Exercise, Aerobic

SIPsmartER targeted decreasing SSB consumption, with the primary goal of achieving the SSB recommendation of less than 8 fluid ounces per day [6 (link), 25 (link)]. To sufficiently target SSB reduction, participants were educated on recommendations for all beverage categories (e.g., water, noncalorically sweetened beverages, milk) [25 (link)]. A pragmatic approach was taken when developing a comparison condition that was matched for contact and structure, but focused on a behavior independent of SSB consumption. This approach ensured that all study participants in these medically-underserved counties had an opportunity to benefit from study participation [26 (link)]. As such, the comparison condition, MoveMore targeted PA promotion, with the primary goal of achieving 150 min of moderate-intensity aerobic activity and doing muscle-strengthening activities on two or more days per week [27 ].
Several formative research phases guided development of the culturally-sensitive SIPsmartER intervention [16 (link), 28 (link), 29 (link)]; and MoveMore was adapted from a previous research tested group-based PA intervention [30 (link)–32 (link)]. Prior to launching the Talking Health trial, a 5 week randomized-controlled pilot test was used to evaluate participant feedback on intervention content and structure, as well as understand the potential reach and preliminary effect sizes [29 (link)]. The final 6 month intervention structure, informed by the preliminary work, included three small-group classes, one live teach-back call, and 11 Interactive Voice Response (IVR) calls. SIPsmartER and MoveMore conditions were matched in duration and contact. Each of the small group classes were 90–120 min in duration, and delivered during weeks one, six, and seventeen. Participants who missed a class were mailed a packet that outlined key content information and then a research assistant called participants to verbally review and reinforce the content, using a semi-structured script. Approximately 1 week following the first class (or missed class call), a scripted teach-back call occurred, lasting an average of 18.6 (SD = 5.6) minutes. Participants were asked to teach-back key concepts from the first class and to explain how they tracked their behaviors and calculated weekly averages. When recalled incorrectly, participants were given correct answers and offered additional opportunities to recall concepts correctly [33 ]. Participants also received 11 IVR calls, weekly for the first 3 weeks and then bi-weekly for the remainder of the intervention. Each IVR call, lasting an average of 6.9 (SD = 1.9) minutes, reinforced key intervention messages, provided new content, and led participants through a personal action planning procedure [34 (link)–36 (link)].
A comprehensive overview of the intervention structure, theoretical constructs, and key learning objectives for SIPsmartER and MoveMore are published elsewhere [37 (link)]. In brief, the foundational program elements including the TPB [19 (link), 38 (link)–41 (link)] and concepts related to HL, media literacy, and numeracy [42 (link)–45 ]. Clear communication techniques are embedded throughout the interventions, including activity approaches (e.g., hands-on demonstrations, pictorial information); materials with simplified language; teach-back strategies to promote comprehension of learning objectives [33 ]; and non-written reinforcement of key intervention messages (i.e., IVR calls). Intervention content is aimed at building HL skills related to numeracy [41 (link)] and to interpreting SSB- and PA-specific media messages [46 (link)] as well as self-monitoring skills (e.g., personal action planning and behavior tracking) [47 (link)].
Three masters-level research staff (i.e., MPH, MS/RD, MS/MCHES) and two PhD investigators with expertise in media literacy delivered the classes. Trained graduate research assistants provided additional class support and completed the teach-back calls.
Implementation data was tracked via detailed bi-monthly research meeting minutes and the IVR system generated reports. Program engagement was tracked systematically in SPSS statistical analyses software and operationalized as attending small group classes or completing missed call, completing the teach-back call, and completing the IVR calls.

Values are shown as the mean ± standard error of mean (SEM), and error bars for scatter dot plots represent one SEM. Since aerobic capacity and cardiac fibrosis are significant clinical outcomes related to the survival of HF patients [4 (link), 8 (link)], power (1- β) analysis for paired sample t tests used to compare the difference in $V$ O_2peak and ECV fractions before and after HIIT. Differences in physical PCS, MCS, and LVWMS were estimated by the chi-square test.
The nonparametric test was used in the study owing to the limited sample size. The Wilcoxon signed rank test was conducted to estimate within-group differences between data before and after HIIT, including exercise capacity function, CMR-LGE results (LV geometry, functions, and ECV fractions), and blood chemistry data. The Mann‒Whitney U test was used to estimate differences in selected protein amounts obtained from LC‒MS results and methylation levels between cells incubated in patient serum before and after HIIT. Relationships between the DNMT1 levels and health-related physical fitness and CMR-LGE findings were assessed by Spearman’s correlation analysis.
Relative protein expression (measurements/baseline) of VLCAD, Cyto C, CASP3, lamin B1, actin and Arp2 in HCFs between the original and knockdown of ACADVL was compared by the Mann‒Whitney U test. This test was also used to assess mitochondrial intensity in HCFs treated with patient serum before and after HIIT and in cells with and without ACADVL knockdown. Kruskall-Wallis test was conducted to assess cell migration speed in three different culture media and with different cell numbers at different times (baseline, 24 h and 48 h after inoculation). Multiple comparisons Dunn’s test was used to estimate differences of cell behaviours between each of the above sampling time. The relationships between normalized changes (  $\mathrm{\Delta }\text{Value}={\displaystyle \frac{{\text{Value}}_{\text{post}-\text{HIIT}}-{\text{Value}}_{\text{pre}-\text{HIIT}}}{{\text{Value}}_{\text{pre}-\text{HIIT}}}}$ ) in exercise performance and CMR-LGE measurements after HIIT were estimated by Spearman correlation and partial correlation analysis after controlling LV mass. All statistical assessments were considered significant at p < 0.05.