The effect of a pre- and post-operative exercise program versus standard care on physical activity and sedentary behavior of patients with esophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (the PERIOP-OG Trial): a randomized controlled trial†

Neoadjuvant cancer treatment (NCT) reduces both physical fitness and physical activity (PA) levels, which can increase the risk of adverse outcomes in cancer patients. This study aims to determine the effect of exercise prehabilitation on PA and sedentary behavior (SB) in patients undergoing NCT and surgery for esophagogastric malignancies. This study is a randomized pragmatic controlled multi-center trial conducted across three Irish hospitals. Participants were aged ≥18 years scheduled for esophagectomy or gastrectomy and were planned for NCT and surgery. Participants were randomized to an exercise prehabilitation group (EX) that commenced following cancer diagnosis, continued to the point of surgery, and resumed following recovery from surgery for 6 weeks or to usual care (UC) who received routine treatment. The primary outcome measures were PA and SB. Between March 2019 and December 2020, 71 participants were recruited: EX (n = 36) or UC (n = 35). No significant differences were found between the EX group and UC group on levels of PA or SBs across all measured timepoints. Significant decreases in moderate-vigorous physical activity levels (MVPAs) were found between baseline and post-surgery (P = 0.028), pre-surgery and post-surgery (P = 0.001) and pre-surgery and 6-week follow-up (P = 0.022) for all participants. Step count also significantly decreased between pre-surgery and post-surgery (P < 0.001). Baseline aerobic fitness was positively associated to PA levels and negatively associated with SB. Esophagogastric cancer patients have lower than recommended levels of PA at the time of diagnosis and this decreased further following completion of NCT. An optional home- or group-based exercise intervention was not effective in improving PA levels or behaviors across the cancer treatment journey.

Assessment of screen time and its correlates among adolescents in selected rural areas of Puducherry

OBJECTIVES

To assess screen time and its correlates among adolescents in selected rural areas of Puducherry.

METHODS

This cross-sectional analytical study was conducted among adolescents aged 10-19 years visiting the Pediatrics and other departments at Sri Lakshmi Narayana Institute of Medical Sciences (SLIMS), Puducherry. The sample size of 164 was determined based on previous studies, with a systematic random sampling technique used for participant selection. Data collection involved a semi-structured questionnaire covering sociodemographic factors, screen time, sleep, dietary, and physical activity patterns. Increased screen time was defined as more than 2 h per day, and adequate physical activity was considered as at least 60 min of moderate-to-vigorous intensity exercises. Statistical analysis was performed using Stata version 17, with associations tested using Chi-square analysis and a significance level set at p<0.05.

RESULTS

The mean age of the participants was 18.2 (0.9) years, with 86 % in the 16-19 years age group. Males comprised 53.7 %, and 66.5 % were from rural areas. The mean screen time was 4.4 (1.5) hours per day, with 79.1 % exceeding the recommended limit. Mobile phones were the most frequently used devices (92.7 %), primarily for watching movies (51.8 %) and videos (23.8 %). Increased screen time was significantly associated with younger age (10-15 years), urban residence, and school-going status. Adolescents with increased screen time exhibited lower physical activity and inadequate sleep. Additionally, increased consumption of packaged foods was observed among those with higher screen time.

CONCLUSIONS

More than three-fourths of the adolescents exceeded the recommended screen time, negatively impacting their physical activity and sleep. These findings underscore the need for targeted interventions to promote healthier lifestyle choices among adolescents in rural Puducherry.

The Impact of a Digital Cancer Survivorship Patient Engagement Toolkit on Older Cancer Survivors' Health Outcomes

Cancer predominantly affects older adults. An estimated 62% of the 15.5 million American cancer survivors are 65 years or older. Provision of supportive care is critical to this group; however, limited resources are available to them. As older survivors increasingly adopt technology, digital health programs have significant potential to provide them with longitudinal supportive care. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit for older adults, Cancer Survivorship Patient Engagement Toolkit Silver. The study examined the preliminary impact of the Cancer Survivorship Patient Engagement Toolkit Silver on older survivors' health outcomes. This was a 2-arm randomized controlled trial with two observations (baseline, 8 weeks) on a sample of 60 older cancer survivors (mean age, 70.1 ± 3.8 years). Outcomes included health-related quality of life, self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. At 8 weeks, the Cancer Survivorship Patient Engagement Toolkit Silver group showed more improved physical health-related quality of life (P < .001, effect size = 0.64) and symptom burden (P = .053, effect size = -0.41) than the control group. Self-efficacy (effect size = 0.56), mental health-related quality of life (effect size = 0.26), and communication (effect size = 0.40) showed clinically meaningful effect sizes of improvement. Most participants reported benefits on health management (mean, 19.41 ± 2.6 [3-21]). Further research is needed with larger and more diverse older cancer populations.

Resting energy expenditure during spinal cord injury rehabilitation and utility of fat-free mass-based energy prediction equations: a pilot study

STUDY DESIGN

Longitudinal observational study. Measurements were undertaken between weeks 4-6 post-spinal cord injury (SCI), repeated at week 8 and every 4 weeks thereafter until week 20 or rehabilitation discharge, whichever occurred first.

OBJECTIVES

Observe variation in measured resting energy expenditure (REE) and body composition in males undergoing SCI rehabilitation, compare REE with SCI-specific prediction equations incorporating fat-free mass (FFM), and explore the prevalence of clinical factors that may influence individual REE.

SETTING

Spinal Injuries Unit, Brisbane, Queensland, Australia.

METHODS

Indirect calorimetry was used to measure REE and bioimpedance spectroscopy to assess body composition. Four SCI-specific FFM-based REE and basal metabolic rate (BMR) prediction equations were compared to measured REE. A clinically significant change in REE was defined as +/- 10% difference from the week 4-6 measurement. Clinical factors that may affect REE variations were collected including infection, pressure injuries, autonomic dysreflexia, spasticity, and medications.

RESULTS

Fifteen people participated (mean age 35 ± 13 years, 67% paraplegic). There was no statistically significant change in mean REE, weight, or body composition, and the Chun and Nightingale BMR prediction equations performed best (rc > 0.8 at all time points). One-third of participants had >10% change in REE on 11 occasions, with clinical factors not consistently associated with the observed changes.

CONCLUSION

During SCI rehabilitation, mean REE, weight, and body composition remain unchanged, and FFM-based BMR prediction equations may be an acceptable alternative to indirect calorimetry. Future research designs should avoid single indirect calorimetry measures as snapshot data may not represent typical REE in this population.

Psychometric property and measurement invariance of perceived benefits and barriers of physical activity in Chinese adolescents

Background

The perceived benefits and barriers to physical activity play crucial roles in determining daily physical activity levels. However, previous studies have employed tools lacking adequate validation, leading to inconsistent conclusions about the impact of these two factors. Therefore, this national, population-based study was conducted to assess the psychometric properties, measurement invariance, and predictive validity of the Chinese versions of the perceived benefits (C-PBEPA) and barriers to physical activity (C-PBAPA) scales.

Methods

The final sample (N = 2942, 49.3 % for boys) was randomly split into two subsamples. The first subsample was used for exploratory factor analysis and the second subsample was used for confirmatory factor analysis. Measurement invariance across gender and age groups were examined. Structural equation models were developed to examine the predictive validity of the revised C-PBEPA and C-PBAPA on moderate to vigorous PA.

Results

The results showed that both scales were unidimensional, had excellent model fit (e.g., X 2/df < 3, CFI >0.9, RMSEA <0.06) and demonstrated convergent validity. Findings also revealed lack of scalar invariance for C-PBAPA between preadolescents and adolescents' groups (ΔCFI >0.01) and supported the predictive validity of both scales (p < 0.001).

Conclusion

The study demonstrated that the revised C-PBEPA and C-PBAPA are valid scales for measuring Chinese adolescents' perceived benefits and barriers to PA.

Effect of two dynamic seat cushions on postural shift, trunk muscle activation and spinal discomfort in office workers

We investigated the effect of two dynamic seat cushions on postural shift, trunk muscle activation and spinal discomfort. In this repeated-measures study, 30 healthy office workers were randomly assigned to a sequence of three conditions: sitting on a dynamic seat cushion-A, cushion-B and control (no seat cushion). The two dynamic seat cushions had different inflation levels. Participants typed a standard text for an hour and were monitored for postural shift by using a seat pressure mat, transversus abdominis/internal oblique and lumbar multifidus muscles activity by using surface EMG, spinal discomfort by using Borg's CR-10 scale. Two-way repeated ANOVAs showed no statistically significant interaction effects between condition and time on postural shift and muscle activation. Post hoc Bonferroni tests showed that postural shifts and lumbar multifidus activation during sitting on cushion-A were significantly higher (p < 0.01) than in the control and cushion-B conditions. Both cushions reduced spinal discomfort, compared to the control condition (p < 0.05).

Body mass index trajectories and their predictors in undergraduate students from Canada: Results from the GENEiUS study

Objective: To explore the patterns and predictors of body mass index (BMI) change among undergraduate students from Ontario (Canada). Participants: 68 undergraduate students were followed longitudinally for 3 years with anthropometric data collected bi-annually. Methods: BMI measurements were plotted to generate individual BMI trajectory curves, which were categorized, based on the observed trajectory pattern. Within and between group comparisons of BMI were conducted via nonparametric paired tests. The association of baseline BMI, sex, and ethnicity with BMI trajectory type was assessed using multinomial logistic regression. Results: Four BMI trajectory types were observed: "stable weight" (n = 15, 22.1%), "weight gain" (n = 30, 44.1%), "weight loss" (n = 12, 17.6%), and "weight cycling" (n = 11, 16.2%) trajectories. Higher baseline BMI was significantly associated with the "weight gain," "weight loss," and the "weight cycling" trajectories as compared to the "stable weight" trajectory type. Conclusions: Our findings demonstrate an association between high baseline BMI and "nonstable" subsequent BMI change patterns among Canadian students.

Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study

BACKGROUND/OBJECTIVES

Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation.

METHODS

Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation.

RESULTS

Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement.

CONCLUSION

Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

Exploring the acceptability of and adherence to prehabilitation and rehabilitation in patients undergoing major abdominal surgery: A systematic review and meta-analysis

BACKGROUND AND AIMS

Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery.

METHODS

We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs).

RESULTS

The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I2 = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I2 = 39%), compared with rehabilitation or standard pre- and post-surgical care.

CONCLUSION

Prehabilitation was acceptable to patients, with good adherence, and improved physical function.

A Workplace Physical Activity Intervention and a Smartphone App for Overweight and Obese Sedentary Women

BACKGROUND

The sedentary aspects of many U.S. occupations and the amount of time American workers spend in the workplace make it an ideal location to implement health promotion programs.

METHODS

This study assessed the effectiveness of a free smartphone app with a goal-setting feature to increase physical activity (PA) and impact anthropometric, body mass (BM), and body composition (BC) changes among overweight and obese women within a community health workforce. Eighteen overweight and obese (body mass index [BMI] = 32.18 ± 4.48 kg/m2), adult (50.73 ± 8.76 years), female volunteers, tracked daily steps with a free smartphone app (StridekickTM) over an 8-week period. Pre- and post-program body composition (BC) measurements included: relative (%) body fat (BF), fat mass (FM), fat-free mass (FFM), and lean mass (LM), using dual X-ray absorptiometry (DEXA scan), and five anthropometric measurements (biceps, waist, abdomen, hips, and thigh).

FINDINGS

Pre- to post-program average daily steps resulted in significant anthropometric changes for biceps, hips, and thigh measures, with encouraging changes in FFM, LM, and relative (%) BF. The goal-setting feature of the app did not result in significant differences between the experimental and control groups. No differences were noted in FM, BMI, waist, and abdomen or step goals compared with steps completed.

CONCLUSIONS

An occupational PA health promotion intervention program that tracked daily steps through the StridekickTM smartphone app resulted in anthropometric, BM, and BC changes.

APPLICATION TO PRACTICE

The workplace is an ideal location to affect change in health behaviors via a free smartphone app to increase PA and improve health.

Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study

OBJECTIVE

This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy.

METHODS

A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation.

RESULTS

A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline.

CONCLUSIONS

The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

Racial and Ethnic Variations in Resilience Factors Among Sexual and Gender Minority Midlife and Older Adults

BACKGROUND AND OBJECTIVES

This study explores resilience factors among sexual and gender minority (SGM) midlife and older adults, identifying historical/environmental, psychological, social, and behavioral predictors, and examining variations across racial/ethnic subgroups. By adopting a resilience-focused perspective, this research contributes to understanding strengths in the SGM community in the context of aging.

RESEARCH DESIGN AND METHODS

Using weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this research investigates distinct risk and protective factors associated with resilience among SGM midlife and older adults. Subgroup variations were assessed using regression models. Factors moderated by race/ethnicity were integrated into final interaction models.

RESULTS

Hispanic and Black individuals showed significantly higher resilience than non-Hispanic Whites. Lifetime victimization and day-to-day discrimination were negatively associated with resilience. Positive associations were found for higher income, identity affirmation, larger network size, greater social participation, increased physical activity, and sufficient food intake. Interaction models revealed nuanced patterns by subgroups; education negatively impacted resilience among Black individuals, while income positively influenced Hispanic individuals' resilience. The Other racial/ethnic group demonstrated unique associations between optimal sleep and resilience.

DISCUSSION AND IMPLICATIONS

This study shifts from a deficit-based to a resilience-focused approach among SGM midlife and older adults, revealing key strengths within diverse subgroups. Results underscore the significance of recognizing racial/ethnic differences in factors promoting resilience and posing risks for SGM midlife and older adults. Tailoring interventions to address the intersectional needs of SGM aging populations is essential for enhancing their abilities to bounce back from adverse events.

Participation in physical activity and sport in adolescent girls from Middle Eastern backgrounds

OBJECTIVES

This study investigated the barriers and facilitators to physical activity and sport participation among adolescent girls from Middle Eastern backgrounds. These factors were explored through the perspectives of both adolescent girls and parents of adolescent girls, living in Australia.

DESIGN

A qualitative study design was used to understand perceived barriers and facilitators to physical activity and sport in adolescent girls. Participants were 18 adolescent girls and 9 parents of adolescent girls, all of Middle Eastern backgrounds, living in Western Sydney, Australia. Data were collected through five focus groups and four one-on-one interviews, separated for girls and parents. Data were analysed using an inductive approach and thematic analysis.

RESULTS

Three main themes (family, social support, religion and culture) and nine subthemes were identified. The main facilitators for physical activity and sport included the values and presence of an active family role model, religion to encourage lifelong physical activity skills, and promotion of physical activity from peers, school, and social media. The predominant barriers to physical activity and sport included established cultural norms and traditional gender roles, which were often influenced by religion and culture, and extended time using technology.

CONCLUSION

The findings of the current study show the complex relationships between family, religion, and culture when promoting physical and sport participation. Such factors highlight the need to develop culturally tailored physical activity interventions that consider the perceived barriers and facilitators for adolescent girls' participation from Middle Eastern backgrounds.

The effects of nutrition education on nutritional knowledge and dietary behaviours in primary school students in Zhongshan city

BACKGROUND

Adequate nutritional knowledge and healthy dietary behaviours are essential for promoting rational nutrition for children. However, lack of nutritional knowledge and unhealthy dietary behaviours are common among Chinese children. Therefore, we developed a school-based nutrition education (NE) program to assess its impacts on nutritional knowledge and dietary behaviours in pupils.

METHODS

In this trial, one school was assigned as an intervention group (n = 199) and the other two schools were designated as a control group (n = 140). Children in the intervention group received the NE program in addition to their regular health curriculum, whereas the control group continued with their usual health curriculum without any NE program materials.

RESULTS

Concerning nutritional knowledge, the mean difference (follow-up minus baseline) of average knowledge scores in the intervention group was significantly higher than that in the control group (1.99 ± 3.22 vs. 0.66 ± 3.60, p = 0.001). However, subgroup analysis revealed that this difference disappeared among boys and students with malnutrition status. Regarding dietary behaviours, the NE program significantly increased the proportion of children exhibiting high frequencies of meat and nuts consumption in the intervention group, along with diverse food choice at breakfast. Additionally, it markedly reduced the proportion of children exhibiting high frequencies of sugar-sweetened beverages and fast food consumption. Structural equation modelling analyses indicated a significant direct effect of NE intervention on nutritional knowledge and an indirect effect on dietary behaviours.

CONCLUSIONS

The NE program effectively enhanced nutritional knowledge scores and further improved dietary behaviours among Chinese primary school students. Future NE programs should pay more attention to boys and children with malnutrition.

Development of a Concise Healthy Diet Score for Cardiovascular Disease among Japanese; The Japan Collaborative Cohort Study

AIMS

Several diet quality indicators have been developed primarily for cardiovascular disease (CVD) prevention in Western countries. However, those previous indicators are complicated and less feasible in clinical and health-promoting settings. Therefore, we aimed to develop a concise dietary risk score for CVD prevention in Japanese.

METHODS

Using the self-administered food frequency questionnaire with 35 food items, we developed a concise healthy diet score (cHDS) ranging from 0 to 5 points. We examined the association of cHDS with risks of all-cause and cause-specific mortality among 23,115 men and 35,557 women who were free of CVD and cancer.

RESULTS

During 19.2 years of median follow-up, 6,291 men and 5,365 women died. In men, the multivariable hazard ratios (95% confidence intervals) for the highest cHDS (5 points) compared to the lowest (0-1 points) were 0.74 (0.60-0.91, P-trend=0.008) for CVD and 0.86 (0.77-0.95, P-trend=0.05) for all causes. No significant associations were found for stroke, coronary heart disease, and other causes in men. The corresponding hazard ratio in women was 0.65 (0.52-0.81, P-trend＜0.001) for CVD, 0.63 (0.45-0.88, P-trend＜0.001) for stroke, 0.48 (0.30-0.78, P-trend=0.008) for coronary heart disease, 0.67 (0.54-0.84, P-trend＜0.001) for other causes, and 0.75 (0.66-0.85, P-trend＜0.001) for all causes.

CONCLUSION

We developed a concise diet quality score named cHDS in the Japanese population and found the inverse association of cHDS with mortality from CVD and all causes for both men and women.

Construct validity and reliability of a French-Canadian translation of the eating in the absence of hunger questionnaire for children and adolescents

Eating in the absence of hunger (EAH) has been associated with overweight and obesity during childhood. The gold standard to assess this behavior is a laboratory-based protocol, but a questionnaire to assess EAH more efficiently in children and adolescents has been developed and validated in English. We assessed construct validity (structural and convergent validity) and reliability (internal consistency and temporal stability) of a French translation of the EAH Questionnaire for Children and Adolescents among French-Canadian youths. We recruited participants in Montreal (Canada) aged 7-15 years old, who completed the questionnaire and provided anthropometric data. We asked participants to complete the questionnaire a second time ∼4 weeks later. The questionnaire consists of 14 questions and 3 subscales that assess EAH due to negative affect, fatigue/boredom, and external cues. We performed an exploratory factor analysis to test the factor structure and we calculated Cronbach alpha coefficients and intra-class correlations to assess internal consistency and temporal stability, respectively. We assessed associations between EAH and BMI z-score using Pearson correlations. We included 196 participants (50% girls; mean (SD) 11.9 (2.3) years old) for the first completion and 153 for the second completion. The exploratory factor analysis generated the same three subscales as the original questionnaire: negative affect (α = 0.86; ICC = 0.78), fatigue/boredom (α = 0.75; ICC = 0.70), and external cues (α = 0.68; ICC = 0.54). Participant's BMI z-scores were positively associated with the average scores from the negative affect subscale (r = 0.19; ρ = 0.009). Our results suggest that this questionnaire has an adequate construct validity, internal consistency, and temporal stability.

Association Between Physical Activity, Sedentary Behaviors, and Sleep-Related Outcomes Among Cancer Survivors: a Cross-Sectional Study

BACKGROUND

Limited research has examined the association between moderate to vigorous physical activity (MVPA), sedentary behavior (SB), and sleep-related outcomes in cancer survivors. Therefore, this study aimed to examine these associations using a nationally representative sample of US adults.

METHODS

Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. A total of 3229 adults with cancer histories were included. Physical activity was measured through accelerometry, and questions on daily activities, sedentary time, and sleep were collected during the household interview. Weighted multivariable analyses were conducted after accounting for the complex sampling design of the NHANES dataset.

RESULTS

After adjustments, physical activity and SB outcomes were associated with several self-reported sleep-related parameters. Increases in minutes of self-reported MVPA and SB were associated with a decreased likelihood of reporting ≥ 8 h of sleep (OR = 0.92, 95% CI = 0.86, 0.99 and OR = 0.88, 95% CI = 0.82, 0.95). Converse associations were found between device-measured MVPA and SB with the likelihood of reporting often/always feeling overly sleepy during the day (OR = 0.86, 95% CI = 0.75 and OR = 1.13, 95% CI = 1.05, respectively). However, an increased likelihood of waking up too early in the morning (OR = 1.22, 95% CI = 1.04) was observed with increases in minutes of device-measured MVPA.

CONCLUSIONS

A sensible strategy to decrease the frequency of sedentary breaks and increase minutes of physical activity throughout the day may reduce sleep complaints reported in cancer survivors.

Screen time, sleep duration, leisure physical activity, obesity, and cardiometabolic risk in children and adolescents: a cross-lagged 2-year study

BACKGROUND

Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up.

METHODS

This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z_BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented.

RESULTS

ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z_BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z_BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016.

CONCLUSION

Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z_BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents.

Physical activity intensity and older adolescents' stress: The 'STress-Reactivity after Exercise in Senior Secondary EDucation' (STRESSED) 3-arm randomised controlled trial

OBJECTIVES

Late adolescence (15-19 years) is a period of heightened susceptibility to stress, but regular physical activity may attenuate reactivity to stressors. We aimed to explore the effects of physical activity intensity on older adolescents' stress-reactivity and self-reported mental health.

DESIGN

and methods. Three-arm randomised controlled trial in New South Wales, Australia (April-June, 2021). Thirty-seven older adolescents (16.1±0.2 years, 59.5% female) were randomised to: i) non active control (CON), ii) light-intensity physical activity (LPA), or iii) moderate-to-vigorous-intensity physical activity (MVPA). Physical activity groups participated in 2 x 20-min sessions/week for 6 weeks. Salivary cortisol (sCort) reactivity to induced stress was assessed using the Trier Social Stress Test for Groups and quantified as area under the curve (sCortAUC; Primary outcome). Secondary outcomes included peak cortisol (sCortPeak), subjective-reactivity, perceived stress, and non-specific psychological distress. Group differences were assessed using multiple linear regression and quantified using Cohen's d.

RESULTS

No effects were observed for sCortAUC or sCortPeak and the pattern of effects for subjective-reactivity was inconsistent. Effects for self-reported mental health were also non-significant (p > .05 for all) but of meaningful magnitude, favouring LPA and MVPA over CON (d's = -0.38 to -0.54). Delivery fidelity was high, satisfaction was moderate-to-high, and there was no evidence of harm. However, recruitment, retention for sCort measures, and adherence were lower than expected.

CONCLUSION

Suboptimal recruitment, retention, and adherence limited our ability to conclude on the effect of physical activity intensity on older adolescents' sCort-reactivity to induced stress. We observed potentially meaningful effects on self-reported mental health irrespective of intensity, which could be confirmed in a future powered trial.

Metabolic and behavioural risk factors for cardiovascular diseases in Southern Latin America: analysis of the Global Burden of Disease 1990-2019

OBJECTIVES

Cardiovascular diseases (CVDs) are the leading causes of global mortality. Modifiable behavioural and metabolic risk factors significantly contribute to the burden of CVD. Given the vast socio-demographic and health outcome heterogeneity in Latin America, similar southern Latin American countries (Argentina, Chile, and Uruguay) were analysed as a distinct group to describe the CVD death rates related to metabolic and behavioural risk factors.

STUDY DESIGN

An ecological study was performed using data from the Global Burden of Disease Study 2019.

METHODS

Metabolic and behavioural risk factors-related CVD death were examined by analysing age-standardised rates per 100,000 individuals in the three countries between 1990 and 2019.

RESULTS

While exposure to behavioural risk is decreasing, an upwards trend was observed in metabolic risks. Among the assessed risk factors, metabolic factors emerged as the primary contributors to deaths. High fasting plasma glucose exhibited a remarkable increase in relative importance across most studied contexts. Dietary risks stood out among behavioural factors due to their complexity and substantial changes observed. Although mortality rates have declined for overall CVD, peripheral artery disease mortality is rising.

CONCLUSION

Modifiable behavioural and metabolic risk factors significantly influence CVD mortality in Southern Latin America. Despite the increasing exposure to metabolic risks, advancements in prevention and treatment are evidenced in the decline of mortality rates for most CVD. These findings emphasise the need for targeted interventions and comprehensive strategies to address their impact on cardiovascular health, advocating for healthy lifestyle behaviours to mitigate the progression and CVD development.

Trauma-Informed Practice in Physical Activity Programs for Young People: A Systematic Review

Physical activity, sport, and physical education share many similar qualities with trauma-informed practice, including promoting relationships, inclusion, and physical and mental well-being. There is growing research and programs that incorporate trauma-informed practices into physical activity programs for young people. The aim of this systematic review was to explore current evidence-based, Trauma-Informed Physical Activity programs for young people. Four databases were searched using the Preferred Reporting Items of Systematic Review and Meta-Analyses guidelines for systematic reviews. The search identified 19 studies that highlighted most Trauma-Informed Physical Activity programs reviewed resulted in positive social, emotional, behavioral, and academic outcomes for children and adolescents. However, further research and randomized control trials are required to understand the longitudinal outcomes of Trauma-Informed Physical Activity programs for children and adolescents. Program facilitators reported on the benefits of support and professional development opportunities for trauma awareness to administer Trauma-Informed Physical Activity programs with children and young people. Implications from this study emphasize the importance of the continued design, delivery, and research of Trauma-Informed Physical Activity programs for young people exposed to trauma.

Concurrent validity of the Global Physical Activity Questionnaire to accelerometry in Hispanic/Latino adults: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVES

The validity of the Global Physical Activity Questionnaire has not been thoroughly evaluated among Hispanics/Latinos. In this cross-sectional study, we assessed the concurrent validity and correlates of discordance of the Global Physical Activity Questionnaire by comparing it to accelerometry in estimating sedentary behavior, moderate-to-vigorous physical activity, and meeting United States physical activity guidelines by sociodemographic, behavioral, and health characteristics.

DESIGN

The Hispanic Community Health Study/Study of Latinos is a 4-site cohort study of United States adults aged 18-74 years enrolled from 2008 to 2011.

METHODS

Participants (n = 11,873) completed the Global Physical Activity Questionnaire and wore an accelerometer for 1 week. Lin's concordance and Pearson correlations assessed concurrent validity between self-reported and accelerometry-assessed measures of sedentary behavior and moderate-to-vigorous physical activity. Kappa coefficients assessed agreement of meeting physical activity guidelines. Linear and logistic regression models identified correlates of discordance.

RESULTS

The overall Lin's concordance and Pearson correlations between the Global Physical Activity Questionnaire and accelerometry estimates were 0.10 (95 % confidence interval 0.09, 0.12) and 0.24 (0.21, 0.27) for sedentary behavior, and 0.04 (0.03, 0.05) and 0.18 (0.15, 0.22) for moderate-to-vigorous physical activity, respectively. Agreement was poor for meeting the physical activity guideline classifications (Kappa coefficients: 0.12 to 0.26). Over a 16-hour day, sedentary behavior was under-reported by 3.8 h and moderate-to-vigorous physical activity was over-reported by 1.9 h.

CONCLUSIONS

The concurrent validity of the Global Physical Activity Questionnaire in measuring moderate-to-vigorous physical activity and sedentary behavior when compared to accelerometry was poor among Hispanic/Latino adults.

Household and housing determinants of sleep duration during the COVID-19 pandemic: Results from the COHESION Study

BACKGROUND

Public health measures in response to the COVID-19 pandemic forced individuals to spend more time at home. We sought to investigate the relationship between housing characteristics and sleep duration in the context of COVID-19.

METHODS

Our exploratory study was part of the COvid-19: Health and Social Inequities across Neighborhoods (COHESION) Study Phase-1, a pan-Canadian population-based cohort involving nearly 1300 participants, launched in May 2020. Sociodemographic, household and housing characteristics (dwelling type, dissatisfaction, access to outdoor space, family composition, etc.), and self-reported sleep were prospectively collected through COHESION Study follow-ups. We explored the associations between housing and household characteristics and sleep duration using linear regressions, as well as testing for effect modification by income satisfaction and gender.

RESULTS

Our study sample involved 624 COHESION Study participants aged 50 ± 16years (mean±SD), mainly women (78%), White (86%), and university graduates (64%). The average sleep duration was 7.8 (1.4) hours. Sleep duration was shorter according to the number of children in the household, income dissatisfaction, and type of dwelling in multivariable models. Sleep was short in those without access to a private outdoor space, or only having a balcony/terrace. In stratified analyses, sleep duration was associated with housing conditions dissatisfaction only in those dissatisfied with their income.

CONCLUSION

Our exploratory study highlights the relationship between housing quality and access to outdoor space, family composition and sleep duration in the context of COVID-19. Our findings also highlight the importance of housing characteristics as sources of observed differences in sleep duration.

Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team

PURPOSE

The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D).

MATERIALS AND METHODS

An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation.

RESULTS

EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings.

CONCLUSIONS

RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Breast cancer survivors' exercise preferences change during an exercise intervention are associated with post-intervention physical activity

PURPOSE

Exercise program preferences are important for designing physical activity (PA) interventions; yet may change following an intervention. Further, the relationship between preferences and PA behavior change is unclear. This study evaluated exercise program preferences among breast cancer survivors (BCS) before and after a behavioral intervention and associations between program preferences and PA change.

METHODS

BCS were randomized to the BEAT Cancer intervention (n = 110) or written materials (n = 112). Questionnaires assessed exercise program preferences. Minutes per week of moderate-to-vigorous PA (MVPA) were accelerometer-measured and self-reported at baseline (M0), post-intervention (M3), and 3-month follow-up (M6).

RESULTS

At M0, the majority of intervention group participants preferred exercising with others (62%) yet shifted to preferring exercising alone (59%) at M3 (p < 0.001). Furthermore, preferring exercising with others at M0 was associated with greater increases in self-reported MVPA between M0 and M6 (124.2 ± 152 vs. 53.1 ± 113.8, p = 0.014). BCS preferring facility-based exercise decreased after the BEAT Cancer intervention (14% vs. 7%, p = 0.039) and preferring exercising at home/had no preference at M0 had greater improvements in accelerometer-measured MVPA from M0 to M3 (74.3 ± 118.8 vs. -2.3 ± 78.4, p = 0.033) and M0 to M6 (44.9 ± 112.8 vs. 9.3 ± 30.4, p = 0.021). Exercise program preferences regarding mode of counseling, training supervision, and type of exercise changed from M0 to M3 but were not associated with changes in MVPA.

CONCLUSION

Findings suggest BCS exercise program preferences may change after an intervention and be associated with changes in MVPA. Understanding the role of PA preferences will better inform the design and success of PA behavior change interventions. ClinicTrials.gov, ClinicalTrials.gov number: NCT00929617.

Increasing participation in resistance training using outdoor gyms: A study protocol for the ecofit type III hybrid effectiveness implementation trial

Background

In this paper we outline the protocol for an implementation-effectiveness trial of ecofit, a multi-component mHealth intervention aimed at increasing participation in resistance and aerobic physical activity using the outdoor built environment (i.e., outdoor gyms) and social support. We have previously demonstrated the efficacy and effectiveness of the ecofit program in insufficiently active people with (or at risk of) type 2 diabetes and community-dwelling adults, respectively. The objective of this trial is to compare the effects of two implementation support models (i.e., 'Low' versus 'Moderate') on the reach (primary outcome), uptake, dose received, impact and fidelity of the ecofit program.

Research design and methods

This hybrid type III implementation-effectiveness study will be evaluated using a two-arm randomized controlled trial, including 16 outdoor gym locations in two large regional municipalities in New South Wales, Australia. Outdoor gym locations will be pair-matched, based on an established socio-economic status consensus-based index (high versus low), and randomized to the 'Low' (i.e., ecofit app only) or 'Moderate' (i.e., ecofit app, face-to-face workout sessions and QR codes) implementation support group. The primary outcome of 'reach' will be measured using a modified version of the 'System for Observing Play and Recreation in Communities', capturing outdoor gym use amongst community members.

Conclusion

This implementation-effectiveness trial will evaluate the effects of different levels of implementation support on participation in resistance-focused physical activity using mHealth and outdoor gyms across the broader community. This may guide widespread dissemination for councils (municipalities) nation-wide wanting to promote outdoor gym usage.

Trial registry

This trial was preregistered with the Australian and New Zealand Clinical Trial Registry (ACTRN12624000261516).

Enhancing physical and cognitive function in older adults through walking & resistance exercise: Korean national aging project randomized controlled study

Background

The rapid aging of Korea's population underscores the urgent need for effective programs to enhance the well-being and longevity of the elderly. This study presents preliminary results from the Korean project, examining the impact of cost-effective and accessible exercise programs on functional performance of older people and to determine the long-term maintenance of intervention.

Methods

We randomized 90 older adults aged ≥65 years to the walking group (WG), resistance + walking (RWG), or active control (CG) group. We designed a 12-week main intervention (supervised resistance training 2 d/week and individual walking exercise) and a 12-week follow-up through self-directed exercise (same protocol but unsupervised). The participants' mini mental state examination, color-word Stroop test and 5-time sit to stand, timed up & go, handgrip strength, and knee extensor strength tests were assessed at pre, post, as well as follow-up.

Results

For the RWG group, significant improvements were found in timed up & go (P < 0.001), and 5-time sit to stand (P < 0.001) compared to CG, with benefits maintained at follow-up. Both RWG and WG showed significant enhancements in knee extensor power (RWG: P < 0.0001; WG: P < 0.001) and flexor power (RWG: P < 0.01; WG: P = 0.018) compared to CG. Although cognitive performance did not show significant group-by-time interactions, RWG exhibited improvements in the Stroop Color and Color-Word tests at follow-up compared to baseline.

Conclusion

A resistance training program combined with walking effectively enhanced functional performance in older adults, providing lasting benefits over 12 weeks on physical functions, such as strength and endurance. However, it showed limited benefits on cognitive performance.

Moderate physical activity and higher frequency are inversely associated with incidence of frailty in middle-aged and older population: a 4-year longitudinal study in Europe

BACKGROUND

Global aging is leading to an increase in frailty patients, and physical activity (PA) may have an impact on frail in middle-aged and older population. This study aimed to explore the relationship between the frequency of different PA intensities and the incidence and prevalence of frailty in middle-aged and older adults based on the Survey of Health, Ageing, and Retirement in Europe (SHARE).

METHOD

Self-reported questionnaires were used to obtain information on demographics and PA, and frailty was assessed using the SHARE Frailty Instrument (SHARE-FI). Cox regression and logistic regression models were used to explore the association between PA and frailty and stratified according to middle or old age.

RESULTS

Among 6315 baseline non-frail participants aged 44-96 years, 16.1% developed frailty over 4 years, with higher incidence and prevalence in women (P < 0.05). Women accounting for 55.80% of the sample. The frequency of participants participating in sports decreased over 4 years (P < 0.05). Compared with participants who engaged in PA more than once a week, participants who engaged in moderated PA less frequently had a higher risk of new-onset frailty (HR: 3.174-6.115), and participants who engaged in vigorous PA 1-3 times a month had a higher risk of new-onset frailty (HR: 1.335). Participation in low-frequency moderate PA and vigorous PA 1-3 times per month were positively associated with the prevalence of frailty (P < 0.05).

CONCLUSION

Physical activity frequency decreases with age in middle-aged and older adults. Those adults who engage in moderate PA more than once a week have a lower risk of incidence of frailty, compared to those with more sedentary life-styles. Additionally, women need to pay more attention to frailty management.

Impact of the child's birth weight on maternal misperceptions of young children's weight: A retrospective study with nationally representative data

AIM

A young child's abnormal birth weight (BW) can affect a mother's misperceptions of her child's weight, potentially hindering the child's health management. Therefore, this study investigated the impact of children's BW on maternal misperceptions of children's weight during early childhood.

METHODS

A retrospective study was conducted for 485,095 children who were 54-60 months of age, born between 2011 and 2013, and participated in South Korea's Sixth National Health Screening Program for Infants and Children (NHSPIC). Data on BW, weight, sex, birth year, preterm birth, breastfeeding history, maternal age, mothers' perceptions of the child's weight, and socioeconomic status were collected and incorporated in the final analysis via data linkage between the NHSPIC and Korean healthcare claims information. Multiple logistic regression analysis was applied to identity the impact of BW on mothers' misperceptions of children's weight, after adjustment for all variables.

RESULTS

Low BW (LBW) children had the lowest proportion (57.1%) of mothers who accurately identified their child's weight compared to normal or high BW. LBW was an independent factor affected maternal misperception of the child's weight (underestimation: adjusted odds ratio [aOR]: 1.46, 95% confidence interval [CI]: 1.41-1.52; overestimation: aOR: 0.84, 95% CI: 0.73-0.97). Overweight or underweight status, male gender, preterm birth, a younger mother, and low socioeconomic status were also associated with both underestimation and overestimation.

CONCLUSION

LBW emerged as an important risk factor for maternal misperception of a child's weight. Therefore, pediatric nurses need to apply interventions to improve perceptions of children's weight among mothers of young LBW children.

Feasibility and preliminary efficacy of an online nutrition education intervention for those with a sleeve gastrectomy: A pilot randomised control trial

BACKGROUND

A sleeve gastrectomy (SG) is a lifelong treatment that improves health and better outcomes are associated with follow-up. However, there is lack of access or high attrition to aftercare. This potentially contributes to sub-optimal dietary intake and a lack of evidence for nutrition interventions. The present study assessed the feasibility and preliminary efficacy of a nutrition intervention to improve diet quality in Australian adults living with a SG.

METHODS

Adults (n = 96) post-SG were recruited into a cross-sectional diet quality study, with 68 eligible for randomisation to an intervention or wait-list control group. Over 10 weeks, a Facebook group was used to post daily nutrition education. Feasibility outcomes included participant recruitment, engagement, retention and acceptability. Preliminary efficacy was assessed using change in Australian Recommended Food Score (ARFS). Linear mixed models were used to measure differences in mean outcome between the experimental groups over time.

RESULTS

Sixty-eight participants (97% female) aged 48.2 ± 9.8 years, body mass index 33.1 ± 5.8 kg/m2, and mean ± SD ARFS 39 ± 9 points were randomised to the intervention, with 66% retention at 10 weeks. At follow-up, diet quality increased for the intervention group (mean ARFS, 95% confidence interval = 0.2 [-1.5 to 1.9]) and decreased for the control group (mean ARFS, 95% confidence interval= -2.0 [-5.2 to 1.2]) with no between group difference (p = 0.2). Participants (n = 30) rated the intervention positively.

CONCLUSIONS

Recruiting and retaining adults post-SG into a nutrition intervention is feasible. Low-cost recruitment attracted strong interest from women to identify greater support to know what to eat following SG. A future fully powered trial to assess intervention efficacy is warranted.

The views and experiences of people with myeloma referred for autologous stem cell transplantation, who declined to participate in a physiotherapist-led exercise trial: a qualitative study

BACKGROUND

Recruitment rates to rehabilitation trials are variable among cancer survivors, and deeper investigation into the causes for declining participation is needed. The aim of this study was to qualitatively explore the experiences of people with myeloma referred for autologous stem cell transplant who were approached to take part in a physiotherapist-led exercise trial but declined.

METHODS

Participants were asked to participate in this qualitative study after declining to participate in a trial conducted at a UK tertiary cancer center. Semi-structured interviews were conducted. Data was analyzed inductively using reflexive thematic analysis.

RESULTS

Interviews from 18 myeloma patients (56% male, mean age 62 years) were analyzed. Four themes were identified: 1) Traveling to the specialist center is challenging, not just logistically; 2) Individualized approach valued but recall of research information variable; 3) Being less active has profound impact yet ameliorative support is lacking; and 4) Common side-effects of treatment are expected and endured but personal impact underestimated and unaddressed.

CONCLUSION

A number of barriers to participation were identified. Travel, a commonly cited reason for declining research participation, is more than a logistical issue for cancer survivors experiencing side-effects and the time burden of clinical appointments. Expectation or knowledge of the typical side-effects from myeloma and its treatment may lead to under-reporting of concerns to care providers, despite their impact upon daily activities and quality of life. Approaches used for research recruitment should consider the timing and consequences of ongoing cancer treatment to reduce potential barriers to participation.

Associations of neighborhood social cohesion and changes in BMI-The Maastricht Study

The role of the social environment can facilitate positive health outcomes through active community engagement, normalization of healthy behaviors, and stress buffering. We aim to examine the associations of neighborhood social cohesion with changes in BMI over time. A total of 7641 participants from The Maastricht Study between the ages of 40 and 75 years were analyzed. Weight and height were measured at baseline, and weight was self-reported annually up to 10 years of follow-up (median = 4.7 years). Perceived social cohesion was obtained by questionnaire. Home addresses for each participant were linked to geographic information system data from the Geoscience and Health Cohort Consortium to create neighborhood exposure variables including area level social cohesion, neighborhood walkability, and food environment within a 1000 m Euclidian buffer. Linear regression analyses were performed with BMI adjusted for socioeconomic variables. A mixed model analysis was carried out to examine changes in BMI. Living in the highest quartile area of individually perceived social cohesion was associated with lower BMI (Q4 B: -.53; 95% CI = -.79, -.28) compared to the lowest quartile. Similar findings were discovered using the area level measure (Q4 B: -.97; 95% CI = -1.29, -.65). There was no longitudinal association between social cohesion and BMI. Neighborhood social cohesion was associated with lower BMI classifying it as an obesogenic area characteristic that influences weight, independent of conventional built environment features.

Does sedentary time and physical activity predict chronic back pain and morphological brain changes? A UK biobank cohort study in 33,402 participants

BACKGROUND

The relationship between sedentary time, physical activity, and chronic back pain remains unclear. The study aims to investigate whether sedentary time and physical activity predict chronic back pain and morphological brain changes.

METHODS

This cohort study recruited adults aged 37-73 years enrolled between 2006 and 2010, with follow-up until 2014. The total cohort comprised 33,402 participants (mean age: 54.53). Data were collected on daily sedentary time, physical activity, lifestyle factors, and health outcomes.

RESULTS

After nearly 8-year follow-up, 3,006 individuals (9.00%) reported chronic back pain in total. Individuals with daily sedentary time exceeding 6 h had a 33% higher risk of chronic back pain compared to those with sedentary time of 2 h or less (RR, 1.33, 95%CI, 1.17-1.52). Sedentary time was also associated with decreased grey matter volume in several brain regions, including bilateral primary somatosensory cortex (S1), secondary somatosensory cortex, putamen, primary motor cortex (M1), insula, hippocampus, amygdala, as well as right supplementary motor area, left medial frontal cortex, and right anterior cingulate cortex (FDR-corrected p-value < 0.05). Compared to individuals who sat for more than 6 h with light physical activity, those engaging in moderate physical activity with sedentary time of 2 h or less (RR, 0.71, 95%CI, 0.52-0.99) exhibited a significant decrease in chronic back pain risk. In addition, replacing sedentary time with equivalent amount of physical activity also demonstrated a reduction in the risk of chronic back pain (RR, 0.87, 95%CI, 0.77-0.99) and increased the reginal grey matter volumes including the amygdala, insula, M1, putamen and S1.

CONCLUSIONS

Prolonged sedentary time is associated with heightened risks of chronic back pain and deterioration in brain health.

Co-occurrence of unhealthy lifestyle behaviours in middle-aged adults: findings from the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Middle-aged adults engaging in unhealthy lifestyle behaviors are at higher risk of chronic diseases. However, little is known about the co-occurrence of these behaviors and their determinants. This cohort study examined the co-occurrence of unhealthy lifestyle behaviors (alcohol consumption, diet, physical inactivity, and smoking) in 30,154 middle-aged adults and their associations with sociodemographic factors, social support, and disease history. Alcohol use was measured by the AUDIT, diet by the MiniMeal-Q, and physical inactivity and smoking by single questions. Participants had a mean age of 58 years, with 51% being female. Of them, 14% had no unhealthy behaviors, 38% had one, 36% had two, 10% had three, and 2% had all four. The most common co-occurrence was between physical inactivity and poor diet (38%). Higher education decreased the likelihood of having three or four unhealthy behaviors, while financial difficulties, having no one around who appreciated one's efforts, and suffering of a lung disease increased it. In conclusion, middle-aged adults exhibit varying levels of unhealthy lifestyle behaviors. Higher education is linked to reduced engagement in multiple unhealthy behaviors, whereas financial strain, lower quality of social support, and lung disease increase the risk.

Household income is associated with attack frequency, but not with the prevalence of headache: an analysis of self-reported headache in the general population in Germany

BACKGROUND

Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample.

METHODS

Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month).

RESULTS

Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms.

CONCLUSIONS

To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate.

The association between breakfast frequency and diabetes incidence in middle-aged women: Results from the MTC study

BACKGROUND AND AIMS

Breakfast consumption could have a synchronizer role in chronobiological functions. Across observational studies, the assessment of breakfast frequency consumption is heterogeneous, therefore consensus on the relation between of weekly frequency of breakfast consumption and the risk of diabetes is unclear. We examined the relation between weekly breakfast frequency consumption and the incidence of diabetes in middle-age women.

METHODS AND RESULTS

Since baseline (2006-2008) we prospectively followed 71,373 women from the Mexican Teachers' Cohort. Participants were classified according to breakfast consumption frequency of 0, 1-3, 4-6, or 7 days/week. Diabetes was identified by self-report and clinical-administrative databases. We used Cox proportional hazards multivariable models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for breakfast frequency and diabetes adjusting for covariates. Stratified analyses were performed for age, birth weight, ethnicity, and physical activity. We identified 3613 new diabetes cases between baseline and 2014. The prevalence of daily breakfast consumers was 25%. The median follow-up was 2.2 years, interquartile range 1.8-3.8 years. Relative to women who skipped breakfast, those who consumed breakfast every day had a 12% lower risk of diabetes (multivariable HR = 0.88; 95% CI 0.78, 0.99; p-trend = 0.0018). One additional day per week of breakfast was associated with a lower risk of diabetes (HR = 0.98; 95% CI 0.97, 0.99). In stratified analysis, the observed inverse relation appeared to be stronger in women aged ≥40 years and in indigenous women.

CONCLUSIONS

Breakfast frequency was inversely associated with the incidence of diabetes independently of lifestyle factors. Regular breakfast consumption may be a potential component of diabetes prevention.

Lifestyle Medicine in Medical Education: Maximizing Impact

The relationship between lifestyle behaviors and common chronic conditions is well established. Lifestyle medicine (LM) interventions to modify health behaviors can dramatically improve the health of individuals and populations. There is an urgent need to meaningfully integrate LM into medical curricula horizontally across the medical domains and vertically in each year of school and training. Including LM content in medical and health professional curricula and training programs has been challenging. Barriers to LM integration include lack of awareness and prioritization of LM, limited time in the curricula, and too few LM-trained faculty to teach and role model the practice of LM. This limits the ability of health care professionals to provide effective LM and precludes the wide-reaching benefits of LM from being fully realized. Early innovators developed novel tools and resources aligned with current evidence for introducing LM into didactic and experiential learning. This review aimed to examine the educational efforts in each LM pillar for undergraduate and graduate medical education. A PubMed-based literature review was undertaken using the following search terms: lifestyle medicine, education, medical school, residency, and healthcare professionals. We map the LM competencies to the core competency domains of the Accreditation Council for Graduate Medical Education. We highlight opportunities to train faculty, residents, and students. Moreover, we identify available evidence-based resources. This article serves as a "call to action" to incorporate LM across the spectrum of medical education curricula and training.

Results from Chile's 2022 report card on physical activity for children and adolescents

Purpose

To summarize the results of Chile's 2022 Report Card (RC) on physical activity (PA) for Children and Adolescents.

Methods

Chile's 2022 RC included ten core PA indicators common to the Global Matrix 4.0. Evidence from scientific articles, reports, and databases published between 2018 and January 2022 was included for each indicator. The data were collected and analyzed by a national scientific committee, which assigned letter grades (A to F) using a consensus based on benchmarks defined and revised by the Active Healthy Kids Global Alliance.

Results

The committee assigned the following grades: Overall PA, D-; Organized Sports and Physical Activity Participation, C-; Active Play, Incomplete; Active Transportation, D; Sedentary Behavior, D-; Physical Fitness, Incomplete; Family and Peers, D; School, C; Community and Environment, D+; Government, A-.

Conclusions

Chile's 2022 RC, like its previous versions, shows persistently low grades for most indicators. Overall PA remained nearly unchanged, while Community and Environment scored lower. Slight improvements were seen in Organized Sports, Family and Peers, and School Environment. While Chile has endeavored to increase children's activity levels, policies require implementation through a systemic, coherent framework to promote sustainable changes and reach a larger portion of children and youth.

Evaluating the impact of individuals' morningness-eveningness on the effectiveness of a habit-formation intervention for a simple and a complex behavior

Planning-based interventions are often used to help individuals form habits. Existing literature suggests a one-size-fits all approach to habit formation, but planning interventions may be optimized if tailored to individual differences and/or behavioral complexity. We test the hypothesis that planning to do a relatively complex behaviour (exercise) at a time that matches an individuals' diurnal preference will facilitate behavioral engagement; whereas for a simpler behaviour (calcium supplementation), the optimal time-of-day for a new behavior will occur in the morning. Young, women volunteers (N = 317) were randomly assigned to take calcium supplements or to exercise for 4 weeks and to control (no planning) or to one of three planning interventions (morning plan; evening plan; unassigned-time plan). Participants reported diurnal preference at baseline and habit strength and behavioral frequency weekly. Fitbit Zips and Medication Event Monitoring System Caps (MEMS) were used to objectively assess behavioral engagement. Multilevel modelling found that calcium-supplementation was greatest for morning-types in the morning-cue condition, whereas exercise was greatest for morning-types with morning cues and evening-types with evening cues. Habit-formation strategies may depend on diurnal preference and behavioral complexity. Future research can evaluate the role of other individual differences.

Arriba por la Vida Estudio: a randomized controlled trial promoting standing behavior to reduce sitting time among postmenopausal Latinas

Postmenopausal Hispanic/Latina (N = 254) women with a body mass index (BMI) ≥ 25 kg/m2 were randomized to an intervention to reduce sitting time or a comparison condition for 12 weeks. The standing intervention group received three in-person health-counseling sessions, one home visit, and up to eight motivational interviewing calls. The heart healthy lifestyle comparison group (C) received an equal number of contact hours to discuss healthy aging. The primary outcome was 12-week change in sitting time measured via thigh-worn activPAL. Group differences in outcomes were analyzed using linear mixed-effects models. Participants had a mean age of 65 (6.5) years, preferred Spanish language (89%), BMI of 32.4 (4.8) kg/m2, and sat for an average of 540 (86) minutes/day. Significant between-group differences were observed in reductions of sitting time across the 12-week period [Mdifference (SE): C - 7.5 (9.1), SI - 71.0 (9.8), p < 0.01]. Results demonstrate that coaching models to reduce sitting are feasible and effective.

Broad versus narrow bandwidth measures of experienced automaticity for physical activity

Objective: Physical activity is important for health, yet most young adults are insufficiently active. Physical activity is regulated in part, by habit, typically operationalised as automaticity. Little is known about the characteristics of automaticity, or whether broad bandwidth unidimensional measures of automaticity for physical activity are superior to narrower bandwidth multi- dimensional measures. Design: This secondary analysis (N = 238) investigated the nature of automaticity, and relations between the dimensions of automaticity, global automaticity, and physical activity.Main Outcome Measures: The structure of the Generic Multifaceted Automaticity Scale (GMAS) was examined by confirmatory factor analyses. Structural equation models were estimated to evaluate relations between automaticity (measured on the GMAS and the Self- Report Behavioral Automaticity Index, SRBAI) and device- measured activity.Results: The hypothesised 3- factor structure of the GMAS was rejected, in favour of a 2- factor solution. Lack of intention/control and efficiency were associated with global automaticity, but not physical activity. Global automaticity was associated with moderate to vigorous physical activity and daily steps, but not light physical activity.Conclusion: Multi- dimensional measures of automaticity may not provide a more nuanced understanding of automaticity when predicting overall physical activity.

Associations of Reallocating Sedentary Time to Physical Activity and Sleep with Physical and Mental Health of Older Adults

INTRODUCTION

Twenty-four-hour movement behaviors: moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior (SB), and sleep are crucial factors affecting older adults' health. Using a compositional data analysis approach, this study examined the associations of time spent in these four movement behaviors with cardiometabolic health, physical fitness, and mental health among older adults. Furthermore, this study identified the estimated changes in aforementioned health outcomes by reallocating SB time to other movement behaviors.

METHODS

A population-based cross-sectional study of 4562 participants (67.68 ± 5.03 yr; 55.8% female) were implemented in Hubei China between July 25 and November 19, 2020. Measures included demographics, movement behaviors, cardiometabolic indicators (body mass index, waist circumference, waist-hip ratio, percentage body fat, systolic and diastolic blood pressure), physical fitness, and mental health outcomes (depressive symptoms and loneliness). Compositional data analyses were implemented in R.

RESULTS

MVPA and sleep time were associated with greater health outcomes (all P < 0.001), except blood pressure ( P = 0.13-0.83). LPA time was associated with waist circumference ( B = 0.313, P = 0.009), waist-hip ratio ( B = 0.003, P = 0.003), physical fitness ( B = 0.36, P < 0.001), and mental health indicators (both P < 0.001). Reallocating 30-min SB to MVPA and sleep was associated with predicated improvements in all health outcomes, except blood pressure, whereas reallocating 30-min SB to LPA resulted in predicted improvements in physical fitness (0.187 units), depressive symptoms (-0.264 units), and loneliness (-0.395 units). For dose-effect relationships, reallocating 5-60 min of SB to MVPA showed greatest benefits for all health outcomes.

CONCLUSIONS

This study provides timely empirical evidence for future interventions and policymaking on promoting healthy aging during the post-COVID-19 era. The findings underline the importance of including 24-h movement behaviors in future health promotion among older adults.

Timing Matters: A Longitudinal Study Examining the Effects of Physical Activity Intensity and Timing on Adolescents' Mental Health Outcomes

Physical activity is universally acknowledged for its benefits to mental health; however, the specific intensities and timings that best benefit adolescents' mental health, crucial due to their significant influence on daily schedules, have not been thoroughly investigated. This study addresses the substantive research gap by exploring the varied effects of physical activity intensity (light versus moderate to vigorous) and timing (weekdays versus weekends and holidays) on adolescent mental health. Utilizing a large-scale longitudinal dataset (NT1 = 84,054; NT2 = 44,623) from 158 schools, this research describes the current state of adolescent physical activity and investigates the effects of physical activity on mental health outcomes, including positive (i.e., life satisfaction, positive mental health) and negative indicators (depression, anxiety), over a 6-month period. Participants were adolescents aged 9-19 years (mean age = 12.73 ± 2.43 years, 48.9% female), with the analysis adjusted for potential confounding factors. Results showed that as adolescents grow older, their engagement in moderate-to-vigorous physical activity during both weekdays and weekends/holidays tends to decrease, while light physical activity during weekdays increases. Multilevel regression analysis indicated that moderate-to-vigorous physical activity during weekends/holidays at Time 1 positively correlated with better mental health outcomes at Time 2 (six months later), featuring enhanced positive indicators and reduced negative ones. Moderate-to-vigorous physical activity on weekdays at Time 1 was positively linked to mental health at Time 2. Light physical activity during weekends/holidays at Time 1 positively predicted life satisfaction and positive mental health at Time 2. In contrast, light physical activity on weekdays at Time 1 negatively correlated with life satisfaction at Time 2. The study underscores the importance of promoting moderate-to-vigorous physical activity, particularly on weekends and holidays, to improve mental health outcomes among adolescents.

Predictors of parent self-monitoring patterns in a family-based behavioral weight loss treatment program

OBJECTIVE

Self-monitoring dietary intake is a critical component of family-based intensive health behavior and lifestyle treatment for pediatric obesity, but adherence rates are often low. This study identifies predictors of parent self-monitoring rates during treatment.

METHODS

A secondary analysis of parent self-monitoring data from a randomized controlled trial involving 150 parent-child dyads. Patterns of self-monitoring were identified using a latent class mixed model approach. Logistic regression analyses evaluated predictors of self-monitoring patterns.

RESULTS

Latent class models identified two trajectory groups: a high consistent self-monitoring group and a low-decreasing self-monitoring group. When compared to parents in the low group, parents in the high group lost more weight throughout treatment. Children in the high group had a similar trajectory for weight loss; however, the groups were not statistically different. Higher levels of family chaos and poorer family problem-solving skills were associated with higher odds of being in the low group.

CONCLUSION

This study identified two patterns of rates of parent self-monitoring, which were associated with parent weight loss and were differentiated by family chaos and poor problem-solving. These findings suggest that families with high levels of chaos and poor problem-solving could benefit from early intervention to improve outcomes in pediatric obesity treatment programs.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT01197443.

Improving Osteoporosis Prediction Using Vertebral Bone Quality Score and Paravertebral Muscle Measurements From Lumbar MRI Scans

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <-2.5.

SUMMARY OF BACKGROUND DATA

Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements.

METHODS

A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <-2.5.

RESULTS

The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <-2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals.

CONCLUSIONS

The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.

Move more today, sleep better tonight? Daily associations between physical activity and sedentary behavior with sleep among young adults with and without insomnia symptoms

OBJECTIVE

At the between-person level, it is well-documented that individuals with more physical activity (PA) and less sedentary behavior (SB) tend to have better sleep outcomes than their peers. However, the associations at the within-person level remain unclear. This study investigated the daily associations between PA and SB with nighttime sleep among young adults with and without insomnia symptoms.

METHODS

Data was collected through activity trackers and online questionnaires for 7 consecutive days among 147 university students, including time spent on moderate to vigorous physical activity (MVPA), light physical activity (LPA), and SB, along with sleep duration, efficiency, and quality. Participants were classified into two subgroups according to the presence of insomnia symptoms, which were determined by a self-reported insomnia scale. Multilevel compositional data analysis was conducted on the total sample, and separately on subsamples characterized by the presence and absence of insomnia symptoms.

RESULTS

In the total sample and subsample without insomnia symptoms, substitutions among MVPA, LPA, and SB were not associated with changes in sleep outcomes at the daily level. However, in the subsample with insomnia symptoms, days with more MVPA or SB and less LPA were associated with higher sleep efficiency, while days with more LPA at the expense of MVPA or SB were associated with lower sleep efficiency.

CONCLUSIONS

For young adults with insomnia symptoms, replacing LPA with MVPA on a given day may improve their sleep efficiency that night.

Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis

BACKGROUND

Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation.

OBJECTIVE

To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation.

DESIGN

Systematic review and network meta-analysis.

METHODS

We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643).

RESULTS

This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence.

CONCLUSIONS

Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.

A novel approach for predicting usability of upper limb prostheses

Limb amputation can lead to significant functional challenges in daily activities, prompting amputees to use prosthetic devices (PDs). However, the cognitive demands of PDs and usability issues have resulted in user rejections. This study aimed to create a Human Performance Model for Upper-Limb Prosthetic Devices (HPM-UP). The model used formulations of learnability, error rate, memory load, efficiency, and satisfaction to assess usability. The model was validated in an experiment with 30 healthy participants using a bypass prosthetic device. Findings indicated that the HPM-UP successfully predicted the usability of prosthetic devices, aligning with human subject data. This research proposes a quantitative approach to predict upper limb prosthetic device usability by quantifying each dimension and computationally connecting them. The model, available on Github and executable with Rstudio, could enable clinicians to assess and analyze the human performance of various commercial prostheses, aiding in recommending optimal devices for patients.

Eating vegetables at school lunchtimes: Pilot and feasibility studies testing strategies to improve intake

Vegetable provision at schools in the UK has increased over recent years; however children still eat few of the vegetables that are served to them. Two experimental pilot and feasibility studies implemented a vegetables-served-first (study 1) plus experiential learning (study 2) approach to increase children's (3-5 years and 4-7 years respectively) vegetable consumption at school lunchtimes. Both studies involved vegetables-served-first 10-min before the rest of the meal, with experiential learning techniques (repeated exposure, "veg-first" dinner plates, vegetable songs, videos, and nutrition education) complementing the vegetable service in study 2. Study 1 (n = 38) found that vegetables-served-first, compared with serving all foods together, increased vegetable intake by ∼12 g. Study 2 (n = 69) found that vegetable consumption depended on individual schools. Schools where vegetable intake was low showed increases in consumption during intervention weeks, whereas schools with high vegetable intake showed little change. Acceptability of interventions was found to be good for children and schools that participated, although concerns about time to serve vegetables first and COVID-related environmental restrictions reduced feasibility for some schools. Child engagement could also be improved by offering a wider variety of vegetables during repeated exposure to reduce monotony. Future research should design interventions using co-design methods including schools to suit their context best, whilst also addressing the problem with a systems approach. Interventions which focus on child learning through experience need to take account of specific school environments including curricular needs, resources available for school lunch (including both time and space), provision of food, support from teachers and parents, and the culture around eating (e.g. encouragement, pressure to eat, lunchtime competing with playtime). Joined-up systems approaches could enhance both provision and uptake of vegetables at school meals.

Nutrient clustering, NOVA classification, and nutrient profiling: How do they overlap, and what do they predict about food palatability?

We compared the performance of three food categorisation metrics in predicting palatability (taste pleasantness) using a dataset of 52 foods, each rated virtually (online) by 72-224 participants familiar with the foods in question, as described in Appetite 193 (2024) 107124. The metrics were nutrient clustering, NOVA, and nutrient profiling. The first two of these metrics were developed to identify, respectively: 'hyper-palatable' foods (HPFs); and ultra-processed foods (UPFs), which are claimed to be 'made to be hyper-palatable'. The third metric categorises foods as high fat, sugar, salt (HFSS) foods versus non-HFSS foods. There were overlaps, but also significant differences, in categorisation of the foods by the three metrics: of the 52 foods, 35 (67%) were categorised as HPF, and/or UPF, and/or HFSS, and 17 (33%) were categorised as none of these. There was no significant difference in measured palatability between HPFs and non-HPFs, nor between UPFs and non-UPFs (p ≥ 0.412). HFSS foods were significantly more palatable than non-HFSS foods (p = 0.049). None of the metrics significantly predicted food reward (desire to eat). These results do not support the use of hypothetical combinations of food ingredients as proxies for palatability, as done explicitly by the nutrient clustering and NOVA metrics. To discover what aspects of food composition predict palatability requires measuring the palatability of a wide range of foods that differ in composition, as we do here.