Health & Lifestyle Medicine


Recent Submissions

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    National Health and Medical Research Council Statement on Electronic Cigarettes: 2022 Update
    (Wiley, 2024-02-05) Freeman, Becky; Peters, Matthew J.; Bittoun, Renee; Brightwell, Richard; English, Dallas R.; Thomas, David P.; Otlowski, Margaret FA; Zwar, Nicholas A.; Chamberlain, Catherine
    Introduction: Electronic cigarette (e-cigarette) use in Australia has rapidly increased since the 2017 National Health and Medical Research Council (NHMRC) Chief Executive Officer (CEO) statement on e-cigarettes. The type of products available and the demographic characteristics of people using these products have changed. New evidence has been published and there is growing concern among public health professionals about the increased use, particularly among young people who do not currently smoke combustible cigarettes. The combination of these issues led NHMRC to review the current evidence and provide an updated statement on e-cigarettes. In this article, we describe the comprehensive process used to review the evidence and develop the 2022 NHMRC CEO statement on electronic cigarettes. Main recommendations: • E-cigarettes can be harmful; all e-cigarette users are exposed to chemicals and toxins that have the potential to cause adverse health effects. • There are no health benefits of using e-cigarettes if you do not currently smoke tobacco cigarettes. • Adolescents are more likely to try e-cigarettes if they are exposed to e-cigarettes on social media. • Short-term e-cigarette use may help some smokers to quit who have been previously unsuccessful with other smoking cessation aids. There are other proven safe and effective options available to help smokers to quit. Changes in management as a result of this statement: The evidence base for the harms of e-cigarette use has strengthened since the previous NHMRC statement. Significant gaps in the evidence base remain, especially about the longer-term health harms of using e-cigarettes and the toxicity of many chemicals in e-cigarettes inhaled as an aerosol.
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    Intergenerational Programs may be Especially Engaging for Aged Care Residents With Cognitive Impairment: Findings from the Avondale Intergenerational Design Challenge
    (SAGE, 2017-06) Baker, Jess Rose; Webster, Lindl; Lynn, Nigel; Rogers, Julie; Belcher, Jessica
    Intergenerational programs are an authentic way to engage elders in meaningful activity and report benefits to both elders and youth. The Avondale Intergenerational Design Challenge (AVID) randomly assigned small teams of technology students aged 13 to 15 years (total N = 59) to 1 of 24 aged care residents with a range of cognitive impairment. Students met with the resident 4 times over 15 weeks and ultimately crafted a personalized item for them. Students showed no change in self-reported attitudes to elders, empathy, or self-esteem post-AVID or at 3-month follow-up, compared to a 3-month within-subject control period pre-AVID. Compared to usual lifestyle activities, residents showed significant improvements in self-reported positive affect and negative affect after student visits and were observed to be significantly more engaged during visits, especially residents with greater cognitive impairment. The personal and guided nature of intergenerational programs may be especially effective in engaging elders with cognitive impairment in meaningful activity.
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    The Complete Health Improvement Program (CHIP)
    (2012-01-01) Morton, Darren

    Over 2,000 years ago Hippocrates asserted: "Food and exercise... work together to produce health". Evidence for the wisdom of this Hippocratic council emerged throughout the 20th Century as large epidemiological studies, including the Framingham Heart Study, Nurses Health Study, EPIC (European Prospective Investigation into Cancer and Nutrition) and the Adventist Health Study, highlighted the relationship between lifestyle and disease.

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    Live More Active: Activate Your Life for Good
    (2014-01-01) Morton, Darren

    We are made to move-and things go wrong when we don't. Live More: Active brings together the latest scientific and medical research regarding our inactivity crisis and, importantly, how to beat it. More than a collection of information, it also offers the inspiration to activate your life for good through a 21-day program that show what to do-and why-and how to overcome the challenges that often drain our motivation. Live More: Active can help you create better activity habits so you can live more.

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    Seven Secrets for Feeling Fantastic: A Proven Plan for Vibrant Living
    (2006-01-01) Morton, Darren

    In the past decade, neurophysiologists have discovered some staggering insights into how our brain works. These new insights provide strategies for changing the way we feel, empowering us to feel good on a more consistent basis.

    We all want to feel fantastic but people of all ages are depressed, stressed or anxious. It is an epidemic debilitating individuals, families and communities.

    Seven Secrets for Feeling Fantastic explores how God put us together so we can be happy-and be all He desires us to be.

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    The 'Stitch' Story: Epidemiology and Aetiology of Exercise Related Transient Abdominal Pain
    (2010-01-01) Morton, Darren

    The 'stitch' is an unwelcomed abdominal pain experienced by numerous sportspeople. Yet despite being so well-known, the condition has historically been poorly understood. While many anecdotal reports of the pain have appeared in popular magazines, no empirical research of the condition was conducted for almost fifty years-from 1951 to 1999. In 'The Stitch Story', Dr Darren Morton documents his quest to understand the phenomenon by conducting large scale epidemiological studies through to evoking the pain in subjects within a laboratory in order to take measurements. The result is a series of investigations that have redefined the medical community's understanding of the pain. Of the ten papers relating to stitch that have been published in peer-reviewed journals over the past decade, nine have arisen from the work contained in 'The Stitch Story'. [from book back cover].

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    The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study
    (2021-11-11) Renfrew, Melanie; Morton, Jason K.; Morton, Darren; Przybylko, Geraldine

    Background: The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood.

    Objective: The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting.

    Methods: This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program.

    Results: On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures.

    Conclusions: Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs.

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    Here For Good: Living Your Best Life
    (2019-04-12) Morton, Darren

    Here For Good is a podcast series from leading researchers at Avondale University College. This episode features Lifestyle and Health Research Centre Director Associate Professor Darren Morton in conversation with Associate Dean (Research) Associate Professor Carolyn Rickett.

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    Factors Predicting Alcohol Consumption in Adolescents Attending a Faith-Based School System in Australia: A Multigroup Structural Equation Analysis
    (2019-08-21) Price, Kevin; Rankin, Paul; Butler, Terry; Gane, Barry; Beamish, Peter; Kent, Lillian; Morey, Peter; Morton, Darren; Craig, Bevan

    Structural equation modeling was used to explore the direct and indirect association of childhood experiences, attitudes, subjective norms, and intentions on the alcohol consumption of adolescents attending faith-based Seventh-day Adventist schools in Australia. Data were collected on 1,266 adolescents and the structural model developed explained 48% of the variance for alcohol consumption. Intentions had the highest degree of association with Alcohol Consumption Status (ACS) (b.0.52). Attitudes were more strongly associated to ACS (btotal . 0.36) than subjective norms (btotal . 0.17). Adverse Childhood Experiences (ACEs) were associated with every variable in the model and had a combined direct and indirect association with ACS of btotal . 0.14.

    Multigroup analysis found significant pathway differences in the model for gender and age with regards to the association of intentions, attitudes, ACEs, and Childhood Family Dynamics with alcohol consumption status. The study fills a gap in the alcohol literature by presenting a model describing the complex network of factors that predict alcohol consumption in a low-ACS population. The outcomes of the study highlight the importance of early intervention for children and their families to delay or minimize alcohol consumption in adolescents.

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    From Health to Happiness
    (2019-07-31) Morton, Darren

    In this webinar recording you will learn about the important connection between health and mood. Simple, evidence-based strategies are explored that health care professionals can use to help improve not only the health of their patients but also their happiness!

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    Neuroprotective Effects of Naturally Occurring Polyphenols on Quinolinic Acid-induced Excitotoxicity in Human Neurons
    (2010-01-01) Guillemin, Gilles; Adams, Seray; Grant, Ross; Braidy, Nady

    Quinolinic acid (QUIN) excitotoxicity is mediated by elevated intracellular Ca2+ levels, and nitric oxide-mediated oxidative stress, resulting in DNA damage, poly(ADP-ribose) polymerase (PARP) activation, NAD+ depletion and cell death. We evaluated the effect of a series of polyphenolic compounds [i.e. epigallocatechin gallate (EPCG), catechin hydrate, curcumin, apigenin, naringenin and gallotannin] with antioxidant properties on QUIN-induced excitotoxicity on primary cultures of human neurons. We showed that the polyphenols, EPCG, catechin hydrate and curcumin can attenuate QUIN-induced excitotoxicity to a greater extent than apigenin, naringenin and gallotannin. Both EPCG and curcumin were able to attenuate QUIN-induced Ca2+ influx and neuronal nitric oxide synthase (nNOS) activity to a greater extent compared with apigenin, naringenin and gallotannin. Although Ca2+ influx was not attenuated by catechin hydrate, nNOS activity was reduced, probably through direct inhibition of the enzyme. All polyphenols reduced the oxidative effects of increased nitric oxide production, thereby reducing the formation of 3-nitrotyrosine and poly (ADP-ribose) polymerase activity and, hence, preventing NAD+ depletion and cell death. In addition to the well-known antioxidant properties of these natural phytochemicals, the inhibitory effect of some of these compounds on specific excitotoxic processes, such as Ca2+ influx, provides additional evidence for the beneficial health effects of polyphenols in excitable tissue, particularly within the central nervous system.

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    Live More Happy: Scientifically Proven Ways to Lift Your Mood and Your Life
    (2018-02-01) Morton, Darren

    This book discusses strategies for boosting your emotional health and well being and improving symptoms of depression, anxiety and stress.

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    Lifestyle as Medicine - Past Precepts for Present Problems
    (2016-04-01) Hurlow, Trevor; Egger, Garry; Kent, Lillian; Mitchell, Brett G.; Morton, Darren

    Lifestyle principles have been advocated for the promotion of health and prevention of disease since antiquity. More than 2000 years ago, Hippocrates asserted, ‘Let food be thy medicine and medicine be thy food’.

    Predating Hippocrates, Levitical health laws mandated lifestyle practices such as hand washing after touching dead bodies or diseased animals, and avoiding pathogenic substances such as blood and mould. The consumption of animal fat was also forbidden, which is intriguing given that chronic disease was not the major health threat at the time.

    Notwithstanding the developments in pharmacological and surgical technologies that have profoundly enhanced healthcare, the authors propose that the historical practice of ‘lifestyle as medicine’ will become increasingly re-emphasised in future healthcare for mitigating and/or managing contemporary concerns relating to chronic and infectious diseases.

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    'Live More': Study Protocol for a Community-Based Lifestyle Education Program Addressing Non-Communicable Diseases in Low-Literacy Areas of the South Pacific
    (2015-12-09) Morton, Darren; Reierson, Pia; Kent, Lillian

    Background Non-communicable diseases (NCDs) have reached epidemic proportions in Pacific Island countries. Unhealthy lifestyle is one of the major risk factors and lifestyle interventions have been shown to be efficacious for primary, secondary and early tertiary prevention. However, there is a paucity of evidence regarding effective community-based lifestyle interventions in the Pacific Islands. The Complete Health Improvement Program for high-income countries was contextualised for rural communities with relatively low-literacy rates in low-income countries using the REFLECT delivery approach. This study will assess the effect of this ‘Live More’ program to reduce participant’s NCD risk factors and improve lifestyle behaviours associated with health and wellbeing, in low-literacy communities in countries of the South Pacific.

    Methods/Design This study is a 6-month cluster-randomised controlled trial of 288 adults (equal proportions of men and women aged 18 years and over) with waist circumference of ≥92cm for men and ≥80cm for women in four rural villages in each of Fiji, Vanuatu and Solomon Islands. Participants will permanently reside in their village and be able to prepare their own meals. Two villages will be randomised to the ‘Live More’ intervention (n=24) or to control receiving only country specific Ministry of Health literature (n=24). Intervention participants will meet three times a week in the first month, then once a week for the next two months and once a month for the last three months. Themes covered include: NCDs and their causes; and the benefits of positive lifestyle choices, positive psychology, stress management, forgiveness and self-worth, and how these influence long-term health habits. Outcome assessments at baseline, 30-days, 3-months and 6-months include body mass index, waist circumference, blood lipids, blood pressure and blood glucose. Secondary outcomes include changes in medication and substance use, diet, physical activity, emotional health and supportive relationships, collected by lifestyle questionnaire at the same time points.

    Discussion This is the first lifestyle intervention using the Reflect approach to target NCDs. The findings from the study will be used to guide broader delivery of a lifestyle intervention to improve health and wellbeing across the South Pacific.

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    Heart Rate Responses and Fluid Balance of Competitive Cross-Country Hang Gliding Pilots
    (2010-03-01) Morton, Darren

    Purpose: To evaluate the physiological challenges of competitive cross-country hang gliding.

    Methods: Seventeen experienced male pilots (age = 41 ± 9 y; mean ± SD) were fitted with a monitor that recorded heart rate and altitude at 0.5 Hz throughout a competitive flight. Fluid losses were evaluated by comparing pilot pre- and postflight mass.

    Results: The pilots’ displacement was 88.4 ± 43.7 km in 145.5 ± 49.4 min. Mean flight altitude was 1902 ± 427 m (range = 1363–2601 m) with a maximum altitude of 2925 ± 682 m (1870–3831 m). The mean in-flight heart rate of the pilots was 112 ± 11 bpm (64 ± 6% predicted HRmax). For all except one subject, heart rate was highest while launching (165 ± 12 bpm, 93 ± 7% predicted HRmax), followed by landing (154 ± 13 bpm, 87 ± 7% predicted HRmax). No statistically significant relationship was observed between heart rate during the launch and reported measures of state anxiety. Heart rate was inversely related (P < .01) to altitude for all pilots except one. Fluid loss during the flight was 1.32 ± 0.70 L, which approximated 0.55 L/h, while mean in-flight fluid consumption was 0.39 ± 0.44 L. Six pilots consumed no fluid during the flight.

    Conclusions: Even among experienced pilots, high heart rates are more a function of state anxiety than physical work demand. Fluid losses during flight are surprisingly moderate but pilots may still benefit from attending to fluid balance.

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    The Relative Impact of a Vegetable-rich Diet on Key Markers of Health in a Cohort of Australian Adolescents
    (2008-03-01) Ashton, John; Hokin, Bevan; Pearce, Robyn; Guy, Trish; Zeuschner, Carol; Bilgin, Ayse; Grant, Ross

    Childhood obesity is a widespread health problem in Australia. Overweight in childhood can lead to adult overweight and the development of risk factors for cardiovascular disease (CVD). Effective strategies for reducing childhood obesity are urgently required. A vegetarian diet has been shown to be an effective prophylactic to many lifestyle diseases in the adult population and may therefore be beneficial in children. However the metabolic demands of adolescents are different to adults and the impact of a vegetarian diet on CVD markers in this demographic is not certain. We compared key physiological and biochemical markers of health against responses to a modified, Schools Physical Activity and Nutrition Survey (SPANS) using one-way and two-way Analysis of Variance. 215 adolescents (14-15yrs) from 5 Adventist secondary schools in the Sydney and Hunter regions of New South Wales, Australia, participated in this study. Adolescents consuming predominantly vegetarian foods showed significantly better scores on markers of cardiovascular health, including, body mass index (BMI), waist circumference, Cholesterol/High density lipoprotein ratio and low density lipoprotein. Adolescents consuming nuts more than once per week, also showed lower scores for BMI and serum glucose irrespective of their vegetarian status. Markers of general health including haemoglobin and average height were not different between groups; however a lower serum level of vitamin B12 was apparent in the vegetarian cohort. Surprisingly, exercise on its own was not statistically associated with any of the risk factors tested suggesting that diet may be the most significant factor in promoting health in this age group.

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    Promotion of Cellular NAD+ Anabolism: Therapeutic Potential for Oxidative Stress in Ageing and Alzheimer’s Disease
    (2008-01-01) Grant, Ross; Guillemin, Gilles; Braidy, Nady

    Oxidative imbalance is a prominent feature in Alzheimer’s disease and ageing. Increased levels of reactive oxygen species (ROS) can result in disordered cellular metabolism due to lipid peroxidation, protein-cross linking, DNA damage and the depletion of nicotinamide adenine dinucleotide (NAD+). NAD+ is a ubiquitous pyridine nucleotide that plays an essential role in important biological reactions, from ATP production and secondary messenger signalling, to transcriptional regulation and DNA repair. Chronic oxidative stress may be associated with NAD+ depletion and a subsequent decrease in metabolic regulation and cell viability. Hence, therapies targeted toward maintaining intracellular NAD+ pools may prove efficacious in the protection of age-dependent cellular damage, in general, and neurodegeneration in chronic central nervous system inflammatory diseases such as Alzheimer’s disease, in particular.

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    Mechanism for Quinolinic Acid Cytotoxicity in Human Astrocytes
    (2009-01-01) Guillemin, Gilles J.; Brew, Bruce J.; Adams, Seray; Grant, Ross; Braidy, Nady

    There is growing evidence implicating the kynurenine pathway (KP) and particularly one of its metabolites, quinolinic acid (QUIN), as important contributors to neuroinflammation in several brain diseases. While QUIN has been shown to induce neuronal and astrocytic apoptosis, the exact mechanisms leading to cell death remain unclear. To determine the mechanism of QUIN-mediated excitotoxicity in human brain cells, we measured intracellular levels of nicotinamide adenine dinucleotide (NAD+) and poly(ADP-ribose) polymerase (PARP) and extracellular lactate dehydrogenase (LDH) activities in primary cultures of human neurons and astrocytes treated with QUIN. We found that QUIN acts as a substrate for NAD+ synthesis at very low concentrations (nM) in both neurons and astrocytes, but is cytotoxic at sub-physiological concentrations (>150 nM) in both the cell types. We have shown that the NMDA ion channel blockers, MK801 and memantine, and the nitric oxide synthase (NOS) inhibitor, L-NAME, significantly attenuate QUIN-mediated PARP activation, NAD+ depletion, and LDH release in both neurons and astrocytes. An increased mRNA and protein expression of the inducible (iNOS) and neuronal (nNOS) forms of nitric oxide synthase was also observed following exposure of both cell types to QUIN. Taken together these results suggests that QUIN-induced cytotoxic effects on neurons and astrocytes are likely to be mediated by an over activation of an NMDA-like receptor with subsequent induction of NOS and excessive nitric oxide (NO•)-mediated free radical damage. These results contribute significantly to our understanding of the pathophysiological mechanisms involved in QUIN neuro- and gliotoxicity and are relevant for the development of therapies for neuroinflammatory diseases.

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    Runner's Stitch and the Thoracic Spine
    (2004-04-01) Aune, T; Morton, Darren

    The cause of the abdominal pain commonly referred to as "stitch", but more accurately known as exercise related transient abdominal pain (ETAP), had until recently attracted more speculation than research. Explanations for the pain have included diaphragmatic ischaemia, (1) stress on peritoneal ligaments, (2) and irritation of the parietal peritoneum. (3) Although the exact cause of the pain remains to be elucidated, a neurogenic explanation has not appeared in the literature. We present the case of an elite runner who, after a thoracic spine trauma, developed severe and recurrent episodes of ETAP which were relieved by localised treatment. As a follow up study, we made observations on 17 other runners who often experience episodes of ETAP and found that palpation of specific facet joints could reproduce symptoms of ETAP shortly after an episode of the pain had been relieved.

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    Spirometry Measurements During an Episode of Exercise-Related Transient Abdominal Pain
    (2006-12-01) Morton, Darren

    Purpose: To determine whether changes in lung function are associated with exercise-related transient abdominal pain (ETAP). Methods: Twenty-eight subjects susceptible to ETAP performed a flow-volume loop before (pre) and after (post) treadmill exercise. Fourteen of the subjects developed symptoms of ETAP during the exercise and completed the flow-volume loop while the pain was present. The remaining 14 subjects reported no symptoms of ETAP. Results: Forced inspiratory vital capacity was essentially unchanged from pre to post in both groups (ETAP group –0.8% ± 5.1%, comparison group –0.9% ± 6.5%). Peak inspiratory-flow rate increased in both the ETAP group (12.4% ± 16.2%) and the comparison group (17.9% ± 16.6%), but the difference between groups (–4.6%, standardized effect size [EF] = –0.17) was trivial. Forced expiratory vital capacity decreased by approximately 4% in both groups (ETAP group –3.9% ± 3.3%, comparison group –4.0% ± 5.1%). Small differences in the mean change from pre to post between groups were recorded for peak expiratory-flow rate (–7.4%, EF = –0.28) and the forced expiratory volume in the first second of the test (–4.4%, EF = –0.44). Conclusions: ETAP does not appear to be associated with reduced inspiratory performance, suggesting that the diaphragm is not implicated directly in the etiology of ETAP. Expiratory power might be slightly reduced during an episode of ETAP, but the magnitude of this effect is unlikely to compromise exercise performance.