The lifetime total physical activity questionnaire: development and reliability

Physical activity patterns in healthy middle-aged women

Exercise in healthy female adults around the menopausal transition has been routinely examined in leisure activities alone, potentially discounting the physical activity (PA) that is accumulated in household and outdoor domains. The purpose of this study was to quantify PA in healthy middle-aged women and to examine the extent to which the Center for Disease Control (CDC) PA guidelines were met through leisure, household, and outdoor activities.

METHODS

440 healthy women, 51-64 years old, BMI ≥18.5 or < 40 kg/m², participated in the study using the Lifetime Physical Activity Questionnaire (LPAQ) to quantify PA.

RESULTS

25.91% met the CDC PA guidelines if leisure time alone was examined. When multiple domains were included, 73.41% of the women met the PA guidelines. This percentage is much higher than the reported 20.6% of U.S. adults who met the guidelines in 2011. PA in women may be underrepresented in data limited to leisure time PA.

Relationships between physical activity across lifetime and health outcomes in older adults: Results from the NuAge cohort

This study aims to (1) describe participation in four physical activity (PA) domains across life and (2) examine the influence of PA during adolescence, early, middle, and later adulthood on health variables at older age. This observational study was conducted in 1378 generally healthy older adults (age 67-84 at baseline in 2003-2005; 52% women) in Quebec, Canada. Using a modified version of the interviewer-administered Lifetime Total Physical Activity Questionnaire (LTPAQ) and life events calendar to facilitate the recall, participants reported the frequency, duration, and intensity of occupational (OPA), commuting (CPA), household (HPA), and leisure time (LTPA) they participated in at age 15, 25, 45, and 65, and at the first follow-up (age 68-85 in 2005-2006). Fat mass, lean body mass, body mass index, waist-to-hip ratio, fasting glucose, systolic and diastolic blood pressures, self-reported chronic diseases, and socio-demographic data were assessed at baseline. Changes in PA over time differed by sex in each domain. However, there was a general decline in all PA domains in both sexes after age 65. In multiple regression analyses, LTPA at first-follow-up was associated with more favourable waist-to-hip ratio in both sexes, fat mass in women and fat mass percentage in men, whereas CPA, OPA, and HPA across life were not consistently associated with health variables. Older adults' LTPA at first follow-up was related to health variables, but PA recalled during adolescence, early adulthood, and mid-life was not. Results support the idea that current PA is positively related to better health outcomes.

Sedentary work and the risk of breast cancer in premenopausal and postmenopausal women: a pooled analysis of two case-control studies

OBJECTIVES

There is limited research on the association between sedentary behaviour and breast cancer risk, particularly whether sedentary behaviour is differentially associated with premenopausal and postmenopausal breast cancer. We pooled data from 2 case-control studies from Australia and Canada to investigate this association.

METHODS

This pooled analysis included 1762 incident breast cancer cases and 2532 controls. Participants in both studies completed a lifetime occupational history and self-rated occupational physical activity level. A job-exposure matrix (JEM) was also applied to job titles to assess sedentary work. Logistic regression analyses (6 pooled and 12 study-specific) were conducted to estimate associations between both self-reported and JEM-assessed sedentary work and breast cancer risk among premenopausal and postmenopausal women.

RESULTS

No association was observed in the 6 pooled analyses, and 10 of the study-specific analyses also showed null results. 2 study-specific analyses provided inconsistent and contradictory results, with 1 showing statistically significant increased risk of breast cancer for self-reported sedentary work among premenopausal women cancer in the Canadian study, and the other a non-significant inverse association between JEM-assessed sedentary work and breast cancer risk among postmenopausal women in the Australian study.

CONCLUSIONS

While a suggestion of increased risk was seen for premenopausal women in the Canadian study when using the self-reported measure, overall this pooled study does not provide evidence that sedentary work is associated with breast cancer risk.

Lifetime physical activity and the risk of non-Hodgkin lymphoma

Research regarding the association between physical activity and the risk of non-Hodgkin lymphoma (NHL) is limited and inconsistent, and few studies have investigated whether the intensity and timing of physical activity influence the association. A case-control study of NHL was conducted in British Columbia, Canada, in 2000 to 2004. Data were collected on various NHL risk factors, including moderate-intensity and vigorous-intensity physical activity performed over the lifetime. Logistic regression was used to estimate the association between physical activity and the risk of NHL. This analysis included 818 controls and 749 cases. Lifetime vigorous-intensity physical activity was inversely associated with NHL risk. Participants in the second, third, and fourth quartiles of lifetime vigorous-intensity physical activity had an approximately 25% to 30% lower risk of NHL than those in the lowest quartile [adjusted odds ratios, 0.69 (95% confidence interval [CI], 0.52-0.93); 0.68 (95% CI, 0.50-0.92); and 0.75 (95% CI, 0.55-1.01), respectively]. No consistent associations were observed for total or moderate-intensity physical activity. There were no apparent age periods in which physical activity appeared to confer a greater risk reduction. In this study, we found that lifetime vigorous-intensity physical activity was associated with a significantly reduced risk of NHL. Given this finding, more research on physical activity intensity and timing in relation to NHL risk is warranted.

Physical Activity and Survival After Prostate Cancer

BACKGROUND

Despite the high global prevalence of prostate cancer (PCa), few epidemiologic studies have assessed physical activity in relation to PCa survival.

OBJECTIVE

To evaluate different types, intensities, and timing of physical activity relative to PCa survival.

DESIGN, SETTING, AND PARTICIPANTS

A prospective study was conducted in Alberta, Canada, in a cohort of 830 stage II-IV incident PCa cases diagnosed between 1997 and 2000 with follow-up to 2014 (up to 17 yr). Prediagnosis lifetime activity was self-reported at diagnosis. Postdiagnosis activity was self-reported up to three times during follow-up.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Cox proportional hazards models related physical activity to all-cause and PCa-specific deaths and to first recurrence/progression of PCa.

RESULTS AND LIMITATIONS

A total of 458 deaths, 170 PCa-specific deaths, and, after first follow-up, 239 first recurrences/progressions occurred. Postdiagnosis total activity (>119 vs ≤42 metabolic equivalent [MET]-hours/week per year) was associated with a significantly lower all-cause mortality risk (hazard ratio [HR]: 0.58; 95% confidence interval [CI], 0.42-0.79; p value for trend <0.01). Postdiagnosis recreational activity (>26 vs ≤4 MET-hours/week per year) was associated with a significantly lower PCa-specific mortality risk (HR: 0.56; 95% CI, 0.35-0.90; p value for trend = 0.01). Sustained recreational activity before and after diagnosis (>18-20 vs <7-8 MET-hours/week per year) was associated with a lower risk of all-cause mortality (HR: 0.66; 95% CI, 0.49-0.88). Limitations included generalisability to healthier cases and an observational study design.

CONCLUSIONS

These findings support emerging recommendations to increase physical activity after the diagnosis of PCa and would inform a future exercise intervention trial examining PCa outcomes.

PATIENT SUMMARY

In a 17-yr prostate cancer (PCa) survival study, men who survived at least 2 yr who were more physically active postdiagnosis or performed more recreational physical activity before and after diagnosis survived longer. Recreational physical activity after diagnosis was associated with a lower risk of PCa death.

Antiretroviral Therapy, Especially Efavirenz, Is Associated with Low Bone Mineral Density in HIV-Infected South Africans

Purpose

We determined the prevalence and correlates of low bone mineral density (BMD) in HIV-infected South Africans as there is a paucity of such data from Africa.

Methods

BMD and serum 25-hydroxyvitamin D were measured in HIV-positive participants on antiretroviral therapy (ART) and in those not yet on ART (ART-naïve).

Results

We enrolled 444 participants [median age 35(IQR: 30, 40) years; 77% women]. BMD was low (z score <-2SD) in 17% and 5% of participants at the lumbar spine and total hip, respectively. Total hip [0.909 (SD 0.123) vs 0.956 (SD 0.124) g/cm², p = 0.0001] and neck of femur BMD [0.796 (SD 0.130) vs 0.844 (SD 0.120) g/cm², p = 0.0001] were lower in the ART, compared to the ART-naïve group. Vitamin D deficiency was present in 15% of participants and was associated with efavirenz use [adjusted OR 2.04 (95% CI 1.01 to 4.13)]. In a multivariate linear regression, exposure to efavirenz or lopinavir-based ART was associated with lower total hip BMD, whereas higher weight, being male and higher vitamin D concentration were associated with higher total hip BMD (adjusted R² = 0.28). Age, weight, sex, and the use of efavirenz-based ART were independently associated with lumbar spine BMD (adjusted R² = 0.13).

Conclusions

Vitamin D status, use of efavirenz or lopinavir/ritonavir, weight, age and sex are significantly associated with lower BMD in this young cohort of HIV-infected South Africans.

Association between Lifetime Physical Activity and Cognitive Functioning in Middle-Aged and Older Community Dwelling Adults: Results from the Brain in Motion Study

To determine if total lifetime physical activity (PA) is associated with better cognitive functioning with aging and if cerebrovascular function mediates this association. A sample of 226 (52.2% female) community dwelling middle-aged and older adults (66.5 ± 6.4 years) in the Brain in Motion Study, completed the Lifetime Total Physical Activity Questionnaire and underwent neuropsychological and cerebrovascular blood flow testing. Multiple robust linear regressions were used to model the associations between lifetime PA and global cognition after adjusting for age, sex, North American Adult Reading Test results (i.e., an estimate of premorbid intellectual ability), maximal aerobic capacity, body mass index and interactions between age, sex, and lifetime PA. Mediation analysis assessed the effect of cerebrovascular measures on the association between lifetime PA and global cognition. Post hoc analyses assessed past year PA and current fitness levels relation to global cognition and cerebrovascular measures. Better global cognitive performance was associated with higher lifetime PA (p=.045), recreational PA (p=.021), and vigorous intensity PA (p=.004), PA between the ages of 0 and 20 years (p=.036), and between the ages of 21 and 35 years (p.5), but partially mediated the relation between current fitness and global cognition. This study revealed significant associations between higher levels of PA (i.e., total lifetime, recreational, vigorous PA, and past year) and better cognitive function in later life. Current fitness levels relation to cognitive function may be partially mediated through current cerebrovascular function.

A healthy lifestyle index is associated with reduced risk of colorectal adenomatous polyps among non-users of non-steroidal anti-inflammatory drugs

In a Columbia, South Carolina-based case-control study, we developed a healthy lifestyle index from five modifiable lifestyle factors (smoking, alcohol intake, physical activity, diet, and body mass index), and examined the association between this lifestyle index and the risk of colorectal adenomatous polyps (adenoma). Participants were recruited from a local endoscopy center and completed questionnaires related to lifestyle behaviors prior to colonoscopy. We scored responses on each of five lifestyle factors as unhealthy (0 point) or healthy (1 point) based on current evidence and recommendations. We added the five scores to produce a combined lifestyle index for each participant ranging from 0 (least healthy) to 5 (healthiest), which was dichotomized into unhealthy (0-2) and healthy (3-5) lifestyle scores. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for adenoma with adjustment for multiple covariates. We identified 47 adenoma cases and 91 controls. In the main analyses, there was a statistically nonsignificant inverse association between the dichotomous (OR 0.54; 95% CI 0.22, 1.29) and continuous (OR 0.75; 95% CI 0.51, 1.10) lifestyle index and adenoma. Odds of adenoma were significantly modified by the use of non-steroidal anti-inflammatory drugs (NSAIDs) (p(interaction) = 0.04). For participants who reported no use of NSAIDs, those in the healthy lifestyle category had a 72% lower odds of adenoma as compared to those in the unhealthy category (OR 0.28; 95% CI 0.08, 0.98), whereas a one-unit increase in the index significantly reduced odds of adenoma by 53% (OR 0.47; 95% CI 0.26, 0.88). Although these findings should be interpreted cautiously given our small sample size, our results suggest that higher scores from this index are associated with reduced odds of adenomas, especially in non-users of NSAIDs. Lifestyle interventions are required to test this approach as a strategy to prevent colorectal adenomatous polyps.

Lifetime physical activity and female stress urinary incontinence

OBJECTIVE

We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years.

STUDY DESIGN

Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures.

RESULTS

SUI odds increased slightly with overall lifetime activity (odds ratio [OR], 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval [CI], 1.02-1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99-1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09-1.71); OR, 1.75; 95% CI, 1.15-2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years.

CONCLUSION

In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.

SMART: physical activity and cerebral metabolism in older people: study protocol for a randomised controlled trial

Background

Physical activity exerts a variety of long-term health benefits in older adults. In particular, it is assumed to be a protective factor against cognitive decline and dementia.

Methods/design

Randomised controlled assessor blinded 2-armed trial (n = 60) to explore the exercise- induced neuroprotective and metabolic effects on the brain in cognitively healthy older adults. Participants (age ≥ 65), recruited within the setting of assisted living facilities and newspaper advertisements are allocated to a 12-week individualised aerobic exercise programme intervention or a 12-week waiting control group. Total follow-up is 24 weeks. The main outcome is the change in cerebral metabolism as assessed with Magnetic Resonance Spectroscopic Imaging reflecting changes of cerebral N-acetyl-aspartate and of markers of neuronal energy reserve. Imaging also measures changes in cortical grey matter volume. Secondary outcomes include a broad range of psychometric (cognition) and movement-related parameters such as nutrition, history of physical activity, history of pain and functional diagnostics. Participants are allocated to either the intervention or control group using a computer-generated randomisation sequence. The exercise physiologist in charge of training opens sealed and opaque envelopes and informs participants about group allocation. For organisational reasons, he schedules the participants for upcoming assessments and exercise in groups of five. All assessors and study personal other than exercise physiologists are blinded.

Discussion

Magnetic Resonance Spectroscopic Imaging gives a deeper insight into mechanisms of exercise-induced changes in brain metabolism. As follow-up lasts for 6 months, this study is able to explore the mid-term cerebral metabolic effects of physical activity assuming that an individually tailored aerobic ergometer training has the potential to counteract brain ageing.

Trial registration

NCT02343029 (clinicaltrials.gov; 12 January 2015).

Perspectives on mammography after receipt of secondary screening owing to a false positive

BACKGROUND

The utility of mammography screening as an efficacious tool for early detection is being contested owing to the risk of potential harms, including psychological distress and exposure to unnecessary procedures associated with false-positive (FPs) results and overdiagnosis. However, there is little research regarding women's experiences, values, or preferences for participating in mammography programs. Our aim was to explore women's actual experiences of a FP mammography screen and their perceptions of the value, risks and benefits given their recent experience.

METHODS

We conducted semistructured interviews with 40 women who experienced a recent FP mammogram. Interviews were recorded and transcribed verbatim. A directed content analysis was used to identify and explore primary themes. Knowledge of breast cancer risk was also assessed.

FINDINGS

Receiving a FP mammography screen generated significant worry among 60% (n=24) of women. Yet 70% maintained that mammography screening was necessary despite the worry incurred. Women also described the experience as stimulating greater interest in additional cancer prevention activities (32.5%; n=13) and one-third discussed needing more information about the risks and benefits of mammography screening. Less than one-quarter of women (22.5%; n=9) correctly identified a women's lifetime risk of developing breast cancer; 20% (n=8) overestimated, and 57.5% (n=23) underestimated this risk.

CONCLUSION

Women reported needing more information about the risks and benefits of mammography screening, but also considered FP results an acceptable risk. Further, our results suggest that breast cancer screening programs may provide a unique opportunity to deliver additional breast cancer prevention interventions.

Adult bone strength of children from single-parent families: the Midlife in the United States Study

Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adulthood.

INTRODUCTION

Because peak bone mass is acquired during childhood, bone health may be negatively impacted by childhood socio-environmental disadvantage. The goal of this study was to determine whether being raised in a single-parent household is associated with lower bone strength in adulthood.

METHODS

Using dual-energy X-ray absorptiometry data from 708 participants (mean age 57 years) in the Midlife in the United States Biomarker Project, we examined the independent associations of composite indices of femoral neck bone strength relative to load (in three failure modes: compression, bending, and impact) in adulthood with the experience of single-parent childhood and parental death or divorce in childhood.

RESULTS

After adjustment for gender, race, menopause transition stage, age, and body mass index, each additional year of single-parent childhood was associated with 0.02 to 0.03 SD lower indices of adult femoral neck strength. In those with 9-16 years of single-parent childhood, the compression strength index was 0.41 SD lower, bending strength index was 0.31 SD lower, and impact strength index was 0.25 SD lower (all p values < 0.05). In contrast, parental death or divorce during childhood was not by itself independently associated with adult bone strength indices. The magnitudes of these associations were unaltered by additional adjustment for lifestyle factors and socioeconomic status in childhood and adulthood.

CONCLUSIONS

Independent of parental death or divorce, growing up in a single-parent household is associated with lower femoral neck bone strength in adulthood, and this association is not entirely explained by childhood or adult socioeconomic conditions or lifestyle choices.

Does bracing affect bone health in women with adolescent idiopathic scoliosis?

PURPOSE

Adolescent idiopathic scoliosis (AIS) is often associated with low bone mineral content and density (BMC, BMD). Bracing, used to manage spine curvature, may interfere with the growth-related BMC accrual, resulting in reduced bone strength into adulthood. The purpose of this study was to assess the effects of brace treatment on BMC in adult women, diagnosed with AIS and braced in early adolescence.

METHODS

Participants included women with AIS who: (i) underwent brace treatment (AIS-B, n = 15, 25.6 ± 5.8 yrs), (ii) underwent no treatment (AIS, n = 15, 24.0 ± 4.0 yrs), and (iii) a healthy comparison group (CON, n = 19, 23.5 ± 3.8 yrs). BMC and body composition were assessed using dual-energy X-ray absorptiometry. Differences between groups were examined using a oneway ANOVA or ANCOVA, as appropriate.

RESULTS

AIS-B underwent brace treatment 27.9 ± 21.6 months, for 18.0 ± 5.4 h/d. Femoral neck BMC was lower (p = 0.06) in AIS-B (4.54 ± 0.10 g) compared with AIS (4.89 ± 0.61 g) and CON (5.07 ± 0.58 g). Controlling for lean body mass, calcium and vitamin D daily intake, and strenuous physical activity, femoral neck BMC was statistically different (p = 0.02) between groups. A similar pattern was observed at other lower extremity sites (p < 0.05), but not in the spine or upper extremities. BMC and BMD did not correlate with duration of brace treatment, duration of daily brace wear, or overall physical activity.

CONCLUSION

Young women with AIS, especially those who were treated with a brace, have significantly lower BMC in their lower limbs compared to women without AIS. However, the lack of a relationship between brace treatment duration during adolescence and BMC during young adulthood, suggests that the brace treatment is not the likely mechanism of the low BMC.

Finding medical care for colorectal cancer symptoms: experiences among those facing financial barriers

Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer symptoms. Using verbatim transcripts of the narratives collected from patients between 2008 and 2010, three themes were identified: insurance status as a barrier (discussed by n = 84; 100% of subsample), finding medical care (discussed by n = 30; 36% of subsample) and, insurance companies as barriers (discussed by n = 7; 8% of subsample). Our analysis revealed that insurance status is more nuanced than the categories insured/uninsured and differentially affects how patients attempt to secure health care. While barriers to medical care for the uninsured have been well documented, the experiences of those who are underinsured are less well understood. To improve outcomes in these patients it is critical to understand how financial barriers to medical care are manifested. Even with anticipated changes of the Affordable Care Act, it remains important to understand how perceived financial barriers may be influencing patient behaviors, particularly those who have limited health care options due to insufficient health insurance coverage.

The relationship between BPAQ-derived physical activity and bone density of middle-aged and older men

The bone-specific physical activity questionnaire (BPAQ) accounts for activities that affect bone but has not been used in studies with older adults. Relationships exist between the BPAQ-derived physical activity and bone density in healthy middle-aged and older men but not men with prostate cancer. Disease-related treatments detrimental to bone should be considered when administering the BPAQ.

INTRODUCTION

The bone-specific physical activity questionnaire (BPAQ) was developed to account for bone-specific loading. In this retrospective study, we examined the relationship between BPAQ-derived physical activity and bone mineral density (BMD) in middle-aged and older men with and without prostate cancer.

METHODS

Two groups, 36 healthy men and 69 men with prostate cancer receiving androgen suppression therapy (AST), completed the BPAQ and had whole body, total hip, femoral (FN) and lumbar spine BMD assessed by dual-energy X-ray absorptiometry.

RESULTS

Past (pBPAQ), current (cBPAQ) and total BPAQ (tBPAQ) scores for the healthy men were related to FN BMD (pBPAQ r = 0.36, p = 0.030; cBPAQ r s = 0.35, p = 0.034; tBPAQ r = 0.41, p = 0.014), and pBPAQ and tBPAQ were related to total hip (r s = 0.35, p = 0.035 and r s = 0.36, p = 0.029, respectively) and whole body BMD (r s = 0.44, p = 0.007 and r s = 0.45, p = 0.006, respectively). In men with prostate cancer, the BPAQ was not significantly associated with BMD. In stepwise regression analyses, body mass and tBPAQ predicted 30 % of the variance in total hip BMD (p = 0.003), cBPAQ predicted 14 % of the variance in FN BMD (p = 0.002), and body mass, age and tBPAQ predicted 47% of the variance in whole body BMD (p < 0.001) in healthy men. In men with prostate cancer, the BPAQ was not an independent predictor of BMD.

CONCLUSIONS

Although BPAQ-derived estimates of physical activity are related to bone status in healthy middle-aged and older men, the adverse effect of AST on bone appears to obscure this relationship in men with prostate cancer.

Neighborhood influences on recreational physical activity and survival after breast cancer

PURPOSE

Higher levels of physical activity have been associated with improved survival after breast cancer diagnosis. However, no previous studies have considered the influence of the social and built environment on physical activity and survival among breast cancer patients.

METHODS

Our study included 4,345 women diagnosed with breast cancer (1995-2008) from two population-based studies conducted in the San Francisco Bay Area. We examined questionnaire-based moderate/strenuous recreational physical activity during the 3 years before diagnosis. Neighborhood characteristics were based on data from the 2000 US Census, business listings, parks, farmers' markets, and Department of Transportation. Survival was evaluated using multivariable Cox proportional hazards models, with follow-up through 2009.

RESULTS

Women residing in neighborhoods with no fast-food restaurants (vs. fewer fast-food restaurants) to other restaurants, high traffic density, and a high percentage of foreign-born residents were less likely to meet physical activity recommendations set by the American Cancer Society. Women who were not recreationally physically active had a 22% higher risk of death from any cause than women that were the most active. Poorer overall survival was associated with lower neighborhood socioeconomic status (SES) (p(trend) = 0.02), whereas better breast cancer-specific survival was associated with a lack of parks, especially among women in high-SES neighborhoods.

CONCLUSION

Certain aspects of the neighborhood have independent associations with recreational physical activity among breast cancer patients and their survival. Considering neighborhood factors may aide in the design of more effective, tailored physical activity programs for breast cancer survivors.

"How Hard Could it Be?" A Descriptive Analysis of Errors Made on a Validated Lifetime Physical Activity Questionnaire

BACKGROUND

Measuring historical physical activity in epidemiologic research depends on self-report. We aimed to describe data reporting errors women made in completing 2 validated questionnaires: Lifetime Physical Activity Questionnaire (LPAQ) and Occupational Questionnaire (OQ).

METHODS

Participants--229 women aged 38 to 65 years--completed questionnaires on paper (n = 160) or by web interface (n = 69). One research assistant collected questionnaire data, identified potential errors and contacted participants to trouble-shoot errors.

RESULTS

Women made mean 9.7 (SD 11.2) errors on paper and 7.1 (SD 6.2) errors on electronic versions of the LPAQ and 2.6 (SD 3.8) and 1.1 (SD 1.4) errors on paper and electronic versions of the OQ, respectively. Fewer mistakes were made on electronic versions of both questionnaires combined (8.5 ± 6.1) when compared with the paper versions (12.7 ± 13.1). Only ~2% of the sample completed all questionnaires without detectable errors. The most common errors were reporting activities or frequencies inconsistently between past year survey and the current age epoch, reporting more years than allowed by age epoch and missing information.

CONCLUSIONS

Despite the implications of "self-report" questionnaires, we recommend researchers provide participants with additional instructions, either verbally or as written tip sheet or both, and follow-up after questionnaire completion to correct mistakes as needed.

Lifetime physical activity and pelvic organ prolapse in middle-aged women

OBJECTIVE

To determine, in a case-control study, whether pelvic organ prolapse (POP) is associated with overall lifetime physical activity (combined leisure, outdoor, household, occupational), and lifetime leisure, lifetime strenuous, and teen years strenuous activity.

STUDY DESIGN

One hundred ninety-one POP cases (defined as maximal vaginal descent ≥1 cm below the hymen) and 191 age and recruitment-site matched controls (defined as maximal vaginal descent ≤1 cm above the hymen) between 39-65 years with no or mild urinary incontinence, were recruited chiefly from primary care clinics. Participants completed Lifetime Physical Activity and Occupation Questionnaires, recalling activities during 4 age epochs. We performed separate logistic regression models for physical activity measures.

RESULTS

Compared with controls, POP cases had greater body mass index and parity. Median overall lifetime activity, expressed in metabolic equivalents-hours/week, did not differ significantly between cases and controls. In adjusted analyses, we observed no associations between odds of POP and overall lifetime physical activity, lifetime leisure activity, or lifetime strenuous activity. There was a marginally significant nonlinear relationship between teen strenuous activity and POP with an increase in the log-odds of POP for women reporting ≥21 hours/week of strenuous activity (P = .046).

CONCLUSION

Lifetime physical activity does not increase the odds of anatomic POP in middle-aged women not seeking care for POP. Strenuous activity during teenage years may confer higher odds of POP. This relationship and the potential role of physical activity and POP incidence should be evaluated prospectively.

Factors associated with delayed patient appraisal of colorectal cancer symptoms

OBJECTIVE

To evaluate the relationship between symptoms, financial and cognitive barriers with patient delays in seeking evaluation of symptoms.

METHODS

Data were collected from 252 colorectal cancer patients from academic and community oncology practices in Virginia and Ohio. We used a cross-sectional, mixed methods design collected data through patient interviews and medical record reviews. Structural equation modeling (SEM) tested the hypothesized relationships between symptoms, financial and cognitive barriers and patient care seeking delays.

RESULTS

In bivariate analyses, patients who reported a financial barrier to accessing health care (t (246) = -2.6, p < 0.01) were more likely to have greater care-seeking delays. Model testing revealed that experiencing cognitive barriers was a significant, positive, direct predictor of appraisal delay (0.35; p < 0.01). Indirect pathways from symptoms (0.07; p < 0.05) and financial barriers (0.09; p < 0.05) to appraisal delay via cognitive barriers were significant.

CONCLUSIONS

Patient interpretations of symptoms were influenced by financial barriers. Conceptualizing financial barriers as a component of the symptom appraisal process is conceptually different from viewing it as only a structural barrier preventing healthcare access. Implications for practice These findings extend our understanding of why and how patients seemingly ignore serious symptoms, which hamper physician ability to provide curative therapy. In addition to uninsured patients, this may have important implications for the treatment and care of those who are underinsured.

Reliability and validity of the Iranian version of the QAPACE in adolescents

PURPOSE

The aim of this study was to determine the reliability and validity of the Iranian version of the Quantification de l'Activite Physique en Altitude Chez les Enfants (QAPACE) in adolescents.

METHODS

After linguistic validation, the Iranian version of the QAPACE was completed by 359 (52.4 % girls) schoolchildren, aged 15-18 years. Test-retest reliability of the questionnaire was determined by intraclass correlation coefficients (ICCs). For validation purposes, two methods were used for (1) the correlation between VO2peak and the DEE and (2) known-group validity, which was examined by comparing the normal weight adolescents and those who were overweight/obese.

RESULTS

ICCs for test-retest ranged from 0.79 to 0.98. The mean scores in test-retest surveys for total score and all of the subscores were significant (p < 0.05). Sex-specific analysis showed a significant correlation between VO2peak and DEE over 12-month, school, and vacation periods in girls (p < 0.05). The mean values for all activities except for transportation, other activities in school, personal artistic activities, sport competition, and home activities were significantly lower in overweight/obese group than normal group.

CONCLUSION

Our results support the initial reliability and validity of the Iranian version of QAPACE as a daily physical activity measure in adolescents.

Motivation, exercise, and stress in breast cancer survivors

PURPOSE

Reduced stress and reduced risk of cancer recurrence are among the many benefits of physical activity (PA) for cancer survivors. Exercise behaviors are linked to motivational factors. We investigated the associations between motivational profile, self-reported levels of PA and stress, and mental functioning in 94 posttreatment breast cancer survivors who voluntarily enrolled in an exercise program.

METHODS

Participants completed the Apter Motivational Style Profile (AMSP), Lifetime of Physical Activity (LTPA) Questionnaire, International Physical Activity Questionnaire (IPAQ), Medical Outcomes Short Form SF-36® (SF-36), and Perceived Stress Scale (PSS) and provided 10 saliva specimens (to measure cortisol levels). PA levels were calculated in metabolic equivalent hours per week (MET-hours/week).

RESULTS

Participants reported high levels of current and historical PA (M = 39.2 MET-h/week, SD = 39.7; M = 14.2 MET-h/week, SD = 15.4, respectively). They also reported high levels of stress (M = 33.6, SD = 4.5) coupled with low mental functionality as measured by SF-36 mental component scale (MCS) (M = 44.4, SD = 8.8). PSS was negatively associated with MCS (r = -0.27, p = 0.009). Salivary cortisol was not associated with any measure. Participants had a conformist ("follow rules") and alloic ("about others") motivational profile. No motivational, exercise history, or stress variables were associated with current PA.

CONCLUSIONS

As expected, participants reported higher levels of stress and lower mental functioning. Participants presented a unique motivational profile relative to the general population. Further research into the associations of motivation, exercise behaviors, and stress is warranted.

Childhood socioeconomic status and adult femoral neck bone strength: findings from the Midlife in the United States Study

PURPOSE

Bone acquisition in childhood impacts adult bone mass, and can be influenced by childhood socioeconomic conditions. Socioeconomic status is also associated with body weight which affects the load that bone is exposed to in a fall. We hypothesized that socioeconomic advantage in childhood is associated with greater bone strength relative to load in adulthood.

METHODS

Hip dual x-ray absorptiometry scans from 722 participants in the Midlife in the United States Study were used to measure femoral neck size and bone mineral density, and combined with body weight and height to create composite indices of femoral neck strength relative to load in different failure modes: compression, bending, and impact. A childhood socioeconomic advantage score was created for the same participants from parental education, self-rated financial status relative to others, and not being on welfare. Multiple linear regression was used to determine the association of childhood socioeconomic advantage with femoral neck composite strength indices, stratified by gender and race (white/non-white), and adjusted for study site, age, menopause status in women, education, and current financial advantage.

RESULTS

Childhood socioeconomic advantage was independently associated with higher indices of all three composite strength indices in white men (adjusted standardized effect sizes, 0.19 to 0.27, all p values<0.01), but not in the other three race/gender groups. Additional adjustment for adult obesity, physical activity in different life stages, smoking, and heavy drinking over the life-course significantly attenuated the associations in white men.

CONCLUSIONS

Socioeconomic disadvantage in childhood is associated with lower hip strength relative to load in white men, and these influences are dampened by healthy lifestyle choices.

Lifestyle factors associated with survival after colorectal cancer diagnosis

Background:

Aside from tumour stage and treatment, little is known about potential factors that may influence survival in colorectal cancer patients. The aim of this study was to investigate the associations between physical activity, obesity and smoking and disease-specific and overall mortality after a colorectal cancer diagnosis.

Methods:

A cohort of 879 colorectal cancer patients, diagnosed in Western Australia between 2005 and 2007, were followed up to 30 June 2012. Cox's regression models were used to estimate the hazard ratios (HR) for colorectal cancer-specific and overall mortality associated with self-reported pre-diagnosis physical activity, body mass index (BMI) and smoking.

Results:

Significantly lower overall and colorectal cancer-specific mortality was seen in females who reported any level of recent physical activity than in females reporting no activity. The colorectal cancer-specific mortality HR for increasing levels of physical activity in females were 0.34 (95% CI=0.15, 0.75), 0.37 (95% CI=0.17, 0.81) and 0.41 (95% CI=0.18, 0.90). Overweight and obese women had almost twice the risk of dying from any cause or colorectal cancer compared with women of normal weight. Females who were current smokers had worse overall and colorectal cancer-specific mortality than never smokers (overall HR=2.64, 95% CI=1.18, 5.93; colorectal cancer-specific HR=2.70, 95% CI=1.16, 6.29). No significant associations were found in males.

Conclusion:

Physical activity, BMI and smoking may influence survival after a diagnosis of colorectal cancer, with more pronounced results found for females than for males.

Web versus paper-based completion of the epidemiology of prolapse and incontinence questionnaire

OBJECTIVES

This study aimed to examine the validity and reliability of a Web-based version of the epidemiology of prolapse and incontinence questionnaire (EPIQ).

METHODS

Participants included 876 women age 38 to 65 years attending primary care clinics in the Salt Lake Valley. Women completed a single Web- or paper-based version of the symptom bother questions from EPIQ, and a subset repeated the same or opposite method at 2 separate time points. To assess subscales for the Web-based version factor, analysis of the 22 EPIQ items related to pelvic floor disorder symptoms was performed using principal components analysis and varimax rotation. Internal consistency was assessed using coefficient α. Test-retest and intermethod reliability were assessed using intraclass correlation coefficients for domain scores. Correlations above 0.70 were considered acceptable.

RESULTS

Overall, 384 and 492 women completed at least 1 Web and 1 paper EPIQ and 93% were white with mean age of 50 (7) years. Of these, 63 completed Web-Web, 57 Web-paper, 47 paper-Web, and 109 paper-paper test-retest. Overall, factor analyses were consistent with the 7 domains of the original EPIQ. Cronbach α for the 4 symptomatic pelvic floor disorder domains and range of test-retest reliability for the various administration methods were similar to the original EPIQ instrument. Correlations for domain scores were above 0.70, except the anal incontinence scale (intraclass correlation coefficients, 0.68.)

CONCLUSIONS

Web administration of the EPIQ has similar psychometric properties with comparable internal consistency and test-retest reliability when administered in the same modality. Reliability between both methods of administration is acceptable.

Prostate cancer: is it time to expand the research focus to early-life exposures?

Although the contribution of lifestyle and environment (non-genetic factors) to prostate carcinogenesis is indicated by international variation in prostate cancer occurrence and migration studies, no conclusive modifiable risk factors have yet been identified. One possible reason for this may be the dearth of epidemiological research on exposures experienced early in life, when the immature prostate may be more susceptible to carcinogenic exposures. In this Opinion article, we summarize the rationale for studying early-life exposures, describe the small body of early-life research and its associated challenges, and point to solutions for future research.

Reproducibility of physical activity recall over fifteen years: longitudinal evidence from the CARDIA study

Background

To examine the benefits of physical activity (PA) on diseases with a long developmental period, it is important to determine reliability of long-term PA recall.

Methods

We investigated 15-year reproducibility of PA recall. Participants were 3605 White and African-American adults in the Coronary Artery Risk Development in Young Adults study, aged 33–45 at the time of recall assessment. Categorical questions assessed PA before and during high school (HS) and overall PA level at Baseline, with the same timeframes recalled 15 years later. Moderate- and vigorous-intensity scores were calculated from reported months of participation in specific activities.

Results

HS PA recall had higher reproducibility than overall PA recall (weighted kappa = 0.43 vs. 0.21). Correlations between 15-year recall and Baseline reports of PA were r = 0.29 for moderate-intensity scores, and r = 0.50 for vigorous-intensity. Recall of vigorous activities had higher reproducibility than moderate-intensity activities. Regardless of number of months originally reported for specific activities, most participants recalled either no activity or activity during all 12 months.

Conclusion

PA recall from the distant past is moderately reproducible, but poor at the individual level, among young and middle aged adults.

The brain-in-motion study: effect of a 6-month aerobic exercise intervention on cerebrovascular regulation and cognitive function in older adults

BACKGROUND

Aging and physical inactivity are associated with declines in some cognitive domains and cerebrovascular function, as well as an elevated risk of cerebrovascular disease and other morbidities. With the increase in the number of sedentary older Canadians, promoting healthy brain aging is becoming an increasingly important population health issue. Emerging research suggests that higher levels of physical fitness at any age are associated with better cognitive functioning and this may be mediated, at least in part, by improvements in cerebrovascular reserve. We are currently conducting a study to determine: if a structured 6-month aerobic exercise program is associated with improvements or maintenance of both cerebrovascular function and cognitive abilities in older individuals; and, the extent to which any changes seen persist 6 months after the completion of the structured exercise program.

METHODS/DESIGN

Two hundred and fifty men and women aged 55-80 years are being enrolled into an 18-month combined quasi-experimental and prospective cohort study. Participants are eligible for enrollment into the study if they are inactive (i.e., not participating in regular physical activity), non-smokers, have a body mass index <35.0 kg/m(2), are free of significant cognitive impairment (defined as a Montreal Cognitive Assessment score of 24 or more), and do not have clinically significant cardiovascular, cerebrovascular disease, or chronic obstructive pulmonary airway disease. Repeated measurements are done during three sequential six-month phases: 1) pre-intervention; 2) aerobic exercise intervention; and 3) post-intervention. These outcomes include: cardiorespiratory fitness, resting cerebral blood flow, cerebrovascular reserve, and cognitive function.

DISCUSSION

This is the first study to our knowledge that will examine contemporaneously the effect of an exercise intervention on both cerebrovascular reserve and cognition in an older population. This study will further our understanding of whether cerebrovascular mechanisms might explain how exercise promotes healthy brain aging. In addition our study will address the potential of increasing physical activity to prevent age-associated cognitive decline.

Intensity of recreational physical activity in different life periods in relation to breast cancer among women in the region of Western Pomerania

Background

Recreational physical activity has been consistently associated with lower breast cancer risk, but there is a need to study the intensity and duration of activity that are critical to reduce the risk. The aim of this study was to examine the influence of moderate and vigorous intensity of recreational physical activity performed at different age periods on breast cancer risk.

Material and methods

The case-control study included 858 women with histological confirmation of invasive breast cancer and 1085 women free of any cancer diagnosis, residents of the region of Western Pomerania, aged 28–79 years. The frequency, duration and intensity of lifetime household, occupational and recreational physical activity, sociodemographic characteristics, reproductive factors, family history of breast cancer, current weight and height, and lifestyle habits were measured using a self-administered questionnaire. Unconditional logistic regression analyses were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The risk estimates were controlled for potential risk factors and lifetime household and occupational activities.

Results

We found a risk reduction for recreational activity done early in life (age periods 14–20, 21–34, 35–50 years), particularly at ages 14–20 and 21–34 years, regardless of intensity. Active women engaging in more than 4.5 hours per week of moderate activity during ages 14–20 years had, on average, a 36% lower risk (OR = 0.64, 95% CI: 0.45–0.89) than women who were never or rarely active. For the women who reported 4.5 hours per week of vigorous activity during this period we found about 64% risk reduction (OR = 0.36, 95% CI: 0.26–0.51). For the period after 50 years of age, recreational activity of moderate or vigorous intensity was not significantly associated with the risk.

Conclusions

Recreational physical activity of moderate or vigorous intensity done during adolescence, early and middle adulthood, particularly at ages 14–20 and 21–34 years, is associated with significantly decreased breast cancer risk.

The Alberta moving beyond breast cancer (AMBER) cohort study: a prospective study of physical activity and health-related fitness in breast cancer survivors

Background

Limited research has examined the association between physical activity, health-related fitness, and disease outcomes in breast cancer survivors. Here, we present the rationale and design of the Alberta Moving Beyond Breast Cancer (AMBER) Study, a prospective cohort study designed specifically to examine the role of physical activity and health-related fitness in breast cancer survivorship from the time of diagnosis and for the balance of life. The AMBER Study will examine the role of physical activity and health-related fitness in facilitating treatment completion, alleviating treatment side effects, hastening recovery after treatments, improving long term quality of life, and reducing the risks of disease recurrence, other chronic diseases, and premature death.

Methods/Design

The AMBER Study will enroll 1500 newly diagnosed, incident, stage I-IIIc breast cancer survivors in Alberta, Canada over a 5 year period. Assessments will be made at baseline (within 90 days of surgery), 1 year, and 3 years consisting of objective and self-reported measurements of physical activity, health-related fitness, blood collection, lymphedema, patient-reported outcomes, and determinants of physical activity. A final assessment at 5 years will measure patient-reported data only. The cohort members will be followed for an additional 5 years for disease outcomes.

Discussion

The AMBER cohort will answer key questions related to physical activity and health-related fitness in breast cancer survivors including: (1) the independent and interactive associations of physical activity and health-related fitness with disease outcomes (e.g., recurrence, breast cancer-specific mortality, overall survival), treatment completion rates, symptoms and side effects (e.g., pain, lymphedema, fatigue, neuropathy), quality of life, and psychosocial functioning (e.g., anxiety, depression, self-esteem, happiness), (2) the determinants of physical activity and health-related fitness including demographic, medical, social cognitive, and environmental variables, (3) the mediators of any observed associations between physical activity, health-related fitness, and health outcomes including biological, functional, and psychosocial, and (4) the moderators of any observed associations including demographic, medical, and biological/disease factors. Taken together, these data will provide a comprehensive inquiry into the outcomes, determinants, mechanisms, and moderators of physical activity and health-related fitness in breast cancer survivors.

Is lifelong knee joint force from work, home, and sport related to knee osteoarthritis?

Purpose. To investigate the association of cumulative lifetime knee joint force on the risk of self-reported medically-diagnosed knee osteoarthritis (OA). Methods. Exposure data on lifetime physical activity type (occupational, household, sport/recreation) and dose (frequency, intensity, duration) were collected from 4,269 Canadian men and women as part of the Physical Activity and Joint Heath cohort study. Subjects were ranked in terms of the "cumulative peak force index", a measure of lifetime mechanical knee force. Multivariable logistic regression was conducted to obtain adjusted effects for mean lifetime knee force on the risk of knee OA. Results. High levels of total lifetime, occupational and household-related force were associated with an increased in risk of OA, with odds ratio's ranging from approximately 1.3 to 2. Joint injury, high BMI and older age were related to risk of knee OA, consistent with previous studies. Conclusions. A newly developed measure of lifetime mechanical knee force from physical activity was employed to estimate the risk of self-reported, medically-diagnosed knee OA. While there are limitations, this paper suggests that high levels of total lifetime force (all domains combined), and occupational force in men and household force in women were risk factors for knee OA.

Socioeconomic status over the life-course and adult bone mineral density: the Midlife in the U.S. Study

PURPOSE

Adult bone mass depends on acquisition in childhood and decline in adulthood, and may be influenced by socioeconomic conditions over the entire life course.

METHODS

We examined associations of bone mineral density (BMD) in adulthood with life course socioeconomic status in 729 participants in the Midlife in the United States Biomarker Project, adjusting for age, menopausal transition stage, race, gender, body weight, smoking, physical activity in several life stages, and research site. Primary predictors were a) childhood socioeconomic advantage score (including parental education, self-rated financial status relative to others, not being on welfare), b) adult education level (no college vs. some college vs. college graduate), and c) adult current financial advantage score (including family-adjusted poverty to income ratio, self-assessed current financial situation, having enough money to meet needs, ease in paying bills).

RESULTS

Mean age was 56.9 (range 34-85) years. After adjustment for covariates, childhood socioeconomic advantage and adult education level were positively associated with lumbar spine BMD: 0.27 standard deviations (SD) higher at 90th compared to 10th percentile of childhood advantage score (P=0.009), and 0.24 SD higher in college graduates compared to participants without college education (P=0.01). Adult current financial advantage was not associated with lumbar spine BMD. None of the three socioeconomic indicators was significantly associated with femoral neck BMD.

CONCLUSIONS

Childhood socioeconomic advantage and adult education level were associated with higher adult lumbar spine BMD. Current financial advantage was not associated with BMD. Childhood socioeconomic factors may influence acquisition of lumbar BMD.

Exploring the association between lifetime physical activity and pelvic floor disorders: study and design challenges

BACKGROUND

One in four women has moderate to severe symptoms of at least one pelvic floor disorder. Lifetime physical activity, a modifiable risk factor, may theoretically predispose women to, or protect them from, developing pelvic floor disorders. It is neither feasible nor ethical to test this association using the most rigorous (level I) study design.

PURPOSE

The aim of this manuscript is to describe the methods for the PHysical ACtivity Study (PHACTS), which encompasses two case-control studies and the development of a registry, and to describe challenges and solutions to study progress to date. For each of the case-control studies, the primary aims are to determine, compared to controls with neither pelvic organ prolapse nor urinary incontinence, whether 1) pelvic organ prolapse or 2) stress urinary incontinence is associated with a) increased or decreased current leisure activity or b) increased or decreased overall lifetime activity (including leisure, household, outdoor, and occupational) measured in MET-hours per week, as well as in strenuous hours per week.

METHODS

To obtain 175 pelvic organ prolapse cases, 175 stress urinary incontinence cases, and an equal number of age, body mass index and recruitment site matched controls, we plan to enroll 1500 women from about 20 primary care level clinics.

RESULTS

We have encountered various challenges leading to lessons learned about minimizing bias, recruitment from community clinics, the lifetime physical activity instrument used, and data management.

CONCLUSIONS

Our experiences can help guide future investigators studying risk factors, particularly physical activity, and pelvic floor disorders.

Resistance training and the risk of colon and rectal cancers

PURPOSE

Although there is convincing evidence that physical activity reduces colon cancer risk, research in this area has focused on aerobic activity. We conducted a case-control study to investigate whether resistance training was associated with the risk of colon and rectal cancers.

METHODS

Data were collected on various colorectal cancer risk factors, including recreational physical activity performed during three age periods, from 870 cases and 996 controls in Western Australia in 2005-2007. Participants were classified as having never, possibly, or definitely performed resistance training in each age period and over the adult lifetime. The association between resistance training and colon and rectal cancer risk was analyzed using multinomial logistic regression.

RESULTS

Participants who definitely performed resistance training in their lifetime had a non-significant reduced risk of colon cancer compared with those who did no resistance training (adjusted odds ratio (AOR) = 0.70, 95 % confidence interval (CI) = 0.45-1.11). No association was found for rectal cancer risk (AOR = 1.16, 95 % CI = 0.71-1.87). Performing resistance training was associated with a lower risk of colon cancer in each age period, although none of the relationships were statistically significant.

CONCLUSION

This study provides some initial evidence, albeit inconclusive, that resistance training may be inversely associated with colon cancer risk.

Patient-reported physical activity questionnaires: a systematic review of content and format

Background

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.

Methods

Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers.

Results

104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories.

Conclusions

A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.

A comprehensive systematic review of the development process of 104 patient-reported outcomes (PROs) for physical activity in chronically ill and elderly people

BACKGROUND

Capturing dimensions of physical activity relevant to patients may provide a unique perspective for clinical studies of chronically ill patients. However, the quality of the development of existing instruments is uncertain. The aim of this systematic review was to assess the development process of patient-reported outcome (PRO) instruments including their initial validation to measure physical activity in chronically ill or elderly patient populations.

METHODS

We conducted a systematic literature search of electronic databases (Medline, Embase, Psychinfo, Cinahl) and hand searches. We included studies describing the original development of fully structured instruments measuring dimensions of physical activity or related constructs in chronically ills or elderly. We broadened the population to elderly because they are likely to share physical activity limitations. At least two reviewers independently conducted title and abstract screening and full text assessment. We evaluated instruments in terms of their aim, items identification and selection, domain development, test-retest reliability, internal consistency, validity and responsiveness.

RESULTS

Of the 2542 references from the database search and 89 from the hand search, 103 full texts which covered 104 instruments met our inclusion criteria. For almost half of the instruments the authors clearly described the aim of the instruments before the scales were developed. For item identification, patient input was used in 38% of the instruments and in 32% adaptation of existing scales and/or unsystematic literature searches were the only sources for the generation of items. For item reduction, in 56% of the instruments patient input was used and in 33% the item reduction process was not clearly described. Test-retest reliability was assessed for 61%, validity for 85% and responsiveness to change for 19% of the instruments.

CONCLUSIONS

Many PRO instruments exist to measure dimensions of physical activity in chronically ill and elderly patient populations, which reflects the relevance of this outcome. However, the development processes often lacked definitions of the instruments' aims and patient input. If PROs for physical activity were to be used in clinical trials more attention needs to be paid to the establishment of content validity through patient input and to the assessment of their evaluative measurement properties.

Measurement of human energy expenditure, with particular reference to field studies: an historical perspective

Over the years, techniques for the study of human movement have ranged in complexity and precision from direct observation of the subject through activity diaries, questionnaires, and recordings of body movement, to the measurement of physiological responses, studies of metabolism and indirect and direct calorimetry. This article reviews developments in each of these domains. Particular reference is made to their impact upon the continuing search for valid field estimates of activity patterns and energy expenditures, as required by the applied physiologist, ergonomist, sports scientist, nutritionist and epidemiologist. Early observers sought to improve productivity in demanding employment. Direct observation and filming of workers were supplemented by monitoring of heart rates, ventilation and oxygen consumption. Such methods still find application in ergonomics and sport, but many investigators are now interested in relationships between habitual physical activity and chronic disease. Even sophisticated questionnaires still do not provide valid information on the absolute energy expenditures associated with good health. Emphasis has thus shifted to use of sophisticated pedometer/accelerometers, sometimes combining their output with GPS and other data. Some modern pedometer/accelerometers perform well in the laboratory, but show substantial systematic errors relative to laboratory reference criteria such as the metabolism of doubly labeled water when assessing the varied activities of daily life. The challenge remains to develop activity monitors that are sufficiently inexpensive for field use, yet meet required accuracy standards. Possibly, measurements of oxygen consumption by portable respirometers may soon satisfy part of this need, although a need for valid longer term monitoring will remain.

Timing and intensity of recreational physical activity and the risk of subsite-specific colorectal cancer

PURPOSE

Although there is convincing evidence that physical activity reduces colon cancer risk, there are important questions that remain unanswered about the association. These include the timing and intensity of activity required to optimally reduce risk, and whether physical activity has a different effect on cancers at different sites within the colon. We conducted a case-control study to investigate these issues.

METHODS

A case-control study of colorectal cancer was conducted in Western Australia in 2005-2007. Data were collected on various risk factors. The estimated effects of recreational physical activity on the risk of cancers of the distal colon, proximal colon, and rectum were analyzed using multinomial logistic regression. This analysis included 870 cases and 996 controls.

RESULTS

The risk of distal colon cancer was reduced by performing a high level of vigorous-intensity activity between the ages 19 and 34 years (women), 35 and 50 years (men), after the age of 51 years (men and women), and consistently over the adult lifetime (men and women). The risk of rectal cancer was reduced by performing a high level of vigorous activity between the ages 35 and 50 years (men), and consistently over the adult lifetime (men). Proximal colon cancer risk was not associated with physical activity in any of the age periods or over the adult lifetime. Moderate intensity activity did not reduce the risk of colorectal cancer.

CONCLUSION

Physical activity may have a greater effect on the risk of distal colon cancer than proximal colon cancer. Vigorous physical activity is required to reduce colorectal cancer risk.

Long-term sedentary work and the risk of subsite-specific colorectal cancer

Research suggests that sedentary behavior may increase the risk of some chronic diseases. The aims of the study were to examine whether sedentary work is associated with colorectal cancer and to determine whether the association differs by subsite. A total of 918 cases and 1,021 controls participated in a population-based case-control study of colorectal cancer in Western Australia in 2005-2007. Data were collected on lifestyle, physical activity, and lifetime job history. The estimated effects of sedentary work on the risk of cancers of the proximal colon, distal colon, and rectum were analyzed by using multinomial logistic regression. Compared with participants who did not spend any time in sedentary work, participants who spent 10 or more years in sedentary work had almost twice the risk of distal colon cancer (adjusted odds ratio = 1.94, 95% confidence interval: 1.28, 2.93) and a 44% increased risk of rectal cancer (adjusted odds ratio = 1.44, 95% confidence interval: 0.96, 2.18). This association was independent of recreational physical activity and was seen even among the most recreationally active participants. Sedentary work was not associated with the risk of proximal colon cancer. These results suggest that long-term sedentary work may increase the risk of distal colon cancer and rectal cancer.