World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Embodied navigation: the influence of lived experience on physical activity and sedentary behavior among older adults

PURPOSE

The impact of a sedentary lifestyle on health and well-being is well recognized. However, there is limited understanding of how a lifetime of physical activity and sedentary behaviour influences an active lifestyle in older adults. The aim of this study was to describe how lived experience of physical activity and sedentary behaviour impacts daily activities among older adults, from a life course perspective.

METHODS

Qualitative content analysis was used; individual telephone interviews were conducted with fourteen older adults aged 71 to 92 years. The participants received initial support from community care and lived in ordinary housing in southern Sweden.

RESULTS

The interviews yielded one theme, "Navigating with an embodied activity compass," and two sub-themes: "Being guided by the past" and "Unveiling pathways through body awareness."

CONCLUSIONS

Our study highlights how older adults' lived experiences of physical activity, with their connections to body awareness and acceptance, impact daily physical activity. These findings offer new knowledge for clinical practitioners balancing recommendations of sedentary behaviour and physical activity, to promote healthy daily physical activity among older adults. Future research and policies should consider the lived experiences of older adults when addressing public health matters related to sedentary behaviour and physical activity.

The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians: A longitudinal study

BACKGROUND

A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease (CVD) prevention. However, despite their interlinked effects on metabolic health, the 2 behaviors are rarely considered jointly, particularly within the context of CVD prevention. We examined the independent, interactive, and joint associations of diet and physical activity with CVD hospitalization, CVD mortality, and all-cause mortality.

METHODS

CVD-free Australian participants aged 45-74 years (n = 85,545) reported physical activity, diet, sociodemographic, and lifestyle characteristics at baseline (2006-2009) and follow-up (2012-2015), and data were linked to hospitalization and death registries (03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality). Diet quality was categorized as low, medium, and high based on meeting dietary recommendations. Physical activity was operationalized as (a) total moderate-to-vigorous physical activity (MVPA) as per guidelines, and (b) the composition of MVPA as the ratio of vigorous-intensity physical activity (VPA) to total MVPA. We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.

RESULTS

During a median of 10.7 years of follow-up, 6576 participants were admitted to the hospital for CVD and 6581 died from all causes (876 from CVD during 9.3 years). A high-quality diet was associated with a 17% lower risk of all-cause mortality than a low-quality diet, and the highest MVPA category (compared with the lowest) was associated with a 44% and 48% lower risk of CVD and all-cause mortality, respectively. Multiplicative interactions between diet and physical activity were non-significant. For all outcomes, the lowest risk combinations involved a high-quality diet and the highest MVPA categories. Accounting for total MVPA, some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.

CONCLUSION

For CVD prevention and longevity, one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

Exercise training mode effects on myokine expression in healthy adults: A systematic review with meta-analysis

BACKGROUND

The benefits of exercise are well known; however, many of the underlying molecular mechanisms are not fully understood. Skeletal muscle secretes myokines, which mediate muscle-organ crosstalk. Myokines regulate satellite-cell proliferation and migration, inflammatory cascade, insulin secretion, angiogenesis, fatty oxidation, and cancer suppression. To date, the effects of different exercise modes (namely, aerobic and resistance exercise) on myokine response remain to be elucidated. This is crucial considering the clinical implementation of exercise to enhance general health and wellbeing and as a medical treatment.

METHODS

A systematic search was undertaken in PubMed, MEDLINE, CINAHL, Embase, SPORTDiscus, and Web of Science in April 2023. Eligible studies examining the effects of a single bout of exercise on interleukin15 (IL-15), irisin, secreted protein acidic and rich in cysteine (SPARC), oncostatin M (OSM), and decorin were included. A random-effects meta-analysis was also undertaken to quantify the magnitude of change.

RESULTS

Sixty-two studies were included (n = 1193). Overall, exercise appeared to induce small to large increases in myokine expression, with effects observed immediately after to 60 min post-exercise, although these were mostly not statistically significant. Both aerobic and resistance exercise resulted in changes in myokine levels, without any significant difference between training modes, and with the magnitude of change differing across myokines. Myokine levels returned to baseline levels within 180 min to 24 h post-exercise. However, owing to potential sources of heterogeneity, most changes were not statistically significant, indicating that precise conclusions cannot be drawn.

CONCLUSION

Knowledge is limited but expanding with respect to the impact of overall and specific effects of exercise on myokine expression at different time points in the systemic circulation. Further research is required to investigate the effects of different exercise modes at multiple time points on myokine response.

How many adults have sufficient muscle-strengthening exercise and the associated factors: A systematic review consisting of 2,629,508 participants

Purpose

The aim of this systematic review was to (1) estimate the prevalence of adhering to the MSE guidelines (at least 2 times/days a week) among adults; and (2) synthesize evidence on the correlates of adhering to the MSE guidelines.

Methods

Five electronic databases were searched (March 2022), with a total of 30 observational studies consisting of 2,629,508 participants meeting the eligibility criteria. A meta-analysis was conducted to pool the prevalence of adhering to the MSE guidelines using the results of 21 eligible studies (study aim 1); and data reporting correlates of adhering to the MSE guidelines using 12 eligible studies were synthesized and categorized based on the Socioecological Model Framework (study aim 2).

Results

Overall, 22.8 % (95%CI: 18.18 % ─ 27.77 %) of adults adhered to the MSE guidelines, and 23 potential correlates at five levels were examined. Five variables (i.e., sex, age, education level, socioeconomic status) at the sociodemographic level and two variables (i.e., body mass index, self-rated health) at the physical related level were identified as consistent correlates, but displaying weak to moderate association strengths.

Conclusions

Less than a quarter of adults meet the MSE guidelines and multidimensional correlates are associated with the adherence to the guidelines, particularly sociodemographic correlates (e.g., sex, age, and educational level). Findings highlight the need to further promote the importance of engaging in MSE among adults and investing effective interventions that not only provide opportunities for MSE for adults, but also facilitate the development of skills and confidence to engage in MSE.

Increasing physical activity among adults affected by COVID-19 social distancing restrictions: A feasibility trial of an online intervention

In response to COVID-19 social distancing restrictions, digitally delivered health interventions present as a potential solution for maintaining or improving individuals' physical activity. This study explored the feasibility of a web-based intervention, informed by the multi-process action control (M-PAC) framework to promote PA among individuals affected by social distancing. Fifty adults self-reporting as insufficiently active were randomized to a 6-week web-intervention (n = 27) or wait-list control (n = 23). Primary feasibility outcomes included recruitment and retention rates and usability and satisfaction scores; secondary outcomes of MVPA and M-PAC constructs and tertiary outcomes of mental health and wellbeing were also assessed. Overall, feasibility of the intervention was high, with a 96% recruitment rate, 84% retention rate, high satisfaction and usability scores, and comparable website usage to similar eHealth interventions. Intervention participants trended towards improved MVPA and M-PAC constructs and outcomes of mental health and wellbeing. Findings suggest study extension to a full-scale RCT.

Exerkines: Benign adaptation for exercise and benefits for non-alcoholic fatty liver disease

Exercise has multiple beneficial effects on human metabolic health and is regarded as a "polypill" for various diseases. At present, the lack of physical activity usually causes an epidemic of chronic metabolic syndromes, including obesity, cardiovascular diseases, and non-alcoholic fatty liver disease (NAFLD). Remarkably, NAFLD is emerging as a serious public health issue and is associated with the development of cirrhosis and hepatocellular carcinoma. Unfortunately, specific drug therapies for NAFLD and its more severe form, non-alcoholic steatohepatitis (NASH), are currently unavailable. Lifestyle modification is the foundation of treatment recommendations for NAFLD and NASH, especially for exercise. There are under-appreciated organs that crosstalk to the liver during exercise such as muscle-liver crosstalk. Previous studies have reported that certain exerkines, such as FGF21, GDF15, irisin, and adiponectin, are beneficial for liver metabolism and have the potential to be targeted for NAFLD treatment. In addition, some of exerkines can be modified for the new proteins and get enhanced functions, like IL-6/IC7Fc. Another importance of exercise is the physiological adaptation that combats metabolic diseases. Thus, this review aims to summarize the known exerkines and utilize a multi-omics mining tool to identify more exerkines for the future research. Overall, understanding the mechanisms by which exercise-induced exerkines exert their beneficial effects on metabolic health holds promise for the development of novel therapeutic strategies for NAFLD and related diseases.

Physical activity volume, frequency, and intensity: Associations with hypertension and obesity over 21 years in Australian women

BACKGROUND

Optimal patterns of accrual of recommended levels of physical activity (PA) for prevention of hypertension and obesity are not known. The overall aim of this study was to investigate whether different patterns of accumulation of PA are differentially associated with hypertension and obesity in Australian women over 21 years. Specifically, we investigated whether, for the same weekly volume of PA, the number of sessions (frequency) and vigorousness of PA (intensity) were associated with a reduction in the occurrence of hypertension and obesity in women.

METHODS

Data from the 1973-1978 and 1946-1951 cohorts of the Australian Longitudinal Study on Women's Health were analyzed (n = 20,588; 12%-16% with a Bachelor's or higher degree). Self-reported PA, hypertension, height, and weight were collected using mail surveys every 3 years from 1998/2000 to 2019/2021. Generalized Estimating Equation models with a 3-year lag model were used to investigate the association of PA volume (metabolic equivalent min/week) (none; 33-499; 500-999; ≥1000, weekly frequency (none; 1-2 times; 3-4 times; 5-7 times; ≥8 times), and the proportion of vigorous PA to total volume of PA (none; 0%; 1%-33%; 34%-66%; 67%-100%) with odds of hypertension and obesity from 2000 to 2021.

RESULTS

The cumulative incidence of hypertension was 6% in the 1973-1978 and 23% in the 1946-1951 cohort; 27% of women in the 1973-1978; and 15% in the 1946-1951 cohort developed obesity over the period. Overall, a higher volume of PA was associated with reduced odds of hypertension and obesity. When the volume of PA was considered, the odds of hypertension did not vary according to the frequency or intensity of PA. However, increased proportion of vigorous PA to the total volume of PA was associated with a small additional reduction in the risk of obesity.

CONCLUSION

PA volume appears to be more important than the pattern of accumulation for the prevention of hypertension and obesity. Incorporating more sessions, particularly of vigorous-intensity PA, may provide extra benefits for the prevention of obesity.

Physical activity and circulating inflammatory markers and cytokines during pregnancy: A population-based cohort study

INTRODUCTION

Physical activity (PA) during pregnancy has numerous benefits, which may be mediated via effects on the immune system. However, supportive evidence is inconsistent and is mainly from studies in high-risk groups. We estimated the effect of PA during pregnancy on systemic inflammatory markers and cytokines in mothers recruited in the Barwon infant study.

MATERIAL AND METHODS

The Barwon infant study is a prebirth cohort of 1064 mothers recruited in the Barwon Region of Victoria, Australia. Participants reported their previous week's PA at their 28-week antenatal appointment using the International PA Questionnaire. Women were grouped into low, moderate, and high PA categories based on daily duration and weekly frequency of walking, moderate- or vigorous-intensity PA. Women reporting moderate levels of PA, consistent with current recommendations, served as the comparison group. Markers of systemic inflammation, high-sensitivity C-reactive protein (hsCRP), glycoprotein acetyls (GlycA), and 17 cytokines were measured at 28 weeks gestation and log transformed as appropriate. Regression analyses adjusted for maternal smoking, gestational diabetes mellitus, prepregnancy BMI, and household size were performed.

RESULTS

Compared to women in the moderate group (n = 371, 42%), women reporting low PA (n = 436, 50%) had 10.1% higher hsCRP (95% CI (3.7% to 16.6%), p < 0.01) while women in high PA (n = 76, 9%) had a 14% higher hsCRP (95% CI (3.1% to 24.8%), p = 0.01). Women in the high PA category had higher interleukin (IL)-4 (q = 0.03) and IL-9 (q = 0.03) levels compared to those in moderate category. Each vigorous MET minute/week was associated with lower GlycA (β = -0.004, 95% CI (-0.044 to 0.035); p = 0.03).

CONCLUSIONS

Low and high PA are each associated with higher hsCRP than moderate PA, suggesting that undertaking the recommended moderate PA during pregnancy decreases systemic inflammation. High PA affects T cell-associated cytokines during pregnancy. Evidence from our study suggests that PA can modulate the immune responses during pregnancy. Studies are now required to assess whether PA during pregnancy impacts maternal and infant clinical outcomes by modifying inflammatory responses.

Validation of "CENTR(AR)" walking trails: Different field criteria do not lead to different physical activity intensities in people with COPD

BACKGROUND

Validating walking trails is essential to promote physical activity (PA) safely and confidently in people with COPD.

OBJECTIVES

We aimed to validate predetermined light, moderate, and vigorous intensities of walking trails in people with COPD.

METHODS

This cross-sectional study included individuals with COPD walking in predetermined light, moderate and vigorous intensity trails. Activity intensity and volume outcomes were collected. Dyspnoea and fatigue (modified Borg scale), energy expenditure (EE, Sensewear), heart rate (HR, HR monitor), time spent in different PA intensities, and cadence (ActiGraph) were recorded and used to classify PA intensity.

RESULTS

Twenty people with COPD [71(7) years, 80 % male, FEV1%predicted 65.6(11.6)] were included. Fatigue differed significantly between light and moderate [3.0(2.0;4.0) vs 3.4(2.5;4.5), p = 0.01], but not vigorous (3.5[2.5-4.0]) tracks. Dyspnoea [2.3(1.5) vs 2.7(1.6) vs 2.6(1.4)], EE [5.1(0.8) vs 4.9(0.5) vs 4.6(0.8) METs], HR [92.5(11.1) vs 93.7(18.6) vs 95.4(15.0) beats/min] and cadence [115.1(104.0;120.3) vs 104.7(99.6;117.6) vs 111.2(99.9;118.5) steps/min] were similar across trails (p > 0.05). Time spent in light and moderate PA, EE volume, walking time, and step count increased along with the proposed intensity levels (p < 0.01). Walking trails were categorised as moderate intensity in most participants.

CONCLUSION

Walking trails were safe and valid for practising moderate-intensity PA in people with COPD. Participants adjusted their physiological responses and perceived symptoms to match a moderate intensity.

What's Your Poison? Is Sitting Always Health Hindering and Moving Always Health Promoting?

The clear public messaging from international health authorities is that individuals should "sit less and move more." While it is acknowledged that this guidance needs to be tailored to the age of people and also to their health, and abilities, the guidance is not tailored to their current level of physical behaviors. This opinion piece aims to highlight that although people with excessive sitting and insufficient moderate-to-vigorous physical activity should sit more and move less, for other people their health would be promoted by sitting more and moving less. Thus, physical behaviors are not always "poison" or "medicine," but rather the health impact of changes in physical behaviors depends on people's initial levels. Policy, research, and practice implications of this realization are presented. Only tailoring messaging to age and health status could be far from optimal for people with very different current levels of physical behaviors. Policy, research, and practice will be enhanced when the potential for physical behaviors to be either health hindering or health promoting is adequately considered.

Dose/Exposure Relationship of Exercise and Distant Recurrence in Primary Breast Cancer

PURPOSE

Postdiagnosis exercise is associated with lower breast cancer (BC) mortality but its link with risk of recurrence is less clear. We investigated the impact and dose-response relationship of exercise and recurrence in patients with primary BC.

METHODS

Multicenter prospective cohort analysis among 10,359 patients with primary BC from 26 centers in France between 2012 and 2018 enrolled in the CANcer TOxicities study, with follow-up through October 2021. Exercise exposure was assessed using the Global Physical Activity Questionnaire-16, quantified in standardized metabolic equivalent of task-hours per week (MET-h/wk). We examined the dose/exposure response of pretreatment exercise on distant recurrence-free interval (DRFI) for all patients and stratified by clinical subtype and menopausal status using inverse probability treatment weighted multivariable Cox models to estimate hazard ratios (HRs).

RESULTS

For the overall cohort, the relationship between exercise and DRFI was nonlinear: increasing exercise ≥ 5 MET-h/wk was associated with an inverse linear reduction in DRFI events up to approximately 25 MET-h/wk; increasing exercise over this threshold did not provide any additional DRFI benefit. Compared with <5 MET-h/wk, the adjusted HR for DRFI was 0.82 (95% CI, 0.61 to 1.00) for ≥ 5 MET-h/wk. Stratification by subtype revealed the hormone receptor-/human epidermal growth factor receptor 2- (HR-/HER2-; HR, 0.59 [95% CI, 0.38 to 0.92]) and HR-/HER2+ (HR, 0.37 [95% CI, 0.14 to 0.96]) subtypes were preferentially responsive to exercise. The benefit of exercise was observed especially in the premenopausal population.

CONCLUSION

Postdiagnosis/pretreatment exercise is associated with lower risk of DRFI events in a nonlinear fashion in primary BC; exercise has different impact on DRFI as a function of subtype and menopausal status.

Visceral fat mass dynamics in a 2-year randomized STrength versus ENdurance training trial in people with obesity

AIM

To compare the effectiveness of strength versus endurance training on reducing visceral fat in individuals with obesity.

MATERIALS AND METHODS

For the STrength versus ENdurance (STEN) 24-month randomized clinical trial, we assigned 239 participants with abdominal obesity to either strength or endurance training (two to three times a week, 60 min/training session) in addition to standard nutritional counselling to promote a healthy diet. Changes in abdominal visceral adipose tissue (VAT) area quantified by magnetic resonance imaging after 12 months were defined as a primary endpoint.

RESULTS

Participants (aged 44 years, 74% women, body mass index: 37 kg/m2, mean VAT volume: 4050 cm3) had an approximately 50% retention rate and a 30% good training programme adherence at 12 months. There was no difference between strength and endurance training in VAT volume dynamics after 12 and 24 months (p = .13). Only in the good adherence group did we find a trend for reduced VAT volume in both training regimens. Independently of the exercise programme, there was a continuous trend for moderate loss of abdominal subcutaneous AT volume, body fat mass, body mass index and improved parameters of insulin sensitivity. Although parameters of physical fitness improved upon both exercise interventions, the dynamics of resting energy expenditure, glucose and lipid metabolism parameters were not different between the intervention groups and did not significantly improve during the 2-year trial (p > .05).

CONCLUSIONS

Despite heterogeneous individual training responses, strength and endurance training neither affected VAT volume nor key secondary endpoints differently.

High prevalence of stress fractures and long-term amenorrhoea in high endurance female athletes: The misleading lack of correlation with bone mineral density

Aim & objectives

Females who engage in high levels of sports have a high prevalence of menstrual cycle disorders and bone stress injuries (BSI). In this study, we determined the prevalence of menstrual disorders and fractures in female athletes and their association with bone mineral density (BMD) parameters.

Material & methods

Cross-Sectional Study. Forty-one female athletes from a public High-Performance Regional Centre; 24 high-endurance athletes (HEA) and 17 other athletes, were included. To form the control group, we invited medical students from a public University. Twenty-nine non-athletes (NA) were included. A health surveys and a dual-energy X-ray absorptiometry (DXA) were conducted for all participants.

Results

Among the participants (median age, 24 years; body mass index, 21 kg/m2), the percentage of long-term amenorrhoea was 42 % in HEA vs. 0 % in NHEA (OR 25.35; 95 % CI 1.37-470.50, p = 0.008) or 10 % in NA (OR 6.20; 95 % CI 1.46-26.24, p = 0.022), and the percentage of BSI was 29 % in HEA vs. 0 % in NHEA or NA. Both groups of female athletes (HEA and NHEA) showed higher Z-scores than those of NA in the femur; however, only NHEA had a significant increase in the BMD on lumbar spine than that of NA.

Conclusion

The prevalence of long-term amenorrhoea and/or BSI was significantly higher in the HEA than in the NHEA or NA females. In contrast, HEA, like NHEA, had higher BMD values in the femur than those of controls. It is unlikely that DXA parameters can be used to estimate cortical BSI risk in this population.

Evidence mapping and quality assessment of systematic reviews on exercise intervention for Alzheimer's disease

BACKGROUND

A significant body of literature suggests that exercise can reverse cognitive impairment and ameliorate somatic function in patients with Alzheimer's disease (AD). Systematic reviews (SRs), a common approach of evidence-based medicine, concentrate on a specific issue of a research area. The objective of this work is to provide an overview of existing evidence on the effects of exercise intervention in AD patients and report related health outcomes by reviewing SRs.

METHODS

SRs on exercise intervention in AD patients were retrieved from the PubMed, the Cochrane Library, CBMdisc, Scopus, Web of Science, Embase (via Ovid), China National Knowledge Infrastructure, and WanFang databases from the time of inception to February 2023. The quality of the SRs was evaluated utilizing the A Measurement Tool to Assess Systematic Review 2 (AMSTAR 2) checklist. The results were reported according to the population-intervention-comparison-outcome (PICO) framework and the corresponding evidence mapping was illustrated in tables and bubble plots.

RESULTS

A total of 26 SRs met the eligibility criteria. In terms of methodological quality, 10 SRs were rated as "critically low", 13 SRs were rated as "low", and 3 SRs were rated as "moderate". Exercise was found to exert a beneficial effect on cognitive function, functional independence, physical function, and neuropsychiatric symptoms in patients with AD.

CONCLUSION

Exercise intervention benefits AD patients mainly by improving cognitive function, physical function, functional independence, and neuropsychiatric symptoms. However, due to the low-to-moderate methodology of most SRs included in this analysis, further investigations are required to support our current findings.

Impact of Hypertension on the Dose-Response Association Between Physical Activity and Stroke: A Cohort Study

BACKGROUND

Regular physical activity is associated with a reduced stroke risk. However, this relationship might be attenuated in the presence of hypertension and antihypertensive medication use. We examined the dose-response relationship between physical activity and stroke in normotensive and hypertensive individuals.

METHODS

A Dutch population-based cohort including 139 930 individuals (41% men; mean age, 44±13) was performed (median follow-up, 6.75 years). Participants were stratified at baseline as hypertensive (44%) or normotensive (56%) and categorized into quartiles of the lowest (Q1) to the highest (Q4) moderate-to-vigorous, self-reported physical activity. The primary outcome was incident stroke (fatal and nonfatal). Cox regression estimated hazard ratios and 95% CIs. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Hypertensives were stratified into medicated (21%) or non-medicated (79%).

RESULTS

Compared with Q1, adjusted hazard ratios were 0.87 (0.69-1.10; P=0.23), 0.75 (0.59-0.95; P=0.02), and 0.94 (0.74-1.20; P=0.64) for Q2 to Q4, respectively in the total population. Hazard ratios for normotensives were 0.79 (0.50-1.25; P=0.32), 0.75 (0.48-1.18; P=0.22), 0.97 (0.62-1.51; P=0.90) for Q2 to Q4, respectively. In hypertensives, hazard ratios were 0.89 (0.68-1.17; P=0.41), 0.74 (0.56-0.98; P=0.03), 0.92 (0.69-1.23; P=0.56) for Q2 to Q4, respectively. There was no significant interaction between hypertension status for the relation between physical activity and stroke risk. The stratified analysis revealed a smaller benefit of moderate-to-vigorous physical activity in medicated hypertensives compared with nonmedicated hypertensives, but no significant interaction effect was found.

CONCLUSIONS

Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension. Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke, but further research is warranted.

The impact of exercise on food-related inhibitory control- do calories, time of day, and BMI matter? Evidence from an event-related potential (ERP) study

A growing body of research suggests exercise improves inhibitory control functions. We tested if exercise-related inhibitory control benefits extend to food-related inhibitory control and differ by calorie content, time of day, and weight status. One hundred thirty-eight individuals were pseudo-randomly assigned to a morning or evening group. Each subject participated in two lab sessions where they completed questionnaires (rest session) or walked on a treadmill at 3.8mph (exercise session) for 45 min. After each session, participants completed both a high-calorie and low-calorie go/no-go task while N2 and P3 event-related potentials (ERP), both neural indicators of inhibitory control, were measured. Participants also rated food images for valence and arousal. While N2 and P3 difference amplitudes were larger to high-calorie than low-calorie foods, neither exercise nor time of day affected results. Individuals had faster response times after exercise without decreases in accuracy. Arousal and valence for high-calorie foods were lower after exercise and lower for all foods after morning compared to evening exercise. In a subset of individuals with obesity and normal-weight individuals, individuals with obesity had larger N2 difference amplitudes after morning exercise, while normal-weight individuals had larger P3 difference amplitudes to high-calorie foods after exercise. Results suggest moderate exercise did not affect food-related inhibitory control generally, although morning exercise may be beneficial in improving early recruitment of food-related inhibitory control in individuals with obesity. Moderate exercise, particularly in the morning, may also help manage increased attention allocated to food.

Exposure to Smartphones and Tablets, Physical Activity and Sleep in Children From 5 to 10 Years Old: A Systematic Review and Meta-Analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to verify the association between smartphone/tablet exposure and physical activity and sleep in children from 5 to 10 years old. Data Source: This study followed the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and included studies that met eligibility criteria based on the "PECO" strategy: participants (children from 5 to 10 years old), exposure (smartphone and tablet use), and outcome (physical activity and sleep).

STUDY INCLUSION AND EXCLUSION CRITERIA

The inclusion criteria were observational studies published in indexed scientific journals and written in Portuguese, English, and Spanish that verified the association of exposure to smartphones/tablets with physical activity and sleep in children aged 5 to 10 years of both sexes. Studies were considered eligible only if they met the previous criteria. Data Extraction: The search was conducted in January 2023 on databases from electronic journals without the restriction of the period. To meta-analyze were extracted and grouped using models of fixed and random effects, the coefficients Odds Ratio (OR), Beta (β), Standard Error (SE), and Confidence Intervals of 95% (95%CI). Data Synthesis: 2396 potentially relevant papers were identified, and 17 met the inclusion criteria.

RESULTS

It can be verified that there was an inverse association between smartphones with physical activity and sleep. Studies indicate that for every additional hour of smartphone and tablet use, sleep can be expected to decrease by an average of 11 minutes (β = - 0.11; 95%CI = -0.13; -0.09). Children using smartphones and tablets were 1.79 times (OR = 1.79; 95%CI = 1.72-1.86) more likely to have shorter sleep duration and 1.53 times (OR = 1.53; 95%CI = 1.41-1.65) more likely to have worse sleep quality. Children with shorter smartphone and tablet usage were 1.19 times more likely to be active (OR = 1.19; 95% CI = 1.03-1.37).

CONCLUSION

Children of 5 to 10 years who are more often exposed to smartphones and tablets are prone to have worse quality and quantity of sleep, as well as less practice of physical activity. Health promotion actions can be encouraged based on the results, aiming to reduce the use time of these devices and improve children's health and quality of life.

Motor unit firing rates increase in prepubescent youth following linear periodization resistance exercise training

PURPOSE

The purpose was to examine the effects of 8-weeks (3 days/week) of linear periodization resistance exercise training (RET) on neuromuscular function in prepubescent youth.

METHODS

Twenty-five healthy prepubescent youth (11 males, 14 females, age = 9.1 ± 0.8 years) completed the RET (n = 17) or served as controls (CON, n = 8). Isometric maximal voluntary contractions (MVCs) and trapezoidal submaximal contractions at 35 and 60% MVC of the right leg extensors were performed with surface electromyography (EMG) recorded from the leg extensors [vastus lateralis (VL), rectus femoris, and vastus medialis] and flexors (biceps femoris and semitendinosus). EMG amplitude of the leg extensors and flexors were calculated during the MVCs. Motor unit (MU) action potential trains were decomposed from the surface EMG of the VL for the 35 and 60% MVCs. MU firing rates and action potential amplitudes were regressed against recruitment threshold with the y-intercepts and slopes calculated for each contraction. Total leg extensor muscle cross-sectional area (CSA) was collected using ultrasound images. ANOVA models were used to examine potential differences.

RESULTS

Isometric strength increased post-RET (P = 0.006) with no changes in leg extensor and flexor EMG amplitude. Furthermore, there were no changes in total CSA or the MU action potential amplitude vs. recruitment threshold relationships. However, there were increases in the firing rates of the higher-threshold MUs post-RET as indicated with greater y-intercepts (P = 0.003) from the 60% MVC and less negative slope (P = 0.004) of the firing rates vs. recruitment threshold relationships at 35% MVC.

CONCLUSIONS

MU adaptations contribute to strength increases following RET in prepubescent youth.

Trajectories of Physical Activity and Chronic Conditions Among Mid-Aged Women

INTRODUCTION

Women's physical activity levels vary throughout adulthood. However, the associations between trajectories of physical activity and health outcomes have been little studied. The aim of this study was to examine the associations of physical activity trajectories with incident diabetes, hypertension, obesity, depression, and physical disability in mid-aged women.

METHODS

Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (n=11,611). Mailed surveys at 3-year intervals from 1998 (age 47-52) to 2019 (age 68-73) were used to collect data on physical activity and each outcome. The analyses were conducted in 2023/24. Physical activity trajectories from age 47-61 (2-4 time-points) were identified using group-based trajectory modeling. Cox regression models with time-varying covariates were used to examine the associations of physical activity trajectories with adverse health outcomes onset from ages 56-73 (2-5 time-points).

RESULTS

Trajectories of physical activity were labeled as Low (59.7% of participants), Declining (5.9%), Increasing (26.3%), and High (8.1%). The median of 9-year overall physical activity (MET.minutes/week) was 450 in the Low, 1324 in the Declining, 1399 in the Increasing, and 2323 in the High group. Compared with the Low group, the risks of diabetes, obesity and physical disability were lower in the Increasing and High groups, and the risk of depression was lower in the High group. Conversely, the risk of obesity was higher in the Declining group.

CONCLUSIONS

Targeting mid-aged women with declining physical activity for prevention programs could enhance health in later life.

Public health importance of light intensity physical activity

•Light intensity physical activity is associated with a marked reduction in chronic disease and mortality risk. •That activities of daily living are associated with health benefits supports public health initiatives that advocate for replacing sitting time with standing and engaging in routine activities such as casual walking, leisurely sports and light housework. •The shift in focus from movement behaviors in isolation to the integration of all movement behaviors over the whole day will provide movement options for adults, treatment options for practitioners, and greater opportunities for public health promotion.

The Association Between Meeting Physical Activity Guidelines and Mental Health Among High-School Students in the United States During the COVID-19 Pandemic

PURPOSE

Physical activity (PA) is associated with mental health outcomes in high-school students, yet many students do not meet the recommended PA levels. Furthermore, both PA levels and mental health were severely impacted by the COVID-19 pandemic. The aim of this study was to assess whether the number of PA recommendations students met during the COVID-19 pandemic was associated with their self-reported mental health (including their experiences with stress, anxiety, and depression) during the COVID-19 pandemic.

METHODS

Students completed the Adolescent Behaviors and Experiences Survey, where they reported PA behaviors, mental health, and COVID-19-related experiences (as control variables) during the pandemic.

RESULTS

Each PA recommendation that was met was associated with a 17% decrease in the odds of students self-reporting that they experienced stress, anxiety, or depression most of the time or always during the COVID-19 pandemic.

DISCUSSION

Students should be provided with opportunities to participate in PA to obtain the physical and mental health benefits, especially in the event of a crisis like the pandemic.

'Walk Buds': A walking intervention to increase physical activity, physical fitness, and emotional wellbeing, in 9-13 year old children with intellectual disabilities. Results of a clustered randomised feasibility trial

BACKGROUND

Children with intellectual disability are less physically active and more sedentary than typically developing peers. To date no studies have tested the feasibility of a school-based walking intervention for children with Intellectual Disability.

METHOD

A clustered randomised controlled trial (cRCT), with an embedded process evaluation, was used to test the feasibility of a school-based walking intervention. Eight schools (n = 161 pupils aged 9-13 years) were randomised into either an intervention arm or an 'exercise as usual' arm. Measures included physical activity, physical fitness and emotional wellbeing. Baseline and 3-month follow-up data were collected.

RESULTS

The 'Walk Buds' intervention was found to be acceptable to teaching staff and pupils, with an uptake rate of the walking sessions offered of 84%.

CONCLUSION

A number of challenges were experienced, relating to the COVID-19 pandemic, and difficulties collecting accelerometer data. Barriers, facilitators and required changes identified through the mixed methods process evaluation are discussed.

Leisure Sedentary Behavior, Physical Activities, and Cardiovascular Disease Among Individuals With Metabolic Dysfunction-Associated Fatty Liver Disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease is a significant risk factor for cardiovascular disease (CVD). This study assesses the association between leisure-time physical activity, sedentary behavior, and CVD risk among patients with metabolic dysfunction-associated fatty liver disease, considering genetic predisposition to CVD.

METHODS

This cohort study included 157 794 participants with metabolic dysfunction-associated fatty liver disease from the UK Biobank who were free of CVD at baseline. The study measured leisure-time sedentary behaviors (watching TV, using a computer, and driving) and physical activities (walking for pleasure, light and heavy do-it-yourself activities, strenuous sports, and other exercises) in terms of frequency and duration over the 4 weeks before assessment. Both a Cox proportional hazard model and an isotemporal substitution model were utilized in the study to assess the association between leisure sedentary behavior, physical activities, and CVD risk.

RESULTS

During a median 12.5 years of follow-up, 26 355 CVD cases were reported, including 19 746 coronary heart disease, 4836 stroke, and 7398 heart failure cases. High physical activity levels were linked to a significantly lower risk of CVD (21%), coronary heart disease (20%), stroke (15%), and heart failure (31%). In contrast, individuals with >6.5 h/d of sedentary behavior faced a 16% to 21% higher risk of these conditions compared with those with ≤3.5 h/d. Notably, replacing 30 minutes of inactivity with physical activity reduced CVD risks by 3% to 16%, particularly with strenuous sports. A significant interaction was observed between physical activity, sedentary behavior, and genetic predisposition in relation to stroke risk.

CONCLUSIONS

Among patients with metabolic dysfunction-associated fatty liver disease, higher leisure-time physical activity levels correlate with reduced CVD risks, while increased sedentary behavior is linked to higher CVD risks. Replacing sedentary time with physical activity consistently shows benefits in reducing CVD outcomes, irrespective of genetic predisposition.

Effect of wearable activity trackers on physical activity in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical inactivity in children and adolescents has become a pressing public health concern. Wearable activity trackers can allow self-monitoring of physical activity behaviour and promote autonomous motivation for exercise. However, the effects of wearable trackers on physical activity in young populations remain uncertain.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, SPORTDiscus, and Web of Science for publications from database inception up to Aug 30, 2023, without restrictions on language. Studies were eligible if they were randomised controlled trials or clustered randomised controlled trials that examined the use of wearable activity trackers to promote physical activity, reduce sedentary behaviours, or promote overall health in participants with a mean age of 19 years or younger, with no restrictions on health condition or study settings. Studies were excluded if children or adolescents were not the primary intervention cohort, or wearable activity trackers were not worn on users' bodies to objectively track users' physical activity levels. Two independent reviewers (WWA and FR) assessed eligibility of studies and contacted authors of studies if more information was needed to assess eligibility. We also searched reference lists from relevant systematic reviews and meta-analyses. Systematic review software Covidence was used for study screening and data extraction. Study characteristics including study setting, participant characteristics, intervention characteristics, comparator, and outcome measurements were extracted from eligible studies. The two primary outcomes were objectively measured daily steps and moderate-to-vigorous physical activity. We used a random-effects model with Hartung-Knapp adjustments to calculate standardised mean differences. Between-study heterogeneity was examined using Higgins I2 and Cochran Q statistic. Publication bias was assessed using Egger's regression test. This systematic review was registered with PROSPERO, CRD42023397248.

FINDINGS

We identified 9619 studies from our database research and 174 studies from searching relevant systematic reviews and meta-analyses, of which 105 were subjected to full text screening. We included 21 eligible studies, involving 3676 children and adolescents (1618 [44%] were female and 2058 [56%] were male, mean age was 13·7 years [SD 2·7]) in our systematic review and meta-analysis. Ten studies were included in the estimation of the effect of wearable activity trackers on objectively measured daily steps and 11 were included for objectively measured moderate-to-vigorous physical activity. Compared with controls, we found a significant increase in objectively measured daily steps (standardised mean difference 0·37 [95% CI 0·09 to 0·65; p=0·013]; Q 47·60 [p<0·0001]; I2 72·7% [95% CI 53·4 to 84·0]), but not for moderate-to-vigorous physical activity (-0·08 [-0·18 to 0·02; p=0·11]; Q 10·26 [p=0·74]; I2 0·0% [0·0 to 53·6]).

INTERPRETATION

Wearable activity trackers might increase daily steps in young cohorts of various health statuses, but not moderate-to-vigorous physical activity, highlighting the potential of wearable trackers for motivating physical activity in children and adolescents. More rigorously designed trials that minimise missing data are warranted to validate our positive findings on steps and to explore possible long-term effects.

FUNDING

The Hong Kong University Grants Committee and Seed Fund for Basic Research of the University of Hong Kong.

Physical Demands of Walking Football in Patients With Cardiovascular Risk Factors and Diseases

OBJECTIVE

To compare the exercise intensity of walking football (WF) with walking (WA) and to describe specific movement characteristics of WF.

DESIGN

Cross-sectional study.

SETTING

Sports facilities Saarland University, Germany.

PATIENTS

Eighteen patients with cardiovascular risk factors CVRFs and diseases (13 men and 5 women, age: 69 ± 10 years).

INDEPENDENT VARIABLES

Patients completed a WF match and WA session of 2 x 10 min each. Video analysis was used to characterize movements during WF.

MAIN OUTCOME MEASURES

Rate of perceived exertion (RPE, Borg Scale 6-20), % maximum heart rate (HR max ), musculoskeletal pain on a visual analog scale (VAS, 1-100 mm) before and up to 72 hours after exercise, and movement patterns during WF.

RESULTS

The mean RPE during WF (12.1 ± 2.7) and WA (11.9 ± 3.0) did not differ ( P = 0.63). The mean HR during WF (79 ± 12% of HR max ) was higher than during WA (71% ± 11%; P < 0.01). The HR variability coefficient of variation during WF (10.3% ± 5.8%) and WA (7.1 ± 5.5%) did not differ ( P = 0.13). There was no influence of exercise mode (WF vs WA) on musculoskeletal pain perception ( P = 0.96 for interaction). Injury-inciting activities such as lunges (median: 0.5 [interquartile range (IQR) 0-1.3]) and goal kicks (median: 4 [IQR: 1.8-5.3]) occurred rarely during WF.

CONCLUSIONS

Walking football might represent an alternative to WA for health prevention programs in patients with CVRF and diseases as it is characterized by a manageable cardiocirculatory strain, moderate RPE, low pain induction, and a low number of injury-inciting activities.

Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis

BACKGROUND

High-intensity interval training (HIIT) promotes similar or superior gains in physical fitness and health compared to continuous moderate-intensity training (MICT) in young individuals. However, the effectiveness of HIIT in older adults is uncertain.

OBJECTIVE

This meta-analysis compared the effects of HIIT and MICT on cardiorespiratory fitness, body composition, vascular, metabolic, and hormonal variables, cognitive function, and quality of life in older adults.

METHODS

PubMed, Embase, Cochrane, Web of Science, Scopus, and SportDiscus databases were searched from inception until December 2023. Trials included adults ≥ 60 y. Hedge's effect sizes (g) were calculated and study quality and features of training interventions were tested as moderators.

RESULTS

Twenty-nine trials including 1,227 subjects (65.4 ± 3.3 y). HIIT and MICT elicited significant (p < 0.021) and similar (p > 0.156) 'gs' for VO2max (0.722 vs. 0.490), maximal workload/peak power output ratio (0.290 vs. 0.372),% fat (-0.297 vs. -0.262), glycemia (-0.273 vs. -0.334), systolic (-0.465 vs. -0.341), and diastolic blood pressure (-0.566 vs. -2.311). HIIT (p < 0.04) but not MICT (p > 0.170) produced significant 'gs' for fat mass (-0.245 vs. -0.103), waist circumference (-0.239 vs. -0.116), testosterone (0.339 vs. 0.170), and complex Stroop test (-0.595 vs. -0.250). Increases in the VO2max occurred only in controlled trials after HIIT but not MICT (Q = 6.286, p = 0.012; HITT-g = 1.068, p < 0.0001 vs. MICT-g = 0.109, p= 0.596).

CONCLUSION

HIIT and MICT produced similar changes in most of the investigated variables. In trials with greater quality (controlled vs. non-controlled trials), cardiorespiratory gains were higher in HIIT vs. MICT. These findings suggest that HIIT might be suitable for improving fitness and health in older adults.

Physical activity attenuates the excess mortality risk from prolonged sitting time among adults with osteoporosis or osteopenia

PURPOSE

Osteoporosis is a common generalized skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. This study aims to crystallize associations of physical activity (PA) and sedentary behaviour with the survival of adults with osteoporosis or osteopenia.

METHODS

A total of 3103 participants aged 50 years or older from the National Health and Nutrition Examination Survey (NHANES) were included in the study. All participants were diagnosed with osteopenia or osteoporosis. Multivariable Cox proportional hazards regression models were used to assess the association of PA and sedentary behaviour with overall mortality, cancer-related mortality, and cardiovascular disease (CVD)-related mortality.

RESULTS

During 21349 person-years of follow-up, 675 deaths were documented. Highly active participants had a lower risk of all-cause (hazard ratios [HR] = 0.61; 95% confidence interval [CI], 0.42-0.87; P for trend = 0.004), cancer-specific (HR = 0.64; 95%CI, 0.35-1.17; P for trend = 0.132), CVD-specific (HR = 0.75; 95%CI, 0.45-1.25; P for trend = 0.452), and other (HR, 0.51; 95%CI, 0.29-0.88; P for trend = 0.005) mortality than inactive participants. And sitting time was not associated with mortality among physically active participants; while among those who were insufficiently active or inactive, longer sitting time was associated with increased risks of all-cause (HR per 1-h increase = 1.05; 95% CI, 1.01-1.09), cancer-specific (HR per 1 h increase = 0.98; 95% CI, 0.90-1.07), CVD-specific (HR per 1-h increase = 1.11; 95% CI = 1.04-1.18), and other (HR per 1-h increase = 1.05; 95% CI, 0.98-1.13) mortality in a dose-response manner.

CONCLUSIONS

PA can attenuate the excess mortality risk from prolonged sitting for individuals with osteoporosis and/or osteopenia. The combination of prolonged sedentary behaviour with inactive (participants without any PA during a week) PA was associated with an increased risk of mortality. The all-cause mortality risk of individuals who engage in less than 150 min/wk PA and sit more than 8 h/d is 2.02 (95% CI, 1.37-2.99) times higher than that of individuals who engage in more than 150 min/wk PA and sit less than 4 h/d.

Impact of Multidisciplinary Prehabilitation Interventions on Postoperative Hospital Length of Stay and Functional Capacity in Patients Undergoing Resection of Colorectal Cancer: A Systematic Review and Meta-analysis

BACKGROUND

Although surgery is commonly regarded as the primary curative treatment for colorectal cancer, it could potentially be associated with postoperative morbidity and mortality.

OBJECTIVE

To determine the pooled effect of exercise and multidisciplinary prehabilitation interventions on postoperative hospital length of stay and functional capacity in patients undergoing resection of colorectal cancer.

DATA SOURCES

A systematic search was conducted in MEDLINE (via PubMed) and Web of Science databases from inception to November 2022.

STUDY SELECTION

The original systematic search retrieved 2005 studies. After the removal of duplicates and screening by title and abstract, 77 eligible full-text documents were evaluated for final inclusion in the meta-analysis. A total of 12 randomized controlled trials, 5 nonrandomized controlled trials, and 3 uncontrolled before-and-after studies were selected.

MAIN OUTCOME MEASURES

Postoperative hospital length of stay (in days) and functional capacity (assessed with the peak of oxygen consumption [VO2 peak] and 6-minute walking test) were the outcome measures.

RESULTS

The meta-analysis was conducted on 20 studies (3805 participants). Randomized controlled trials and nonrandomized controlled trials showed significant reductions in postoperative hospital length of stay (d = -0.10, nearly 2 days) and significant incremental improvements in VO2 peak (d = 0.27) and 6-minute walking test (d = 0.31). Regarding the before-and-after studies, the pooled effect of multidisciplinary prehabilitation interventions was positively significant for VO2 peak (d = 0.29) and 6-minute walking test (d = 0.29). There was no risk of publication bias (Egger test: p > 0.05), with a score of 0.71 (0-1) on average.

LIMITATIONS

There was a high between-studies heterogeneity, and several outcomes did not have the required number of studies for a desirable statistical power.

CONCLUSIONS

These findings suggest that multidisciplinary prehabilitation interventions might be effective at decreasing postoperative hospital length of stay (nearly 2 days) and improving functional capacity.

REGISTRATION

PROSPERO registration number CRD42022373982.

Surgeon Recommendations for Physical Activity in Patients With Pediatric Hip Conditions

BACKGROUND

While physical activity (PA) is important during youth, it is unclear if children and adolescents with developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease (LCPD), or slipped capital femoral epiphysis (SCFE) are expected or encouraged to return to PA once they have healed. This study examines the orthopaedic surgeons' role in advising pediatric hip patients on the PA they should engage in, assessing their practice, opinions, and consensus when making recommendations.

METHODS

Orthopaedic surgeons were invited from member lists of 4 hip study groups. The survey included demographics, opinions regarding PA, and 10 case scenarios that queried respondents on the duration and intensity of PA as well as the restrictions on activity type that they would recommend for DDH, LCPD, or SCFE patients. Consensus was evaluated on a scale ranging from 0 to 1, with a value of 0 indicating no agreement among respondents and a value of 1 indicating complete agreement.

RESULTS

A total of 51 orthopaedic surgeons responded. While 94% agreed that it is important for school-aged hip patients to return to PA after they have healed, 53% believed that PA may compromise the hip and contribute to the development of osteoarthritis. Average standardized consensus was 0.92 for suggesting the patient engage in some amount of PA, 0.44 for suggesting the recommended daily minimum of 60 minutes of moderate-to-vigorous physical activity (MVPA), and 0.33 for suggesting restrictions on activity type. The most frequently selected restrictions included avoiding impact activities (93%, 235/254) and contact activities (58%, 147/254), followed by weight-bearing activities (24%, 62/254). Respondents were not aware of existing PA guidelines, although 57% expressed interest in following guidelines and 39% were uncertain.

CONCLUSIONS

While there is consensus among orthopaedic surgeons that children with chronic hip conditions should engage in PA, there is considerable variation when recommending the recommended daily MVPA minimum and placing restrictions on activity type. This study suggests interest among orthopaedic surgeons in developing PA guidelines that optimize outcomes for pediatric hip patients.

LEVEL OF EVIDENCE

Level II-Survey study.

"You are either sporty or you are not" a qualitative exploration of pre-teen girls of low-socioeconomic position experiences of being physically active

BACKGROUND

Eighty one percent of adolescents do not meet the recommended physical activity (PA) guidelines with levels of physical activity declining steadily with age and more pronounced in girls of low socioeconomic position (SEP). Furthermore, early adolescence is a time when the rate of decline in PA is most severe amongst girls, placing them at an increased likelihood of developing negative health outcomes associated with physical inactivity. In response, the aim of this study was to explore low-SEP pre-teen girls' experiences of being physically active and to understand their perceptions of the individual, social and environmental factors that influence these experiences.

METHODS

Focus groups were conducted with 107 girls aged 10-12 years from four urban and three rural primary schools. Reflexive thematic analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework (TDF).

RESULTS

Themes highlighted how skills and confidence underpin girls' self-identity for PA. Girls described how their social network (i.e., peers, family, coaches and teachers) shaped their experiences of being active. Girls recognised how being active was impacted by the challenges and opportunities in their local community (e.g., lack of facilities and anti-social behaviour).

CONCLUSION

This study provides insight into low-SEP pre-teen girls' experiences of being physically active in both rural and urban locations, while highlighting the complex interplay of individual, social and environmental factors. Additionally, the use of the TDF presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote low-SEP pre-teen girls PA.

Associations between physical activity and ankle-brachial index: the Swedish CArdioPulmonary bioImage Study (SCAPIS)

BACKGROUND

The ankle-brachial index (ABI) is the ratio of the ankle and brachial systolic blood pressures. In the clinical setting, low ABI (< 0.9) is an indicator of peripheral atherosclerosis, while high ABI (> 1.4) is a sign of arterial stiffness and calcification. The purpose of the current study was to investigate the association between ABI and physical activity levels, measured by accelerometer.

METHODS

The Swedish CArdioPulmonary bioImage Study (SCAPIS) is a Swedish nationwide population-based cross-sectional cohort for the study of cardiovascular and pulmonary diseases, in which individuals aged 50-64 years were randomly invited from the general population. The study population with data on ABI, physical activity, and sedentary time based on accelerometry was 27,737. Differences between ABI categories and associations to sedentary behavior, moderate to vigorous physical activity (MVPA), and other metabolic characteristics were compared. ABI was categorized as low, ABI ≤ 0.9, borderline, ABI 0.91-0.99, normal, ABI 1.0-1.39, and high, ABI ≥ 1.4.

RESULTS

Prevalence of low ABI was higher in the most sedentary quartiles compared to the least sedentary (0.6% vs. 0.1%, p < 0.001). The most sedentary individuals also exhibited higher BMI, higher prevalence of diabetes and hypertension. The proportion of wake time spent in MVPA was lowest in those with low ABI (0.033 ± 0.004; p < 0.001) and highest in those with ABI > 1.4 (0.069 ± 0.001; p < 0.001) compared to those with normal ABI. Compared to normal ABI, the proportion of sedentary time was highest in those with low ABI (0.597 ± 0.012; p < 0.001) and lowest in those with ABI > 1.4 (0.534 ± 0.002; p = 0.004).

CONCLUSION

This population-based study shows that middle-aged individuals with ABI > 1.4 have the highest level of physical activity, while individuals with a lower ABI, especially those with ABI < 0.9, are less active and spend more time sedentary. Future studies are needed to understand the relationships between ABI, physical activity, and the risk of peripheral arterial and cardiovascular disease in the general population.

The Energetic Saver Profile From Sit-to-Stand Does Not Persist During Very Low-Intensity Physical Activity in Healthy Men and Women

BACKGROUND

It is essential to better characterize the energetic profile of individuals during very low-intensity physical activity. The objectives of the present study were to determine whether the saver profile from sit-to-stand persists during light physical activity and characterize patterns in substrate utilization from sit-to-stand and during very low-intensity physical activity in healthy men and women.

METHODS

Sixty-two healthy adults (38 women) performed an experimental sequence that corresponded to 15-minute sitting (SIT1), followed by 15-minute standing (STAND), 15-minute sitting again (SIT2), and finally 15 minutes of light cycling. Continuous indirect calorimetry was allowed to calculate energy expenditure (EE) and respiratory quotient through the entire sequence. Savers and nonsavers (<5% and ≥ 5% increase in EE from sitting to standing, respectively) were determined.

RESULTS

There was an interaction effect in EE between savers and nonsavers through the whole sequence (P = .008). Only nonsavers (71%) exhibited a significant increase in EE from SIT1 to STAND (P < .001). Nonsavers and savers significantly increased EE during 15 minutes of light cycling relative to sitting or standing (P < .001), without any difference between groups. The percentage of change in respiratory quotient from SIT1 to STAND was significantly different between the 2 groups, with increased values in savers and decreased values in nonsavers (P = .03). Significantly lower values in respiratory quotient and EE were found during 15 minutes of light cycling in women compared with men (P < .001).

CONCLUSIONS

It is essential to determine individuals' energetic phenotype to determine those who may benefit more from strategies such as standing or light physical activity. The sexual dimorphism in terms of substrate use during such exercise should be considered.

Dose-Response Relationships of Moderate to Vigorous Physical Activity and Sedentary Time With Renal Function Indices in Adolescents With Reduced Renal Function: A Cross-Sectional Study

BACKGROUND

This study aimed to explore the associations between moderate to vigorous physical activity (MVPA) and sedentary time with renal function indices in adolescents with kidney disease.

METHODS

A cross-sectional study was conducted on 719 adolescents (median age 15 y, 40.6% female) with kidney disease from the National Health and Nutrition Examination Survey 2007-2016. The exposures were MVPA time and sedentary time. Renal metabolic parameters included serum uric acid (SUA), creatinine, blood urea nitrogen, the estimated glomerular filtration rate (eGFR), and the albumin creatinine ratio. Weighted multivariate regression analysis was used to estimate associations between exposures and outcomes.

RESULTS

After stratifying MVPA time, the regression effect values β (95% CI) for MVPA on SUA (Q2: -0.22 [-0.41 to -0.03]; Q3: -0.32 [-0.53 to -0.11]) and creatinine (Q2: -0.08 [-0.15 to -0.01]; Q3: -0.04 [-0.11 to 0.03]) gradually decreased with increasing MVPA time. In males (-0.76 [-1.19 to -0.32]), MVPA time was significantly associated with lower SUA levels compared with females (-0.14 [-0.38 to 0.10]). Notably, female adolescents who had an MVPA time exceeding 420 minutes exhibited lower albumin creatinine ratio (-75.37 [-146.63 to -4.11]). In addition, both recreational MVPA time (-0.26 [-0.45 to -0.06]) and sedentary time (-3.15 [-5.83 to -0.46]) were negatively associated with eGFR.

CONCLUSIONS

Our study found an association between MVPA and lower levels of SUA in male adolescents with kidney disease and albuminuria in female adolescents with kidney disease. In addition, MVPA was also negatively associated with creatinine and eGFR, whereas sedentary time was only associated with eGFR. Further studies are needed to confirm these findings.

Association between physical activity and visceral adiposity index (VAI) in U.S. population with overweight or obesity: a cross-sectional study

BACKGROUND

Previous studies have revealed the effects of different physical activity (PA) types on visceral adipose tissue (VAT) accumulation in individuals with overweight/obesity. However, the independent association (especially the dose-response relationship) between PA and VAT in individuals with and without overweight/obesity remains less explored. Visceral adiposity index (VAI), calculated from waist circumference, body mass index (BMI), triglyceride and high-density lipoprotein cholesterol, is a novel indicator of VAT. This study aims to elucidate the association between PA and VAI in participants with and without overweight/obesity.

METHODS

Participants who are overweight or obese and with complete data on VAI, PA, and other essential covariates from the National Health and Nutrition Examination Survey (NHANES) database (2015-2018) were included in this study. PA was evaluated by the PA questionnaire and converted into metabolic equivalent task (MET) hours per week (MET-h/wk) based on the suggested MET scores. Multivariate linear regression models were used to identify the association between PA and VAI. Subgroup analyses, combined with interaction tests and restricted cubic spline (RCS) regression analyses, were utilized to explore the stability and nonlinearity of PA-VAI association, respectively.

RESULTS

A total of 4, 312 participants with complete data on PA and VAI was included in this study, with 3, 441 of them being overweight or obese. After adjusting for all potential covariates, increased PA was found to be significantly associated with remarkable lower level of VAI in all participants (β = -0.0004, P = 0.003), participants with (β = -0.0013, P = 0.012) and without (β = -0.0004, P = 0.003) overweight/obesity. Subgroup analyses and interaction tests revealed that the PA-VAI association was not modified by other covariates in individuals with overweight/obesity. Furthermore, RCS analyses revealed that PA was significantly, linearly and negatively associated with VAI in all participants, participants with and without overweight/obesity (all P < 0.05, all P for nonlinearity > 0.05). Noteworthily, as opposed to individuals without overweight/obesity, PA was significantly associated with lower VAI in participants with overweight/obesity after exceeding the threshold of 150 MET-h/wk.

CONCLUSION

Increased PA was significantly associated with lower level of VAI, but a higher level of PA (> 150 MET-h/wk) was needed to obtain significantly lower level of VAI in individuals with overweight/obesity.

Predictors of post-exercise affect: A self-determination theory approach considering physical, social, and psychological factors

BACKGROUND

Studies have shown increases in affect after acute exercise. However, the specific aspects of an exercise experience that predict or contribute to post-exercise affect remain relatively unknown. This study aimed to determine which physical (i.e., duration and intensity), contextual (i.e., social context and time of day), and psychological factors (i.e., motivation and need satisfaction) predicted post-exercise affect.

METHODS

In 2021, 296 gym users self-reported affect before and immediately after exercising at a gym facility. Participants also reported situational motivation towards exercise, need satisfaction (i.e., autonomy, competence, and relatedness), who they exercised with (social interaction), and the duration and perceived intensity of their exercise session. We first conducted a paired samples t-test to identify whether affect significantly increased from before to after exercise, and then a hierarchical regression model to determine which factors predicted post-exercise affect.

RESULTS

Affect significantly increased from before to after exercise (t[291] = 8.116, p < .001). Autonomous motivation (β = .23, p = <.001), autonomy satisfaction (β = .15, p = <.05), and relatedness satisfaction (β = .19, p = <.01) significantly predicted post-exercise affect, whereas duration, perceived intensity, social interaction, and time of day did not.

CONCLUSIONS

People should be encouraged to engage in activities that satisfy their need for autonomy and relatedness during leisure-time (i.e., not during the workday). SO WHAT?: This approach to physical activity promotion may lead to better affective outcomes and increased adherence compared to focusing on how long, how intense, or with whom people exercise.

Immediate Effects of High-Intensity Blood Flow Restriction Training on Muscle Performance and Muscle Soreness

Purpose: The aim was to investigate the immediate effects of high-intensity resistance training with blood flow restriction (HIRT-BFR) on rectus femoris (RF) muscle activity, reaction time, muscular performance, and delayed onset muscle soreness (DOMS) in healthy young adults. Methods: Twenty-four healthy young adults were randomized into the HIRT-BFR group or HIRT group. Both groups performed a single session of training with 80% of 1RM, 8 repetitions, 2 sets, and 3 minutes rest to RF muscle. The activity and reaction time of the dominant extremity RF muscle were evaluated by superficial electromyography (sEMG), muscular performance by single-leg squat test, and DOMS by the Visual Analog Scale. Results: Single-leg squat performance was significantly increased in HIRT-BFR (p = .001) and HIRT group (p = .04). Additionally, in HIRT group resting average (p = .03), resting maximal voluntary contraction % (p = .04), and relaxation minimum (p = .02) values of RF were significantly increased. DOMS level decreased significantly in HIRT-BFR (p < .001) and HIRT group (p = .019). The differences were similar in the groups for sEMG parameters, muscle performance, and DOMS level. Conclusion: We observed that HIRT-BFR and HIRT were similar in terms of muscle activation, reaction time, muscular performance of the RF, and DOMS level.Trial registration number: This study is registered at www.clinicaltrails.gov (NCT05274542).

Acceptability of a Portable Exercise Bike in Older Adults With Cardiovascular Diseases

BACKGROUND

Ways to help older adults overcome barriers to performing regular exercise is a challenge to nurses.

OBJECTIVE

The study evaluated the acceptability of a portable exercise bike for arm/foot pedaling among older patients with cardiovascular diseases (CVDs).

METHODS

Participants reported their physical activity levels using the International Physical Activity Questionnaire (short form) and thereafter performed two 6-minute-long arm/foot pedal biking sessions using a portable exercise bike. Participants provided qualitative feedback (one open-ended question) on the bike while exercising and completed the quantitative Acceptability Use Questionnaire following the two exercise sessions.

RESULTS

Twenty-five older adults (52% male and 48% female), with a mean (SD) age of 70 (6.4) years and a body mass index of 30 (7.4), completed the study. Most participants performed moderate to light physical activity at home with a daily mean (SD) sitting/sedentary time of 8 (3.4) hours. The mean scores from the Acceptability Use Questionnaire and the participants' comments alluded to the bike's multitasking utility and acceptability. Three broad themes derived from the qualitative analysis were: (1) the acceptability of the bike with participants who had musculoskeletal problems; (2) the ability to operate and use the bike for aerobic exercise engaging both arms and legs; and (3) the importance of overall utility, ease of use, and cost of the bike.

CONCLUSIONS

The portable exercise bike was found acceptable in a group of older adults with CVDs. The bike has the potential to be applied in home-based exercise interventions.

Establishing a Consensus-Based Framework for the Use of Wearable Activity Trackers in Health Care: Delphi Study

BACKGROUND

Physical activity (PA) plays a crucial role in health care, providing benefits in the prevention and management of many noncommunicable diseases. Wearable activity trackers (WATs) provide an opportunity to monitor and promote PA in various health care settings.

OBJECTIVE

This study aimed to develop a consensus-based framework for the optimal use of WATs in health care.

METHODS

A 4-round Delphi survey was conducted, involving a panel (n=58) of health care professionals, health service managers, and researchers. Round 1 used open-response questions to identify overarching themes. Rounds 2 and 3 used 9-point Likert scales to refine participants' opinions and establish consensus on key factors related to WAT use in health care, including metrics, device characteristics, clinical populations and settings, and software considerations. Round 3 also explored barriers and mitigating strategies to WAT use in clinical settings. Insights from Rounds 1-3 informed a draft checklist designed to guide a systematic approach to WAT adoption in health care. In Round 4, participants evaluated the draft checklist's clarity, utility, and appropriateness.

RESULTS

Participation rates for rounds 1 to 4 were 76% (n=44), 74% (n=43), 74% (n=43), and 66% (n=38), respectively. The study found a strong interest in using WATs across diverse clinical populations and settings. Key metrics (step count, minutes of PA, and sedentary time), device characteristics (eg, easy to charge, comfortable, waterproof, simple data access, and easy to navigate and interpret data), and software characteristics (eg, remote and wireless data access, access to multiple patients' data) were identified. Various barriers to WAT adoption were highlighted, including device-related, patient-related, clinician-related, and system-level issues. The findings culminated in a 12-item draft checklist for using WATs in health care, with all 12 items endorsed for their utility, clarity, and appropriateness in Round 4.

CONCLUSIONS

This study underscores the potential of WATs in enhancing patient care across a broad spectrum of health care settings. While the benefits of WATs are evident, successful integration requires addressing several challenges, from technological developments to patient education and clinician training. Collaboration between WAT manufacturers, researchers, and health care professionals will be pivotal for implementing WATs in the health care sector.

Healthcare professional and commissioners' perspectives on the factors facilitating and hindering the implementation of digital tools for self-management of long-term conditions within UK healthcare pathways

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings. Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n = 15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)'s four constructs used to aid interpretation. Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or 'making sense'). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action-needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action-promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring). Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation.

High sensitivity troponins and mortality in the population with metabolic dysfunction-associated steatotic liver disease

Given the global high prevalence of MASLD and its poor CVD prognosis, it is essential to perform risk stratification for MASLD patients. The specific impact of High Sensitivity Troponins (hs-cTn ) on mortality in MASLD patients remains unexplored.  The NHANES databases from 1999 to 2004, which include data on high-sensitivity cardiac troponin (hs-cTn) levels and comorbidities, were linked with the most recent mortality dataset. Myocardial injury was determined using the 99th upper reference limits (URL) for hs-cTn.  Our study included 3460 MASLD patients. The mean follow-up duration was 192 months, during which 1074 (23%) MASLD participants died from all-cause mortality, and 363 (7.3%) died from CVD mortality. Our findings indicate that MASLD patients with elevated levels of hs-cTnT (> 99th URL) exhibit increased risks of all-cause mortality [adjusted hazard ratio (aHR) = 1.93] and CVD mortality (aHR = 2.4). Similar results were observed for hs-cTnI, where the aHRs for all-cause mortality and CVD mortality were 2.03 and 2.97, respectively. Furthermore, we identified a nonlinear dose-response relationship between hs-cTn levels and the risk of mortality (P for nonlinearity < 0.001).  Our findings suggest that hs-cTn can predict mortality risk in MASLD, aiding clinicians in risk-stratifying this population. Therefore, we recommend considering hs-cTn detection in individuals with MASLD to effectively assess their future mortality risk.

Interplay between physical activity volume and intensity with modeled life expectancy in women and men: A prospective cohort analysis

BACKGROUND

There is a lack of research examining the interplay between objectively measured physical activity volume and intensity with life expectancy.

METHODS

Individuals from UK Biobank with wrist-worn accelerometer data were included. The average acceleration and intensity gradient were extracted to describe the physical activity volume and intensity profile. Mortality data were obtained from national registries. Adjusted life expectancies were estimated using parametric flexible survival models.

RESULTS

40,953 (57.1%) women (median age = 61.9 years) and 30,820 (42.9%) men (63.1 years) were included. Over a median follow-up of 6.9 years, there were 1719 (2.4%) deaths (733 in women; 986 in men). At 60 years, life expectancy was progressively longer for higher physical activity volume and intensity profiles, reaching 95.6 years in women and 94.5 years in men at the 90th centile for both volume and intensity, corresponding to 3.4 (95% confidence interval (95%CI): 2.4-4.4) additional years in women and 4.6 (95%CI: 3.6-5.6) additional years in men compared to those at the 10th centiles. An additional 10-min or 30-min daily brisk walk was associated with 0.9 (95%CI: 0.5-1.3) and 1.4 (95%CI: 0.9-1.9) years longer life expectancy, respectively, in inactive women; and 1.4 (95%CI: 1.0-1.8) and 2.5 (95%CI: 1.9-3.1) years in inactive men.

CONCLUSION

Higher physical activity volumes were associated with longer life expectancy, with a higher physical activity intensity profile further adding to a longer life. Adding as little as a 10-min brisk walk to daily activity patterns may result in a meaningful benefit to life expectancy.

Associations between habitual sleep characteristics and cardiometabolic disease risk in corporate executives

OBJECTIVES

Corporate executive job demands may lead to poor sleep habits, increasing their risk for cardiometabolic disease. This study aimed to describe and explore associations between objectively measured habitual sleep characteristics and cardiometabolic disease risk of corporate executives, while accounting for occupational, psychological, and lifestyle factors.

METHODS

Habitual sleep was measured using wrist-worn actigraphy and a sleep diary over seven consecutive days in 61 (68.3% men) corporate executives aged 46.4 ± 8.7years. A composite cardiometabolic disease risk score was determined using body mass index, waist circumference, blood pressure and fasting glucose and lipid concentrations. Prediction models were built using a backward stepwise selection approach to explore associations between sleep characteristics and cardiometabolic disease risk factors adjusting for occupational, psychological, and lifestyle covariates.

RESULTS

Average total sleep time was 6.60 ± 0.75 hours, with 51.7% of participants reporting poor sleep quality and 26.2% extending their weekend sleep. Adjusted models showed that lower sleep efficiency (β = -0.25, 95%CI: -0.43; -0.08, P = .006), shorter weekday total sleep time (β = -1.37, 95% CI: -2.41, -0.32; P = .011) and catch-up sleep (β = 0.84, 95%CI: 0.08, 1.60, P = .002) were associated with higher cardiometabolic disease risk scores. Adjusted models also found that shorter average time-in-bed (ß=-2.00, 95%CI: -3.76; -0.18, P = .031), average total sleep time (ß=1.98, 95%CI: -3.70; -0.25, P = .025) and weekday total sleep time (β = -2.13, 95%CI: -3.56; -0.69, P = .025) as well as catch-up sleep (β = 1.67, 95% CI: 0.52; 2.83; P = .012) were all associated with a higher body mass index.

CONCLUSION

Corporate executives who compromise sleep duration during the working week may increase their risk for obesity and future cardiometabolic disease.

Intergenerational and genetic influences on physical activity: family data from the HUNT study, Norway

OBJECTIVES

The objectives of this study are to examine the association of physical activity in parents with physical activity in their adult offspring and explore if the offspring's genetic liability (ie, polygenic risk score) to physical activity influences this association.

METHODS

The Trøndelag Health Study cohort is a population-based longitudinal study with data collected in 1984-1986, 1995-1997, 2006-2008 and 2017-2019. We calculated the odds ratio for being physically active and mean difference in physical activity levels according to parental physical activity (device-measured and self-reported) and own polygenic risk score.

RESULTS

Compared with offspring with mothers in the lowest third of metabolic equivalent of task (MET)-min/day accumulated by vigorous physical activities, offspring with mothers in the upper third had an OR of 1.93 (95% CI 1.65 to 2.27) for accumulating ≥900 MET-min/week of vigorous physical activity. The OR for the corresponding father-offspring association was 1.78 (95% CI 1.48 to 2.14). Compared with offspring of parents not accumulating ≥900 MET-min/week, we found an OR of 1.89 (95% CI 1.45 to 2.44) for offspring to meet the same threshold if both parents accumulated ≥900 MET-min/week. Offspring with higher polygenic risk score to bephysically active and having physically active parents did more weekly physical activity, but we found no strong evidence of multiplicative synergistic effects between these two factors (all p values ≥0.01).

CONCLUSION

Both parental physical activity and offspring's polygenic risk score were positively associated with physical activity levels in the adult offspring, but there was no evidence of effect modification between these factors. A family-based approach to promote physical activity may be effective from a public health perspective.