symptom tool, termed the Veterans Specific Activity Questionnaire (VSAQ), and nonexercise clinical variables were obtained from 1545 clinically referred subjects (60 ± 13 yr), and followed for a mean of 5.6 ± 4.2 yr. The VSAQ along with nonexercise clinical and historical variables was used to develop a multivariate model to predict achieved CRF from maximal exercise testing. Proportional hazards analysis was used to assess the association between measured and eCRF and all-cause mortality. Results: The eCRF model was significantly associated with achieved CRF (multiple R = 0.67, P < .001). Mean achieved CRF from maximal treadmill testing and eCRF were similar (8...

Innovation in Aging, 2021

Family members of persons diagnosed with dementia or a traumatic brain injury (TBI) are often rel... more Family members of persons diagnosed with dementia or a traumatic brain injury (TBI) are often relied upon to provide daily support to their care recipients. However, research on the differing experiences of caregivers based on care recipient diagnosis is limited. The aim of this study was to examine the impact of worry and feelings of vigilance among caregivers of people with cognitive impairment due to either TBI or dementia. This sample included 61 caregivers (88.5% female, mean age 57.3±15.5) of persons with either a TBI (n = 32) or dementia (n = 29). Worry was assessed with the Penn State Worry Questionnaire and Vigilance was assessed with the Caregiver Vigilance Scale. Linear regressions revealed that after controlling for age, care recipient diagnosis moderated the relationship between worry and caregiver vigilance. Specifically, worry was significantly associated with caregiver vigilance in those caring for someone with dementia; however, a similar relationship was not seen i...

Circulation, 2019

Objective: The interaction between obesity, CRF and incidence of AF has been debated. Therefore, ... more Objective: The interaction between obesity, CRF and incidence of AF has been debated. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a coho...

Innovation in Aging, 2020

Objective and subjective cognitive function have been associated with decreased quality of life a... more Objective and subjective cognitive function have been associated with decreased quality of life and increased psychological distress in older adults. The present study examined relations of objective and subjective cognition with quality-of-life and mental-health outcomes in individuals with amnestic mild cognitive impairment (aMCI). The sample included 98 older adults with aMCI (92.5% male, age = 70.9±9.2 years). Measures included objective cognition (i.e., attention, memory, language, visuospatial abilities, processing speed, executive function, and overall), subjective memory (Multifactorial Memory Questionnaire [MMQ]), quality of life (Dementia Quality of Life [DQoL]), and mental health (Geriatric Depression Scale, Geriatric Anxiety Inventory, and Penn State Worry Questionnaire). Objective and subjective cognition were weakly correlated (range |r| = .00–.23). Objective cognitive measures were largely uncorrelated with quality of life or mental health, with only two significant (...

IJC Heart & Vasculature, 2020

Background: The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibri... more Background: The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans. Methods: Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017. No history of AF was evident at the time of the ETTs. CRF was expressed as quartiles of peak metabolic equivalents (METs) achieved within each age decile. Weight status was classified as normal (BMI < 25 kg/m 2), overweight (BMI 25-30 kg/m 2), obese (BMI 30-35 kg/m 2), or severely obese (BMI > 35 kg/m 2). Multivariable Cox proportional hazards regression models were used to compare the association between BMI, CRF categories, and incidence of AF. Results: Over a median follow-up of 10.7 years, 2,155 (13.1%) developed AF. Obese and severely obese subjects had 13% and 32% higher risks for incidence of AF, respectively, vs. normal weight subjects. Overweight and obese subjects in the most fit quartile had 50% decline in AF risk compared to the least-fit subjects. Severely obese subjects had marked increases in AF risk (~50-60%) regardless of fitness level. Risk of developing AF increases with higher BMI and lower CRF. Conclusion: Improving CRF should be advocated when assessing those at risk for developing AF.

Innovation in Aging, 2019

Informal or unpaid care is the most common form of long-term care. Despite clear benefits for the... more Informal or unpaid care is the most common form of long-term care. Despite clear benefits for the care recipient, caregiving can have unintended physical and emotional consequences for caregivers. Traditional caregiver interventions are limited in scope, as they often focus on the emotional consequences of caregiving; however, the physiological effects of caregiving are equally deleterious to caregiver health. Exercise improves physical health, yet the demands of caregiving can limit participation in physical activity. Traditional gym-based interventions may not be feasible for many caregivers. Advances in technology present an opportunity to address these limitations, specifically in the areas of accessibility and acceptability. The Combined Online Assistance for Caregiver Health (COACH) program combines evidence-based skills training with physical exercise in a tablet-based intervention. Preliminary evidence for the physical and psychological benefits are promising; however, diffe...

The American Journal of Medicine, 2019

BACKGROUND This study aimed to determine the association between cardiorespiratory fitness and he... more BACKGROUND This study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes. METHODS: Health care costs were quantified among 3924 consecutive men (mean age 58 ± 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 ± 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 ± 1.5 metabolic equivalents; n = 938), fit (9.4 ± 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 ± 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period. RESULTS: Age, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 10 3) (mean ± standard deviation

Mayo Clinic Proceedings, Feb 1, 2021

Physical activity may improve cognitive function in women with breast cancer. In a cross-sectiona... more Physical activity may improve cognitive function in women with breast cancer. In a cross-sectional study, we explored the relationship between cognitive function and physical activity (actigraph) and cardiorespiratory fitness (sub-maximal graded exercise test) in 73 postmenopausal women with early stage breast cancer prior to the initiation of systemic adjuvant therapy. Cognitive function was assessed with a standardized battery of neurocognitive measures assessing eight domains. Data were analyzed using partial correlations, controlling for age and total hours of actigraph wear-time. Women were, on average, 63.71 (± 5.3) years of age with 15.47 (± 2.48) years of education. For physical activity, greater average number of steps per day were associated with better attention (r = .262, p = .032) and psychomotor speed (r = .301, p = .011); greater average hours of moderate and moderate/vigorous intensity physical activity were associated with better visual memory (r = .241, p = .049; r = .241, p = .049, respectively); and greater average daily energy expenditure was associated with better visual memory (r = .270, p = .027) and psychomotor speed (r = .292, p = .017). For fitness, higher peak maximum VO 2 was associated with better concentration (r = .330, p = .006), verbal memory (r = .241, p = .048), and working memory (r = .281, p = .019). These results suggest that higher levels of physical activity and cardiorespiratory fitness are associated with better cognitive function in postmenopausal women with breast cancer. Randomized controlled trials (RCT) to examine whether physical activity improves cognitive function in women with breast cancer are warranted. These RCTs should also determine the mechanisms of the influence of physical activity on cognitive function.

Mayo Clinic proceedings, 2021

OBJECTIVE To determine population-attributable risk (PAR) and exposure impact number (EIN) for mo... more OBJECTIVE To determine population-attributable risk (PAR) and exposure impact number (EIN) for mortality associated with impaired cardiorespiratory fitness (CRF), physical inactivity, and other risk markers among veteran subjects. METHODS The sample included 5890 male subjects (mean age 58±15) who underwent a maximal exercise test for clinical reasons between January 1, 1992, and December 31, 2014. All-cause mortality was the end point. Cox multivariable hazard models were performed to determine clinical, demographic, and exercise-test determinants of mortality. Population-attributable risks and EIN for the lowest quartile of CRF and for inactive behavior were analyzed, accounting for competing events. RESULTS There were 2728 deaths during a mean ± standard deviation follow-up period of 9.9±5.8 years. Having low CRF (<5.0 metabolic equivalents [METs]) was associated with an approximate 3-fold higher risk of mortality and a PAR of 12.9%. Each higher MET achieved on the treadmill w...

BACKGROUND: This study aimed to determine the association between cardiorespiratory fitness and h... more BACKGROUND: This study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes. METHODS: Health care costs were quantified among 3924 consecutive men (mean age 58 § 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 § 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 § 1.5 metabolic equivalents; n = 938), fit (9.4 § 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 § 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period. RESULTS: Age, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 10 3) (mean § standard deviation) that were on average 32,178and32,178 and 32,178and30,816 lower, respectively, than individuals in the least-fit category. For each 1-metabolic equivalent higher fitness , annual cost savings per person were 5,193and5,193 and 5,193and3,603 for individuals with and without diabetes, respectively. CONCLUSIONS: Higher fitness is associated with lower health care costs. Cost savings associated with higher fitness are particularly evident among individuals with diabetes. The economic burden of diabetes may be reduced through interventions that target improvements in fitness.

Purpose of Review Physical inactivity and sedentary behavior are highly prevalent. The benefits a... more Purpose of Review Physical inactivity and sedentary behavior are highly prevalent. The benefits and risks of physical activity and evidence base for exercise prescription are not widely known by healthcare providers. Recent Finding Regular exercise and reducing sedentary time are essential elements of primordial and primary prevention in healthy adults. The underlying physiological mechanisms, such as physiologic cardiac hypertrophy, enhanced autonomic and vascular function, and improved circulation and mitochondrial function, are extensive. The recent scientific evidence supporting the current recommendations for the quantity and quality of exercise and evidence-informed principles of exercise prescription for improving cardiorespiratory fitness in the healthy adult are explained. Summary All adults should receive a prescription for exercise due to its powerful effect upon health. Using evidence-based prescription principles tailored to the individual can maximize the beneficial effects of exercise in chronic disease and disability prevention.