The purpose of this investigation was to examine social desirability and social approval as sources of error in three self-reported physical activity assessments using objective measures of physical activity as reference measures. In 1997, women (n = 81) living in Worcester, Massachusetts, completed doubly labeled water measurements and wore an activity monitor for 14 days. They also completed seven interviewer-administered 24-hour physical activity recalls (PARs) and two different self-administered 7-day PARs. Measures of the personality traits “social desirability” and “social approval” were regressed on 1) the difference between physical activity energy expenditure estimated from doubly labeled water and each physical activity assessment instrument and 2) the difference between monitor-derived physical activity duration and each instrument. Social desirability was associated with overreporting of activity, resulting in overestimation of physical activity energy expenditure by 0.65 kcal/kg/day on the second 7-day PAR (95% confidence interval: 0.06, 1.25) and overestimation of activity durations by 4.15–11.30 minutes/day (both 7-day PARs). Social approval was weakly associated with underestimation of physical activity on the 24-hour PAR (–0.15 kcal/kg/day, 95% confidence interval: –0.30, 0.005). Body size was not associated with reporting bias in this study. The authors conclude that social desirability and social approval may influence self-reported physical activity on some survey instruments.

Parkinson disease is a progressive neurodegenerative disorder characterized by rigidity, tremor, bradykinesia, and postural instability, ultimately leading to disability.^1,2 Because medications have adverse effects and reduced effectiveness over time,³ disease-modifying nonpharmacologic interventions are needed. One intervention, endurance exercise, promotes neurogenesis and neuroprotection in animals^4-8 and has had symptom-modifying and health-related benefits in patients with Parkinson disease.^9-13 Retrospective studies^14,15 have found that moderate to vigorous exercise in midlife can protect against Parkinson disease. Studies^9,16 in humans suggest that high-intensity endurance exercise improves motor symptoms, but current evidence is insufficient to determine whether exercise intensity influences symptom modification or disease progression. To date, no study has been conducted at 80% to 85% maximum heart rate, and typically most studies were powered on fitness or functional measures but not disease severity.^9-11,17,18 This study (Study in Parkinson Disease of Exercise [SPARX]) was a phase 2 randomized clinical trial to investigate the dose response of treadmill exercise performed at 2 different intensities (high and moderate). To remove the potential confounder of medication, this study included patients with de novo Parkinson disease.¹⁹ The study examined whether patients with de novo Parkinson disease can consistently and safely exercise on a treadmill at high intensity (80%-85% maximum heart rate) or moderate intensity (60%-65% maximum heart rate) at least 3 days per week and whether high- or moderate-intensity treadmill exercise warrants further investigation for treatment of motor symptoms.

Hypertension is common in autosomal dominant polycystic kidney disease (ADPKD) and is associated with increased total kidney volume, activation of the renin–angiotensin–aldosterone system, and progression of kidney disease. In this double-blind, placebo-controlled trial, we randomly assigned 558 hypertensive participants with ADPKD (15 to 49 years of age, with an estimated glomerular filtration rate [GFR] >60 ml per minute per 1.73 m² of body-surface area) to either a standard blood-pressure target (120/70 to 130/80 mm Hg) or a low blood-pressure target (95/60 to 110/75 mm Hg) and to either an angiotensin-converting–enzyme inhibitor (lisinopril) plus an angiotensin-receptor blocker (telmisartan) or lisinopril plus placebo. The primary outcome was the annual percentage change in the total kidney volume. The annual percentage increase in total kidney volume was significantly lower in the low-blood-pressure group than in the standard-blood-pressure group (5.6% vs. 6.6%, P=0.006), without significant differences between the lisinopril–telmisartan group and the lisinopril–placebo group. The rate of change in estimated GFR was similar in the two medication groups, with a negative slope difference in the short term in the low-blood-pressure group as compared with the standard-blood-pressure group (P<0.001) and a marginally positive slope difference in the long term (P=0.05). The left-ventricular-mass index decreased more in the low-blood-pressure group than in the standard-blood-pressure group (−1.17 vs. −0.57 g per square meter per year, P<0.001); urinary albumin excretion was reduced by 3.77% with the low-pressure target and increased by 2.43% with the standard target (P<0.001). Dizziness and light-headedness were more common in the low-blood-pressure group than in the standard-blood-pressure group (80.7% vs. 69.4%, P=0.002). In early ADPKD, the combination of lisinopril and telmisartan did not significantly alter the rate of increase in total kidney volume. As compared with standard blood-pressure control, rigorous blood-pressure control was associated with a slower increase in total kidney volume, no overall change in the estimated GFR, a greater decline in the left-ventricular-mass index, and greater reduction in urinary albumin excretion. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; HALT-PKD [Study A] ClinicalTrials.gov number, NCT00283686.)

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities. We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.