Precision in Promoting Physical Activity and Exercise With the Overarching Goal of Moving More

Engagement in physical activity among African American women caregivers: a cross-sectional study

Family caregivers and African Americans often do not achieve the recommended 150 minutes of moderate-intensity aerobic activity per week. Factors associated with engaging in physical activity among African American caregivers have not been systematically examined. This cross-sectional study examined how contextual factors were associated with meeting the recommended amount of physical activity among African American women caregivers. We used a population-based sample of 1,478 African American women caregivers in the U.S. from the 2015, 2017, and 2019 Behavioral Risk Factor Surveillance System. We used survey-weighted multivariate regression analyses to examine associations between condition-specific factors, physical and social environment, and individual and family factors and meeting the national aerobic physical activity guideline (i.e., participating in 150 minutes (or vigorous equivalent minutes) of physical activity per week). Over half (53.9%) of African American women caregivers in the U.S. did not meet the guideline. Being age 65 years or older was associated with decreased odds of meeting the guideline compared to being between the ages of 25-44 years (OR = 0.50, 95% CI[0.26-0.99]). Compared to college graduates, women with partial college education had higher odds of meeting the guideline (OR = 2.08, 95%CI[1.24-3.51]). Having health insurance was associated with increased odds of meeting the guideline (OR = 2.28, 95%CI[1.12-4.63]). Our findings suggest several contextual factors are independently associated with meeting the national guideline. Understanding the relationships between contextual factors and engaging in physical activity among African American women caregivers can inform interventions aimed at protecting and promoting the health of these women.

Metabolic equivalents intensity thresholds for physical activity classification in older adults

BACKGROUND

Although the metabolic equivalents (METs) system is a common procedure to quantify the intensity of physical activity in older adults, it remains unclear whether the conventional METs intensity thresholds (CTs) used for this purpose are appropriate in this population. Therefore, this study aimed (i) to derive overall and fitness-specific METs intensity thresholds in older adults ≥ 60 years old (OATs) expressed both in standard METs (VO2/3.5 mL O2·kg-1·min-1) and older adults METs60+ (VO2/2.7 mL O2·kg-1·min-1), and (ii) to compare them with the CTs.

METHODS

A total of 93 subjects were assessed for cardiorespiratory fitness. Graded exercise test protocols using indirect calorimetry were performed to calculate individual VO2max and categorize subjects as "very poor/fair" or "good/superior" fitness. Overall and fitness-specific OATs expressed in standard METs (OATsstandard) and METs60+ (OATs60+) were derived based on the %VO2max and the ventilatory thresholds (VTs) physical intensity categories.

RESULTS

Significantly higher VO2max, VO2 at VT1 and VO2 at VT2 (p < 0.001) were obtained in the "good/superior" subgroup compared to the "very poor/fair" fitness subgroup. Accordingly, OATs were approximately 69% higher in individuals with a "good/superior" fitness compared to those with a "very poor/fair" fitness. Furthermore, this study showed that OATsstandard were approximately 21-24% lower than OATs60+, and 10-22% higher OATs were observed when following the VTs intensity categories (heavy-intensity physical activity [HPA] and severe-intensity physical activity [SPA]) compared to the %VO2max categories (moderate-intensity physical activity [MPA] and vigorous-intensity physical activity [VPA]). When compared with the CTs, similar or higher OATsstandard and OATs60+ for MPA, and HPA were obtained compared to the conventional MPA threshold (3.0 METs). Conversely, for VPA and SPA, lower, similar, or higher OATs were obtained depending on the METs derivation approach (OATsstandard or OATs60+) or the intensity categories (VO2max or VTs), compared to the conventional VPA threshold (6.0 METs).

CONCLUSIONS

None of the derived OATs were concurrently similar to the CTs, suggesting that fitness-specific METs intensity thresholds adapted to the METs derivation approach should be used in older adults.

TRIAL REGISTRATION

FenotipAGING (Non-health-care intervention study), PRO-Training (NCT05619250).

Global status of cardiorespiratory fitness and physical activity - Are we improving or getting worse?

Despite heightened recognition of the importance of cardiorespiratory fitness (CRF) to cardiovascular (CV) health, along with updated international consensus guidelines for physical activity (PA) and sedentary behavior (SB), significant proportions of the global adult population are physically inactive, and do not meet the threshold for CRF. Physical inactivity is considered a surrogate for low CRF given that the former is defined as not reaching the recommended minimum level of PA per week to derive a health benefit. Physical inactivity remains a major global public health problem despite decades of work by various United Nations agencies, and members of the international community to improve PA levels. Given the common coupling between physical inactivity and poor health status, it is reasonable to suggest that for a significant proportion of the global population, CRF is compromised by physical inactivity. This poses a longer-term risk to morbidity and mortality. Here we provide an indicative summary of the global status of CRF and PA and reference the implications for global health. We briefly reference opportunities moving forward, including reinforcement of the importance of engaging in movement from an early age, discouraging SB, and taking a life course approach to optimise healthy living for all.

Time Devoted to Individual, Collective, and Two-Person Sports: Its Association with Risk of Exercise Addiction and Alcohol Use Disorder

INTRODUCTION

Although sport activities have beneficial effects on health, excessive practice can lead to exercise addiction (EA), which can be associated with other addictive behaviors. However, results regarding the comorbidities between EA and alcohol use disorder (AUD) remain heterogeneous. This study aims to investigate the relationship between a proxy of AUD and different sport practices, more specifically focusing on EA.

METHODS

One thousand nine hundred eighty-five (N = 1,985) participants were recruited online and selected to represent the French adult population. Participants were asked to answer questions regarding sport activity, with the EA inventory questionnaire investigating EA, and alcohol consumption, with the CAGE questionnaire investigating a proxy of AUD (score ≥2).

RESULTS

AUD was associated with a higher risk of EA and with more time devoted to collective sports (such as football) and two-person sports (such as tennis). The risk of EA was higher for individual sports (such as running), and the risk of AUD seems to increase with the level of physical activity for collective sport but to decrease for individual sports. The type of sports partly but significantly mediated the relationship between AUD and EA.

CONCLUSIONS

Results support the hypothesis that different types of sport have different risks for EA (individual sports being more concerned) and AUD (collective sports being more concerned). Results suggest that the type of sports may be a crucial variable to understand how physical activity can be a risk factor for alcohol disorders. The social dimension of collective sports should be further investigated to facilitate preventive approaches.

Occupational and domestic physical activity and diabetes risk in adults: Results from a long-term follow-up cohort

BACKGROUND

Physical activity (PA) has been associated with decreased incidence of diabetes. However, few studies have evaluated the influence of occupational and domestic PA on the risk of diabetes with a long-term follow-up. We aimed to examine the association between occupational and domestic PA and the risk of diabetes in a long-term prospective cohort of Chinese adults.

METHODS

A total of 10,343 adults who were followed up in the China Health and Nutrition Survey from 1997 to 2015 were included in our analysis. Occupational and domestical PA were collected with detailed seven-day data and were converted into metabolic equivalents values. Total PA included occupational, domestic, transportation, and leisure time PA. Diabetes cases were identified by self-reported doctor/health professional diagnosis of diabetes, fasting blood glucose ≥7.0 mmol/L, and glycosylated hemoglobin (HbA1c) ≥6.5%. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

During up to 18 years of follow-up (median 10 years), there were 575 diabetes cases documented. Occupational PA accounted for the majority of total PA (68%) in Chinese population, followed by domestic PA (25%). With adjustments for possible covariates, the highest quartiles of total PA (HR, 0.728 [95% CI, 0.570-0.929]) and occupational PA (HR, 0.765 [95% CI, 0.596-0.982]) were significantly associated with a lower risk of diabetes compared with lowest quartiles. The association between domestic PA and the risk of diabetes was insignificant (P >0.05).

CONCLUSION

Higher levels of occupational PA were associated with a decreased risk of diabetes risk in the Chinese population. Domestic PA was not associated with the incidence of diabetes.

Investigating the Immediate Influence of Moderate Pedal Exercises during an Assembly Work on Performance and Workload in Healthy Men

Physical inactivity has increased in prevalence among adults in industrialized and developing countries owing to the fact that the majority of job situations require individuals to remain seated for extended periods of time. This research aims to evaluate the influence of cycling on a stationary bike while executing a keyboard assembly task on the task completion time, error percentage, and physiological and subjective measurements. The physiological measures were electroencephalography (EEG) and electrocardiographic (ECG) signal responses, whereas the subjective measures were subjective workload ratings and subjective body discomforts. Two variables were evaluated, namely assembly methods (with versus without pedal exercises at a moderate intensity) and session testing (pre- versus post-test). Thus, the repeated measures design (i.e., assembly method by session testing of participants) was used. According to the completion time, error %, participant self-reports, and ECG and EEG statistical analysis data, the participants' performances in the keyboard assembly task did not decrease while they performed pedaling exercises (p > 0.05). Additionally, when participants completed the assembly task while executing the pedaling exercises, the mean inter-beat (RR) intervals significantly reduced (p < 0.05) while the mean heart rate increased (p < 0.05), which mean that pedaling exercises caused physical workloads on the participants. Participant performance was unaffected by performing a workout while performing the assembly activity. Thus, administrations should encourage their employees to engage in short sessions of moderate-intensity exercise similar to the suggested exercise in the study to improve a person's physical health during work without interfering with the effectiveness of work.

Utilizing Machine Learning Techniques to Predict the Efficacy of Aerobic Exercise Intervention on Young Hypertensive Patients Based on Cardiopulmonary Exercise Testing

Recently, the incidence of hypertension has significantly increased among young adults. While aerobic exercise intervention (AEI) has long been recognized as an effective treatment, individual differences in response to AEI can seriously influence clinicians' decisions. In particular, only a few studies have been conducted to predict the efficacy of AEI on lowering blood pressure (BP) in young hypertensive patients. As such, this paper aims to explore the implications of various cardiopulmonary metabolic indicators in the field by mining patients' cardiopulmonary exercise testing (CPET) data before making treatment plans. CPET data are collected "breath by breath" by using an oxygenation analyzer attached to a mask and then divided into four phases: resting, warm-up, exercise, and recovery. To mitigate the effects of redundant information and noise in the CPET data, a sparse representation classifier based on analytic dictionary learning was designed to accurately predict the individual responsiveness to AEI. Importantly, the experimental results showed that the model presented herein performed better than the baseline method based on BP change and traditional machine learning models. Furthermore, the data from the exercise phase were found to produce the best predictions compared with the data from other phases. This study paves the way towards the customization of personalized aerobic exercise programs for young hypertensive patients.

Ambiguity in Communicating Intensity of Physical Activity: Survey Study

Background

Communicating physical activity information with sufficient details, such as activity type, frequency, duration, and intensity, is vital to accurately delineate the attributes of physical activity that bring positive health impact. Unlike frequency and duration, intensity is a subjective concept that can be interpreted differently by people depending on demographics, health status, physical fitness, and exercise habits. However, activity intensity is often communicated using general degree modifiers, degree of physical exertion, and physical activity examples, which are the expressions that people may interpret differently. Lack of clarity in communicating the intensity level of physical activity is a potential barrier to an accurate assessment of exercise effect and effective imparting of exercise recommendations.

Objective

This study aimed to assess the variations in people’s perceptions and interpretations of commonly used intensity descriptions of physical activities and to identify factors that may contribute to these variations.

Methods

A Web-based survey with a 25-item questionnaire was conducted using Amazon Mechanical Turk, targeting adults residing in the United States. The questionnaire included questions on participants’ demographics, exercise habits, overall perceived health status, and perceived intensity of 10 physical activity examples. The survey responses were analyzed using the R statistical package.

Results

The analyses included 498 responses. The majority of respondents were females (276/498, 55.4%) and whites (399/498, 79.9%). Numeric ratings of physical exertion after exercise were relatively well associated with the 3 general degree descriptors of exercise intensity: light, moderate, and vigorous. However, there was no clear association between the intensity expressed with those degree descriptors and the degree of physical exertion the participants reported to have experienced after exercise. Intensity ratings of various examples of physical activity differed significantly according to respondents’ characteristics. Regression analyses showed that those who reported good health or considered regular exercise was important for their health tended to rate the intensity levels of the activity examples significantly higher than their counterparts. The respondents’ age and race (white vs nonwhite) were not significant predictors of the intensity rating.

Conclusions

This survey showed significant variations in how people perceive and interpret the intensity levels of physical activities described with general severity modifiers, degrees of physical exertion, and physical activity examples. Considering that these are among the most widely used methods of communicating physical activity intensity in current practice, a possible miscommunication in assessing and promoting physical activity seems to be a real concern. We need to adopt a method that represents activity intensity in a quantifiable manner to avoid unintended miscommunication.

Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults

Objective

Aim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity.

Research design and methods

The prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate.

Results

After ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m2, which differed by ~0.5 kg/m2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI.

Conclusions

Among Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.

Evaluating Individual Level Responses to Exercise for Health Outcomes in Overweight or Obese Adults

Background

Understanding group responses to a given exercise exposure is becoming better developed; however, understanding of individual responses to specific exercise exposures is significantly underdeveloped and must advance before personalized exercise medicine can become a functional reality. Herein, utilizing data from the STRRIDE studies, we address some of the key issues surrounding our efforts to develop better understanding of individual exercise responsiveness.

Methods

We assessed individual cardiometabolic and cardiorespiratory fitness responses in subjects successfully completing STRRIDE I (n = 227) and STRRIDE II (n = 155). Subjects were previously sedentary, overweight or obese men and women with mild-to-moderate dyslipidemia. Subjects were randomized to either an inactive control group or to an exercise training program. Training groups varied to test the differential effects of exercise amount, intensity, and mode on cardiometabolic health outcomes. Measures included fasting plasma glucose, insulin, and lipids; blood pressure, minimal waist circumference, visceral adipose tissue, and peak VO₂. Absolute change scores were calculated for each subject as post-intervention minus pre-intervention values in order to evaluate the heterogeneity of health factor responsiveness to exercise training.

Results

For subjects completing one of the aerobic training programs, change in peak VO₂ ranged from a loss of 37% to a gain of 77%. When ranked by magnitude of change, we observed discordant responses among changes in peak VO₂ with changes in visceral adipose tissue, HDL-C, triglycerides, and fasting plasma insulin. There was also not a clear, direct relationship observed between magnitudes of individual response in the aforementioned variables with aerobic training adherence levels. This same pattern of highly variable and discordant responses was displayed even when considering subjects with adherence levels greater than 70%.

Conclusion

Our findings illustrate the unclear relationship between magnitude of individual response for a given outcome with training adherence and specific exercise exposure. These discordant and heterogeneous responses highlight the difficult nature of developing understanding for how individuals will respond to any given exposure. Further investigation into the biological, physiological, and genetics factors affecting individual responsiveness is vital to making personalized exercise medicine a reality.

Impact of therapeutic lifestyle changes in resistant hypertension

Hypertensive individuals are at an increased risk of developing heart disease and stroke. Adopting healthy lifestyles, such as being active on ≥4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN). Among the 1 in 3 Americans who have HTN (systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg), 16% are diagnosed with resistant HTN (RHT). Although there are comparatively fewer studies examining the blood pressure lowering effects of therapeutic lifestyle interventions in patients with resistant HTN, the available literature appears promising. This paper reviews key studies that quantify the blood pressure lowering effects of certain therapeutic lifestyles in patients with RHT and highlights areas needing more attention.