Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women

Prevalence of cold-related musculoskeletal pain according to self-reported threshold temperature among the Finnish adult population

BACKGROUND

Exposure to cold reportedly increases musculoskeletal pains. We assessed the prevalence of such pain and self-reported threshold temperature (TT) at which the pain emerges.

METHODS

A random sample of 6591 people in Finland, aged 25-74 years, answered a questionnaire on repeated cold-related musculoskeletal pain (CMP) and its TT. The response rate was 64%. We used quantile regression to quantify the effects of personal characteristics and region of residence on TT at various locations of its distribution.

RESULTS

Of the participants, 1892 (30%) experienced CMP in at least one body site and 1692 reported TT. Ten percent of the participants who perceived CMP did so at -2 °C, 50% at -14 °C and 90% at -23 °C. Residence in the South elevated TT by 1-6 °C compared with residence in the North, depending on the proportion of participants reporting CMP at various temperatures. Joint disorders increased TT at milder temperatures, at which only 10% of all participants perceived CMP, whereas back disorders did so mainly at lower temperatures, at which 70% were affected. Overweight was associated with a 2 °C lower TT, and physical inactivity with a 1 °C higher TT, and TT increased by 1 °C per 10-year increase in age. The greatest model-estimated difference in median TT between subgroups was 12 °C.

CONCLUSIONS

People suffering from musculoskeletal disorders and those living in the warmer areas of Finland need special advice to protect themselves against the cold. Our study provides preliminary information to support such advice.

Joy, exercise, enjoyment, getting out: a qualitative study of older people's experience of cycling in Sydney, Australia

Introduction. Cycling can be an enjoyable way to meet physical activity recommendations and is suitable for older people; however cycling participation by older Australians is low. This qualitative study explored motivators, enablers, and barriers to cycling among older people through an age-targeted cycling promotion program. Methods. Seventeen adults who aged 50–75 years participated in a 12-week cycling promotion program which included a cycling skills course, mentor, and resource pack. Semistructured interviews at the beginning and end of the program explored motivators, enablers, and barriers to cycling. Results. Fitness and recreation were the primary motivators for cycling. The biggest barrier was fear of cars and traffic, and the cycling skills course was the most important enabler for improving participants' confidence. Reported outcomes from cycling included improved quality of life (better mental health, social benefit, and empowerment) and improved physical health. Conclusions. A simple cycling program increased cycling participation among older people. This work confirms the importance of improving confidence in this age group through a skills course, mentors, and maps and highlights additional strategies for promoting cycling, such as ongoing improvement to infrastructure and advertising.

Physical activity is inversely associated with multimorbidity in elderly men: results from the KORA-Age Augsburg Study

OBJECTIVE

Physical activity is suggested to play a key role in the prevention of several chronic diseases. However, data on the association between physical activity and multimorbidity are lacking.

METHODS

Using data from 1007 men and women aged 65-94 years who participated in the population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age project conducted in Augsburg/Germany and two adjacent counties in 2008/09, 13 chronic conditions were identified, and physical activity scores were calculated based on the self-reported physical activity scale for the elderly (PASE). Multivariable sex-specific logistic regression was applied to determine the association of the continuous physical activity score with multimorbidity (≥ 2 out of 13 diseases).

RESULTS

Physical activity (mean PASE score±SD) was higher in men (125.1 ± 59.2) than in women (112.2 ± 49.2). Among men, the odds ratio (OR) for multimorbidity was 0.73 (95% CI: 0.60-0.90) for a 1 standard deviation increase of the PASE score. No significant results could be observed for women (OR: 1.05; 95% CI: 0.83-1.33).

CONCLUSION

We demonstrated an inverse association between physical activity and multimorbidity among men. Further prospective studies have to confirm the temporality of effects.

Associations between active travel to work and overweight, hypertension, and diabetes in India: a cross-sectional study

BACKGROUND

Increasing active travel (walking, bicycling, and public transport) is promoted as a key strategy to increase physical activity and reduce the growing burden of noncommunicable diseases (NCDs) globally. Little is known about patterns of active travel or associated cardiovascular health benefits in low- and middle-income countries. This study examines mode and duration of travel to work in rural and urban India and associations between active travel and overweight, hypertension, and diabetes.

METHODS AND FINDINGS

Cross-sectional study of 3,902 participants (1,366 rural, 2,536 urban) in the Indian Migration Study. Associations between mode and duration of active travel and cardiovascular risk factors were assessed using random-effect logistic regression models adjusting for age, sex, caste, standard of living, occupation, factory location, leisure time physical activity, daily fat intake, smoking status, and alcohol use. Rural dwellers were significantly more likely to bicycle (68.3% versus 15.9%; p<0.001) to work than urban dwellers. The prevalence of overweight or obesity was 50.0%, 37.6%, 24.2%, 24.9%; hypertension was 17.7%, 11.8%, 6.5%, 9.8%; and diabetes was 10.8%, 7.4%, 3.8%, 7.3% in participants who travelled to work by private transport, public transport, bicycling, and walking, respectively. In the adjusted analysis, those walking (adjusted risk ratio [ARR] 0.72; 95% CI 0.58-0.88) or bicycling to work (ARR 0.66; 95% CI 0.55-0.77) were significantly less likely to be overweight or obese than those travelling by private transport. Those bicycling to work were significantly less likely to have hypertension (ARR 0.51; 95% CI 0.36-0.71) or diabetes (ARR 0.65; 95% CI 0.44-0.95). There was evidence of a dose-response relationship between duration of bicycling to work and being overweight, having hypertension or diabetes. The main limitation of the study is the cross-sectional design, which limits causal inference for the associations found.

CONCLUSIONS

Walking and bicycling to work was associated with reduced cardiovascular risk in the Indian population. Efforts to increase active travel in urban areas and halt declines in rural areas should be integral to strategies to maintain healthy weight and prevent NCDs in India. Please see later in the article for the Editors' Summary.

Active over 45: a step-up jogging programme for inactive female hospital staff members aged 45+

BACKGROUND

Inactive individuals face motivational obstacles for becoming and remaining physically active. Therefore, sustainable physical activity promotion programmes tailored to reach inactive individuals are needed. The aim of this study was to test the role of motivation and the effect and feasibility of a training programme.

METHODS

We enrolled physically inactive female hospital staff members aged 45 and older in an uncontrolled exercise trial. Follow-up assessments were at 3 and 12 months. The primary outcome was running distance (Cooper test). Secondary outcomes were level of physical activity (Freiburger Physical Activity Questionnaire) and body mass index.

RESULTS

Out of 1249 female hospital staff, 275 classified themselves as inactive and 250 (91%) of them were interested in the exercise programme. Of these, 68 (27%; mean age 53.2 years) agreed to participate in our study and 47 (69%) completed the programme. Average running distance increased by 255.70 m [95% confidence interval (CI) 208.09-303.31] at 3-month follow-up with a sustained benefit at 12-month follow-up (194.02; 95% CI 143.75-244.47). Physical activity level increased by 1152.52 kcal week(-1) (95% CI 703.73-1601.32) at 3 months with a sustained benefit (1279.10 kcal week(-1), 95% CI 826.80-1731.40) after 12 months. Notably, baseline motivation to become physically active was not associated with change in physical performance or physical activity level during the programme.

CONCLUSION

The 3-month step-up jogging programme is a feasible and effective exercise intervention for physically inactive, middle-aged female hospital staff members. The intervention leads to sustained benefits independently of motivation to become more physically active.

Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case-crossover design

Background

This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk.

Methods

In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case–crossover design compared the infrastructure of injury and control sites within each injured bicyclist's route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801).

Results

At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections.

Conclusions

These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure.

Changes in leisure-time physical activity and subsequent sickness absence: a prospective cohort study among middle-aged employees

OBJECTIVE

The aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence.

METHODS

Helsinki Health Study cohort baseline questionnaire survey data were collected in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (>3 days) sickness absence spells were examined, using Poisson regression analysis.

RESULTS

Inactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR=0.80, 95% CI 0.65-0.97) and medically certified (RR=0.63, 95% CI 0.49-0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found.

CONCLUSIONS

For reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity.

Active transportation and cardiovascular disease risk factors in U.S. adults

BACKGROUND

Evidence of associations between active transportation (walking and bicycling for transportation) and health outcomes is limited. Better understanding of this relationship would inform efforts to increase physical activity by promoting active transportation.

PURPOSE

This study examined associations between active transportation and cardiovascular disease risk factors in U.S. adults.

METHODS

Using the 2007-2008 and 2009-2010 cycles of the National Health and Nutrition Examination Survey (NHANES), adults (N=9933) were classified by level of active transportation. Multivariable linear and logistic regression analyses controlled for sociodemographic characteristics, smoking status, and minutes/week of non-active transportation physical activity. Analyses were conducted in 2011.

RESULTS

Overall, 76% reported no active transportation. Compared with no active transportation, mean BMI was lower among individuals with low (-0.9, 95% CI= -1.4, -0.5) and high (-1.2, 95% CI= -1.7, -0.8) levels of active transportation. Mean waist circumference was lower in the low (-2.2 cm, 95% CI= -3.2, -1.2) and high (-3.1 cm, 95% CI= -4.3, -1.9) active transportation groups. The odds of hypertension were 24% lower (AOR=0.76, 95% CI=0.61, 0.94) and 31% lower (AOR=0.69, 95% CI=0.58, 0.83) among individuals with low and high levels of active transportation, respectively, compared with no active transportation. High active transportation was associated with 31% lower odds of diabetes (AOR=0.69, 95% CI=0.54, 0.88). Active transportation was not associated with high-density lipoprotein level.

CONCLUSIONS

Active transportation was associated with more-favorable cardiovascular risk factor profiles, providing additional justification for infrastructure and policies that permit and encourage active transportation.

Lifestyle management in the metabolic syndrome

Type 2 diabetes and metabolic syndrome are two of the fastest growing public health problems in both developed and developing countries. Cardiovascular disease is the most prevalent complication of type 2 diabetes and the metabolic syndrome. Overweight, obesity, or weight gain has been shown to be an important risk factor for the development of type 2 diabetes and an important component of the metabolic syndrome. Physical inactivity is another important risk factor for the development of type 2 diabetes. Data from prospective studies have shown that at least 30 min/day of moderate to vigorous physical activity can prevent type 2 diabetes. Moderate or high levels of physical fitness are effective in preventing type 2 diabetes. Results from clinical trials have indicated that lifestyle changes, including dietary modification and increase in physical activity, can prevent type 2 diabetes. Analyses from prospective studies have confirmed that healthy diets are effective and safe ways to prevent type 2 diabetes and the metabolic syndrome. Public health messages, health care professionals, and the health care system should aggressively promote physical activity and responsible nutritional habits during occupation, leisure time, and daily life and prevent overweight and obesity.

Physical activity, physical fitness, and risk of type 2 diabetes mellitus

Type 2 diabetes mellitus (DM) is a common chronic disease. Cardiovascular disease is the most prevalent complication of DM. In the past decade, the associations of physical activity, physical fitness, and changes in lifestyle with the risk of type 2 DM have been assessed by a number of prospective epidemiologic studies and clinical trials. Several studies also evaluate the joint associations of physical activity, body mass index, and glucose levels with the risk of type 2 DM. The results of 21 prospective studies and four clinical trials demonstrated that moderate or high levels of physical activity or physical fitness, as well as changes in lifestyle (dietary modification and enhanced physical activity) could prevent type 2 DM.

Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review

Background

This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region.

Methods

Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18–65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated.

Results

A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced.

Conclusions

The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.

Measuring Free-Living Energy Expenditure and Physical Activity with Triaxial Accelerometry

OBJECTIVE

To investigate the ability of a newly developed triaxial accelerometer to predict total energy expenditure (EE) (TEE) and activity-related EE (AEE) in free-living conditions.

RESEARCH METHODS AND PROCEDURES

Subjects were 29 healthy subjects between the ages of 18 and 40. The Triaxial Accelerometer for Movement Registration (Tracmor) was worn for 15 consecutive days. Tracmor output was defined as activity counts per day (ACD) for the sum of all three axes or each axis separately (ACD-X, ACD-Y, ACD-Z). TEE was measured with the doubly labeled water technique. Sleeping metabolic rate (SMR) was measured during an overnight stay in a respiration chamber. The physical activity level was calculated as TEE x SMR(-1), and AEE was calculated as [(0.9 x TEE) - SMR]. Body composition was calculated from body weight, body volume, and total body water using Siri's three-compartment model.

RESULTS

Age, height, body mass, and ACD explained 83% of the variation in TEE [standard error of estimate (SEE) = 1.00 MJ/d] and 81% of the variation in AEE (SEE = 0.70 MJ/d). The partial correlations for ACD were 0.73 (p < 0.001) and 0.79 (p < 0.001) with TEE and AEE, respectively. When data on SMR or body composition were used with ACD, the explained variation in TEE was 90% (SEE = 0.74 and 0.77 MJ/d, respectively). The increase in the explained variation using three axes instead of one axis (vertical) was 5% (p < 0.05).

DISCUSSION

The correlations between Tracmor output and EE measures are the highest reported so far. To measure daily life activities, the use of triaxial accelerometry seems beneficial to uniaxial.

Coffee consumption and risk of gastric and pancreatic cancer--a prospective cohort study

Only few prospective studies have examined the association between coffee consumption and risk of gastric and pancreatic cancer. This study is designed to evaluate this relationship among Finns, whose coffee consumption is the highest in the world. A total of 60,041 Finnish men and women who were 26-74 years of age and without history of any cancer at baseline were included in the present analyses. Coffee consumption and other study parameters were determined at baseline using standardized measurements. Participants were prospectively followed up for onset of gastric and/or pancreatic cancer, emigration, death or until June 30, 2006. During a mean follow-up period of 18 years, 299 cases of gastric cancer and 235 cases of pancreatic cancer were found. There was a nonsignificant inverse association between coffee consumption and risk of gastric cancer among men but not in the women. The multivariate-adjusted hazard ratio of stomach and pancreatic cancer incidence for ≥ 10 cups of coffee per day compared with nondrinkers were 0.75 (95% CI, 0.40-1.41) (P for trend = 0.19) and 0.82 (95% CI, 0.38-1.76) (P for trend = 0.95) for the combined population of men and women, respectively. We did not find a significant association between coffee consumption and the risk of gastric and/or pancreatic cancers.

Global physical activity levels: surveillance progress, pitfalls, and prospects

To implement effective non-communicable disease prevention programmes, policy makers need data for physical activity levels and trends. In this report, we describe physical activity levels worldwide with data for adults (15 years or older) from 122 countries and for adolescents (13-15-years-old) from 105 countries. Worldwide, 31·1% (95% CI 30·9-31·2) of adults are physically inactive, with proportions ranging from 17·0% (16·8-17·2) in southeast Asia to about 43% in the Americas and the eastern Mediterranean. Inactivity rises with age, is higher in women than in men, and is increased in high-income countries. The proportion of 13-15-year-olds doing fewer than 60 min of physical activity of moderate to vigorous intensity per day is 80·3% (80·1-80·5); boys are more active than are girls. Continued improvement in monitoring of physical activity would help to guide development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases.

Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes: a cross-sectional analysis within a community-based diabetes prevention project FIN-D2D

BACKGROUND

Increased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals' perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes.

METHODS

Opportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis.

RESULTS

74% of men (n = 2 577) and 76% of women (n = 4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants' perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants.

CONCLUSIONS

Subjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.

Occupational health care identifies risk for type 2 diabetes and cardiovascular disease

AIMS

To assess the risk for type 2 diabetes (T2D) and cardiovascular disease (CVD) among employees of a Finnish airline; to study the association of shift work with T2D and CVD risk; and to test the feasibility of risk screening in occupational health care setting.

METHODS

Altogether 4169 employees were invited for a health check-up and 2312 participated in this study. The check-up included physical examinations, questionnaires on working hours, sleep, and lifestyle, diabetes risk score FINDRISC, and blood tests. Lifestyle counselling was offered for those with increased T2D risk.

RESULTS

Altogether 15% of participants had a high T2D risk (FINDRISC≥15 and/or elevated, but non-diabetic blood glucose), and a further 15% had a moderate T2D risk (FINDRISC 10-14 and normal blood glucose). Of those 60% agreed to attend lifestyle counselling. Metabolic syndrome was more common, lipid profile more unfavorable and hsCRP higher by increasing FINDRISC score category. Risk factor profiles linked to shift work status were not self-evident.

CONCLUSIONS

The renewed health check-up process effectively identified those employees with increased T2D and CVD risk who would benefit from lifestyle intervention. The use of FINDRISC questionnaire was a feasible first-step screening method in occupational health care setting.

Active transport, physical activity, and body weight in adults: a systematic review

CONTEXT

Physical activity has various health benefits. Active transport can contribute to total physical activity and thus affect body weight because of increased energy expenditure. This review summarizes published evidence on associations of active transport, general physical activity, and body weight in adults.

EVIDENCE ACQUISITION

A systematic review of the literature was conducted in October 2010 using eight databases. A total of 14,216 references were screened; full texts were retrieved for 95 articles. Forty-six articles (36 unique studies) were included: 20 (17) from Europe; 18 (13) from North America, Australia, and New Zealand; and eight (six) from other countries. Analyses of the retrieved papers were carried out between November 2010 and March 2011.

EVIDENCE SYNTHESIS

Of 15 studies assessing active transport and physical activity, five found associations in the expected direction (more active transport associated with more physical activity) for all or most variables studied, nine found some associations, and one reported no associations. Of 30 studies assessing active transport and body weight, 13 reported associations in the expected direction (more active transport associated with lower body weight) for all or most variables studied, 12 found some associations, two presented some associations in the expected and some in the opposite direction, and three reported no associations.

CONCLUSIONS

There is limited evidence that active transport is associated with more physical activity as well as lower body weight in adults. However, study heterogeneity, predominantly cross-sectional designs, and crude measures for active transport and physical activity impede quantitative conclusions.

Interaction between physical activity and sleep duration in relation to insulin resistance among non-diabetic Chinese adults

BACKGROUND

It is of a public health interest to explore the relationship between different types of physical activity, sleep duration and diabetes/insulin resistance. However, little is known about such relationship. This study examines the single and joint associations of different types of physical activity, and sleep duration on insulin resistance among non-diabetic Chinese adults.

METHODS

Data was collected from 1124 non-diabetic adults in Jiangsu Province from the China Health and Nutrition Survey (CHNS). Domestic, occupational, transportation and leisure physical activity were assessed in terms of metabolic equivalent (MET)-hours-per-week to account for both intensity and time spent. Sleep duration was categorized into three groups: ≤ 7 hours, 7-9 hours, and ≥ 9 hours. Insulin resistance was evaluated by the homeostasis model of assessment (HOMA) and defined as the highest quartile of HOMA.

RESULTS

Total physical activity was mainly composed of occupational activity (75.1%), followed orderly by domestic, transportation and leisure time activity in both men and women. Total physical activity level was strongly negatively associated with fasting insulin and HOMA (p < 0.001). Among four types of physical activity, occupational activity was significantly negatively associated with HOMA after full adjustment (p < 0.05). Transportation activity was also negatively associated with HOMA when adjusted for age and gender (p = 0.028). Moreover, the combination of low physical activity and short sleep duration was associated with the highest odds of insulin resistance (adjusted OR = 3.26, 95% CI: 1.57-6.78), compared to those with high physical activity and adequate sleep duration.

CONCLUSIONS

Physical activity, mainly occupational physical activity, was negatively associated with insulin resistance in non-diabetic Chinese population, independently of potential confounders. There was a synergic effect of low physical activity and short sleep duration on insulin resistance.

Gasto calórico dos diferentes domínios de atividade física como preditor da ausência de diabetes em adultos

INTRODUÇÃO: A atividade física apresenta efeito protetor contra doenças crônicas e fatores de risco cardiovascular; no entanto, o gasto calórico necessário para promover a prevenção do diabetes permanece especulativo. OBJETIVO: Analisar o gasto calórico dos diferentes domínios da atividade física (trabalho, deslocamento, atividade doméstica, tempo livre e atividade física total) como preditores da ausência de diabetes em adultos de ambos os sexos. MÉTODOS: Estudo transversal realizado na cidade de Lauro de Freitas, Bahia, Brasil (2007-2008) com amostra constituída por 522 indivíduos maiores de 18 anos, sendo 302 do sexo feminino e 220 do sexo masculino. Foram construídas curvas Receiver Operating Characteristic (ROC) e comparadas as áreas sob as mesmas, além de verificar-se a sensibilidade e especificidade para identificar os melhores pontos de corte entre os diferentes domínios da atividade física e a ausência de diabetes. Foi utilizado o intervalo de confiança a 95%. RESULTADOS: Entre os diferentes domínios de atividade física analisados encontrou-se significância estatística nas áreas sob a curva ROC para o tempo livre, deslocamento e para atividade física total. Observou-se também que o gasto calórico na atividade física total de 830kcal/semana quando analisados apenas os homens, e 1,774kcal/semana quando analisados homens e mulheres conjuntamente, foram os melhores pontos de corte para predizer a ausência de diabetes. CONCLUSÃO: A prática da atividade física deve ser sugerida em níveis adequados para indivíduos de ambos os sexos visando contribuir para a prevenção do diabetes.

Physical exercise in southern Germany: a cross-sectional study of an urban population

OBJECTIVES

The aim of this study was to investigate the degree of physical exercise and self-assessment of physical fitness (PF) and their relationship to health- and behaviour-specific factors in a randomly selected sample of an urban population in southern Germany.

DESIGN

Cross-sectional study.

SETTING

In the southern German city of Leutkirch.

PARTICIPANTS

2187 subjects randomly selected from the registry of inhabitants. Of the selected group, aged 18-65 years, 52.1% were women and 47.9% men.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants were asked how many hours per week they spent on physical exercise and sports. They were also asked to rate their own performance and/or PF.

RESULTS

Overall, 38.9% of the participants reported no physical exercise. Men reported a higher level of physical exercise than did women. Less exercise was reported by subjects with diabetes, high body mass index and waist-to-hip ratio and by those who were underweight. Alcohol consumption, smoker status and higher educational level showed a positive association with physical exercise. A negative trend with respect to moderate physical exercise was observed for those with metabolic syndrome, diabetes, hypertension and hepatic steatosis, but this was statistically significant only for subjects with diabetes. In both men and women, there was a relationship between self-assessed 'good' PF and high physical exercise.

CONCLUSIONS

The data show that a large proportion of the study population is not physically active; specific risk groups (overweight subjects, older subjects, smokers or subjects with low educational level) are even less active. The data suggest that there is a great potential for measures promoting physical exercise in these groups.

Steps to preventing type 2 diabetes: exercise, walk more, or sit less?

Accumulated evidence supports the promotion of structured exercise for treating prediabetes and preventing Type 2 diabetes. Unfortunately, contemporary societal changes in lifestyle behaviors (occupational, domestic, transportation, and leisure-time) have resulted in a notable widespread deficiency of non-exercise physical activity (e.g., ambulatory activity undertaken outside the context of purposeful exercise) that has been simultaneously exchanged for an excess in sedentary behaviors (e.g., desk work, labor saving devices, motor vehicle travel, and screen-based leisure-time pursuits). It is possible that the known beneficial effects of more structured forms of exercise are attenuated or otherwise undermined against this backdrop of normalized and ubiquitous slothful living. Although public health guidelines have traditionally focused on promoting a detailed exercise prescription, it is evident that the emergent need is to revise and expand the message to address this insidious and deleterious lifestyle shift. Specifically, we recommend that adults avoid averaging <5,000 steps/day and strive to average ≥7,500 steps/day, of which ≥3,000 steps (representing at least 30 min) should be taken at a cadence ≥100 steps/min. They should also practice regularly breaking up extended bouts of sitting with ambulatory activity. Simply put, we must consider advocating a whole message to "walk more, sit less, and exercise."

Joint effect of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol on the risk of coronary heart disease

AIMS

To evaluate the single and joint associations of serum high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol with coronary heart disease (CHD) risk.

METHODS

Study cohorts included 21,375 Finnish participants who were 25-74 years of age and free of CHD and stroke at baseline.

RESULTS

During a median follow-up period of 10.8 years, 437 participants developed CHD. The sex- and multivariable-adjusted hazard ratios (HRs) of CHD at different levels of HDL cholesterol [<40 (reference), 40-49, 50-59, 60-69, and ≥ 70 mg/dL] were 1.00, 1.00, 0.74, 0.58, and 0.69 (p (trend) = 0.006), respectively. The sex- and multivariable-adjusted HRs of CHD at different levels of LDL cholesterol [<100 (reference), 100-129, 130-159, and ≥ 160 mg/dL] were 1.00, 1.25, 1.92, and 2.65 (p (trend) < 0.001), respectively. In joint analyses, a decreased trend in the incidence rate of CHD with an increasing HDL cholesterol level was consistent in people with any level of LDL cholesterol. Likewise, an increasing trend in incidence of CHD with an increase in the LDL cholesterol level was consistent in subjects with any level of HDL cholesterol.

CONCLUSION

These results suggest an inverse association between HDL cholesterol and CHD risk and a direct association between LDL cholesterol and CHD risk, independent of other risk factors. The protective effect of HDL cholesterol on CHD risk is observed at all levels of LDL cholesterol.

Lifestyle Factors in Relation to Heart Failure Among Finnish Men and Women

Background—

The role of lifestyle factors in explaining the risk of heart failure (HF) is not properly established.

Methods and Results—

The national population-based study included 18 346 Finnish men and 19 729 women who were 25 to 74 years of age and free of HF at baseline. Multivariable Cox proportional hazards regression models was used to examine the association between lifestyle factors (smoking, body mass index [BMI], physical activity, vegetable consumption, fruit consumption, and alcohol consumption) and HF risk. During a median follow-up of 14.1 years (interquartile range, 5.9 to 20.9 years), 638 men and 445 women developed HF. Fruit consumption and alcohol consumption were dropped out of the analyses because no significant associations with the risk of HF were found. When 4 modifiable lifestyle factors (smoking, BMI, physical activity, and vegetable intake) were included in the analysis, the multivariable-adjusted (age, education, systolic blood pressure, total cholesterol, and histories of myocardial infarction, valvular heart disease, diabetes and using antihypertensive drugs) hazard ratios (HRs) of HF associated with engaging in 0, 1, 2, 3, and 4 healthy lifestyle factors were 1.00, 0.69 (95% confidence interval [CI], 0.54 to 0.87), 0.45 (95% CI, 0.35 to 0.58), 0.34 (95% CI, 0.25 to 0.46), and 0.31 (95% CI, 0.17 to 0.56) ( P <0.001 for trend) for men, and 1.00, 0.53 (95% CI, 0.33 to 0.85), 0.42 (95% CI, 0.26 to 0.67), 0.24 (95% CI, 0.14 to 0.39), and 0.19 (95% CI, 0.09 to 0.40) ( P <0.001 for trend) for women, respectively.

Conclusions—

The present study demonstrates an inverse association between healthy lifestyle patterns and the risk of HF in Finnish men and women.

Identifying types of physical activity with a single accelerometer: evaluating laboratory-trained algorithms in daily life

Accurate identification of physical activity types has been achieved in laboratory conditions using single-site accelerometers and classification algorithms. This methodology is then applied to free-living subjects to determine activity behavior. This study is aimed at analyzing the reproducibility of the accuracy of laboratory-trained classification algorithms in free-living subjects during daily life. A support vector machine (SVM), a feed-forward neural network (NN), and a decision tree (DT) were trained with data collected by a waist-mounted accelerometer during a laboratory trial. The reproducibility of the classification performance was tested on data collected in daily life using a multiple-site accelerometer augmented with an activity diary for 20 healthy subjects (age: 30 ± 9; BMI: 23.0 ± 2.6 kg/m(2)). Leave-one-subject-out cross validation of the training data showed accuracies of 95.1 ± 4.3%, 91.4 ± 6.7%, and 92.2 ± 6.6% for the SVM, NN, and DT, respectively. All algorithms showed a significantly decreased accuracy in daily life as compared to the reference truth represented by the IDEEA and diary classifications (75.6 ± 10.4%, 74.8 ± 9.7%, and 72.2 ± 10.3%; p < 0.05). In conclusion, cross validation of training data overestimates the accuracy of the classification algorithms in daily life.

Improving health through policies that promote active travel: a review of evidence to support integrated health impact assessment

BACKGROUND

Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences.

OBJECTIVES AND METHODS

We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions.

RESULTS AND DISCUSSION

Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time.

CONCLUSION

Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs.

Health benefits of cycling: a systematic review

The purpose of this study was to update the evidence on the health benefits of cycling. A systematic review of the literature resulted in 16 cycling-specific studies. Cross-sectional and longitudinal studies showed a clear positive relationship between cycling and cardiorespiratory fitness in youths. Prospective observational studies demonstrated a strong inverse relationship between commuter cycling and all-cause mortality, cancer mortality, and cancer morbidity among middle-aged to elderly subjects. Intervention studies among working-age adults indicated consistent improvements in cardiovascular fitness and some improvements in cardiovascular risk factors due to commuting cycling. Six studies showed a consistent positive dose-response gradient between the amount of cycling and the health benefits. Systematic assessment of the quality of the studies showed most of them to be of moderate to high quality. According to standard criteria used primarily for the assessment of clinical studies, the strength of this evidence was strong for fitness benefits, moderate for benefits in cardiovascular risk factors, and inconclusive for all-cause mortality, coronary heart disease morbidity and mortality, cancer risk, and overweight and obesity. While more intervention research is needed to build a solid knowledge base of the health benefits of cycling, the existing evidence reinforces the current efforts to promote cycling as an important contributor for better population health.

[Exercise prescription: indications, dosage and side effects]

The prescription of exercise is particularly useful for preventing premature death from all causes, ischemic heart disease, stroke, hypertension, colon and breast cancer, type 2 diabetes, metabolic syndrome, obesity, osteoporosis, sarcopenia, functional dependence and falls in the elderly, cognitive impairment, anxiety and depression. This benefit is observed in both sexes and increases with the volume or intensity of exercise. These benefits are obtained through moderate aerobic exercise for at least 30 minutes 5 days per week or vigorous exercise for at least 20 minutes 3 days a week. It is recommended to add a minimum of 2 nonconsecutive days, each week, to practice 8-10 exercises that develop the strength of most muscle groups (arms, shoulders, chest, abdomen, back, hips and legs). It is also advisable to spend 2 sessions of 10 minutes per week to practice 8-10 exercises that maintain the flexibility of most groups of muscles and tendons. The exercise may involve musculoskeletal injuries and cardiovascular risk, but the benefit outweighs the risk.

Commuting physical activity and prevalence of metabolic disorders in Poland

OBJECTIVES

The aim of this study was to examine the relationship between walking or cycling to work and prevalence of metabolic syndrome (MetS) and its components.

METHODS

Cross-sectional analysis of 6401 randomly selected individuals (3297 men and 3104 women) aged 20-74 years, who participated in the National Multicentre Health Survey WOBASZ, Poland (2002-2005). Commuting physical activity (PA) was assessed by asking about type and time spent on transportation to/from work using an interviewer-administered questionnaire. Weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), triglycerides (TG) and high-density cholesterol, (HDL-C) were measured by standard methods. MetS was defined according to the NCEP-ATP III and IDF criteria.

RESULTS

Active commuting was associated with decreased likelihood of abdominal obesity (WC≥94 cm), lower HDL-C and elevated TG in men and abdominal obesity (WC≥80 cm) in women. In a subgroup of postmenopausal women (n=317) active commuting was favourably associated with abdominal obesity, low HDL-C and elevated FPG. Prevalence of MetS was significantly lower among those who spent above 30 min/day daily on walking/cycling to work than among other gender subgroups.

CONCLUSION

Increasing of commuting PA level may have an important influence on reducing the prevalence of metabolic disorders.

Leisure-time physical activity and type 2 diabetes during a 28 year follow-up in twins

AIMS/HYPOTHESIS

The study aimed to investigate whether baseline physical activity protects against the occurrence of type 2 diabetes during a 28 year follow-up, after controlling for childhood environment and genetic predisposition.

METHODS

At baseline in 1975 same-sex twin pairs born in Finland before 1958 were sent a questionnaire including questions on physical activity. The participants (20,487 individuals, including 8,182 complete twin pairs) were divided into quintiles by leisure-time physical activity metabolic equivalent (MET) index (MET h/day). Type 2 diabetes was determined from nationwide registers for the follow-up period (1 January 1976-31 December 2004). Individual and pairwise Cox proportional hazard models were used.

RESULTS

During follow-up, 1,082 type 2 diabetes cases were observed. Among all individuals, participants in MET quintiles (Q) III-V had significantly decreased risk for type 2 diabetes compared with sedentary individuals (QI). The pairwise analysis on pairs discordant for physical activity showed that participants in MET QII to V had significantly lower hazard ratios (0.61, 0.59, 0.61, 0.61) compared with sedentary participants. These findings from the pairwise analysis persisted after adjusting for BMI. In the pairwise analysis, the BMI-adjusted hazard ratio for type 2 diabetes was lower for physically active members of twin pairs (combined QII-V) than for inactive co-twins (HR 0.54; 95% CI 0.37-0.78). Similar results were obtained for both dizygotic and monozygotic pairs, as well as for the subgroup of twin pairs defined as free of co-morbidities in 1981 (HR 0.36; 95% CI 0.17-0.76).

CONCLUSIONS/INTERPRETATION

Leisure-time physical activity protects from type 2 diabetes after taking familial and genetic effects into account.

Reducing the risk of type 2 diabetes with nutrition and physical activity - efficacy and implementation of lifestyle interventions in Finland

BACKGROUND

The prevalence of type 2 diabetes has been increasing in Finland, in parallel with a gradual increase in overweight and obesity during the past decades. The expanding prevalence of type 2 diabetes brings along complications, most importantly CVD. Therefore, it is extremely important to implement activities to prevent type 2 diabetes.

OBJECTIVE

In the present paper, the clinical evidence for the prevention of type 2 diabetes is presented with the Finnish diabetes prevention study. In addition, the paper discusses the practical implementation of prevention of type 2 diabetes using three different types of prevention programmes as examples: FIN-D2D, including risk-screening and repeated consultation in primary health-care; FINNAIR, a workplace-targeted intervention project involving airline employees; and the good ageing in Lahti region (GOAL) programme, a community-based prevention programme.

CONCLUSIONS

FIN-D2D, the FINNAIR project and the GOAL programme have shown that screening for type 2 diabetes risk and implementing large-scale lifestyle intervention in primary health-care are feasible. However, the crucial questions still are whether it is possible to replicate the results concerning effectiveness of lifestyle intervention in primary and occupational health-care systems. Furthermore, it remains to be shown whether it is possible to achieve the same results in different health-care settings, cultures, regions and age groups, especially in adolescents and young adults among whom the increase in the incidence has been the highest. In addition, the importance of co-operation among all sections of society, citizens' awareness of healthy lifestyles and the social inequalities in health must be emphasised because the diabetes epidemic cannot be solved only by concentrating on preventive actions carried out by health-care systems.

Occupational sitting and health risks: a systematic review

CONTEXT

Emerging evidence suggests that sedentary behavior (i.e., time spent sitting) may be negatively associated with health. The aim of this study was to systematically review the evidence on associations between occupational sitting and health risks.

EVIDENCE ACQUISITION

Studies were identified in March-April 2009 by literature searches in PubMed, PsycINFO, CENTRAL, CINAHL, EMBASE, and PEDro, with subsequent related-article searches in PubMed and citation searches in Web of Science. Identified studies were categorized by health outcome. Two independent reviewers assessed methodologic quality using a 15-item quality rating list (score range 0-15 points, higher score indicating better quality). Data on study design, study population, measures of occupational sitting, health risks, analyses, and results were extracted.

EVIDENCE SYNTHESIS

43 papers met the inclusion criteria (21% cross-sectional, 14% case-control, 65% prospective); they examined the associations between occupational sitting and BMI (n=12); cancer (n=17); cardiovascular disease (CVD, n=8); diabetes mellitus (DM, n=4); and mortality (n=6). The median study-quality score was 12 points. Half the cross-sectional studies showed a positive association between occupational sitting and BMI, but prospective studies failed to confirm a causal relationship. There was some case-control evidence for a positive association between occupational sitting and cancer; however, this was generally not supported by prospective studies. The majority of prospective studies found that occupational sitting was associated with a higher risk of DM and mortality.

CONCLUSIONS

Limited evidence was found to support a positive relationship between occupational sitting and health risks. The heterogeneity of study designs, measures, and findings makes it difficult to draw definitive conclusions at this time.

Relationships of land use mix with walking for transport: do land uses and geographical scale matter?

Physical activity and public health recommendations now emphasize the creation of activity-friendly neighborhoods. Mixed land use in a neighborhood is important in this regard, as it reflects the availability of destinations to which residents can walk or ride bicycles, and thus is likely to contribute to residents' active lifestyles that in turn will influence their overall health. Relationships between land use mix (LUM) and physical activity have not been apparent in some studies, which may be because geographical scale and the specificity of hypothesized environment-behavior associations are not taken into account. We compared the strength of association of four Geographic Information Systems-derived LUM measures with walking for transport and perceived proximity to destinations. We assessed physical activity behaviors of 2,506 adults in 154 Census Collection Districts (CCDs) in Adelaide, Australia, for which ''original'' LUM measures were calculated, and then refined by either: accounting for the geographic scale of measurement; including only the most-relevant land uses; or, both. The refined (but not the ''original'') LUM measures had significant associations with the frequency of walking for transport (p < 0.05) and area-corrected measures had significant associations with the duration of walking for transport. All LUM measures had significant associations with perceived proximity to destinations, but stronger associations were seen when using the refined measures compared with the original LUM. Identifying the LUM attributes most strongly associated with walking for transport is a priority and can inform environmental and policy initiatives that are needed to promote health-enhancing physical activity.

Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: evidence from the English Longitudinal Study of Ageing

AIMS/HYPOTHESIS

We examined whether small amounts of low-intensity physical activity were associated with reduced risk of developing type 2 diabetes in a national sample of people aged 50 years and over.

METHODS

The sample comprised 7,466 individuals (55.9% women) free from self-reported doctor-diagnosed diabetes and was prospectively followed for a mean of 45.3 months. Baseline self-reported physical activity was categorised as physical inactivity, low- and vigorous/moderate-intensity physical activity at least once a week. Cox proportional hazard regression was used to model the association between baseline physical activity and incident type 2 diabetes.

RESULTS

Vigorous/moderate-intensity physical activity at least once a week was associated with reduced risk of type 2 diabetes (HR 0.64, 95% CI 0.43-0.95, p = 0.026) but low-intensity physical activity at least once a week was not (HR 0.87, 95% CI 0.58-1.30, p = 0.497) after adjustment for all covariates. However, age-stratified analysis showed that low-intensity physical activity at least once a week was associated with reduced risk of type 2 diabetes for those aged 70 years and over (HR 0.53, 95% CI 0.28-1.02, p = 0.059), but not for those aged 50 to 59 years (HR 1.09, 95% CI 0.52-2.29, p = 0.828) or those aged 60 to 69 years (HR 1.15, 95% CI 0.55-2.41, p = 0.715) after adjustment for all covariates.

CONCLUSIONS/INTERPRETATION

Compared with physical inactivity, any type of physical activity was associated with reduced risk of type 2 diabetes in adults aged 70 years and over, while in adults aged 50 to 69 years, physical activity needed to be vigorous/moderate in intensity to be associated with reduced risk of type 2 diabetes.

Prevalência e fatores associados à inatividade física nos deslocamentos para escola em adolescentes

O objetivo deste estudo foi verificar a prevalência e identificar fatores associados à inatividade física nos deslocamentos para escola em adolescentes. Trata-se de um estudo epidemiológico transversal baseado na análise secundária de dados de uma amostra de 4.207 adolescentes (14-19 anos). Os dados foram coletados por meio de um questionário previamente validado (GSHS-OMS). Foram classificados como "inativos nos deslocamentos" aqueles que relataram que não se deslocavam ativamente para ir à escola e/ou aqueles que o fazem, mas despendem menos de 20 minutos no trajeto de ida e volta. Observou-se que 43% (IC95%: 41,5-44,5) dos adolescentes são fisicamente inativos nos deslocamentos. Verificou-se que o local de residência e a escolaridade materna foram estatisticamente associados ao desfecho (inatividade física nos deslocamentos para escola) (p < 0,001). Entre os rapazes, a inatividade física nos deslocamentos foi significativamente associada à faixa etária (p = 0,02) e à cor da pele (p = 0,04). A inatividade nos deslocamentos é relativamente alta em comparação a outros estudos congêneres.

A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults

This systematic review examines critically the scientific basis for Canada's Physical Activity Guide for Healthy Active Living for adults. Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases (cardiovascular disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes (diabetes mellitus) and osteoporosis). The strength of the relationship between physical activity and specific health outcomes is evaluated critically. Literature was obtained through searching electronic databases (e.g., MEDLINE, EMBASE), cross-referencing, and through the authors' knowledge of the area. For inclusion in our systematic review articles must have at least 3 levels of physical activity and the concomitant risk for each chronic disease. The quality of included studies was appraised using a modified Downs and Black tool. Through this search we identified a total of 254 articles that met the eligibility criteria related to premature all-cause mortality (N = 70), cardiovascular disease (N = 49), stroke (N = 25), hypertension (N = 12), colon cancer (N = 33), breast cancer (N = 43), type 2 diabetes (N = 20), and osteoporosis (N = 2). Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified. Moreover, higher levels of physical activity reduce the risk for premature all-cause mortality. The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality.

Classifying household and locomotive activities using a triaxial accelerometer

The purpose of this study was to develop a new algorithm for classifying physical activity into either locomotive or household activities using a triaxial accelerometer. Sixty-six volunteers (31 men and 35 women) participated in this study and were separated randomly into validation and cross-validation groups. All subjects performed 12 physical activities (personal computer work, laundry, dishwashing, moving a small load, vacuuming, slow walking, normal walking, brisk walking, normal walking while carrying a bag, jogging, ascending stairs and descending stairs) while wearing a triaxial accelerometer in a controlled laboratory setting. Each of the three signals from the triaxial accelerometer was passed through a second-order Butterworth high-pass filter to remove the gravitational acceleration component from the signal. The cut-off frequency was set at 0.7 Hz based on frequency analysis of the movements conducted. The ratios of unfiltered to filtered total acceleration (TAU/TAF) and filtered vertical to horizontal acceleration (VAF/HAF) were calculated to determine the cut-off value for classification of household and locomotive activities. When the TAU/TAF discrimination cut-off value derived from the validation group was applied to the cross-validation group, the average percentage of correct discrimination was 98.7%. When the VAF/HAF value similarly derived was applied to the cross-validation group, there was relatively high accuracy but the lowest percentage of correct discrimination was 63.6% (moving a small load). These findings suggest that our new algorithm using the TAU/TAF cut-off value can accurately classify household and locomotive activities.

The effectiveness of community-based cycling promotion: findings from the Cycling Connecting Communities project in Sydney, Australia

Background

Encouraging cycling is an important way to increase physical activity in the community. The Cycling Connecting Communities (CCC) Project is a community-based cycling promotion program that included a range of community engagement and social marketing activities, such as organised bike rides and events, cycling skills courses, the distribution of cycling maps of the area and coverage in the local press. The aim of the study was to assess the effectiveness of this program designed to encourage the use of newly completed off-road cycle paths through south west Sydney, Australia.

Methods

The evaluation used a quasi-experimental design that consisted of a pre- and post-intervention telephone survey (24 months apart) of a cohort of residents (n = 909) in the intervention area (n = 520) (Fairfield and Liverpool) and a socio-demographically similar comparison area (n = 389) (Bankstown). Both areas had similar bicycle infrastructure. Four bicycle counters were placed on the main bicycle paths in the intervention and comparison areas to monitor daily bicycle use before and after the intervention.

Results

The telephone survey results showed significantly greater awareness of the Cycling Connecting Communities project (13.5% vs 8.0%, p < 0.05) in the intervention area, with significantly higher rates of cycling in the intervention area (32.9%) compared with the comparison area (9.7%) amongst those aware of the project. There was a significant increase in use of bicycle paths in the intervention area (28.3% versus 16.2%, p < 0.05). These findings were confirmed by the bike count data.

Conclusion

Despite relatively modest resources, the Cycling Connecting Communities project achieved significant increases in bicycle path use, and increased cycling in some sub-groups. However, this community based intervention with limited funding had very limited reach into the community and did not increase population cycling levels.

Differential relationship between physical activity and progression to diabetes by glucose tolerance status: the Inter99 Study

AIMS/HYPOTHESIS

The aim of the study was to analyse how strongly commuting and leisure-time physical activity affect progression to diabetes and to study whether this relationship is different in individuals with isolated impaired fasting glucose (i-IFG) and isolated impaired glucose tolerance (i-IGT).

METHODS

We studied the incidence of diabetes in 4,031 individuals without diabetes at baseline who participated in the baseline and 5 year follow-up examinations of a population-based primary prevention study, the Inter99 Study. Glucose tolerance status at baseline and at follow-up were based on OGTTs. Commuting and leisure-time physical activity at baseline were assessed by questionnaire. We present rate ratios from Poisson regression analyses adjusted for relevant confounders.

RESULTS

The progression rate to diabetes was lower among physically active individuals in the total study population and particularly among those with i-IGT. The associations were attenuated and lost statistical significance after further adjustment for BMI. We observed no impact of physical activity on the progression to diabetes in individuals with i-IFG.

CONCLUSIONS/INTERPRETATION

Physical activity was associated with a lower progression to diabetes in the total study population and in individuals with i-IGT, a condition primarily characterised by muscle insulin resistance. Physical activity did not predict progression to diabetes in individuals with i-IFG, a condition primarily characterised by hepatic insulin resistance. Our results suggest that there is a differential relationship between physical activity and progression to diabetes among those with i-IFG and i-IGT. Therefore, clinical trials testing the effect of physical activity on progression from i-IFG to diabetes are needed.

TRIAL REGISTRATION

ClinicalTrials.gov ID No.: NCT00289237

FUNDING

The Danish Medical Research Council, the Danish Center for Evaluation and Health Technology Assessment, Novo Nordisk, Copenhagen County, the Danish Heart Foundation, the Danish Diabetes Association, the Danish Pharmaceutical Association, the Augustinus Foundation, the Ib Henriksen Foundation and the Becket Foundation.

Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport

We used Comparative Risk Assessment methods to estimate the health effects of alternative urban land transport scenarios for two settings-London, UK, and Delhi, India. For each setting, we compared a business-as-usual 2030 projection (without policies for reduction of greenhouse gases) with alternative scenarios-lower-carbon-emission motor vehicles, increased active travel, and a combination of the two. We developed separate models that linked transport scenarios with physical activity, air pollution, and risk of road traffic injury. In both cities, we noted that reduction in carbon dioxide emissions through an increase in active travel and less use of motor vehicles had larger health benefits per million population (7332 disability-adjusted life-years [DALYs] in London, and 12 516 in Delhi in 1 year) than from the increased use of lower-emission motor vehicles (160 DALYs in London, and 1696 in Delhi). However, combination of active travel and lower-emission motor vehicles would give the largest benefits (7439 DALYs in London, 12 995 in Delhi), notably from a reduction in the number of years of life lost from ischaemic heart disease (10-19% in London, 11-25% in Delhi). Although uncertainties remain, climate change mitigation in transport should benefit public health substantially. Policies to increase the acceptability, appeal, and safety of active urban travel, and discourage travel in private motor vehicles would provide larger health benefits than would policies that focus solely on lower-emission motor vehicles.

Active commuting and cardiovascular disease risk: the CARDIA study

BACKGROUND

There is little research on the association of lifestyle exercise, such as active commuting (walking or biking to work), with obesity, fitness, and cardiovascular disease (CVD) risk factors.

METHODS

This cross-sectional study included 2364 participants enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study who worked outside the home during year 20 of the study (2005-2006). Associations between walking or biking to work (self-reported time, distance, and mode of commuting) with body weight (measured height and weight); obesity (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, >or= 30); fitness (symptom-limited exercise stress testing); objective moderate-vigorous physical activity (accelerometry); CVD risk factors (blood pressure [oscillometric systolic and diastolic]); and serum measures (fasting measures of lipid, glucose, and insulin levels) were separately assessed by sex-stratified multivariable linear (or logistic) regression modeling.

RESULTS

A total of 16.7% of participants used any means of active commuting to work. Controlling for age, race, income, education, smoking, examination center, and physical activity index excluding walking, men with any active commuting (vs none) had reduced likelihood of obesity (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.33-0.76), reduced CVD risk: ratio of geometric mean triglyceride levels (trig(active))/(trig(nonactive)) = 0.88 (95% CI, 0.80 to 0.98); ratio of geometric mean fasting insulin (FI(active))/(FI(nonactive)) = 0.86 (95% CI, 0.78 to 0.93); difference in mean diastolic blood pressure (millimeters of mercury) (DBP(active)) - (DBP(nonactive)) = -1.67 (95% CI, -3.20 to -0.15); and higher fitness: mean difference in treadmill test duration (in seconds) in men (TT(active)) - (TT(nonactive)) = 50.0 (95% CI, 31.45 to 68.59) and women (TT(active)) - (TT(nonactive)) = 28.77 (95% CI, 11.61 to 45.92).

CONCLUSIONS

Active commuting was positively associated with fitness in men and women and inversely associated with BMI, obesity, triglyceride levels, blood pressure, and insulin level in men. Active commuting should be investigated as a modality for maintaining or improving health.

[Evidence-based guidelines for physical activity of adult Canadians]

This review of the literature provides an update on the scientific biological and psychosocial bases for Canada's Physical Activity Guide for Health Active Living, with particular reference to the effect of physical activity on the health of adults aged 20-55 years. Existing physical activity guidelines for adults from around the world are summarized briefly and compared to the Canadian guidelines. The descriptive epidemiology of physical activity and inactivity in Canada is presented, and the strength of the relationship between physical activity and specific health outcomes is evaluated, with particular emphasis on minimal and optimal physical activity requirements. Finally, areas requiring further investigation are highlighted. Summarizing the findings, Canadian and most international physical activity guidelines advocate moderate-intensity physical activity on most days of the week. Physical activity appears to reduce the risk for over 25 chronic conditions, in particular coronary heart disease, stroke, hypertension, breast cancer, colon cancer, type 2 diabetes, and osteoporosis. Current literature suggests that if the entire Canadian population followed current physical activity guidelines, approximately one-third of deaths related to coronary heart disease, one quarter of deaths related to stroke and osteoporosis, 20% of deaths related to colon cancer, hypertension, and type 2 diabetes, and 14% of deaths related to breast cancer could be prevented. It also appears that the prevention of weight gain and the maintenance of weight loss require greater physical activity levels than current recommendations.

Prevalence and risk factors for type 2 diabetes mellitus in the Chinese adult population: the InterASIA Study

AIMS

To estimate the prevalence of impaired fasting glucose and type 2 diabetes mellitus (T2DM) and identify the potential risk factors of T2DM in Chinese adults.

METHODS

A nationally representative sample of 15,236 Chinese adults aged 35-74 years was selected by 4-stage random stratified sampling in 2000-2001 for present study.

RESULTS

The prevalence of T2DM in Chinese adults aged 35-74 years was 5.49% (it was 2.51% in China, 1994). The odds ratios (ORs) (95% confidence interval [CI]) for developing T2DM were 2.14 (1.08-4.22) for family history of diabetes, 3.90 (1.39-10.94) for waist-to-hip ratio (WHR) (0.83-0.91 vs. <0.83), 4.82 (1.43-16.28) for WHR (>or=0.92 vs. <0.83), and 3.14 (1.42-6.92) for triglycerides (TG) level (>or=200mg/dl vs. <150 mg/dl) among men but 2.74 (1.14-6.62) for family history of diabetes, 1.92 (1.04-3.56) for hypertension, 3.37 (1.67-6.77) for TG level (150-199 mg/dl vs. <150 mg/dl), and 3.79 (1.62-8.91) for TG level (>or=200mg/dl vs. <150mg/dl) among women.

CONCLUSIONS

The prevalence of T2DM in Chinese adults has increased as compared with previous data for China. An effective intervention program regarding T2DM should focus on lifestyle modification and weight reduction.