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Andrabi M, Key B, Francisco M, Jeremiah M, Mumba M, Radhakrishnan K, Ball K. A quantitative study to assess cardiovascular risks among older African American women living in rural black belt areas of Alabama. Public Health Nurs 2024. [PMID: 38967253 DOI: 10.1111/phn.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/23/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024]
Abstract
Limited information is available regarding the knowledge of Cardiovascular Disease (CVD) risk factors and the actual risk behaviors among African American (AA) older women living in rural areas of Alabama. A pilot study of needs assessment for CVD prevention behaviors was conducted to collect such data from rural AA women. This paper reports the quantitative part of the needs assessment of this pilot study. We recruited participants (N = 30) using convenience sampling. Data collection measures included: i) American Heart Association's CVD-related knowledge questionnaire, ii) Five Times Sit to Stand Test to measure dynamic balance and iii) Six minute walk test (6MWT) to assess exercise endurance iv) standard weighing scale to measure body weight and v) standard measurements scale to measure height. Descriptive and inferential statistics were used to analyze the data. The majority (76%) of participants had hypertension (70%), diabetes (60%), poor balance (70%), and low exercise endurance (100%). Most of the participants had low knowledge related to CVD risk factors. This study demonstrated the need to conduct a large-scale study to assess knowledge related to heart health and the actual needs and preferences of these individuals. Conducting such a study would lay the foundation for developing a need-based program for these underserved individuals while incorporating their preferences and the strategies that would help engage them in a heart health intervention.
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Affiliation(s)
- Mudasir Andrabi
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, United States
| | - Betty Key
- Idda Moffet School of Nursing, The Samford University, Birmingham, Alabama, USA
| | - Marqus Francisco
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, United States
| | - Matthews Jeremiah
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, United States
| | - Mercy Mumba
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, United States
| | | | - Karlene Ball
- Departmen of Psychology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ji Y, Atakan MM, Yan X, Wu J, Kuang J, Peng L. Reallocating just 10 min to moderate-to-vigorous physical activity from other components of 24-hour movement behaviors improves cardiovascular health in adults. BMC Public Health 2024; 24:1768. [PMID: 38961409 PMCID: PMC11221122 DOI: 10.1186/s12889-024-19255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND As components of a 24-hour day, sedentary behavior (SB), physical activity (PA), and sleep are all independently linked to cardiovascular health (CVH). However, insufficient understanding of components' mutual exclusion limits the exploration of the associations between all movement behaviors and health outcomes. The aim of this study was to employ compositional data analysis (CoDA) approach to investigate the associations between 24-hour movement behaviors and overall CVH. METHODS Data from 581 participants, including 230 women, were collected from the 2005-2006 wave of the US National Health and Nutrition Examination Survey (NHANES). This dataset included information on the duration of SB and PA, derived from ActiGraph accelerometers, as well as self-reported sleep duration. The assessment of CVH was conducted in accordance with the criteria outlined in Life's Simple 7, encompassing the evaluation of both health behaviors and health factors. Compositional linear regression was utilized to examine the cross-sectional associations of 24-hour movement behaviors and each component with CVH score. Furthermore, the study predicted the potential differences in CVH score that would occur by reallocating 10 to 60 min among different movement behaviors. RESULTS A significant association was observed between 24-hour movement behaviors and overall CVH (p < 0.001) after adjusting for potential confounders. Substituting moderate-to-vigorous physical activity (MVPA) for other components was strongly associated with favorable differences in CVH score (p < 0.05), whether in one-for-one reallocations or one-for-remaining reallocations. Allocating time away from MVPA consistently resulted in larger negative differences in CVH score (p < 0.05). For instance, replacing 10 min of light physical activity (LPA) with MVPA was related to an increase of 0.21 in CVH score (95% confidence interval (95% CI) 0.11 to 0.31). Conversely, when the same duration of MVPA was replaced with LPA, CVH score decreased by 0.67 (95% CI -0.99 to -0.35). No such significance was discovered for all duration reallocations involving only LPA, SB, and sleep (p > 0.05). CONCLUSIONS MVPA seems to be as a pivotal determinant for enhancing CVH among general adult population, relative to other movement behaviors. Consequently, optimization of MVPA duration is an essential element in promoting overall health and well-being.
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Affiliation(s)
- Yemeng Ji
- Physical Education College, Southwest University, Chongqing, 400715, China
| | - Muhammed M Atakan
- Division of Nutrition and Metabolism in Exercise, Faculty of Sport Sciences, Hacettepe University, Ankara, 06800, Turkey
| | - Xu Yan
- Institute for Health and Sport, Victoria University, Melbourne, 14428, Australia
| | - Jinlong Wu
- Physical Education College, Southwest University, Chongqing, 400715, China
| | - Jujiao Kuang
- Institute for Health and Sport, Victoria University, Melbourne, 14428, Australia
| | - Li Peng
- Physical Education College, Southwest University, Chongqing, 400715, China.
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Lu Y, Li Q, Wang W, Du L, He Q, Chen S, Zhang X, Pan Y. Associations between accelerometer-measured physical activity and sedentary behaviour with physical function among older women: a cross-sectional study. BMC Public Health 2024; 24:1754. [PMID: 38956531 PMCID: PMC11218370 DOI: 10.1186/s12889-024-19270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND This study aimed to investigate the relationships between accelerometer-measured physical activity (PA) and sedentary behaviour (SB) with physical function (PF) among older Chinese women in the community. METHODS The present study comprised 1,113 community-dwelling older females, with an average age of 65 ± 2 years. We employed a linear regression analysis to investigate the relationship between patterns of PA and SB with PF. PA variables consisted of total PA time, bouted PA time (a continuous PA that lasts equal to or more than 10 min), and sporadic PA time (a continuous PA that lasts less than 10 min). SB variables included total SB time, 30-min bout of SB (a continuous SB that lasts equal to or more than 30 min), and 60-min bout of SB (a continuous SB that lasts equal to or more than 60 min). PF variables comprised handgrip strength (HGS), one-legged stance test with eyes closed (OLSTEC), usual walking speed (UWS), maximum walking speed (MWS) and chair-stand time (CT). To explore the joint effects of moderate-to-vigorous-intensity PA (MVPA) and SB on PF, we divided the duration of SB and MVPA participation in older women into different combinations: low MVPA & high SB, low MVPA & low SB, high MVPA & high SB, high MVPA & low SB. RESULTS The study revealed a significant association between 30-min bout of SB and CT, which remained after adjusting for total MVPA time (P = 0.021). Both total MVPA and bouted MVPA were found to be positively associated with better UWS, MWS, CT, and PF Z-score. When the combination of low MVPA & high SB was used as a reference, the regression coefficients for PF ascended by 1.32 (P < 0.001) in the high MVPA & high SB group and by 1.13 (P < 0.001) in the high MVPA & low SB group. CONCLUSIONS A significant association was observed between poorer lower limb function and prolonged, uninterrupted SB in older women, rather than with the total SB time. Concurrently, the insufficient engagement in MVPA may also be a crucial factor contributing to poorer PF in older women. Engaging in longer durations and higher intensity of PA, such as bouts of MVPA lasting a minimum of 10 min or longer, may contribute to better PF.
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Affiliation(s)
- Yanyu Lu
- School of Physical Education, Shandong University, Jinan, China
| | | | - Wenbo Wang
- Zaozhuang Vocational College of Science and Technology, Zaozhuang, China
| | - Litao Du
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Yang Pan
- School of Physical Education, Shandong University, Jinan, China.
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Yang QH, Zhang YH, Lok Wong AY, Xu HR, Bi X, Ching YL, Du SH, Wang YC, Wang XQ. Associations between Physical Activity and the Incidence of Cerebrovascular Disease or All-Cause Mortality among 146,742 Older Adults: A 13-Year Prospective Cohort Study. J Am Med Dir Assoc 2024; 25:105010. [PMID: 38702045 DOI: 10.1016/j.jamda.2024.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Although studies have indicated that physical activity (PA) is related to cardiovascular disease, the specific association between PA and incident cerebrovascular disease (CBVD) remains uncertain. The current study aimed to investigate the associations between PA levels and the CBVD incidence or all-cause mortality. DESIGN Prospective cohort study. SETTINGS AND PARTICIPANTS Older participants (aged >60 years) from the UK Biobank. METHODS The baseline PA was classified as total, light, moderate, and vigorous PA based on the metabolic equivalent-minutes per week (MET-min/wk) and considered as exposures, whereas CBVD incidence and all-cause mortality were considered as the outcomes. Cox proportional hazards were used to calculate the hazard ratios (HRs) and 95% CIs for the influence of the association between PA and CBVD incidence and all-cause mortality. RESULTS A total of 146,742 participants aged 60 years and older were included. During a median follow-up period of 13.5 years (interquartile range of 12.8-14.2), 9338 older individuals developed CBVD and 3033 death were recorded (including 767 CBVD-related deaths). High volumes of PA were consistently associated with lower risks of CBVD and all-cause mortality. The lowest risk of CBVD incidence was observed at 2001-2500 MET-min/wk of total PA (HR 0.61, 95% CI 0.53-0.70), and the lowest risk of all-cause mortality was observed at 2501-5000 MET-min/wk (HR 0.52, 95% CI 0.43-0.63) in older adults. Total PA at 2001-2500 MET-min/wk significantly reduced the CBVD incidence in older women (HR 0.57, 95% CI 0.46-0.71), which was more pronounced than that in older men (HR for 2001-2500 MET-min/wk: 0.64, 95% CI 0.50-0.77). CONCLUSIONS AND IMPLICATIONS Total PA at 2001-2500 MET-min/wk significantly reduced the risk of incident CBVD and all-cause mortality in adults aged >60 years, although the extents of risk reduction vary in men and women.
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Affiliation(s)
- Qi-Hao Yang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yong-Hui Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China; School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hao-Ran Xu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xia Bi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuen Lim Ching
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Chen Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
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Lin LL. Effectiveness of Physical Activity Programs for Older Adults during COVID-19 across Districts with Different Healthcare Resource: A Case Study of Keelung City in Taiwan. Healthcare (Basel) 2024; 12:1177. [PMID: 38921291 PMCID: PMC11202587 DOI: 10.3390/healthcare12121177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
While past research has largely supported the importance of physical activity for the health of older adults, during the COVID-19 pandemic, older individuals may have reduced their opportunities and levels of physical activity to lower the risk of infection by minimizing outings or interactions with others. Additionally, the adequacy of medical resources in a region is often closely related to factors such as infrastructure and economic resources. Therefore, it is important to consider whether there are differences in health promotion among older adults living in areas with varying levels of medical resources. This study aimed to implement a physical activity program for older adults, selecting Keelung City, Taiwan, as the implementation area, and comparing the differences in implementation effectiveness among administrative districts with different levels of medical resources in the city. The study employed a two-way analysis of variance to examine the differences in the effectiveness of the physical activity program among administrative districts, where the average service population in medical institutions was higher or lower than the city average. The results revealed significant improvements in participants' right-hand grip strength and the number of sit-to-stand repetitions in the overall sample after the program intervention. Moreover, in administrative districts where the average service population in medical institutions was higher than the city average, participants showed greater improvement in grip strength, while in districts where it was lower than the city average, participants demonstrated greater improvement in sit-to-stand repetitions. Future research could draw upon these findings to design physical activity programs tailored to different regions with distinct allocations of medical resources. Tailored program designs considering local medical resources are necessary to optimize effectiveness. Governments and organizations should focus on elderly health, especially in resource-scarce areas, by increasing investment and support for these programs to promote well-being and bridge disparities.
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Affiliation(s)
- Lain-Li Lin
- Department of Tourism, Leisure and Health, Deh Yu College of Nursing and Health, Keelung City 203, Taiwan
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Lyons K, Hei Man AH, Booth D, Rena G. Defining Activity Thresholds Triggering a "Stand Hour" for Apple Watch Users: Cross-Sectional Study. JMIR Form Res 2024; 8:e53806. [PMID: 38857078 PMCID: PMC11196905 DOI: 10.2196/53806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Sedentary behavior (SB) is one of the largest contributing factors increasing the risk of developing noncommunicable diseases, including cardiovascular disease and type 2 diabetes. Guidelines from the World Health Organization for physical activity suggest the substitution of SB with light physical activity. The Apple Watch contains a health metric known as the stand hour (SH). The SH is intended to record standing with movement for at least 1 minute per hour; however, the activity measured during the determination of the SH is unclear. OBJECTIVE In this cross-sectional study, we analyzed the algorithm used to determine time spent standing per hour. To do this, we investigated activity measurements also recorded on Apple Watches that influence the recording of an SH. We also aimed to estimate the values of any significant SH predictors in the recording of a SH. METHODS The cross-sectional study used anonymized data obtained in August 2022 from 20 healthy individuals gathered via convenience sampling. Apple Watch data were extracted from the Apple Health app through the use of a third-party app. Appropriate statistical models were fitted to analyze SH predictors. RESULTS Our findings show that active energy (AE) and step count (SC) measurements influence the recording of an SH. Comparing when an SH is recorded with when an SH is not recorded, we found a significant difference in the mean and median AE and SC. Above a threshold of 97.5 steps or 100 kJ of energy, it became much more likely that an SH would be recorded when each predictor was analyzed as a separate entity. CONCLUSIONS The findings of this study reveal the pivotal role of AE and SC measurements in the algorithm underlying the SH recording; however, our findings also suggest that a recording of an SH is influenced by more than one factor. Irrespective of the internal validity of the SH metric, it is representative of light physical activity and might, therefore, have use in encouraging individuals through various means, for example, notifications, to reduce their levels of SB.
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Affiliation(s)
- Katy Lyons
- Division of Cellular and Systems Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Alison Hau Hei Man
- Division of Cellular and Systems Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - David Booth
- School of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Graham Rena
- Division of Cellular and Systems Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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Wang J, Smith SC, Dong J, Chen C, Miller NH, Chang W, Ma Y, Liu H. Moderating Effect of Sex on the Relationship Between Physical Activity and Quality of Life in Coronary Heart Disease Patients in China. J Cardiopulm Rehabil Prev 2024; 44:220-226. [PMID: 38334449 DOI: 10.1097/hcr.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study was to investigate the moderating effect of sex on the relationship between physical activity (PA) and quality of life (QoL) in Chinese patients with coronary heart disease (CHD) not participating in cardiac rehabilitation. METHODS Chinese patients with CHD (aged 18-80 yr) were selected 12 mo after discharge from three Hebei Province tertiary hospitals. The International Physical Activity Questionnaire was used to assess PA in metabolic equivalents of energy (METs) and the Chinese Questionnaire of Quality of Life in Patients With Cardiovascular Disease was used to assess QoL. Data were analyzed using Student's t test and the χ 2 test, multivariant and hierarchical regression analysis, and simple slope analysis. RESULTS Among 1162 patients with CHD studied between July 1 and November 30, 2017, female patients reported poorer QoL and lower total METs in weekly PA compared with male patients. Walking ( β= .297), moderate-intensity PA ( β= .165), and vigorous-intensity PA ( β= .076) positively predicted QoL. Hierarchical regression analysis showed that sex moderates the relationship between walking ( β= .195) and moderate-intensity PA ( β= .164) and QoL, but not between vigorous-intensity PA ( β= -.127) and QoL. Simple slope analysis revealed the standardized coefficients of walking on QoL were 0.397 (female t = 8.210) and 0.338 (male t = 10.142); the standardized coefficients of moderate-intensity PA on QoL were 0.346 (female, t = 7.000) and 0.175 (male, t = 5.033). CONCLUSIONS Sex moderated the relationship between PA and QoL among patients with CHD in China. There was a greater difference in QoL for female patients reporting higher time versus those with lower time for both walking and moderate-intensity PA than for male patients.
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Affiliation(s)
- Jianhui Wang
- Author Affiliations: Nurse Administration Department (Dr Wang and Ms Dong) and Cardiovascular Department (Dr Ma), Tangshan Gongren Hospital, Tangshan, China; Tangshan Gongren Hospital, Tangshan, China, and University of North Carolina, Chapel Hill, the United States (Dr Smith); School of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, China (Ms Chen); The Lifecare Company, Los Altos, California, the United States (Ms Miller); Cardiac Catheterization Laboratories, Tangshan Gongren Hospital, Tangshan, China (Ms Chang); and School of Nursing, Peking Union Medical College, Beijing, China (Dr Liu)
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Ren L, Li Z, Wu J, Duan L, Gao J. Knowledge, Attitudes, and Practices Among Elderly CHD Patients Towards Self-Perceived Health Abilities. J Multidiscip Healthc 2024; 17:1999-2011. [PMID: 38706499 PMCID: PMC11070164 DOI: 10.2147/jmdh.s463043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This study aimed to assess the knowledge, attitudes and practices (KAP) among elderly coronary heart disease (CHD) patients toward self-perceived health abilities. Methods This web-based study was carried out between April 2023 and September 2023 at Guang'anmen Hospital, China Academy of Chinese Medical Sciences. A self-developed questionnaire was utilized to collect demographic information from elderly CHD patients, and evaluate their KAP towards self-perceived health abilities. Results A total of 568 valid questionnaires were collected. Among the participants, the average age was 65.97±5.50 years, and 298 (52.46%) were female, and the mean scores for knowledge, attitudes, and practices were 6.34±2.29 (possible range: 0-9), 35.24±4.99 (possible range: 9-45), and 27.79±10.09 (possible range: 9-45), respectively. The structural equation model demonstrated that elderly CHD patients' knowledge directly affects attitudes and practices, with path coefficient of 0.93 (P<0.001) and 0.39 (P=0.033), respectively. Moreover, attitudes play an intermediary role between knowledge and practice with path coefficient of 0.75 (P<0.001). Furthermore, residence directly affects knowledge with path coefficient of 0.67 (P<0.001), cardiac function directly affects knowledge with path coefficient of -0.97 (P<0.001) and history of interventional therapy directly affects practice with path coefficient of 4.23 (P<0.001). Conclusion Elderly CHD patients demonstrated sufficient knowledge, positive attitudes, and proactive practices towards self-perceived health abilities. However, educational programs and behavior modification are recommended, particularly for elderly with lower age and education, living in rural areas, lacking interventional therapy, obese, or taking multiple CHD medications.
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Affiliation(s)
- Li Ren
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Zhaoling Li
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Ji Wu
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Lian Duan
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Jialiang Gao
- Cardiovascular Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
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LaMonte MJ, LaCroix AZ, Nguyen S, Evenson KR, Di C, Stefanick ML, Hyde ET, Anuskiewicz B, Eaton CB. Accelerometer-Measured Physical Activity, Sedentary Time, and Heart Failure Risk in Women Aged 63 to 99 Years. JAMA Cardiol 2024; 9:336-345. [PMID: 38381446 PMCID: PMC10882503 DOI: 10.1001/jamacardio.2023.5692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
Importance Heart failure (HF) prevention is paramount to public health in the 21st century. Objective To examine incident HF and its subtypes with preserved ejection fraction (HFpEF) and reduced EF (HFrEF) according to accelerometer-measured physical activity (PA) and sedentary time. Design, Setting, and Participants This was a prospective cohort study, the Objective Physical Activity and Cardiovascular Health (OPACH) in Older Women study, conducted from March 2012 to April 2014. Included in the analysis were women aged 63 to 99 years without known HF, who completed hip-worn triaxial accelerometry for 7 consecutive days. Follow-up for incident HF occurred through February 2022. Data were analyzed from March to December 2023. Exposure Daily PA (total, light, moderate to vigorous PA [MVPA], steps) and sedentary (total, mean bout duration) behavior. Main Outcomes and Measures Adjudicated incident HF, HFpEF, and HFrEF. Results A total of 5951 women (mean [SD] age, 78.6 [6.8] years) without known HF were included in this analysis. Women self-identified with the following race and ethnicity categories: 2004 non-Hispanic Black (33.7%), 1022 Hispanic (17.2%), and 2925 non-Hispanic White (49.2%). There were 407 HF cases (257 HFpEF; 110 HFrEF) identified through a mean (SD) of 7.5 (2.6) years (range, 0.01-9.9 years) of follow-up. Fully adjusted hazard ratios (HRs) for overall HF, HFpEF, and HFrEF associated with a 1-SD increment were 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.67-0.91), and 1.02 (95% CI, 0.81-1.28) for minutes per day total PA; 0.74 (95% CI, 0.63-0.88), 0.71 (95% CI, 0.57-0.88), and 0.83 (95% CI, 0.62-1.12) for steps per day; and 1.17 (95% CI, 1.04-1.33), 1.29 (95% CI, 1.10-1.51), and 0.94 (95% CI, 0.75-1.18) for minutes per day total sedentary. Cubic spline curves for overall HF and HFpEF were significant inverse for total PA and steps per day and positive for total sedentary. Light PA and MVPA were inversely associated with overall HF (HR per 1 SD: 0.88; 95% CI, 0.78-0.98 and 0.84; 95% CI, 0.73-0.97) and HFpEF (0.80; 95% CI, 0.70-0.93 and 0.85; 95% CI, 0.72-1.01) but not HFrEF. Associations did not meaningfully differ when stratified by age, race and ethnicity, body mass index, physical function, or comorbidity score. Results for sedentary bout duration were inconsistent. Conclusions and Relevance Higher accelerometer-measured PA (MVPA, light PA, steps per day) was associated with lower risk (and greater total sedentary time with higher risk) of overall HF and HFpEF in a racially and ethnically diverse cohort of older women. Increasing PA and reducing sedentary time for primary HFpEF prevention may have relevant implications for cardiovascular resilience and healthy aging in later life.
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Affiliation(s)
| | | | | | | | - Chongzhi Di
- Fred Hutchinson Cancer Center, Seattle, Washington
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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11
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Li T, Zong G, Peng P, Wang S, Cheng B. Accelerometer-measured physical activity and sample-based frailty in older women: does pattern really matter? Front Public Health 2024; 11:1304279. [PMID: 38332942 PMCID: PMC10850322 DOI: 10.3389/fpubh.2023.1304279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background The relationship between the patterns of physical activity (PA) and frailty, including its various subdomains, remains poorly understood. Therefore, this study aims to investigate the correlations between the patterns of physical activity and frailty and its various subdomains in community-dwelling older women. Methods A cross-sectional study investigated the association between physical activity and frailty in 1,099 women aged between 60 to 70 years. Triaxial accelerometers were used to measure bouted PA (a minimum duration of 10 min) and sporadic PA (a duration of <10 min). Fried's frailty phenotype was utilized to evaluate the status of frailty. Data were analyzed using logistic regression and the receiver operating characteristic (ROC) curve. Results Bouted moderate-to-vigorous PA (MVPA) and sporadic MVPA were associated with decreased odds of being prefrail and frail, and the optimal cutoff values were 6 and 19.7 for the prefrail stage and 6.6 and 19.4 min/day for the frail stage, respectively. Bouted light PA (LPA) was associated with decreased odds of being prefrail, and the optimal cutoff value was 170.2 min/day. Additionally, bouted and sporadic MVPA were associated with decreased odds of being slow and their optimal cutoff values were 5 and 19.1 min/day, respectively. Sporadic MVPA was associated with decreased odds of exhaustion, and the cutoff was 19.7 min/day. Bouted MVPA and LPA were associated with decreased odds of having low PA, and the cutoff values were 4.4 and 163.2 min/day, respectively. Conclusion Any MVPA, regardless of bout duration, could be used as a suitable PA program to improve and prevent frailty in older women, such as bouted MVPA (4-5 times/week) or sporadic MVPA (20 min/day). The improvement effect of bouted and sporadic MVPA on the frailty of older people may not be affected by the subdomain. Additionally, bouted LPA was suitable for the management of prefrailty.
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Affiliation(s)
- Ting Li
- School of Physical Education, Shandong University, Jinan, China
| | | | - Pan Peng
- Ezhou High School, Ezhou, Hubei, China
| | - Shiqiang Wang
- College of Physical Education, Hunan University of Technology, Zhuzhou, China
- Hunan Key Laboratory of Physical Health and Sports Fitness, Zhuzhou, China
- Hunan Research Centre in Physical Fitness, Health, and Performance Excellence, Hunan University of Technology, Hunan, China
| | - Bin Cheng
- School of Physical Education, Shandong University, Jinan, China
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12
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Ge Y, Chao T, Sun J, Huan N, Liu W, Chen Y, Wang C. Light physical activity predicts long-term mortality in individuals with a different cardiovascular health status: a cohort study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:587-599. [PMID: 36599011 DOI: 10.1080/09603123.2022.2160866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Studies have showed that LIPA seems to be favorably associated with mortality in the general population and illness individuals, but the association between different cardiovascular health status and mortality is not clear. After adjustment , the HRs of LIPA in individuals with CVRF and CVD from quartiles 2-4 were less than 1, which were 0.78 (95%CI, 0.61 ~ 0.99; P = 0.042), 0.63 (95%CI, 0.47 ~ 0.83; P = 0.001), 0.55(95%CI, 0.40 ~ 0.76; P < 0.001), and 0.52 (95%CI, 0.37 ~ 0.74; P < 0.001),0.39 (95%CI, 0.27 ~ 0.58; P < 0.001), 0.33 (95%CI, 0.22 ~ 0.51; P < 0.001) LIPA is beneficial for reducing mortality, but the shape of the association depends on cardiovascular health status.
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Affiliation(s)
- Yaru Ge
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tiantian Chao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinghui Sun
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Na Huan
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenjie Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yunru Chen
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenglong Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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13
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Harden JE, Tabacu L, Reynolds LJ. Physical activity intensity and markers of inflammation in those with non-alcoholic fatty liver disease. Diabetes Res Clin Pract 2024; 207:111047. [PMID: 38070545 DOI: 10.1016/j.diabres.2023.111047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024]
Abstract
AIMS To investigate associations between objectively measured light (LPA) and moderate-to-vigorous (MVPA) physical activity on plasma homocysteine and serum C-reactive protein (CRP) in individuals with Non-Alcoholic Fatty Liver Disease (NAFLD). METHODS This study was a secondary analysis using data from 2003 to 2006 National Health and Nutrition Examination Survey including a total of 983 individuals with NAFLD. Physical activity was assessed over 7 days with accelerometers. Participants were split into tertiles based on average daily minutes of LPA or MVPA and CRP and homocysteine were assessed across tertiles. RESULTS Adjusted plasma homocysteine and CRP were not different between groups regarding levels of LPA (Homocysteine: 1st tertile - 10.4 ± 0.7 µmol/L; 2nd tertile - 9.6 ± 0.4 µmol/L; 3rd tertile - 9.6 ± 0.4 µmol/L; p = 0.28; CRP: 1st tertile - 0.79 ± 0.12 mg/dL; 2nd tertile - 0.73 ± 0.09 mg/dL; 3rd tertile - 0.73 ± 0.09 mg/dL; p = 0.72). Adjusted CRP was significantly (p = 0.02) different across MVPA tertiles (1st: 0.87 ± 0.13 mg/dL; 2nd: 0.75 ± 0.10 mg/dL; 3rd:0.65 ± 0.09). CONCLUSIONS LPA does not appear to be effective at improving homocysteine or CRP levels in individuals with NAFLD. However, MVPA may be an effective therapy for decreasing CRP in NAFLD patients.
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Affiliation(s)
- Joel E Harden
- School of Exercise Science, Old Dominion University, Norfolk, VA, USA
| | - Lucia Tabacu
- Department of Mathematics and Statistics, Old Dominion University, Norfolk, VA, USA
| | - Leryn J Reynolds
- School of Exercise Science, Old Dominion University, Norfolk, VA, USA.
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14
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Vieira Sosa M, Chin E, Sethares KA. Perspectives Regarding Engagement in Physical Activity in Women: Traditional Gender Role-Based Themes. J Cardiovasc Nurs 2023:00005082-990000000-00144. [PMID: 37934156 DOI: 10.1097/jcn.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors. OBJECTIVE The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources. METHODS This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity. RESULTS Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support. CONCLUSIONS The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.
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15
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Emerson JA, Schumacher LM, Bond DS, Thomas JG, Lillis J. Physical activity changes during an automated online weight loss program. J Behav Med 2023; 46:680-688. [PMID: 36602619 DOI: 10.1007/s10865-022-00383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/06/2022] [Indexed: 01/06/2023]
Abstract
Evidence-based online behavioral weight loss (BWL) treatment targets a combination of diet, physical activity, and behavioral skills training. While weight loss outcomes are well documented, little is known about changes in physical activity. This study examined changes in objectively measured physical activity across the energy expenditure spectrum during a fully automated, online BWL program. Adults with overweight or obesity (n = 63) completed a 12-week, online BWL program. Participants wore an accelerometer for 7 days and body weight was measured in-clinic at pre- and post-treatment. At post-treatment, mean daily moderate-to-vigorous physical activity increased by about 4 min (SE = 1.59, p = 0.01). There were no statistically significant changes in light physical activity or time spent sedentary (p's > 0.05). Despite only minimal changes in moderate-to-vigorous physical activity overall, larger increases correlated with greater weight loss (r = - 0.28, p = 0.02), which averaged 6.1% of baseline weight at post-treatment. Though achieving important weight loss outcomes, online programs may fail to produce clinically relevant improvements in physical activity, which can put weight loss maintenance at risk.
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Affiliation(s)
- Jessica A Emerson
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
| | - Leah M Schumacher
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
| | - Dale S Bond
- Hartford Hospital/Hartford HealthCare, 80 Seymour Street, Hartford, CT, 06106, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
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Peter‐Marske KM, Evenson KR, Moore CC, Cuthbertson CC, Howard AG, Shiroma EJ, Buring JE, Lee I. Association of Accelerometer-Measured Physical Activity and Sedentary Behavior With Incident Cardiovascular Disease, Myocardial Infarction, and Ischemic Stroke: The Women's Health Study. J Am Heart Assoc 2023; 12:e028180. [PMID: 36974744 PMCID: PMC10122899 DOI: 10.1161/jaha.122.028180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
Background Few studies have investigated associations of acclerometer-based assessments of physical activity (PA) and sedentary behavior (SB) with incidence of cardiovascular disease (CVD) and its components. This prospective cohort study assessed the associations of accelerometer-measured PA and SB with total CVD, myocardial infarction, and ischemic stroke (IS). Methods and Results The authors included 16 031 women aged 62 years and older, free of CVD, with adherent accelerometer wear (≥10 hours/day for ≥4 days) from the Women's Health Study (mean age, 71.4 years [SD, 5.6 years]). Hip-worn ActiGraph GT3X+ accelerometers measured total volume of PA (total average daily vector magnitude), minutes per day of high-light PA and moderate to vigorous PA (MVPA), and SB. Women reported diagnoses of CVD, which were adjudicated using medical records and death certificates. Hazard ratios (HRs) were estimated for each exposure, and 95% CIs using Cox proportional hazards models were adjusted for accelerometer wear time, age, self-reported general health, postmenopausal hormone therapy, smoking status, and alcohol use. The hypothetical effect of replacing 10 minutes/day of SB or high-light PA with MVPA on CVD incidence was assessed using adjusted isotemporal substitution Cox models. Over a mean of 7.1 years (SD, 1.6 years) of follow-up, 482 total CVD cases, 107 myocardial infarction cases, and 181 IS cases were diagnosed. Compared with the lowest quartiles of total average daily vector magnitude and MVPA (≤60 minutes), women who were in the highest quartiles (>120 minutes of MVPA) had a 43% (95% CI, 24%-58%) and 38% (95% CI, 18%-54%) lower hazard of total CVD, respectively. Estimates were similar for total average daily vector magnitude and MVPA with IS, but PA was not associated with myocardial infarction overall. High-light PA was not associated with any CVD outcomes. Women who spent <7.4 hours sedentary per day had a 33% (95% CI, 11%-49%) lower hazard of total CVD compared with those who spent ≥9.5 hours sedentary. Replacing 10 minutes of SB with MVPA was associated with a 4% lower incidence of total CVD (HR, 0.96 [95% CI, 0.93-0.99]). Conclusions Accelerometer-assessed total PA and MVPA were inversely associated with total CVD and IS incidence, and SB was directly associated with total CVD; high-light PA was not related to CVD.
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Affiliation(s)
- Kennedy M. Peter‐Marske
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Christopher C. Moore
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Eric J. Shiroma
- Laboratory of Epidemiology and Population SciencesNational Institute on AgingBaltimoreMDUSA
| | - Julie E. Buring
- Division of Preventive MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMAUSA
| | - I‐Min Lee
- Division of Preventive MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMAUSA
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17
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Posis AIB, Bellettiere J, Salem RM, LaMonte MJ, Manson JE, Casanova R, LaCroix AZ, Shadyab AH. Associations of Accelerometer-Measured Physical Activity and Sedentary Time With All-Cause Mortality by Genetic Predisposition for Longevity. J Aging Phys Act 2023; 31:265-275. [PMID: 36002033 PMCID: PMC9950283 DOI: 10.1123/japa.2022-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
The goal of this study was to examine associations between accelerometer-measured physical activity (PA) and sedentary time (ST) with mortality by a genetic risk score (GRS) for longevity. Among 5,446 women, (mean [SD]: age, 78.2 [6.6] years), 1,022 deaths were observed during 33,350 person-years of follow-up. Using multivariable Cox proportional hazards models, higher light PA and moderate to vigorous PA were associated with lower mortality across all GRS for longevity categories (low/medium/high; all ptrend < .001). Higher ST was associated with higher mortality (ptrend across all GRS categories < .001). Interaction tests for PA and ST with the GRS were not statistically significant. Findings support the importance of higher PA and lower ST for reducing mortality risk in older women, regardless of genetic predisposition for longevity.
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Affiliation(s)
- Alexander Ivan B. Posis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rany M. Salem
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, MA, USA
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Hilbold E, Bär C, Thum T. COVID-19: Insights into long-term manifestations and lockdown impacts. JOURNAL OF SPORT AND HEALTH SCIENCE 2023:S2095-2546(23)00019-4. [PMID: 36868374 PMCID: PMC9977467 DOI: 10.1016/j.jshs.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Coronaviruses are pathogens thought to primarily affect the respiratory tracts of humans. The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 was also marked mainly by its symptoms of respiratory illness, which were named coronavirus disease 2019 (COVID-19). Since its initial discovery, many other symptoms have been linked to acute SARS-CoV-2 infections as well as to the long-term outcomes of COVID-19 patients. Among these symptoms are different categories of cardiovascular diseases (CVDs), which continue to be the main cause of death worldwide. The World Health Organization estimates that 17.9 million people die from CVDs each year, accounting for ∼32% of all deaths globally. Physical inactivity is one of the most important behavioral risk factors for CVDs. The COVID-19 pandemic has affected CVDs as well as the physical activity in different ways. Here, we provide an overview of the current status as well as future challenges and possible solutions.
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Affiliation(s)
- Erika Hilbold
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover 30625, Germany
| | - Christian Bär
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover 30625, Germany; Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover 30625, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover 30625, Germany; Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover 30625, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany.
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19
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Morales-Lara AC, Garzon-Siatoya WT, Fernandez-Campos BA, Adedinsewo D. Advancing Our Understanding of Women's Cardiovascular Health Through Digital Health and Artificial Intelligence. JACC. ADVANCES 2023; 2:100272. [PMID: 38938318 PMCID: PMC11198228 DOI: 10.1016/j.jacadv.2023.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
| | | | | | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
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20
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Liew SJ, Petrunoff NA, Neelakantan N, van Dam RM, Müller-Riemenschneider F. Device-Measured Physical Activity and Sedentary Behavior in Relation to Cardiovascular Diseases and All-Cause Mortality: Systematic Review and Meta-Analysis of Prospective Cohort Studies. AJPM FOCUS 2023; 2:100054. [PMID: 37789935 PMCID: PMC10546582 DOI: 10.1016/j.focus.2022.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction This review synthesized evidence from prospective cohort studies on the association of device-measured physical activity and sedentary behavior with cardiovascular disease and all-cause mortality among adults. Methods Five databases were searched from 2000 through April 29, 2020. Study quality was appraised using the NIH Quality Assessment Tool. Pooled hazard ratio and 95% CI were obtained from random-effects meta-analyses. Subgroup analyses by age and sex were conducted for studies on all-cause mortality. Results Of 29 articles included in the systematic review, 5 studies on cardiovascular disease mortality and 15 studies on all-cause mortality were included in meta-analyses. Comparing the highest with the lowest exposure categories, the pooled hazard ratios (95% CIs) for cardiovascular disease mortality were 0.29 (CI=0.18, 0.47) for total physical activity, 0.37 (CI=0.25, 0.55) for moderate-to-vigorous physical activity, 0.62 (0.41-0.93) for light physical activity, and 1.89 (CI=1.09, 3.29) for sedentary behavior. The pooled hazard ratios (95% CIs) for all-cause mortality were 0.42 (CI=0.34, 0.53) for total physical activity, 0.43 (CI=0.35, 0.53) for moderate-to-vigorous physical activity, 0.58 (CI=0.43, 0.80) for light physical activity, and 1.58 (CI=1.19, 2.09) for sedentary behavior. The pooled hazard ratio (95% CI) for all-cause mortality was 0.35 (CI=0.29, 0.42) for steps per day, but the studies available for analysis were conducted in older adults. The results of subgroup analyses were consistent with the main results. Discussion Rapidly accumulating evidence suggests that more physical activity and less sedentary behavior are associated with a lower risk of cardiovascular disease and all-cause mortality. Similar beneficial relationships were found for step counts and all-cause mortality among older adults. Future studies employing standardized research methodologies and up-to-date data processing approaches are warranted to recommend specific amounts of physical activity and limits to sedentary behavior.
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Affiliation(s)
- Seaw Jia Liew
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Nicholas A. Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Nithya Neelakantan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Berlin Institute of Health, Charité University Medical Centre, Berlin, Germany
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21
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1144] [Impact Index Per Article: 1144.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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22
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Kushniruk A, Middelweerd A, van Empelen P, Preuhs K, Konijnendijk AAJ, Oude Nijeweme-d'Hollosy W, Schrijver LK, Laverman GD, Vollenbroek-Hutten MMR. A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study. JMIR Hum Factors 2023; 10:e40017. [PMID: 36633898 PMCID: PMC9947918 DOI: 10.2196/40017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). OBJECTIVE This paper aimed to describe the systematic development of E-Supporter 1.0. METHODS Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. RESULTS The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. CONCLUSIONS The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.
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Affiliation(s)
| | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | | | | | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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23
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Lin LL, Liu CC. Effectiveness of Comprehensive Physical Activity Health Promotion Program on the Essential Physical Functions of Older Patients With Multiple Diseases and Dementia in Rural Area. Gerontol Geriatr Med 2023; 9:23337214231184127. [PMID: 37435006 PMCID: PMC10331075 DOI: 10.1177/23337214231184127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Against the backdrop of aging populations worldwide, physical activity programs aimed at promoting the health of older adults have begun to flourish. However, few studies have focused on elderly residents in rural areas who may have multiple comorbidities. Therefore, the current study aimed to investigate the effects of a 12-week physical activity program on health promotion among rural elderly with multiple diseases. The study included 18 elderly participants, with a mean age of 82.39 years, who had dementia and one or more additional diseases. Among the participants, 89% were female. The results showed that the 12-week physical activity program intervention significantly improved participants' walking speed and range of motion of the arm joints. Based on these findings, it is hoped that this study will provide a reference for future researchers and practitioners targeting rural or elderly populations who may have multiple diseases to develop more comprehensive physical activity programs.
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Affiliation(s)
- Lain-Li Lin
- Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Chih-Chi Liu
- National Taiwan Normal University, Taipei, Taiwan
- Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
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24
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Dempsey PC, Rowlands AV, Strain T, Zaccardi F, Dawkins N, Razieh C, Davies MJ, Khunti KK, Edwardson CL, Wijndaele K, Brage S, Yates T. Physical activity volume, intensity, and incident cardiovascular disease. Eur Heart J 2022; 43:4789-4800. [PMID: 36302445 DOI: 10.1093/eurheartj/ehac613] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/26/2022] [Accepted: 10/12/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. METHODS AND RESULTS Data were from 88 412 UK Biobank middle-aged adults (58% women) without prevalent CVD who wore accelerometers on their dominant wrist for 7 days, from which we estimated total PA energy expenditure (PAEE) using population-specific validation. Cox proportional hazards regressions modelled associations between PAEE (kJ/kg/day) and PA intensity (%MVPA; the fraction of PAEE accumulated from moderate-to-vigorous-intensity PA) with incident CVD (ischaemic heart disease or cerebrovascular disease), adjusted for potential confounders. There were 4068 CVD events during 584 568 person-years of follow-up (median 6.8 years). Higher PAEE and higher %MVPA (adjusted for PAEE) were associated with lower rates of incident CVD. In interaction analyses, CVD rates were 14% (95% confidence interval: 5-23%) lower when MVPA accounted for 20% rather than 10% of 15 kJ/kg/d PAEE; equivalent to converting a 14 min stroll into a brisk 7 min walk. CVD rates did not differ significantly between values of PAEE when the %MVPA was fixed at 10%. However, the lowest CVD rates were observed for combinations of both higher PAEE and %MVPA. CONCLUSION Reductions in CVD risk may be achievable through higher PA volume and intensity, with the role of moderately intense PA appearing particularly important. This supports multiple approaches or strategies to PA participation, some of which may be more practical or appealing to different individuals.
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Affiliation(s)
- Paddy C Dempsey
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.,Baker Heart and Diabetes Institute, Melbourne, Australia.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Tessa Strain
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nathan Dawkins
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Cameron Razieh
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Kamlesh K Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Tom Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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25
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Wasfy MM, Lee IM. Examining the Dose-Response Relationship between Physical Activity and Health Outcomes. NEJM EVIDENCE 2022; 1:EVIDra2200190. [PMID: 38319830 DOI: 10.1056/evidra2200190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Physical Activity and Health and LongevityPhysical activity is a powerful tool to improve health. This article reviews the evidence supporting a relationship between physical activity and health outcomes, including mortality, and discusses the optimal dose of physical activity.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
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26
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Bakhtari Aghdam F, Aziz-Zadeh S, Musavi S, Abbasalizad-Farhangi M. Psychometric properties of the Last-7-Day Sedentary Time Questionnaire (SIT-Q-7d): Testing the validity and reliability among general population. BMC Public Health 2022; 22:1880. [PMID: 36209048 PMCID: PMC9547410 DOI: 10.1186/s12889-022-14262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Sedentary behavior (SB) is an independent risk factor causing chronic diseases. Previous studies compared sitting time mostly with physical activity. The present study aimed to evaluate the validity and reliability of the Last-7-Day Sedentary Time Questionnaire (SIT-Q-7d) in Iran. Moreover, SB was assessed among the study participants. METHODS The current validity study was conducted among 290 subjects (51.7% males vs. 48.3% females) with a mean age of 34.81 ± 9.63 years in Poldasht, Iran. Sampling was done using simple random sampling and the data were collected using the SIT-Q-7d. To confirm the validity of the questionnaire, forward-backward translation method, content validity, and construct validity were used. Furthermore, temporal stability was calculated by the test-retest method and internal consistency coefficient (ICC). RESULTS Our results confirmed the content validity of the questionnaire (content validity score: 0.90 and content validity index: 0.80). Using exploratory factor analysis (EFA), seven factors of SB were identified as follows: eating while sitting down, doing domestic affairs, screen time, leisure time, studying books, watching TV, and attending family gatherings. The reliability of the questionnaire was confirmed using Cronbach's alpha (α = 0.7). In addition, temporal stability was confirmed by test-retest method and ICC was 0.9 (95% CI: 83-97). CONCLUSION Our results confirmed that the Persian version of SIT-Q-7d is a reliable and valid tool for assessing SB.
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Affiliation(s)
| | - Sepideh Aziz-Zadeh
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Musavi
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad-Farhangi
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Attar Neyshabouri Street, Tabriz, Iran.
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27
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Länsitie M, Kangas M, Jokelainen J, Venojärvi M, Timonen M, Keinänen-Kiukaanniemi S, Korpelainen R. Cardiovascular disease risk and all-cause mortality associated with accelerometer-measured physical activity and sedentary time ‒ a prospective population-based study in older adults. BMC Geriatr 2022; 22:729. [PMID: 36064345 PMCID: PMC9446693 DOI: 10.1186/s12877-022-03414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Low levels of physical activity (PA) and high sedentary time (ST) are common in older adults and lack of PA is a risk factor for cardiovascular disease (CVD). Knowledge about associations with accelerometer-measured PA, ST and CVD risk in older adults is insufficient. This study examines the associations of accelerometer-measured PA and ST with cardiovascular risk measured using the Framingham risk score (FRS) and all-cause mortality in older adults. Methods A population-based sample of 660 (277 men, 383 women) older people (mean age 68.9) participated in the Oulu45 cohort study from 2013‒2015. PA and ST were measured with wrist-worn accelerometers at baseline for two weeks. Ten-year CVD risk (%) was estimated with FRS. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. The associations between moderate to vigorous physical activity (MVPA), light physical activity (LPA), ST and FRS were analyzed using the multivariable linear regression analysis. Associations between LPA, ST and mortality were analyzed using the Cox proportional-hazard regression models. Results Each 10 min increase in MVPA (β = -0.779, 95% CI -1.186 to -0.371, p < 0.001) and LPA (β = -0.293, 95% CI -0.448 to -0.138, p < 0.001) was negatively associated with FRS while a 10 min increase in ST (β = 0.290, 95% CI 0.158 to 0.421, p < 0.001) was positively associated with FRS. After adjustment for waist circumference, only ST was significantly associated with FRS. Each 10 min increase in LPA was associated with 6.5% lower all-cause mortality risk (HR = 0.935, 95% CI 0.884 to 0.990, p = 0.020) and each 10 min increase in ST with 5.6% increased mortality risk (HR = 1.056, 95% CI 1.007 to 1.108, p = 0.025). Conclusion A higher amount of daily physical activity, at any intensity level, and avoidance of sedentary time are associated with reduced cardiovascular disease risk in older people. Higher time spent in light physical activity and lower sedentary time are associated with lower all-cause mortality.
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Affiliation(s)
- Miia Länsitie
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Albertinkatu 18 A, 90100, Oulu, Finland. .,Research Unit of Population Health, University of Oulu, Oulu, Finland. .,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Maarit Kangas
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Timonen
- Research Unit of Population Health, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Research Unit of Population Health, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Albertinkatu 18 A, 90100, Oulu, Finland.,Research Unit of Population Health, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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28
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Mitro SD, Peddada S, Gleason JL, He D, Whitcomb B, Russo L, Grewal J, Zhang C, Yisahak SF, Hinkle SN, Buck Louis GM, Newman R, Grobman W, Sciscione AC, Owen J, Ranzini A, Craigo S, Chien E, Skupski D, Wing D, Grantz KL. Longitudinal Changes in Physical Activity during Pregnancy: National Institute of Child Health and Human Development Fetal Growth Studies. Med Sci Sports Exerc 2022; 54:1466-1475. [PMID: 35482764 PMCID: PMC9378685 DOI: 10.1249/mss.0000000000002947] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Exercise in pregnancy is associated with many perinatal benefits, but patterns of home, work, and commuting activity are not well described. We investigated longitudinal activity in singleton and twin pregnancy by activity domain and maternal characteristics. METHODS In the National Institute of Child Health and Human Development Fetal Growth Studies cohorts, 2778 women with singleton and 169 women with twin gestations reported activity using the Pregnancy Physical Activity Questionnaire at up to six or seven study visits, respectively. Metabolic equivalent of task-hours per week (MET-h·wk -1 ) was calculated from reported activity. Baseline measurements (obtained between 10 and 13 wk) reflected past year activity. Linear mixed models estimated MET-h·wk -1 by domain (household/childcare, occupational, inactive, transportation, sports/exercise), self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian/Pacific Islander), prepregnancy body mass index (<25, 25 to < 30, ≥30 kg·m -2 ), parity (0, ≥1), baseline activity (quartiles), and plurality (singleton, twin). RESULTS Household/caregiving activity made up the largest fraction of reported MET-h·wk -1 at baseline (42%), followed by occupational activity (28%). Median summed activity declined 47%, from 297 to 157 MET-h·wk -1 , between 10 and 40 wk, largely driven by changes in household/caregiving (44% decline), and occupational activity (63% decline). Sports/exercise activity declined 55% but constituted only 5% of reported MET-h·wk -1 at baseline. At baseline, non-Hispanic Black women reported significantly higher activity than non-Hispanic White or Hispanic women, but differences did not persist across pregnancy. Across gestation nulliparous women reported significantly lower activity than parous women. Women with singleton gestations reported significantly more activity than women with twins from weeks 26 to 38. Baseline activity level was strongly associated with later activity levels. CONCLUSIONS Measuring domains of activity beyond exercise, and collecting longitudinal measurements, is necessary to fully describe activity in diverse populations of pregnant women.
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Affiliation(s)
- Susanna D Mitro
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Shyamal Peddada
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Jessica L Gleason
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Dian He
- The Prospective Group, Inc., Fairfax, VA
| | - Brian Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Lindsey Russo
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Samrawit F Yisahak
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Stefanie N Hinkle
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - William Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - John Owen
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Edward Chien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital/Queens, Queens, NY
| | | | - Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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29
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Arigo D, Brown MM, Shank F, Young CM. Ecological Momentary Assessment of Associations Between Social Interactions and Physical Activity Outcomes Among Women in Midlife With CVD Risk Conditions. Ann Behav Med 2022; 57:50-60. [PMID: 35916784 PMCID: PMC9773504 DOI: 10.1093/abm/kaac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Risk for cardiovascular disease is particularly high among women in midlife (ages 40-60). Moderate-to-vigorous-intensity physical activity (PA) can protect against risk during this time, and research is needed to understand contributors to PA motivation and behavior in daily life. PURPOSE This study used ecological momentary assessment to examine: (a) within-person associations between social interactions (both quantity and quality) and PA outcomes (motivation and behavior) among women in midlife, and (b) variability in within-person associations across days. METHODS Women ages 40-60 with one or more cardiovascular disease risk conditions (e.g., hypertension; n = 75; MAge = 51.6 years, MBMI = 34.0 kg/m2) wore waistband accelerometers and completed five surveys per day for 10 days. RESULTS Controlling for social interactions overall, at times when women reported a higher number of positive interactions, they reported higher PA motivation; this association was negative for both the number and valence of negative interactions. At times when women experienced a higher number of interactions overall, they engaged in fewer subsequent minutes of moderate-to-vigorous-intensity PA, though reports of positive and negative interactions were not associated with moderate-to-vigorous-intensity PA behavior. Importantly, the direction of these within-person associations differed between days of observation (positive associations on ~50% of days and negative associations on ~50% of days). CONCLUSIONS Findings show that social interactions influence PA motivation and behavior among women in midlife but that these influences are inconsistent, suggesting the need for careful consideration of how to engage social interactions to promote PA in this group.
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Affiliation(s)
| | - Megan M Brown
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - Faith Shank
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - Chelsie M Young
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
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30
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Daily and hourly patterns of physical activity and sedentary behavior of older adults: Atherosclerosis risk in communities (ARIC) study. Prev Med Rep 2022; 28:101859. [PMID: 35711287 PMCID: PMC9194653 DOI: 10.1016/j.pmedr.2022.101859] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/13/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Older adult activity patterns varied by day of the week with Sunday the least active. Most physical activity was accrued during the morning hours (9 AM-12 PM). Men and those with overweight and obesity had highest sedentary minutes. Older adult movement patterns show opportunities for physical activity promotion.
This cross-sectional study of older adults ≥ 65 years describes daily and hourly patterns of accelerometer-derived steps, sedentary, and physical activity behaviors and examines differences by day of the week and sociodemographic and health-related factors to identify time-use patterns. Data were from 459 Atherosclerosis Risk in Communities (ARIC) study participants (60% female; mean ± SD age = 78.3 ± 4.6 years; 20% Black) who wore a hip accelerometer ≥ 4 of 7 days, for ≥ 10 h/day in 2016. We used linear mixed models to examine daily patterns of steps, sedentary, low light, high light, and moderate-to-vigorous intensity physical activity (MVPA). Differences by sex, median age (</≥ 78 years), body mass index, self-rated health, depressive symptoms, and performance in a two-minute walk test were explored. Men (vs women), and those with overweight and obesity (vs normal weight), had significantly higher sedentary minutes and lower minutes of low light per day. For each additional meter walked during the two-minute walk test, sedentary behavior was lower while high light, MVPA, and daily steps were higher. No significant differences in time-use behaviors were found by self-reported race, age, education, self-rated health, or depressive symptoms. Participants were least active (22.5 min MVPA, 95% CI: 11.5, 33.5) and most sedentary (453.9 min, 95% CI: 417.7, 490.2) on Sunday. Most activity was accrued in the morning (before 12 PM) while the evening hours (3–11 PM) were spent ≥ 50% sedentary. Movement patterns suggest opportunities for promotion of activity and reduction in sedentary time on Sundays, in the evening hours, and for those with overweight or obesity.
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LaMonte MJ, Manson JE, Anderson GL, Baker LD, Bea JW, Eaton CB, Follis S, Hayden KM, Kooperberg C, LaCroix AZ, Limacher MC, Neuhouser ML, Odegaard A, Perez MV, Prentice RL, Reiner AP, Stefanick ML, Van Horn L, Wells GL, Whitsel EA, Rossouw JE. Contributions of the Women's Health Initiative to Cardiovascular Research: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:256-275. [PMID: 35835498 DOI: 10.1016/j.jacc.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
The WHI (Women's Health Initiative) enrolled 161,808 racially and ethnically diverse postmenopausal women, ages 50-79 years, from 1993 to 1998 at 40 clinical centers across the United States. In its clinical trial component, WHI evaluated 3 randomized interventions (menopausal hormone therapy; diet modification; and calcium/vitamin D supplementation) for the primary prevention of major chronic diseases, including cardiovascular disease, in older women. In the WHI observational study, numerous clinical, behavioral, and social factors have been evaluated as predictors of incident chronic disease and mortality. Although the original interventions have been completed, the WHI data and biomarker resources continue to be leveraged and expanded through ancillary studies to yield novel insights regarding cardiovascular disease prevention and healthy aging in women.
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Affiliation(s)
- Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo-SUNY, Buffalo, New York, USA.
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura D Baker
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer W Bea
- Department of Health Promotion Science, University of Arizona, Tucson, Arizona, USA
| | - Charles B Eaton
- Department of Family Medicine and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Shawna Follis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - Marian C Limacher
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrew Odegaard
- Department of Epidemiology, University of California, Irvine, California, USA
| | - Marco V Perez
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gretchen L Wells
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jacques E Rossouw
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Stefanick ML, Kooperberg C, LaCroix AZ. Women's Health Initiative Strong and Healthy (WHISH): A pragmatic physical activity intervention trial for cardiovascular disease prevention. Contemp Clin Trials 2022; 119:106815. [PMID: 35691486 PMCID: PMC9420786 DOI: 10.1016/j.cct.2022.106815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND National guidelines promote physical activity to reduce cardiovascular disease (CVD); yet, no RCT has tested the effectiveness of physical activity as the sole intervention for primary CVD prevention in older adults. The Women's Health Initiative (WHI) Strong and Healthy (WHISH) trial, a pragmatic trial embedded in the WHI-Extension Study (ES), is testing whether increasing physical activity and decreasing sedentary behavior will reduce major CV events in older women. METHODS The randomized consent design was used to assign 49,331 women (aged 68-99 years in 2015) who had consented to ongoing WHI-ES follow-up and for whom CV outcomes were available through WHI-ES procedures (N = 18,985) and/or linkage to the Centers for Medicare and Medicaid Services (N = 30,346) to a physical activity (PA) intervention designed to promote national recommendations (N = 24,657) or "usual activity" comparison (N = 24,674). Women assigned to the intervention provided passive consent to receive the intervention and provide data. A multi-component PA intervention is delivered by seasonal (quarterly) newsletters with targeted inserts (lower, middle, higher) based on self-reported levels of physical functioning (PF) and physical activity; monthly motivational telephone messages; monthly emails; a website; and contact with staff, as requested. Major CV events, myocardial infarction (MI), stroke, or CVD death, collected annually through WHI-ES, comprise the primary outcome. Hip fracture and non-CVD death are primary safety outcomes. Intention-to-treat analyses in all randomized participants will include 8 years of follow-up. CONCLUSION Determining whether increased physical activity and decreased sedentary behavior reduce major CV events in older women is of major public health significance. CLINICAL TRIALS REGISTRATION ClinicalTrials.govidentifier:NCT02425345.
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Affiliation(s)
- Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
| | - Charles Kooperberg
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA; Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
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Hooker SP, Diaz KM, Blair SN, Colabianchi N, Hutto B, McDonnell MN, Vena JE, Howard VJ. Association of Accelerometer-Measured Sedentary Time and Physical Activity With Risk of Stroke Among US Adults. JAMA Netw Open 2022; 5:e2215385. [PMID: 35657625 PMCID: PMC9166254 DOI: 10.1001/jamanetworkopen.2022.15385] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE The amount and intensity of physical activity required to prevent stroke are yet to be fully determined because of previous reliance on self-reporting measures. Furthermore, the association between objectively measured time spent being sedentary as an independent risk factor for stroke is unknown. OBJECTIVE To investigate the associations of accelerometer-measured sedentary time and physical activity of varying intensity and duration with the risk of incident stroke. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved participants who were enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from February 5, 2003, to October 30, 2007. Accelerometer data were collected from 7607 Black and White adults 45 years or older in the contiguous US between May 12, 2009, and January 5, 2013. Data on other races and ethnicities were not collected for scientific and clinical reasons. By design, Black adults and residents of the southeastern US stroke belt and stroke buckle were oversampled. Data were analyzed from May 5, 2020, to November 11, 2021. EXPOSURES Sedentary time, light-intensity physical activity (LIPA), and moderate- to vigorous-intensity physical activity (MVPA) were measured using a hip-mounted accelerometer worn for 7 consecutive days and stratified by tertile for the analyses. MAIN OUTCOMES AND MEASURES Incident stroke. RESULTS Among 7607 participants, the mean (SD) age was 63.4 (8.5) years; 4145 participants (54.5%) were female, 2407 (31.6%) were Black, and 5200 (68.4%) were White. A total of 2523 participants (33.2%) resided in the stroke belt, and 1638 (21.5%) resided in the stroke buckle. Over a mean (SD) of 7.4 (2.5) years of follow-up, 286 incident stroke cases (244 ischemic [85.3%]) occurred. The fully adjusted hazard ratios (HRs) for incident stroke in the highest tertile compared with the lowest tertile were 0.74 (95% CI, 0.53-1.04; P = .08) for LIPA and 0.57 (95% CI, 0.38-0.84; P = .004) for MVPA. Higher sedentary time was associated with a 44% greater risk of incident stroke (HR, 1.44; 95% CI, 0.99-2.07; P = .04). When comparing the highest with the lowest tertile, mean sedentary bout duration was associated with a significantly greater risk of incident stroke (HR, 1.53; 95% CI, 1.10-2.12; P = .008). After adjustment for sedentary time, the highest tertile of unbouted MVPA (shorter bouts [1-9 minutes]) was associated with a significantly lower risk of incident stroke compared with the lowest tertile (HR, 0.62; 95% CI, 0.41-0.94; P = .02); however, bouted MVPA (longer bouts [at least 10 minutes]) was not (HR, 0.78; 95% CI, 0.53-1.15; P = .17). When expressed as continuous variables, sedentary time was positively associated with incident stroke risk (HR per 1-hour/day increase in sedentary time: 1.14; 95% CI, 1.02-1.28; P = .02), and LIPA was negatively associated with incident stroke risk (HR per 1-hour/day increase in LIPA: 0.86; 95% CI, 0.77-0.97; P = .02). CONCLUSIONS AND RELEVANCE In this cohort study, objectively measured LIPA, MVPA, and sedentary time were significantly and independently associated with incident stroke risk. Longer sedentary bout duration was also independently associated with an increased risk of incident stroke. These findings suggest that replacing sedentary time with LIPA, or even very short bouts of MVPA, may lower stroke risk, supporting the concept of moving more and sitting less as a beneficial stroke risk reduction strategy among adults.
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Affiliation(s)
- Steven P. Hooker
- College of Health and Human Services, San Diego State University, San Diego, California
| | - Keith M. Diaz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Steven N. Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | | | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | | | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Virginia J. Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
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Lewey J, Murphy S, Zhang D, Putt ME, Elovitz MA, Riis V, Patel MS, Levine LD. Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial. JAMA Cardiol 2022; 7:591-599. [PMID: 35442393 PMCID: PMC9021982 DOI: 10.1001/jamacardio.2022.0553] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease, yet few interventions have targeted this population to decrease long-term risk. Objective To determine whether a digital health intervention improves physical activity in postpartum individuals with hypertensive disorders of pregnancy. Design, Setting, and Participants This 12-week randomized clinical trial enrolled postpartum individuals who delivered at the University of Pennsylvania and had a hypertensive disorder of pregnancy between October 2019 and June 2020. Analysis was intention to treat. Interventions All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the control arm received daily feedback on goal attainment. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics. Main Outcomes and Measures The primary outcome was change in mean daily step count from baseline to 12-week follow-up. Secondary outcome was proportion of participant-days that step goal was achieved. Results A total of 127 participants were randomized (64 in the control group and 63 in the intervention group) and were enrolled a mean of 7.9 weeks post partum. Participants had a mean (SD) age of 32.3 (5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6042 [2270] vs 6175 [1920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily step steps from baseline compared with the control arm (647 steps; 95% CI, 169-1124 steps; P = .009). Compared with the control arm, participants in the intervention arm achieved their steps goals on a greater proportion of participant-days during the intervention period (0.47 vs 0.38; adjusted difference 0.11; 95% CI, 0.04-0.19; P = .003). Conclusions and Relevance In this study, a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks. Trial Registration ClinicalTrials.gov Identifier: NCT03311230.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Samantha Murphy
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dazheng Zhang
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michal A. Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Valerie Riis
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Lisa D. Levine
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Chiba I, Lee S, Bae S, Makino K, Shinkai Y, Katayama O, Harada K, Yamashiro Y, Takayanagi N, Shimada H. Isotemporal Substitution of Sedentary Behavior With Moderate to Vigorous Physical Activity Is Associated With Lower Risk of Disability: A Prospective Longitudinal Cohort Study. Phys Ther 2022; 102:6506312. [PMID: 35079837 DOI: 10.1093/ptj/pzac002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/03/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of the study was to estimate, using an isotemporal substitution model, the effect of replacing sedentary behavior (SB) with physical activity on the incidence of disability in community-dwelling older adults. METHODS This 2-year longitudinal cohort study enrolled 3691 community-dwelling older adults (57.2% women; mean age = 74.0 [SD = 5.0] years). Individuals with dementia, stroke, Parkinson disease, depression, low Mini-Mental State Examination scores, dependence on basic activities of daily living, and missing data were excluded. Physical activity and potential confounding factors were investigated as a baseline survey of disability incidence, defined by Japanese long-term care insurance certification, for 2 years in 2 regions. Physical activity data (SB, light-intensity physical activity, and moderate- to vigorous-intensity physical activity [MVPA]) were measured using triaxial accelerometers for 14 days, and daily mean time spent in each physical activity parameter was computed in increments of 10 minutes. The relationship between baseline physical activity and disability incidence adjusted for potential confounders was analyzed using multilevel Cox proportional hazards regression analyses with an isotemporal substitution model. RESULTS The disability incidence rate was 3.8%, excluding individuals who could not be followed-up. Replacing 10 minutes of SB per day with MVPA was associated with a decreased disability incidence (hazard ratio = 0.870; 95% CI = 0.766-0.988), whereas no evidence was found for replacing SB with light-intensity physical activity (hazard ratio = 0.980; 95% CI = 0.873-1.10). CONCLUSIONS Replacing SB with MVPA was associated with a lower risk of disability. These findings are helpful for establishing disability prevention strategies. IMPACT These results suggest that feasible changes in daily behavior, such as replacing 10 minutes of SB with MVPA daily, might have a protective effect on disability incidence. Clarifying these associations is useful for developing disability prevention strategies and may help reduce the incidence of disability in community-dwelling older adults.
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Affiliation(s)
- Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yukari Yamashiro
- Tokyo Research Laboratories, Kao Corporation, Sumida-ku, Tokyo, Japan
| | - Naoto Takayanagi
- Tokyo Research Laboratories, Kao Corporation, Sumida-ku, Tokyo, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
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Choudhury R, Park JH, Thiamwong L, Xie R, Stout JR. Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: A Cross-sectional Study (Preprint). JMIR Aging 2022; 5:e38172. [PMID: 35994346 PMCID: PMC9400844 DOI: 10.2196/38172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/27/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Renoa Choudhury
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
| | - Joon-Hyuk Park
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
| | - Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
| | - Jeffrey R Stout
- School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
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Franklin PD, Oatis CA, Zheng H, Westby MD, Peter W, Laraque-Two Elk J, Rizk J, Benbow E, Li W. Web-based system to capture consistent and complete real-world data of physical therapy interventions following total knee replacement Methods to define and test structured data to accelerate comparative effectiveness research (Preprint). JMIR Rehabil Assist Technol 2022; 9:e37714. [PMID: 36301608 PMCID: PMC9650563 DOI: 10.2196/37714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Electronic health records (EHRs) have the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform health care system and its data to a "learning health care system" generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. Objective The purpose of this paper was to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case was ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods To identify the PT intervention type and intensity (or dose) used to treat patients with knee arthritis following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing physical therapists and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical structured system for intervention and intensity documentation was designed and deployed. Results The PT documentation system was implemented by 114 physical therapists agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 physical therapists. No technical problems with data entry were reported, and data entry required less than 2 minutes per visit. A total of 42 (2%) interventions could not be categorized and were recorded using free text. Conclusions The use of user-centered design principles provides a road map for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and disseminate knowledge to practice.
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Affiliation(s)
- Patricia D Franklin
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, United States
| | - Marie D Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Wilfred Peter
- Department of Orthopedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | | | - Joseph Rizk
- Cascade Rehabilitation Associates, Everett, WA, United States
| | - Ellen Benbow
- Magee Rehabilitation Hospital, Philadelphia, PA, United States
| | - Wenjun Li
- Department of Public Health, University of Massachusetts-Lowell, Lowell, MA, United States
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Nguyen S, Bellettiere J, Wang G, Di C, Natarajan L, LaMonte MJ, LaCroix AZ. Accelerometer-Derived Daily Life Movement Classified by Machine Learning and Incidence of Cardiovascular Disease in Older Women: The OPACH Study. J Am Heart Assoc 2022; 11:e023433. [PMID: 35191326 PMCID: PMC9075073 DOI: 10.1161/jaha.121.023433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Current physical activity guidelines focus on volume and intensity for CVD prevention rather than common behaviors responsible for movement, including those for daily living activities. We examined the associations of a machine-learned, accelerometer-measured behavior termed daily life movement (DLM) with incident CVD. Methods and Results Older women (n=5416; mean age, 79±7 years; 33% Black, 17% Hispanic) in the Women's Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study without prior CVD wore ActiGraph GT3X+ accelerometers for up to 7 days from May 2012 to April 2014 and were followed for physician-adjudicated incident CVD through February 28th, 2020 (n=616 events). DLM was defined as standing and moving in a confined space such as performing housework or gardening. Cox models estimated hazard ratios (HR) and 95% CI, adjusting for age, race and ethnicity, education, alcohol use, smoking, multimorbidity, self-rated health, and physical function. Restricted cubic splines examined the linearity of the DLM-CVD dose-response association. We examined effect modification by age, body mass index, Reynolds Risk Score, and race and ethnicity. Adjusted HR (95% CIs) across DLM quartiles were: 1.00 (reference), 0.68 (0.55-0.84), 0.70 (0.56-0.87), and 0.57 (0.45-0.74); p-trend<0.001. The HR (95% CI) for each 1-hour increment in DLM was 0.86 (0.80-0.92) with evidence of a linear dose-response association (p non-linear>0.09). There was no evidence of effect modification by age, body mass index, Reynolds Risk Score, or race and ethnicity. Conclusions Higher DLM was independently associated with a lower risk of CVD in older women. Describing the beneficial associations of physical activity in terms of common behaviors could help older adults accumulate physical activity.
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Affiliation(s)
- Steve Nguyen
- Herbert Wertheim School of Public Health and Longevity Science University of California San Diego La Jolla CA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Longevity Science University of California San Diego La Jolla CA
| | - Guangxing Wang
- Division of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle WA
| | - Chongzhi Di
- Division of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle WA
| | - Loki Natarajan
- Herbert Wertheim School of Public Health and Longevity Science University of California San Diego La Jolla CA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo - SUNY Buffalo NY
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Longevity Science University of California San Diego La Jolla CA
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Xu L, Shi H, Shen M, Ni Y, Zhang X, Pang Y, Yu T, Lian X, Yu T, Yang X, Li F. The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e27794. [PMID: 35113034 PMCID: PMC8855282 DOI: 10.2196/27794] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/29/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Background It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions. Objective This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation. Methods We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games. Results Of 2944 studies identified from the database search, 50 (1.69%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60%) combined gamification with wearable devices to improve PA behavior change, and 50% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies. Conclusions Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation.
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Affiliation(s)
- Linqi Xu
- School of Nursing, Jilin University, Changchun, China
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Hongyu Shi
- School of Nursing, Jilin University, Changchun, China
| | - Meidi Shen
- School of Nursing, Peking University, Beijing, China
| | - Yuanyuan Ni
- Department of Anaesthesia, Bethune First Hospital of Jilin University, Changchun, China
| | - Xin Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Yue Pang
- School of Nursing, Jilin University, Changchun, China
| | - Tianzhuo Yu
- School of Nursing, Jilin University, Changchun, China
| | - Xiaoqian Lian
- School of Nursing, Jilin University, Changchun, China
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, China
| | - Xige Yang
- Department of Anaesthesia, Bethune First Hospital of Jilin University, Changchun, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, China
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Garduno AC, LaCroix AZ, LaMonte MJ, Dunstan DW, Evenson KR, Wang G, Di C, Schumacher BT, Bellettiere J. Associations of Daily Steps and Step Intensity With Incident Diabetes in a Prospective Cohort Study of Older Women: The OPACH Study. Diabetes Care 2022; 45:339-347. [PMID: 35050362 PMCID: PMC8914434 DOI: 10.2337/dc21-1202] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The primary aim was to assess associations between total steps per day and incident diabetes, whereas the secondary aim was to assess whether the intensity and/or cadence of steps is associated with incident diabetes. RESEARCH DESIGN AND METHODS Women without physician-diagnosed diabetes (n = 4,838; mean [SD] age 78.9 [6.7] years) were followed up to 6.9 years; 395 developed diabetes. Hip-worn ActiGraph GT3X+ accelerometers worn for 1 week enabled measures of total, light-intensity, and moderate- to vigorous-intensity (MV-intensity) steps per day. Using Cox proportional hazards analysis we modeled adjusted change in the hazard rate for incident diabetes associated with total, light-intensity, and MV-intensity steps per day. We further estimated the proportion of the steps-diabetes association mediated by BMI. RESULTS On average, participants took 3,729 (SD 2,114) steps/day, of which 1,875 (791) were light-intensity steps and 1,854 ± 1,762 were MV-intensity. More steps per day were associated with a lower hazard rate for incident diabetes. Confounder-adjusted models for a 2,000 steps/day increment yielded hazard ratio (HR) 0.88 (95% CI 0.78-1.00; P = 0.046). After further adjustment for BMI, HR was 0.90 (95% CI 0.80-1.02; P = 0.11). BMI did not significantly mediate the steps-diabetes association (proportion mediated = 17.7% [95% CI -55.0 to 142.0]; P = 0.09]). The relationship between MV-intensity steps per day (HR 0.86 [95% CI 0.74-1.00]; P = 0.04) and incident diabetes was stronger than for light-intensity steps per day (HR 0.97 [95% CI 0.73-1.29]; P = 0.84). CONCLUSIONS These findings suggest that for older adults, more steps per day are associated with lower incident diabetes and MV-intensity steps are most strongly associated with a lower hazard of diabetes. This evidence supports that regular stepping is an important risk factor for type 2 diabetes prevention in older adults.
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Affiliation(s)
- Alexis C Garduno
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA.,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Guangxing Wang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Benjamin T Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA.,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2369] [Impact Index Per Article: 1184.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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42
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Gomes IC, Tavares VDDO, Oliveira Neto L, Agrícola PMD, Jenkins M, Smith L, Oliveira Duarte YAD. Associations between levels of physical activity and mortality in older adults: a prospective cohort study. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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43
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Ballin M, Antonsson O, Rosenqvist V, Nordström P, Nordström A. Association of dog ownership with accelerometer-measured physical activity and daily steps in 70-year-old individuals: a population-based cross-sectional study. BMC Public Health 2021; 21:2313. [PMID: 34933682 PMCID: PMC8691041 DOI: 10.1186/s12889-021-12401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Dog ownership (DO) has been associated with higher levels of self-reported walking and physical activity. However, compared to device-based measures, self-reported measures of physical activity may suffer from bias due to recall and social desirability. They are also incapable of quantifying light-intensity physical activity (LPA) and step volume, both of which may have important health benefits, especially for older adults. In this study, we investigated the association of DO with accelerometer-measured physical activity of different intensities and daily steps in 70-year-old individuals. Methods This was a population-based cross-sectional study including 1406 participants aged 70 years [54.1% female] who participated in a health survey in Umeå, Sweden between February 2017–November 2019. All participants self-reported DO [yes/no]. Daily averages of LPA, moderate-to-vigorous-intensity physical activity (MVPA), and steps per day [steps/d] were measured for 1 week using hip-mounted Actigraph GT3X+ accelerometers. Associations were investigated using linear- and logistic regression models, adjusted for sociodemographic and health-related factors, date of examination, and accelerometer wear time. Results The prevalence of DO was 14.1% [N = 199]. After adjustment for all covariates, DO was associated with 19.2 more minutes/d of LPA [95% CI, 8.8–29.6], 11.4 more minutes/d of MVPA [95% CI, 8.0–14.9] and 1738 more steps/d [95% CI, 1326–2149]. DO was also associated with twice the odds of meeting the physical activity recommendations [OR, 2.07, 95% CI, 1.48–2.90]. Exploratory interaction analyses showed that the association between DO and steps/d was stronger [Pinteraction = 0.030] in female [β = 2165, 95% CI, 1585–2744] than in male [β =1255, 95% CI, 664–1845], with a similar trend for MVPA [Pinteraction = 0.082]. Conclusions In this study of community-dwelling 70-year-old individuals, DO was associated with higher levels of daily LPA, MVPA, and steps. With the limitation of the observational design of the study, these findings add knowledge regarding the beneficial role that DO may play for promoting physical activity in the older population. In turn, these findings could support the development and evaluation of targeted interventions seeking to promote dog-friendly environments and facilitate dog walking in the community. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12401-4.
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Affiliation(s)
- Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden. .,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
| | - Oskar Antonsson
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - Viktor Rosenqvist
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.,School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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44
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Dogra S, Dunstan DW, Sugiyama T, Stathi A, Gardiner PA, Owen N. Active Aging and Public Health: Evidence, Implications, and Opportunities. Annu Rev Public Health 2021; 43:439-459. [PMID: 34910580 DOI: 10.1146/annurev-publhealth-052620-091107] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
By 2050, 20% of the world's population will be over the age of 65 years, with projections that 80% of older adults will be living in low- to middle-income countries. Physical inactivity and sedentary time are particularly high in older adults, presenting unique public health challenges. In this article, we first review evidence that points to multiple beneficial outcomes of active aging, including better physical function, cognitive function, mental health, social health, and sleep and suggest the need to shift the research focus from chronic disease outcomes to more relevant outcomes that affect independence and quality of life. Second, we review the critical role of age-friendly environments in facilitating active aging equitably across different countries and cultures. Finally, we consider emerging opportunities related to social engagement and technology-enabled mobility that can facilitate active aging. In all these contexts, it is a priority to understand and address diversity within the global aging population. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Ontario, Canada;
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Paul A Gardiner
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia.,School of Kinesiology, The University of Western Ontario, London, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
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45
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Evenson KR, Bellettiere J, Cuthbertson CC, Di C, Dushkes R, Howard AG, Parada H, Schumacher BT, Shiroma EJ, Wang G, Lee IM, LaCroix AZ. Cohort profile: the Women's Health Accelerometry Collaboration. BMJ Open 2021; 11:e052038. [PMID: 34845070 PMCID: PMC8633996 DOI: 10.1136/bmjopen-2021-052038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This paper describes the Women's Health Accelerometry Collaboration, a consortium of two prospective cohort studies of women age 62 years or older, harmonised to explore the association of accelerometer-assessed physical activity and sedentary behaviour with cancer incidence and mortality. PARTICIPANTS A total of 23 443 women (age mean 73.4, SD 6.8) living in the USA and participating in an observational study were included; 17 061 from the Women's Health Study (WHS) and 6382 from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health (WHI/OPACH) Study. FINDINGS TO DATE Accelerometry, cancer outcomes and covariate harmonisation was conducted to align the two cohort studies. Physical activity and sedentary behaviour were measured using similar procedures with an ActiGraph GT3X+ accelerometer, worn at the hip for 1 week, during 2011-2014 for WHS and 2012-2014 for WHI/OPACH. Cancer outcomes were ascertained via ongoing surveillance using physician adjudicated cancer diagnosis. Relevant covariates were measured using questionnaire or physical assessments. Among 23 443 women who wore the accelerometer for at least 10 hours on a single day, 22 868 women wore the accelerometer at least 10 hours/day on ≥4 of 7 days. The analytical sample (n=22 852) averaged 4976 (SD 2669) steps/day and engaged in an average of 80.8 (SD 46.5) min/day of moderate-to-vigorous, 105.5 (SD 33.3) min/day of light high and 182.1 (SD 46.1) min/day of light low physical activity. A mean of 8.7 (SD 1.7) hours/day were spent in sedentary behaviour. Overall, 11.8% of the cohort had a cancer diagnosis (other than non-melanoma skin cancer) at the time of accelerometry measurement. During an average of 5.9 (SD 1.6) years of follow-up, 1378 cancer events among which 414 were fatal have occurred. FUTURE PLANS Using the harmonised cohort, we will access ongoing cancer surveillance to quantify the associations of physical activity and sedentary behaviour with cancer incidence and mortality.
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Affiliation(s)
- Kelly R Evenson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - John Bellettiere
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Carmen C Cuthbertson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Chongzhi Di
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rimma Dushkes
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Annie Green Howard
- Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Humberto Parada
- Moores Cancer Center, University of California at San Diego, La Jolla, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - Benjamin T Schumacher
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland, USA
| | - Guangxing Wang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrea Z LaCroix
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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46
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Nayor M, Chernofsky A, Spartano NL, Tanguay M, Blodgett JB, Murthy VL, Malhotra R, Houstis NE, Velagaleti RS, Murabito JM, Larson MG, Vasan RS, Shah RV, Lewis GD. Physical activity and fitness in the community: the Framingham Heart Study. Eur Heart J 2021; 42:4565-4575. [PMID: 34436560 PMCID: PMC8633734 DOI: 10.1093/eurheartj/ehab580] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/14/2021] [Accepted: 08/10/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS While greater physical activity (PA) is associated with improved health outcomes, the direct links between distinct components of PA, their changes over time, and cardiorespiratory fitness are incompletely understood. METHODS AND RESULTS Maximum effort cardiopulmonary exercise testing (CPET) and objective PA measures [sedentary time (SED), steps/day, and moderate-vigorous PA (MVPA)] via accelerometers worn for 1 week concurrent with CPET and 7.8 years prior were obtained in 2070 Framingham Heart Study participants [age 54 ± 9 years, 51% women, SED 810 ± 83 min/day, steps/day 7737 ± 3520, MVPA 22.3 ± 20.3 min/day, peak oxygen uptake (VO2) 23.6 ± 6.9 mL/kg/min]. Adjusted for clinical risk factors, increases in steps/day and MVPA and reduced SED between the two assessments were associated with distinct aspects of cardiorespiratory fitness (measured by VO2) during initiation, early-moderate level, peak exercise, and recovery, with the highest effect estimates for MVPA (false discovery rate <5% for all). Findings were largely consistent across categories of age, sex, obesity, and cardiovascular risk. Increases of 17 min of MVPA/day [95% confidence interval (CI) 14-21] or 4312 steps/day (95% CI 3439-5781; ≈54 min at 80 steps/min), or reductions of 249 min of SED per day (95% CI 149-777) between the two exam cycles corresponded to a 5% (1.2 mL/kg/min) higher peak VO2. Individuals with high (above-mean) steps or MVPA demonstrated above average peak VO2 values regardless of whether they had high or low SED. CONCLUSIONS Our findings provide a detailed assessment of relations of different types of PA with multidimensional cardiorespiratory fitness measures and suggest favourable longitudinal changes in PA (and MVPA in particular) are associated with greater objective fitness.
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Affiliation(s)
- Matthew Nayor
- Sections of Cardiology and Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, 72 E Concord St, Suite L-514, Boston, MA 02118, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ariel Chernofsky
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nicole L Spartano
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, USA
| | - Melissa Tanguay
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmine B Blodgett
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Rajeev Malhotra
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas E Houstis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raghava S Velagaleti
- Cardiology Section, Department of Medicine, Boston VA Healthcare System, West Roxbury, MA, USA
| | - Joanne M Murabito
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, USA
| | - Ramachandran S Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, USA
- Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Department of Epidemiology, Boston University Schools of Medicine and Public Health, Center for Computing and Data Sciences, Boston University, Boston, MA, USA
| | - Ravi V Shah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Vanderbilt Clinical and Translational Research Center, Cardiology Division, Vanderbilt University Medical Center, Nashville, TN
| | - Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Pulmonary Critical Care Unit, Massachusetts General Hospital, Boston, MA USA
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Wegner L, Mendoza-Vasconez AS, Mackey S, McGuire V, To C, White B, King AC, Stefanick ML. Physical activity, well-being, and priorities of older women during the COVID-19 pandemic: a survey of Women's Health Initiative Strong and Healthy (WHISH) intervention participants. Transl Behav Med 2021; 11:2155-2163. [PMID: 34633465 PMCID: PMC8524531 DOI: 10.1093/tbm/ibab122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Sheltering-in-place, social distancing, and other strategies to minimize COVID-19 transmission may impact physical activity (PA) and well-being in older adults. To assess self-reported PA changes, well-being, and priorities of older women across the USA early in the COVID-19 pandemic. In May 2020, a 10-question survey was emailed to 5,822 women, aged over 70 years, who had been assigned to the Women’s Health Initiative (WHI) Strong and Healthy (WHISH) trial PA intervention and had provided email addresses. The survey assessed general and physical well-being, current priorities, and PA levels before and during the COVID-19 pandemic. Demographic and physical function data were collected previously. Descriptive analyses characterized participants’ priorities and PA changes from before the pandemic to the time of data collection during the pandemic. Differences in PA change by age, physical function, and geographic region were assessed by Kruskal-Wallis and post hoc Dunn tests. Among 2,876 survey respondents, 89% perceived their general well-being as good, very good, or excellent, despite 90% reporting at least moderate (to extreme) concern about the pandemic, with 18.2% reporting increased PA levels, 27.1% reporting no changes, and 54.7% reporting decreased PA levels. Top priorities “in the midst of the COVID-19 outbreak” were staying in touch with family/friends (21%) and taking care of one’s body (20%). Among priorities related to physical well-being, staying active was selected most frequently (33%). Support for maintaining PA in older populations should be a priority during a pandemic and similarly disruptive events.
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Affiliation(s)
- Lauren Wegner
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,University of Nebraska Medical Center, College of Medicine, Omaha, NE 68198, USA
| | - Andrea S Mendoza-Vasconez
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sally Mackey
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Valerie McGuire
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Epidemiology and Population Health, Stanford University School of Me dicine, Stanford, CA 94305, USA
| | - Cynthia To
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bailey White
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Abby C King
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Epidemiology and Population Health, Stanford University School of Me dicine, Stanford, CA 94305, USA
| | - Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Epidemiology and Population Health, Stanford University School of Me dicine, Stanford, CA 94305, USA
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48
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Sun X, Zhao S, Chen K, Hua W, Su Y, Liu X, Xu W, Wang F, Fan X, Dai Y, Liu Z, Zhang S. Association between cardiac autonomic function and physical activity in patients at high risk of sudden cardiac death: a cohort study. Int J Behav Nutr Phys Act 2021; 18:128. [PMID: 34544427 PMCID: PMC8454096 DOI: 10.1186/s12966-021-01200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background High levels of physical activity (PA) and heart rate variability (HRV) are associated with cardiovascular benefits in patients with cardiovascular diseases. HRV, representing cardiac autonomic function, is positively associated with PA. However, the impacts of PA and cardiac autonomic function on cardiovascular outcomes were not analysed in the same study population. This lack of evidence supported our hypothesis that PA might contribute to cardiovascular benefits via enhanced cardiac autonomic function. Methods Patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy defibrillator (CRT-D) implantation were included from the SUMMIT registry. HRV and PA values were assessed during the first 30–60 days post device implantation using a continuous home monitoring system. Causal mediation analysis was conducted to explore the possible mediation function of HRV in the association of PA with long-term cardiac death and all-cause mortality in patients at a high risk of sudden cardiac death. Results Over a mean follow-up period of 47.7 months, 63 cardiac deaths (18.9%) and 85 all-cause death events (25.5%) were observed among 342 patients with ICD/CRT-D implantation. A positive linear association between HRV and PA was demonstrated and the β value of HRV was 0.842 (95% confidence interval [CI]: 0.261–1.425, P = 0.005) in the multiple linear regression analysis. Multivariable Cox proportional hazards analysis revealed that high levels of PA (≥11.0%) and HRV (≥75.9 ms) were independent protective factors against cardiac death (PA: hazard ratio [HR] = 0.273; 95% CI, 0.142–0.526, P < 0.001; HRV: HR = 0.224; 95% CI, 0.103–0.489, P < 0.001) and all-cause mortality (PA: HR = 0.299; 95% CI, 0.177–0.505, P < 0.001; HRV: HR = 0.394; 95% CI, 0.231–0.674, P = 0.001). Causal mediation analysis demonstrated partial mediation effects of PA that were mediated through HRV on cardiac death (mediation proportion = 12.9, 95%CI: 2.2–32.0%, P = 0.006) and all-cause mortality (mediation proportion = 8.2, 95%CI: 1.6–20.0%, P = 0.006). Conclusions HRV might be a modest mediator in the association between high levels of PA and the reduced risks of cardiac death and all-cause mortality in ICD/CRT-D recipients. This finding supports that enhanced cardiac autonomic function might be one of the underlying mechanisms by which regular PA contributes to cardiovascular benefits.
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Affiliation(s)
- Xuerong Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shuang Zhao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Keping Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Fang Wang
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohan Fan
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Yan Dai
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Zhimin Liu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China.
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Walmsley R, Chan S, Smith-Byrne K, Ramakrishnan R, Woodward M, Rahimi K, Dwyer T, Bennett D, Doherty A. Reallocation of time between device-measured movement behaviours and risk of incident cardiovascular disease. Br J Sports Med 2021; 56:bjsports-2021-104050. [PMID: 34489241 PMCID: PMC9484395 DOI: 10.1136/bjsports-2021-104050] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To improve classification of movement behaviours in free-living accelerometer data using machine-learning methods, and to investigate the association between machine-learned movement behaviours and risk of incident cardiovascular disease (CVD) in adults. METHODS Using free-living data from 152 participants, we developed a machine-learning model to classify movement behaviours (moderate-to-vigorous physical activity behaviours (MVPA), light physical activity behaviours, sedentary behaviour, sleep) in wrist-worn accelerometer data. Participants in UK Biobank, a prospective cohort, were asked to wear an accelerometer for 7 days, and we applied our machine-learning model to classify their movement behaviours. Using compositional data analysis Cox regression, we investigated how reallocating time between movement behaviours was associated with CVD incidence. RESULTS In leave-one-participant-out analysis, our machine-learning method classified free-living movement behaviours with mean accuracy 88% (95% CI 87% to 89%) and Cohen's kappa 0.80 (95% CI 0.79 to 0.82). Among 87 498 UK Biobank participants, there were 4105 incident CVD events. Reallocating time from any behaviour to MVPA, or reallocating time from sedentary behaviour to any behaviour, was associated with lower CVD risk. For an average individual, reallocating 20 min/day to MVPA from all other behaviours proportionally was associated with 9% (95% CI 7% to 10%) lower risk, while reallocating 1 hour/day to sedentary behaviour from all other behaviours proportionally was associated with 5% (95% CI 3% to 7%) higher risk. CONCLUSION Machine-learning methods classified movement behaviours accurately in free-living accelerometer data. Reallocating time from other behaviours to MVPA, and from sedentary behaviour to other behaviours, was associated with lower risk of incident CVD, and should be promoted by interventions and guidelines.
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Affiliation(s)
- Rosemary Walmsley
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Shing Chan
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Karl Smith-Byrne
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Rema Ramakrishnan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- Professorial Unit, The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Kazem Rahimi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Terence Dwyer
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Heart Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Derrick Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Resnick B, Boltz M, Galik E, Zhu S. The Impact of Cognitive impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings. Clin Nurs Res 2021; 31:310-319. [PMID: 34472369 DOI: 10.1177/10547738211040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living using the Evidence Integration Triangle (FFC-AL-EIT). A total of 550 residents were recruited from 59 communities. The average age of participants was 89.30 (SD = 7.63), the majority were white (98%), female (69%), had evidence of cognitive impairment (75%), and 5.16 (SD = 1.86) comorbidities. Those with cognitive impairment had more pain, were more sedentary and less likely to engage in function focused care activities. Addressing pain and implementing interventions for those with cognitive impairment to participate in function focused care may help optimize function and physical activity in assisted living residents.
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Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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