Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study

Get BusActive!: Protocol of a single-blinded randomised controlled trial incentivising public transport use for physical activity gain among young people and adults

Background

Population level physical activity generally does not meet recommended targets. Compared with private motor vehicle users, public transport users tend to be more physically active and financial incentives may encourage more public transport use, but these relationships are under-investigated. This paper describes the protocol of a randomised controlled trial that aimed to determine the effect of financially incentivising public transport use on physical activity in a regional Australian setting.

Methods

Get BusActive! is a 9.5-month single-blinded randomised controlled trial. A convenience sample of Tasmanians aged ≥15 years will be randomised to a 14-week incentive-based intervention (bus trip target attainment rewarded by bus trip credits and weekly supportive text messages) or an active control following baseline measures and will be followed up ∼24 weeks later (maintenance phase). Both groups will receive written physical activity guidelines. The primary outcome is change in accelerometer-measured steps/day from baseline to immediately post intervention phase and maintenance phase. Secondary outcomes are change in: smartcard-measured bus trips/week; measured and self-reported minutes/week of physical activity and sitting; transport-related behaviour (using one-week travel diary), perspectives (e.g. enablers/barriers) and costs; health. Linear mixed model regression will determine group differences. Participant-level process evaluation will be conducted and intervention cost to the public transport provider determined.

Conclusion

Get BusActive! will fill an important knowledge gap about the causal relationship between financially incentivised public transport use and physical activity-the findings will benefit health and transport-related decision makers.

Trial registration

ACTRN12623000613606.

Universal trial number

U1111-1292-3414.

Effects of physical activity on blood pressure and mortality among aged hypertensive patients: A cross-sectional study

Previous research on physical activity (PA) has mostly concentrated on a single or small number of activities, with scant coverage of the effects of PA on hypertension (HTN) and all-cause mortality. Most studies examining HTN in the elderly have been too small or shown contradictory findings. We conducted a cross-sectional study using 10 cycles of the National Health and Nutrition Examination Survey data from 1999 to 2018. Our sample consisted of respondents aged 65 years or older with HTN, who underwent thorough in-person home interviews. We used a questionnaire to assess their PA levels and divided them into 2 groups: physically active and inactive. We then used logistic analysis to determine the association between PA and death in HTN patients. The gender distribution was nearly equal among the 11,258 participants, with a mean age of 74.36 ± 5.88 years. Nearly 80% of the survey respondents identified as non-Hispanic White. Patients in the physically active group were less likely to suffer from co-morbidities than those in the inactive group. A negative correlation was found between physically active and systolic blood pressure (P < .0001) and a positive correlation between physically active and diastolic blood pressure (P = .0007). There was a much higher risk of death from any cause and heart disease in the inactive group in the uncorrected COX model (HR 2.96, CI 2.65-3.32, P < .0001; HR 3.48, CI 2.64-4.58, P < .0001). The risk of death from any cause and HTN mortality was still significantly higher in the physically inactive group, even after controlling for age, sex, and race or taking all covariates into account. These results have the potential to significantly impact healthcare practices, particularly in the field of geriatric care, by emphasizing the importance of PA in reducing the risk of HTN and mortality in aged patients. The present study underscores the significant benefits of PA in patients aged 65 years and older with HTN. Notably, it was found to reduce systolic blood pressure and have a positive impact on the decrease of all-cause and hypertensive mortality. These findings highlight the crucial role of PA in the health and longevity of aged patients with HTN.

NADPH mimics the antidepressant effects of exercise in a chronic unpredictable stress rat model

Exercise is known to be an effective intervention for depression. NADPH has been demonstrated to have neuroprotective effects in our previous studies. This study aimed to investigate if NADPH has antidepressant effects and can mimic the effects of exercise in a chronic unpredictable stress (CUS) rat model. CUS rats underwent an 8-week swimming exercise (30 min/d, 5d/w) or were intraperitoneally administered 4 mg/kg or 8 mg/kg NADPH. The open field test (OFT), sucrose preference test (SPT), novelty-suppressed feeding test (NSFT), and forced swimming test (FST) were used to examine the antidepressant-like behaviors of the rats. Exercise, 4 mg/kg, and 8 mg/kg NADPH similarly reduced anxiety, as demonstrated by the number of fecal pellets. Meanwhile, exercise and 8 mg/kg NADPH significantly increased locomotion activity in the OFT. Exercise, 4 mg/kg, and 8 mg/kg NADPH effectively reversed CUS-induced anhedonia in rats in the SPT. Exercise, 4 mg/kg, and 8 mg/kg NADPH had no impact on appetite of depressed rats; however, 8 mg/kg NADPH increased the rats' exploratory activity in the NSFT. Exercise, 4 mg/kg, and 8 mg/kg NADPH significantly reduced the immobility time of CUS model rats, while exercise and 8 mg/kg NADPH postponed the early CUS-induced "immobility" in the FST. These results demonstrated that NADPH has similar antidepressant-like effects to exercise in CUS-induced depression model rats and is a potential exercise-mimicking antidepressant.

Look, over there! A streaker! - Qualitative study examining streaking as a behaviour change technique for habit formation in recreational runners

Background

Running as a form of physical activity is beneficial to overall health and wellbeing. The aim of the study is to examine 'run streaking' (i.e. running on consecutive days, for a minimum period of time or distance, typically at least one mile) as a technique for habit formation and behaviour change.

Methods

Qualitative semi-structured interviews with 21 recreational adult runners (11 female and 10 male). Run streak length ranged from a minimum of 100 days to over 4500 days. Transcripts were analysed using a hybrid deductive-inductive thematic analysis.

Results

Run streaking was reported to lead to several benefits, health improvements and a sense of accomplishment, although many run streakers reported running through injuries and lack of recovery. Accounts of run streaking showed features of automaticity indicative of habitual behaviour. Other behavioural processes identified included motivation, identity, self-regulation and social support. Behavioural streaking showed the potential to influence change in behaviours other than running.

Conclusion

Accounts of run streaking demonstrate an interplay between automatic and deliberate processes in the maintenance of running behaviour. Behavioural streaking is a technique that could be used in other behaviour change contexts beyond running to support habit formation.

Mixed comparison of different exercise interventions on physical functioning in adult patients with morbid obesity following bariatric surgery: a systematic review and network meta-analysis

Introduction

People who are overweight following bariatric surgery (BS) often need physical exercise to help with body function. However, it is not known which exercise interventions are more effective in improving physical function.

Methods

PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for randomized controlled trials evaluating the effects of different exercise interventions on physical function in patients with excessive obesity following bariatric surgery. Outcome measures included effect sizes for physical function (PF), expressed as the number of stand-sit passes or the maximum distance walked within a time limit, body mass index (BMI), and blood pressure (BP). A systematic review was conducted to screen and synthesize the included studies, followed by a network meta-analysis for quantitative data analysis.

Results

A total of 15 studies involving 1011 patients were included. For PF, telehealth core exercise had the highest probability (0.46) of being the most effective intervention. For BMI, nutritional behavior and guided exercise, intervention had the highest probability (0.27) of being the most effective. Regarding BP, exercise prescription had the highest probability (0.47) for improving systolic blood pressure, while aerobic and strength and flexibility training had the highest probability (0.6) for improving diastolic blood pressure.

Discussion

Telehealth core exercise may be the most effective intervention for enhancing PF in overweight patients after bariatric surgery. Changes in BMI and BP with different postoperative exercise interventions may depend more on the surgery itself than the exercise modality. More specifically designed RCTs are needed for reliable conclusions.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42024507209.

Electroacupuncture Reduces Heart Rate and Perceived Exertion During a Bike Test: A Preliminary Analysis

BACKGROUND

Preliminary research suggests that acupuncture can improve cardiovascular function. The purpose of our study was to determine if electroacupuncture can improve performance and post-exercise recovery.

METHODS

Thirty-two healthy people participated in this study (14 men and 18 women, aged 23.6 ± 3.5 years). The first visit included baseline measurements. Then, the participants received daily electroacupuncture at acupuncture point PC6 for a week, followed by a second visit. Heart rate, perceived exertion, and systolic and diastolic blood pressure were measured before, during, and after a YMCA submaximal bike test.

RESULTS

The heart rate was significantly reduced during the final stage of the YMCA test (151.3 ± 7.0 to 146.7 ± 11.8; p = 0.013) on the second visit. The rate of perceived exertion was significantly lower during all stages in Visit 2 (average RPE Visit 2 = 10.71 ± 2.02; average RPE Visit 1 = 11.45 ± 1.98; p = 0.004). Systolic blood pressure significantly decreased during the 5 min post-test recovery (SBP Visit 2 = 116.9 ± 12.0; SBP Visit 1 = 145.7 ± 14.6, p < 0.05).

CONCLUSIONS

A week of electroacupuncture at PC6 led to reduced heart rate and perceived exertion during exercise, making the workload feel less strenuous. Electroacupuncture at PC6 shows potential for increasing participation in physical activities by making them feel easier to accomplish.

SoccHealth: a health status examination of former professional football (soccer) players within the German National Cohort

The long-term health effects of football (soccer) have received significant attention in recent years. While brain health is currently the focus of this interest, potential long-term risks or benefits related to cardiovascular and metabolic diseases and cancer are also of interest to sports medicine professionals. However, studies assessing the overall health risks for professional football players remain scarce. We introduce 'SoccHealth', a satellite project to the German National Cohort (NAKO), Germany's largest population-based cohort study. SoccHealth examined 348 former professional football players aged 40-69 using the infrastructure and comprehensive examination programme of NAKO. The German Statutory Accidental Insurance for Professional Athletes identified and invited male players, while female players were recruited among former national team members. Details of the examination programme and the sociodemographic and career-related characteristics of the participants are described. The identical examination programme for the NAKO participants provides the opportunity to draw general population controls according to various definitions and focus on the respective research question to be analysed. This report delineates one approach to evaluate the long-term health effects of football across a broad range of diseases.

The impact of parkrun on life satisfaction and its cost-effectiveness: A six-month study of parkrunners in the United Kingdom

An intervention suggested by the World Health Organisation that might increase life satisfaction is parkrun, a free, weekly, timed five kilometre run or walk. The issues with such interventions are (1) whether they impact on the life satisfaction of their participants, and (2) whether they are cost-effective. A study of 548 newly registered parkrunners were asked about their life satisfaction at baseline and six months later. A change of one life satisfaction point per year per participant was defined as one WELLBY (wellbeing adjusted life year), with a value of £13,000. Three approaches were used to estimate the additionality (added value) of parkrun: (1) by comparing a participant's number of parkruns to total activity; (2) by accounting for the participant's perceived impact of parkrun across 16 measures; and (3) combining these two methods equally. After six months, weighted, seasonally adjusted life satisfaction increased from a mean of 7.489 to 7.746, a change of 0.257. Both life satisfaction improvement and additionality were greatest for the least active. Assuming only half a year of benefit, the total value of the life satisfaction change for the 2019 parkrun population of 400,167 participants was estimated as £667.4m, with the least active accounting for almost half. Comparing to the cost of running parkrun in 2019 and using the activity, impact and combined methods for additionality, benefit-cost analysis ratios were found to be 16.7, 98.5 and 59.3 to 1, respectively. These were between 2.8 to 16.7 times that of other population-level physical activity interventions. Physical health was a mediator between activity and life satisfaction; mental health was only found as a mediator when combined with physical activity. Successful features of parkrun that might guide other interventions include its framing (role, time, place and cost) and ability to forge both strong and weak social ties.

Protocol for a randomized controlled trial of moderate intensity interval training in individuals with chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome who have excessive daytime sleepiness

BACKGROUND

The term "Overlap Syndrome" (OS) describes the presence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a single individual. Excessive daytime sleepiness (EDS) is a common symptom of OS shown to be associated with an increased risk of cardiovascular disease (CVD) that could be reduced through exercise. Thus, we propose to investigate a novel exercise intervention in individuals with the EDS-OS phenotype as they are at highest risk of CVD yet have the greatest barriers to exercise.

METHODS

We will conduct a single-site, randomized, two-arm, parallel group-controlled exercise trial in individuals with EDS-OS. The Epworth Sleepiness Scale (ESS) will be assessed at baseline. Individuals with OS and the EDS-OS phenotype (ESS >10) (n = 46) will be randomized to a moderate intensity interval training (MIIT, i.e. intervals of 5 min at 50% VO2peak followed by 3 min of active recovery at 10% VO2peak) or a control group of standard of care. We will investigate if MIIT intervention decreases the risk of CVD in EDS-OS, which will be assessed by: 1) quality of life, measured by the 36-Item Short Form Health Survey; 2) physical activity, measured by daily step counts; and 3) cardiovascular health, assessed as VO2peak, flow-mediated dilation and serum high sensitivity C-reactive protein, lipids, and glucose.

CONCLUSION

Our findings will guide future development and implementation of exercise interventions that could reduce the risk of CVD in the understudied EDS-OS phenotype.

Effect of physical activity on risk reduction of infective endocarditis among patients with diabetes: a nationwide cohort study

Patients with diabetes mellitus (DM) are at a higher risk of infectious diseases, and exercise is an important treatment modality for DM. Despite their susceptibility to infection in diabetic patients, the association between the amount of physical activity and the incidence of infective endocarditis (IE) is unclear. We attempted to demonstrate risk reduction by physical activity in diabetic patients with IE. From the National Health Insurance database, patients with DM were verified, and the incidence of IE was investigated. The level of physical activity was categorized into < 500, 500-999, 1,000-1,499, and ≥ 1,500 metabolic equivalent task (METs) minutes/week. Cox proportional hazard models were used to analyze the relationship between incident IE and physical activity. A total of 2,603,012 patients were included in this study. The incidence rate of IE was 10.06, 9.45, 7.78, and 8.84 in < 500, 500-999, 1,000-1,499, and ≥ 1,500 METs-minutes/week groups, respectively (100,000 person/year). A significant risk reduction of incident IE was observed in the 1,000-1499 and ≥ 1,500 METs-min/week groups compared to the < 500 METs-min/week group (Hazard ratio = 0.82, 95% confidence interval [0.690-0.976], HR = 0.831, 95% CI [0.704-0.981]). An analysis of a large national cohort database demonstrated that physical exercise reduced the risk of IE in patients with DM.

Predicting all-cause mortality and premature death using interpretable machine learning among a middle-aged and elderly Chinese population

Objective

To develop machine learning-based prediction models for all-cause and premature mortality among the middle-aged and elderly population in China.

Method

Adults aged 45 years or older at baseline of 2011 from the China Health and Retirement Longitudinal Study (CHARLS) were included. The stacked ensemble model was built utilizing five selected machine learning algorithms. These models underwent training and testing using the CHARLS 2011-2015 cohort (derivation cohort) and subsequently underwent external validation using the CHARLS 2015-2018 cohort (validation cohort). SHapley Additive exPlanations (SHAP) was introduced to quantify the importance of risk factors and explain machine learning algorithms.

Result

In derivation cohort, a total of 10,677 subjects were included, 478 died during the follow-up. The stacked ensemble model demonstrated the highest efficacy in terms of its discrimination capability for predicting all-cause mortality and premature death, with an AUC[95 % CI] of 0.826[0.792-0.859] and 0.773[0.725-0.821], respectively. In validation cohort, the corresponding AUC[95 % CI] were 0.803[0.743-0.864] and 0.791[0.719-0.863], respectively. Risk factors including age, sex, self-reported health, activities of daily living, cognitive function, ever smoker, levels of systolic blood pressure, Cystatin C and low density lipoprotein were strong predictors for both all-cause mortality and premature death.

Conclusion

Stacked ensemble models performed well in predicting all-cause and premature death in this Chinese cohort. Interpretable techniques can aid in identifying significant risk factors and non-linear relationships between predictors and mortality.

The Spectrum of Coronary Artery Disease in Elite Endurance Athletes-A Long-Standing Debate: State-of-the-Art Review

Physical activity is recommended for the prevention of primary and secondary cardiovascular (CV) disease as it is linked to a number of health benefits, especially CV. However, recent research suggests that high-volume, long-term endurance exercise may hasten rather than slow the coronary atherosclerosis progression. This contentious theory has generated a great discussion and is still a major source of doubt when it comes to the clinical treatment of coronary artery disease (CAD) in athletes. CAD is the primary cause of sudden cardiac death in athletes over 35 years. Thus, recent studies evaluated the prevalence of CAD in athletes and its clinical and prognostic implications. Indeed, many studies have shown a relationship between endurance sports and higher volumes of coronary calcified plaque as determined by computed tomography. However, the precise pathogenetic substrate for the existence of an increased coronary calcification burden among endurance athletes remains unclear. Moreover, the idea that coronary plaques in elite athletes present a benign morphology has been cast into doubt by some recent studies showing potential association with adverse cardiovascular events. This review aims to analyze the association between physical activity and CAD, explaining possible underlying mechanisms of atherosclerotic progression and non-ischemic coronary lesions, focusing primarily on clinical and prognostic implications, multimodal evaluation, and management of CAD in endurance athletes.

Predicting oral and esophageal cancers by one model in a Chinese prospective cohort study

OBJECTIVE

Oral and esophageal cancers are both upper gastrointestinal cancers that share a number of risk factors. However, most previous risk prediction models only focused on one of these two types of cancer. There is no single model that could predict both cancers simultaneously. Our objective was to develop a model specifically tailored for oral and esophageal cancers.

METHODS

From 1996 to 2007, a total of 431,460 subjects aged 20 and older without a history of cancer at baseline were included and were monitored for an average duration of 7.3 years in Taiwan, China. A total of 704 cases of oral and esophageal cancers were detected. We utilized both univariate and multivariate COX regression for screening predictors and constructing the model. We evaluated the goodness of fit of the model based on discriminatory accuracy, Harrell's C-index, and calibration.

RESULTS

Finally, we developed a Cox regression model using the twelve most significant variables: age, gender, alcohol consumption, betel chewing, smoking status, history of oral ulceration, educational level, marital status, oropharynx status, family history of nasopharyngeal carcinoma, volume ratio of blood cell, and gamma-glutamyl transferase. The AUC (area under the curve) for the complete model was 0.82. Additionally, the C-index was 0.807 (with a 95 % confidence interval ranging from 0.789 to 0.824) and internal calibration results demonstrated that the model performed well.

CONCLUSIONS

This study identified the twelve most significant common risk factors for oral and esophageal cancers and developed a single prediction model that performs well for both types of cancer.

Time-Use Sequences: A Mixed-Methods Study Exploring How, When, and Where Spatiotemporal Patterns of Everyday Routines Can Strengthen Public Health Interventions

BACKGROUND

Behavior change interventions are critical for the secondary prevention of cardiovascular disease and for reducing the risk of a repeat event or mortality. However, the effectiveness of behavior change interventions is challenged by a lack of spatiotemporal contexts, limiting our understanding of factors that influence the timing and location in which day-to-day activities occur and the maintenance of behavior change. This study explored how behavior change interventions could incorporate spatiotemporal contexts of patient activities for modifying behaviors.

METHODS

A mixed-methods approach with adapted geo-ethnography techniques was used to solicit detailed descriptions of patients' day-to-day routines, including where, when, and how patients spend time. Data were gathered from patients in one cardiac intervention program in Nova Scotia, Canada, from June to September 2021.

RESULTS

A total of 29 individuals (19 men and 10 women) between the ages of 45 and 81 and referred to the program after a cardiac event participated. The results show three key findings: (1) most patients exceeded the minimum guidelines of 30 min of daily physical activity but were sedentary for long periods of time, (2) patient time-use patterns are heterogenous and unique to contexts of individual space-time activity paths, and (3) time-use patterns reveal when, where, and how patients spend significant portions of time and opportunities for adapting patients' day-to-day health activities.

CONCLUSIONS

This study demonstrates the potential for interventions to integrate tools for collecting and communicating spatial and temporal contexts of patient routines, such as the types of activities that characterize how patients spend significant portions of time and identification of when, where, and how to encourage health-promoting changes in routine activities. Time-use patterns provide insight for tailoring behavior change interventions so that clinic-based settings are generalizable to the contexts of where, when, and how patient routines could be adapted to mitigate cardiovascular risk factors.

Healthy lifestyle practice correlates with decreased obesity prevalence in individuals with high polygenic risk: TMM CommCohort study

Obesity and overweight, fundamental components of the metabolic syndrome, predispose individuals to lifestyle-related diseases. The extent to which adopting healthy lifestyles can reduce obesity risk, even in those with a high genetic risk, remains uncertain. Our aim was to assess the extent to which lifestyle modifications can improve outcomes in individuals with a high polygenic score (PGS) for obesity. We quantified the genetic risk of obesity using PGSs. Four datasets from the Tohoku Medical Megabank Community-Based Cohort (TMM CommCohort) were employed in the study. One dataset (n = 9958) was used to select the best model for calculating PGS. The remaining datasets (total n = 69,341) were used in a meta-analysis to validate the model and to evaluate associated risks. The odds ratio (OR) for obesity risk in the intermediate (11th-90th percentiles in the dataset) and high PGS categories (91st-100th) was 2.27 [95% confidence intervals: 2.12-2.44] and 4.83 [4.45-5.25], respectively, compared to that in the low PGS category (1st-10th). Trend analysis showed that an increase in leisure-time physical activity was significantly associated with reduced obesity risk across all genetic risk categories, representing an OR of 0.9 [0.87-0.94] even among individuals in the high PGS category. Similarly, sodium intake displayed a positive association with obesity across all genetic risk categories, yielding an OR of 1.24 [1.17-1.31] in the high PGS category. The risk of obesity was linked to the adoption of healthy lifestyles, even in individuals with high PGS. Our results may provide perspectives for integrating PGSs into preventive medicine.

An Interdisciplinary Intervention Based on Prescription of Physical Activity, Diet, and Positive Mental Health to Promote Healthy Lifestyle in Patients with Obesity: A Randomized Control Trial

This study used a multimodal approach to address the issue of obesity among individuals with a Body Mass Index (BMI) between 30 and 40 residing in a rural region of north-east Spain. A pretest-posttest model was employed in a clinical trial design, comparing an intervention group with a control group. The intervention, which lasted for a period of nine months, was based on three main strategies: the prescription of physical activity, the promotion of healthy nutritional habits, and the management of emotional wellbeing through Positive Mental Health (PMH). A variety of assessment tools were employed, including the CLASS-AF scale and a stress test for physical activity levels; advanced anthropometry and blood analysis for metabolic and body composition variables; a Mediterranean diet adherence questionnaire for nutritional habits; and a PMH multifactorial questionnaire for the assessment of emotional management. The results revealed significant improvements in the level of physical activity and adherence to the Mediterranean diet in favor of the intervention group, where 89.4% (n = 17) of the participants went from being not very active/sedentary to being active. Also, adherence to the Mediterranean diet improved with a mean increase of 2.2 points on the scale [mean: 10.5 (CI 95%: 9.90, 11.09)]. In addition, significant reductions in body fat [mean: -2.50 kg (CI 95%: -3.56, -1.44)] and free fat mass [mean: -3.38% (IC 95%: -4.34, -2.41), along with decreased cholesterol levels (196 vs. 182 mg/dL), were observed, suggesting a decrease in cardiovascular and metabolic risk. In conclusion, this multimodal intervention was effective at improving the lifestyle of people with obesity and reducing their cardiovascular and metabolic risk. The combination of interventions focused on physical activity, diet, Positive Mental Health, and metabolic changes and were perceived as a comprehensive and complementary strategy in obesity care. These findings highlight the importance of approaching this condition from multiple perspectives to ensure optimal health outcomes.

Sweat lactate sensor for detecting anaerobic threshold in heart failure: a prospective clinical trial (LacS-001)

A simple method for determining the anaerobic threshold in patients with heart failure (HF) is needed. This prospective clinical trial (LacS-001) aimed to investigate the safety of a sweat lactate-monitoring sensor and the correlation between lactate threshold in sweat (sLT) and ventilatory threshold (VT). To this end, we recruited 50 patients with HF and New York Heart Association functional classification I-II (mean age: 63.5 years, interquartile range: 58.0-72.0). Incremental exercise tests were conducted while monitoring sweat lactate levels using our sensor. sLT was defined as the first steep increase in lactate levels from baseline. Primary outcome measures were a correlation coefficient of ≥ 0.6 between sLT and VT, similarities as assessed by the Bland-Altman analysis, and standard deviation of the difference within 15 W. A correlation coefficient of 0.651 (95% confidence interval, 0.391-0.815) was achieved in 32/50 cases. The difference between sLT and VT was -4.9 ± 15.0 W. No comparative error was noted in the Bland-Altman plot. No device-related adverse events were reported among the registered patients. Our sweat lactate sensor is safe and accurate for detecting VT in patients with HF in clinical settings, thereby offering valuable additional information for treatment.

Exploring individual, social and environmental factors related to physical activity: a network analysis

Objectives

Insufficient physical activity (PA) has long been a global health issue, and a number of studies have explored correlates of PA to identify the mechanisms underlying inactive lifestyles. In the literature, dozens of correlates have been identified at different (eg, individual, environmental) levels, but there is little or no direct evidence for the mutual associations of these correlates. This study analysed 44 variables identified as theoretically and empirically relevant for PA to clarify the factors directly and indirectly associated with PA.

Methods

A cross-sectional survey dataset of 19 005 Japanese-speaking adults (mean age=53.50 years, SD=17.40; 9706 women) was analysed. The data encompassed demographic and anthropometric variables; self-reported PA levels; perceived social support and environments (eg, awareness of urban facilities for PA); psychological traits and health-behaviour characteristics (eg, personality, motivation, self-efficacy, decisional balance, process of change strategies); and technology use (eg, mobile health apps).

Results

Network analyses were performed to select meaningful associations (partial correlations) among variables, which identified nine variables directly positively associated with PA: job/employment status, self-efficacy, perceived social support, intrinsic motivation, stage of change, counter conditioning, self-reevaluation, environment and technology use. Indirect associations (two-step neighbourhood) were identified for 40 (out of 44) variables, implying that most of the known PA-correlates are associated with PA-at least indirectly.

Conclusion

These identified associations echo the importance of the multilevel perspective in understanding how people maintain (in)active lifestyles. Interventions for PA could have mixed-level targets, including intraindividual characteristics, social support and physical and digital environments.

Comparing cadence-based and machine learning based estimates for physical activity intensity classification: The UK Biobank

OBJECTIVES

Cadence thresholds have been widely used to categorize physical activity intensity in health-related research. We examined the convergent validity of two cadence-based intensity classification approaches against a machine-learning-based intensity schema in 84,315 participants (≥40 years) with wrist-worn accelerometers.

DESIGN

Validity study.

METHODS

Both cadence-based methods (one-level cadence, two-level cadence) calculated intensity-specific time based on cadence-thresholds while the two-level cadence identified stepping behaviors first. We used an overlapping plot, mean absolute error, and Spearman's correlation coefficient to examine agreements between the cadence-based and machine-learning methods. We also evaluated agreements between methods based on practically-important-difference (moderate-to-vigorous-physical activity: ±20 min/day, moderate-physical activity: ±15, vigorous-physical activity: ±2.5, light-physical activity: ±30).

RESULTS

The group-level (median) minutes of moderate-to-vigorous- and moderate-physical activity estimated by one-level cadence were within the range of practically-important-difference compared to the machine-learning method (bias of median: moderate-to-vigorous-physical activity, -3.5, interquartile range [-15.8, 12.2]; moderate-physical activity, -6.0 [-17.2, 4.1]). The group-level vigorous- and light-physical activity minutes derived by two-level cadence were within practically-important-difference range (vigorous-physical activity: -0.9 [-3.1, 0.5]; light-physical activity, -1.3 [-28.2, 28.9]). The individual-level differences between the cadence-based and machine learning methods were high across intensities (e.g., moderate-to-vigorous-physical activity: mean absolute error [one-level cadence: 24.2 min/day; two-level cadence: 26.2]), with the proportion of participants within the practically-important-difference ranging from 8.4 % to 61.6 %.

CONCLUSIONS

One-level cadence showed acceptable group-level estimates of moderate-to-vigorous and moderate-physical activity while two-level cadence showed acceptable group-level estimates of vigorous- and light-physical activity. The cadence-based methods might not be appropriate for individual-level intensity-specific time estimation.

Protein-enriched soup and weekly exercise improve muscle health: A randomized trial in mid-to-old age with inadequate protein intake

BACKGROUND

Prior research has highlighted the synergistic impact of protein supplementation on muscle function post-exercise in adults; however, evidence supporting the combined effects were less robust and inconsistent on those with protein insufficiency. This investigation aims to explore efficacy of protein-enriched soup coupled with exercise on muscle health and metabolism in middle-aged and older adults with suboptimal protein intake.

METHODS

An open-label, 12-week, randomized controlled trial involving participants with insufficient protein intake (<1.0 g/kg/day) was done. The intervention group consumed protein-enriched soup (24-30 g protein daily) and 1-h weekly exercise, while controls received health education. Assessments included laboratory tests, functional assessments, and body composition.

RESULTS

In this trial, 97 out of 100 randomized participants (mean age: 64.65 ± 4.84 years, 81.8% female) completed the study (47 in intervention group and 50 in control group). Compared results of baselines, at 1 and 3 months of intervention, significant improvements in waist circumference (83.48 ± 10.22 vs. 82.5 ± 9.88 vs. 82.37 ± 9.42 cm, P for trend = 0.046), 6-min walking distance (525.65 ± 58.46 vs. 534.47 ± 51.87 vs. 552.02 ± 57.66 m, P for trend = 0.001), five-time sit-to-stand time (7.63 ± 1.63 vs. 6.81 ± 1.8 vs. 6.4 ± 1.42 s, P for trend <0.001), grip strength (26.74 ± 6.54 vs. 27.53 ± 6.99 vs. 28.52 ± 7.09 kg, P for trend <0.001), and MNA score (26.8 ± 2.14 vs. 27.73 ± 1.74 vs. 27.55 ± 1.72, P for trend <0.001) were discerned within the intervention group. The intervention demonstrated a significant reduction in serum triglyceride (105.32 ± 49.84 vs. 101.36 ± 42.58 vs. 93.43 ± 41.49 mg/dL, P for trend = 0.023), increased HDL-C (60.04 ± 16.21 vs. 60 ± 17.37 vs. 62.55 ± 18.27 mg/dL, P for trend = 0.02), and DHEA-S levels (97.11 ± 54.39 vs. 103.39 ± 56.75 vs. 106.83 ± 60.56 μg/dL, P for trend = 0.002). Serum myostatin did not differ in both groups, but serum leptin levels significantly increased (9118.88 ± 5811.68 vs. 11508.97 ± 7151.08 vs. 11220.80 ± 7190.71 pg/mL, P for trend = 0.016) in controls. The intervention group showed greater improvements in 6 min walking distance (β = 0.71, 95% CI: 6.88 to 40.79, P = 0.006), five-time sit-to-stand test (β = -0.87, 95% CI: -1.59 to -0.15, P = 0.017), MNA score (β = 0.96, 95% CI: 0.20 to 1.71, P = 0.013), serum triglycerides (β = -15.01, 95% CI: -27.83 to -2.20, P = 0.022), LDL-C (β = -9.23, 95% CI: -16.98 to -1.47, P = 0.020), and DHEA-S levels (β = 9.98, 95% CI: 0.45 to 19.51, P = 0.04) than controls.

CONCLUSIONS

Protein-enriched soup with weekly exercise over 12 weeks significantly improved physical performance, lipid profile, and DHEA-S levels among middle-aged and older adults with inadequate protein intake, while studies assessing long-term benefits of the intervention are needed.

The association between different impact exercises and osteoporosis: an analysis of data from the Taiwan biobank

Osteoporosis is a prevalent condition marked by reduced bone density and an elevated risk of fractures, especially among postmenopausal women. Exercise plays a crucial role in preventing and managing osteoporosis, with weight-bearing and impact exercises being particularly effective in enhancing bone density and mitigating disease risk. This study investigated the relationship between various types of impact exercises and osteoporosis using data from the Taiwan Biobank (TWB). The study sample comprised 5,123 individuals without osteoporosis and 1,770 individuals with the condition. Student's t-test and logistic regression analyses were utilized to assess the associations between exercise types and osteoporosis risk. Results indicated that high-impact exercise significantly reduced the likelihood of developing osteoporosis compared to no exercise (odds ratio; OR = 0.573, 95% CI: 0.406-0.810, P = 0.002). Conversely, low-impact exercises did not show a significant overall association with osteoporosis (OR = 1.160, 95% CI: 0.932-1.445, P = 0.184). Stratified analysis by sex revealed that high-impact exercise was protective against osteoporosis in men (OR = 0.391, 95% CI: 0.202-0.755, P = 0.005), but not significantly so in women (OR = 0.671, 95% CI: 0.438-1.027, P = 0.066). These findings suggest that high-impact exercise is associated with a reduced risk of osteoporosis, particularly among Taiwanese men aged 30 to 70.

Relationship between quantitative physical activity and deterioration of locomotive function: a cross-sectional study using baseline data from a cohort

BACKGROUND

In aged society, health policies aimed at extending healthy life expectancy are critical. Maintaining physical activity is essential to prevent the deterioration of body functions. Therefore, it is important to understand the physical activity levels of the target age group and to know the content and intensity of the required physical activity quantitatively. Especially we focused the role of non-exercise activity thermogenesis and sedentary time, which are emphasized more than the introduction of exercise in cases of obesity or diabetes.

METHODS

A total of 193 patients from 25 institutions were included. Participants underwent a locomotive syndrome risk test (stand-up test, 2-step test, and Geriatric Locomotive Function Scale-25 questionnaire) and were classified into three stages. Physical activity was quantitatively monitored for one week with 3-axial accelerometer. Physical activity was classified into three categories; (1) Sedentary behavior (0 ∼ ≤ 1.5 metabolic equivalents (METs)), (2) Light physical activity (LPA:1.6 ∼ 2.9 METs), and (3) Moderate to vigorous physical activity (MVPA: ≥3 METs). We investigated the relationship between physical activity, including the number of steps, and the stages after gender- and age- adjustment. We also investigated the relationship between social isolation using Lubben's Social Network Scale (LSNS), as social isolation would lead to fewer opportunities to go out and less outdoor walking.

RESULTS

Comparison among the three stages showed significant difference for age (p = 0.007) and Body Mass Index (p < 0.001). After gender-and age-adjustment, there was a significant relation with a decrease in the number of steps (p = 0.002) and with MVPA. However, no relation was observed in sedentary time and LPA. LSNS did not show any statistically significant difference. Moderate to high-intensity physical activity and the number of steps is required for musculoskeletal disorders. The walking, not sedentary time, was associated to the locomotive stages, and this finding indicated the importance of lower extremity exercise.

CONCLUSIONS

Adjusting for age and gender, the number of steps and moderate to vigorous activity levels were necessary to prevent worsening, and there was no effect of sedentary behavior. Merely reducing sedentary time may be inadequate for locomotive disorders. It is necessary to engage in work or exercise that moves lower extremities more actively.

Physical activity and the risk of chronic obstructive pulmonary disease: A longitudinal follow-up study in Taiwan

BACKGROUND

This study aimed to investigate whether physical activity (PA) is associated with a lower risk of subsequently developing chronic obstructive pulmonary disease (COPD).

METHODS

We conducted this population-based longitudinal follow-up study in a community in Taiwan. This study recruited 61,446 subjects who had participated in the Keelung Community-based Integrated Screening Program (KCIS) between 2005 and 2012. During their participation in KCIS, they were provided with structured questionnaires to collect their baseline characteristics, including weekly PA time. After excluding subjects diagnosed with COPD before they joined KCIS and/or who provided incomplete lifestyle data, 59,457 subjects remained, and were classified into three groups based on their weekly PA time: i.e., as NPA (no regular PA), LPA (low PA, <90 min/week) and HPA (high PA, ≥90 min/week). The primary outcome was a new diagnosis of COPD, followed up until the end of 2015 or their death. Cox proportional-hazard regression was used to assess the impact of PA on the risk of COPD.

RESULTS

The risk of COPD was more than 20% lower in the LPA and HPA groups than in the NPA group. Specifically, the adjusted hazard ratio for the risk of COPD was 0.72 in the LPA group (95% CI, 0.61-0.85, p < 0.001) and 0.79 in the HPA group (95% CI, 0.69-0.90, p < 0.001).

CONCLUSIONS

Our research uncovered an inverse relationship between PA and COPD. The findings suggest that PA might be useful as a strategy for the primary prevention of COPD.

Occupational physical activity, all-cause, cardiovascular disease, and cancer mortality in 349,248 adults: Prospective and longitudinal analyses of the MJ Cohort

BACKGROUND

Evidence on the health benefits of occupational physical activity (OPA) is inconclusive. We examined the associations of baseline OPA and OPA changes with all-cause, cardiovascular disease (CVD), and cancer mortality and survival times.

METHODS

This study included prospective and longitudinal data from the MJ Cohort, comprising adults over 18 years recruited in 1998-2016, 349,248 adults (177,314 women) with baseline OPA, of whom 105,715 (52,503 women) had 2 OPA measures at 6.3 ± 4.2 years (mean ± SD) apart. Exposures were baseline OPA, OPA changes, and baseline leisure-time physical activity.

RESULTS

Over a mean mortality follow-up of 16.2 ± 5.5 years for men and 16.4 ± 5.4 years for women, 11,696 deaths (2033 of CVD and 4631 of cancer causes) in men and 8980 deaths (1475 of CVD and 3689 of cancer causes) in women occurred. Combined moderately heavy/heavy baseline OPA was beneficially associated with all-cause mortality in men (multivariable-adjusted hazard ratio (HR) = 0.93, 95% confidence interval (95%CI): 0.89-0.98 compared to light OPA) and women (HR = 0.86, 95%CI: 0.79-0.93). Over a mean mortality follow-up of 12.5 ± 4.6 years for men and 12.6 ± 4.6 years for women, OPA decreases in men were detrimentally associated (HR = 1.16, 95%CI: 1.01-1.33) with all-cause mortality, while OPA increases in women were beneficially (HR = 0.83, 95%CI: 0.70-0.97) associated with the same outcome. Baseline or changes in OPA showed no associations with CVD or cancer mortality.

CONCLUSION

Higher baseline OPA was beneficially associated with all-cause mortality risk in both men and women. Our longitudinal OPA analyses partly confirmed the prospective findings, with some discordance between sex groups.

Financial Incentives for Physical Activity and Sports Participation in Young People

Physical inactivity is a global health problem. Childhood is an opportune time to establish healthy physical activity behaviors, including the participation in organized physical activity, such as sports. We hypothesize that financial incentives can improve young people's participation in physical activity and sports. The design of the incentive and the context in which it operates are crucial to its success.

Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension

INTRODUCTION

We investigated the effect vigorous physical activity (VPA) on the risk of incident mild cognitive impairment (MCI) and probable dementia among individuals with high-risk hypertension.

METHODS

Baseline self-reported frequency of VPA was categorized into low VPA (<1 session/week), and high VPA (≥1 session/week). We used multivariate Cox regression analysis to examine the association of VPA categories with incident MCI and probable dementia events.

RESULTS

Participants in the high VPA category, compared with low VPA, experienced lower events rates (per 1000 person-years) of MCI (13.9 vs 19.7), probable dementia (6.3 vs 9.0), and MCI/probable dementia (18.5 vs 25.8). In the multivariate Cox regression model, high VPA, compared with low VPA, was associated with lower risk of MCI, probable dementia, and MCI/probable dementia (HR [95% CI]: 0.81 [0.68-0.97], 0.80 [0.63-1.03], and 0.82 [0.70-0.96]), respectively.

DISCUSSION

This study provides evidence that VPA may preserve cognitive function in high-risk patients with hypertension.

HIGHLIGHTS

Hypertension is associated with an increased risk of cognitive impairment Physical activity (PA) is associated with a lower risk of decline in cognition The effect of ≥1 sessions of vigorous-intensity PA (VPA) per week was assessed This analysis included SPRINT MIND trial participants with high-risk hypertension ≥1 VPA sessions/week was associated with lower risk of future cognitive impairment.

Physical activity and exercise health benefits: cancer prevention, interception, and survival

Physical activity (PA) has an established role in the promotion of health and fitness and the prevention of disease. Expected overall benefits include reduction of all-cause morbidity and death, weight control, improved quality of life, improved bone health and decreased falls of elderly subjects, , deeper cognition, and reduced risk of depression, anxiety, and sleeplessness. Currently, PA is a mainstay in the management of cardiovascular diseases, metabolic syndrome, diabetes, and bone health. Recently, the perception of its role in primary and secondary prevention, interception, and treatment of cancer, however, is also gaining importance. Regular walking, the simplest type of PA, is associated with reduced all-cause and cardiovascular disease mortality, and a role in cancer prevention is of increasing interest. Furthermore, PA improves the quality of life of cancer patients, attenuating side effects of chemotherapy, decreasing sarcopenia, increasing fitness, and inhibiting the recurrence and progression of some cancer types. It promotes emotional and psychological benefits in patients, inducing positive changes. While mechanisms, effective levels and useful amount of PA practice are well established in cardiology, they are yet to be fully determined in oncology. Nevertheless, PA is recommended to reduce cancer risk in the general population, and it has been introduced in programs for the prevention of second cancers. In perspective, it will help as integrative therapy in cancer patients and for cancer survivors. The number of beneficial effects in the cancer continuum is highlighted in this review.

Mortality risk in patients with preserved ratio impaired spirometry: assessing the role of physical activity

BACKGROUND

While all-cause mortality is reportedly increased in preserved ratio impaired spirometry (PRISm), no remedial efforts have been suggested.

AIM

To study the ability of physical activity (PA) on reducing the morality increased in PRISm patients.

DESIGN

We prospectively enrolled a cohort of Taiwanese adults from 1994 to 2018 in a health surveillance program.

METHODS

Mortality risks of those who were inactive were compared against those meeting the current recommendation of 150 min/week of PA. Cox proportional hazards models were used for hazard ratios and life table method was for estimating loss of life expectancy.

RESULTS

A total of 461 183 adults were enrolled. Among them, one-seventh of the cohort (65 832 or 14.3%) had PRISm, and 53.1% were inactive. Those who were inactive with PRISm had 28% increased mortality from all-cause, 45% from cardiovascular diseases (CVDs) and 67% from respiratory disease, with a 3-year reduction in life expectancy (males, 3.72 and females, 2.93). In PRISm patients who met the exercise recommendation, excess mortality was reduced by two-third, both all-cause (from 28% to 9%) and CVD (from 45% to 15%).

CONCLUSION

PRISm involves a large portion of general population (14.3%) and shortens life expectancy by 3 years. More than half of the subjects were physically inactive, and adherence to 150 min/week of PA was associated with a two-third reduction of excess mortality from all cause and from CVD. Recommending PA among those with PRISm might be highly beneficial, although exercise alone may not eliminate all risks associated with PRISm.

The association between physical activity intensity and frailty risk among older adults across different age groups and genders: Evidence from four waves of the China Health and Retirement Longitudinal Survey

"Exercise is the best medicine" is well known, but the optimal dose of physical activity (PA) for males and females across different age groups is still unknown. This study, using data from the four waves of CHARLS, aimed to determine the optimal PA dose that reduces frailty risks among older adults across various age groups and both sexes. We created a frailty index score using 63 health-related variables and used 0.21 as the frailty cut point. Binary logistic regression was used to compare the effect of vigorous, moderate, and light intensity PA under IPAQ criteria on frailty risk. The study found that regardless of whether males or females, the optimal effect of vigorous-intensity PA in reducing the risk of frailty is consistently observed throughout the entire old age career. Moreover, the age groups at which moderate-intensity PA reduces the risk of frailty were from age 70 for males and from age 80 for females. And light-intensity PA had no effect on reducing the risk of frailty. Moderate and vigorous intensity of PA in older adults should be promoted, but guidelines and recommendations must account for optimal associations with PA dose across genders and age groups.

The Exercise Right for Active Ageing Study: Participation in Community-Based Exercise Classes by Older Australians During the COVID-19 Pandemic

The aim of this study was to determine factors associated with participation of community-dwelling older Australians (≥65 years) in the Exercise Right for Active Ageing program, consisting of 12 low- to moderate-intensity group exercise classes, delivered weekly, in person or online, by accredited exercise scientists and physiologists across Australia. Out of 6,949 participants recruited, 6,626 (95%) attended one or more classes and were included in the primary analysis, and 49% of participants attended all 12 classes. Factors associated with higher class attendance included participation in yoga/flexibility/mobility classes, attendance at a free trial class (adjusted incidence rate ratio [95% confidence interval]: 1.05 [1.03, 1.08]), and attending online classes (1.19 [1.11, 1.26]). Factors associated with lower class attendance included state of residence, living in inner regional areas (0.95 [0.93, 0.98]), and having two or more comorbidities (0.97 [0.95, 0.99]). High class attendance suggests that the Exercise Right for Active Ageing program was well received by older Australians, particularly in states less impacted by COVID-19 lockdowns.

Social Network Negativity and Physical Activity: New Longitudinal Evidence for Young and Older Adults 2015-2018

Purpose: Physical activity (PA) has considerable public health benefits. Positive aspects of the interpersonal environment are known to affect PA, yet few studies have investigated whether negative dimensions also influence PA. This study examines the link between changing social network negativity and PA, net of stable confounding characteristics of persons and their environments. Method: Polling respondents in the San Francisco Bay Area over three waves (2015-2018), the UCNets project provides a panel study of social networks and health for two cohorts of adults. Respondents were recruited through stratified random address sampling, and supplemental sampling was conducted through Facebook advertising and referral. With weights, the sample is approximately representative of Californians aged 21-30 and 50-70. Personal social networks were measured using multiple name-generating questions. Fixed effects ordered logistic regression models provide parameter estimates. Results: Younger adults experience significant decreases in PA when network negativity increases, while changes in other network characteristics (e.g. support, size) did not significantly predict changes in PA. No corresponding association was found for older adults. Results are net of baseline covariate levels, stable social and individual differences, and select time-varying characteristics of persons and their environments. Conclusion: Leveraging longitudinal data from two cohorts of adults, this study extends understanding on interpersonal environments and PA by considering the social costs embedded in social networks. This is the first study to investigate how changes in network negativity pattern PA change. Interventions that help young adults resolve or manage interpersonal conflicts may have the benefit of helping to promote healthy lifestyle choices.

Free bus fares, bus use and physical activity: An exploratory cross-sectional study

ISSUE ADDRESSED

Public transport (PT) users often accumulate more physical activity (PA) than private motor vehicle users and financial incentives may increase PT use. Responding to rising petrol prices, from 28 March to 1 May 2022, the Tasmanian government made public bus use fare-free. This exploratory study examined the perceived impact of fare-free buses on bus use and PA.

METHODS

Tasmanian adults who had used the fare-free buses (N = 548) completed an online survey (4 May-14 June 2022). Quantitative data were analysed using descriptive and inferential methods and responses to open-ended questions categorised.

RESULTS

Over the fare-free period, 46% of participants reported more bus use-average weekly bus trips increased from 3.0 to 4.0 (p < 0.001). Most (81%) participants, including 36% (n = 33/93) who were not previous bus users, planned continued bus use despite financial cost. Total PA was reported higher (36%), the same (60%) and lower (4%) than usual during the fare-free period. Higher total PA was more common amongst those reporting increased bus use (n = 186/240; 78%). Responses to open-ended questions revealed: bus use-related PA gain was through walking to/from bus stops, more frequently attending PA settings (e.g., the gym) and unexpected walking due to bus service limitations; household-level cost savings, improved travel opportunities and better social/mental health were additional fare-free benefits.

CONCLUSIONS/SO WHAT

Fare-free buses were commonly perceived to increase bus use and PA. Intervention studies would determine if PA and financially incentivised PT have a causal relationship. Individual- and societal-level health economic analysis of free PT is warranted.

Validity and reliability of Persian version of Low Physical Activity Questionnaire (LoPAQ)

BACKGROUND

The Low Physical Activity Questionnaire (LoPAQ) was specifically developed to measure the low activity level observed in extremely inactive hemodialysis (HD) patients. This study aims to evaluate reliability and validity of Persian version of the LoPAQ.

METHODS

This study was a cross sectional study, conducted in three HD centers in Iran. The LoPAQ was translated into Persian. After cultural adaptions, it was filled out by 120 HD patiens. Convergent validity, was evaluated by calculating the correlations among the Persian version of the LoPAQ and Persian version of the Community Healthy Adults Model Program for Seniors (CHAMPS) questionnaire, physical function scale of the SF-36 and physical function (Short Physical Performance Battery (SPPB) test) using Spearman's correlation coefficients. The test-retest reliability was analyzed using the intraclass correlation coefficient (ICC).

RESULTS

In total, 109 patients completed all of the questionnaires, took part in physical performance tests and had valid data. Their mean age was 64 ± 11 years, with a dialysis history of 31 ± 10 months. For total calories, there was a strong correlation between the Persian version of the LoPAQ and CHAMPS-measured physical activity (rho = 0.85, p < 0.001). In addition, the higher physical activity level reported by Persian version of the LoPAQ was also correlated with better self-reported physical function (rho = 0.7, p < 0.001) and better physical performance (rho = 0.67, p < 0.001). The ICC ranged from 0.65 to 0.78, indicating strong reliability.

CONCLUSION

The assessment of the validity and reliability of the Persian version of the questionnaire confirmed its suitability for evaluating the level of physical activity.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05930964, Registered on 05/07/2023. Registered trial name: Validity and Reliability of Persian Version of Low Physical Activity Questionnaire (LoPAQ).

Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study

INTRODUCTION

Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs.

METHODS AND ANALYSIS

A total of 204 participants aged 18-80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively.

ETHICS AND DISSEMINATION

The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).

A qualitative study of experiences with physical activity among people receiving opioid agonist therapy

BACKGROUND

Physical or mental health comorbidities are common among people with substance use disorders undergoing opioid agonist therapy. As both a preventive and treatment strategy, exercise offers various health benefits for several conditions. Exercise interventions to people with substance use disorders receiving opioid agonist therapy are limited. This study aims to explore experiences with physical activity, perceived barriers, and facilitators among people receiving opioid agonist therapy.

METHOD

Fourteen qualitative interviews were conducted with individuals receiving opioid agonist therapy in outpatient clinics in Western Norway.

RESULTS

Most were males in the age range 30 to 60 years. Participants had diverse and long-term substance use histories, and most received buprenorphine-based opioid agonist therapy. The identified themes were (1) Physical limitations: Participants experienced health-related problems like breathing difficulties, pain, and reduced physical function. (2) Social dynamics: Social support was essential for participating in physical activities and many argued for group exercises, but some were concerned about the possibility of meeting persons influenced by substances in a group setting, fearing temptations to use substances. (3) Shift in focus: As participants felt the weight of the health burden, their preference for activities shifted from sports aiming for "adrenaline" to a health promoting focus. (4) COVID-19's impact on exercise: because of the pandemic, group activities were suspended, and participants described it as challenging to resume. (5) Implementation preferences in clinics: Not interfering with opioid medication routines was reported to be essential.

CONCLUSION

This study offers valuable insights for the development of customized exercise interventions aimed at enhancing the health and well-being of patients undergoing opioid agonist therapy. These findings underscore the significance of addressing social dynamics, overcoming physical limitations, and implementing a practical and effective exercise regimen.

Physical Activity Using a Wearable Device as an Alternative to Performance Status in Patients With Advanced Lung Cancer

Importance

The Eastern Cooperative Oncology Group Performance Status (ECOG PS) is extensively used to guide treatment decisions in patients with advanced lung cancer. However, its assessment is subjective, potentially leading to discordance among observers.

Objective

To investigate the association between measured physical activity and ECOG PS, as well as the potential prognostic value of physical activity measurements in patients with advanced lung cancer.

Design, Setting, and Participants

This single-institution, prospective observational study enrolled 119 patients with advanced lung cancer scheduled to receive systemic therapy as outpatients at Matsusaka Municipal Hospital in Mie, Japan. Participants wore the wearable device amuelink (Sony) for up to 14 days to measure physical activity, including metabolic equivalent tasks, distance walked, and number of steps taken. ECOG PS was assessed at enrollment, which took place from December 2021 to August 2022.

Main Outcomes And Measures

The primary end point was estimating the area under the curve (AUC) for classification into ECOG PS of 2 or higher using physical activity measurements. An analysis of the association with survival was also conducted.

Results

Among the 119 patients (median [range] age, 72 (32-88) years; 71 [59.7%] male), mean distance walked (MDW) had the highest diagnostic value for classifying an ECOG PS of 2 or greater, with an AUC of 0.818 (95% CI, 0.703-0.934). Moreover, MDW was also associated with 6-month survival, with an AUC of 0.806 (95% CI, 0.694-0.918). Survival curves significantly diverged based on the MDW threshold, indicating a potential association with survival outcome (hazard ratio, 0.17; 95% CI, 0.05-0.57).

Conclusions and Relevance

The cohort study suggests that MDW, as measured by a wearable device, was associated with ECOG PS and may serve as a predictor of health status alongside ECOG PS categories. It demonstrates the potential of objectively measured physical activity in complementing subjective ECOG PS assessments in patients with advanced lung cancer. Further research is needed to confirm the prognostic value of physical activity measurements.

No causal association between the volume of strenuous exercise and coronary atherosclerosis: a two-sample Mendelian randomization study

Objective

Several observational studies have shown that high-volume and high-intensity exercise training increases the prevalence and severity of coronary atherosclerosis, but the causal effect still remains uncertain. This study aims to explore the causal relationship between the volume of strenuous exercise (SE) and coronary atherosclerosis (CA) using the Mendelian randomization (MR) method.

Method

The exposure factors were two basic parameters of the volume of strenuous exercise (duration and frequency of strenuous exercise), the outcome factor was coronary atherosclerosis, and the relevant genetic loci were extracted from the summary data of the genome-wide association study (GWAS) as the instrumental variables, and MR analyses were performed using the inverse variance weighting (IVW) method, the weighted median method, and the MR-egger method. Sensitivity analyses were performed using heterogeneity analysis, pleiotropy analysis, and the "leave-one-out" method. The original results were tested using other coronary atherosclerosis data sets.

Result

IVW results showed no causal association between duration of strenuous exercise (DOSE) [OR = 0.9937, 95% CI (0.9847, 1.0028), P = 0.1757] and frequency of strenuous exercise (FOSE) in the last 4 weeks [OR = 0.9930, 95% CI (0.9808, 1.0054), P = 0.2660] and coronary atherosclerosis. All of the above results were validated with other coronary atherosclerosis data sets.

Conclusion

The present study supports that the causal association of duration and frequency of SE with CA was not found, and provides valuable insights into the choice of scientific and correct volume of SE to cardiac rehabilitation (CR).

Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study

PURPOSE

Physical activity is an important modifiable determinant of health. There has been a historical aversion to movement in people with myasthenia gravis (MG) due to the pathophysiology of the disease, however, research suggests engagement in physical activity is safe and does not exacerbate symptoms. There are currently no studies investigating the qualitative perspectives of people with MG on physical activity. The aim of this study was to explore perceptions of physical activity, barriers, enablers, and participants' experiences of physical activity advice from health professionals.

MATERIALS AND METHODS

Semi-structured interviews were used, with verbatim transcripts analysed using content analysis.

RESULTS

Ten adults (median age 64.5 years) living in Australia with generalised MG were interviewed. Key findings were identified: (1) Physical activity is perceived to be important for general health and for MG; (2) Medical management and social support are key enablers; (3) Fatigue and pain are potential barriers; and (4) Experiences with healthcare professionals were considered insufficient and failed to provide disease specific advice regarding MG and physical activity.

CONCLUSION

People with MG have unique barriers and enablers to physical activity engagement that clinicians should consider when providing physical activity behaviour change support to this population.

Dose-response relationship between 15 weeks of running and aerobic fitness: a retrospective analysis based on the fun running program

BACKGROUND

Students' physical fitness, particularly aerobic fitness, has seriously declined during the COVID-19 epidemic. However, in the post-epidemic era, there are few studies on the methods of improving aerobic fitness. Understanding the dose-response relationship between physical activity and aerobic fitness is crucial for developing effective exercise prescriptions.

METHOD

This retrospective study reviewed the Fun Running program at Wannan Medical College in China. We conducted a pre-post study design to analyze the impact of 15 weeks of Fun Running training on aerobic fitness. Middle and long-distance running pace (MLDR-P) was used as the primary indicator of aerobic fitness. A paired sample T-test was used to analyze the differences between the two MLDR-Ps. Pearson's correlation was used to examine the correlation between variables. Multiple linear regression was used to determine the extent to which Fun Running components explain the variance in MLDR-P.

RESULTS

A total of 3244 college students participated in this study. 15 weeks of Fun Running training can significantly improve the MLDR-P in both females (P < 0.001, ES = 0.68) and males (P < 0.001, ES = 0.72). The MLDR-P was significantly correlated with Fun Running (R2 = 0.95, p < 0.05, for females; R2 = 0.96, p < 0.05, for males). The component that had the greatest impact on MLDR-P was pace (β = 1.39, for females; β = 1.09, for males), followed by distance (β = 0.49, for females; β = 0.15, for males), and last frequency (β = -0.03, for all).

CONCLUSION

This study fills the gap in research on the dose-response relationship between running and aerobic fitness among college students in the post-epidemic era. The results show that 15 weeks of Fun Running training can significantly improve aerobic fitness. Examination of the dose-response relationship between Fun Running and MLDR-P provides practitioners with valuable insights into prescribing aerobic fitness training, allowing them to develop more effective training programs. Future research should focus on how to implement a hierarchical Fun Running program effectively.

All-cause mortality risks among participants in mass-participation sporting events

OBJECTIVES

Exercise transiently increases the risk for sudden death, whereas long-term exercise promotes longevity. This study assessed acute and intermediate-term mortality risks of participants in mass-participation sporting events.

METHODS

Data of participants in Dutch running, cycling and walking events were collected between 1995 and 2017. Survival status was obtained from the Dutch Population Register. A time-stratified, case-crossover design examined if deceased participants more frequently participated in mass-participation sporting events 0-7 days before death compared with the reference period (14-21 days before death). Mortality risks during follow-up were compared between participants and non-participants from the general population using Cox regression.

RESULTS

546 876 participants (median (IQR) age 41 (31-50) years, 56% male, 72% runners) and 211 592 non-participants (41 (31-50) years, 67% male) were included. In total, 4625 participants died of which more participants had partaken in a sporting event 0-7 days before death (n=23) compared with the reference period (n=12), and the mortality risk associated with acute exercise was greater but did not reach statistical significance (OR 1.92; 95% CI 0.95 to 3.85). During 3.3 (1.1-7.4) years of follow-up, participants had a 30% lower risk of death (HR 0.70; 95% CI 0.67 to 0.74) compared with non-participants after adjustment for age and sex. Runners (HR 0.65; 95% CI 0.62 to 0.69) and cyclists (HR 0.70; 95% CI 0.64 to 0.77) had the best survival during follow-up followed by walkers (HR 0.88; 95% CI 0.80 to 0.94).

CONCLUSION

Participating in mass-participation sporting events was associated with a non-significant increased odds (1.92) of mortality and a low absolute event rate (4.2/100 000 participants) within 7 days post-event, whereas a 30% lower risk of death was observed compared with non-participants during 3.3 years of follow-up. These results suggest that the health benefits of mass sporting event participation outweigh potential risks.

Influence of a diet and/or exercise intervention on long-term mortality and vascular complications in people with impaired glucose tolerance: Da Qing Diabetes Prevention Outcome study

AIM

We aimed to investigate the long-term influence of a diet and/or exercise intervention on long-term mortality and cardiovascular disease (CVD) events.

METHODS

The Da Qing Diabetes Prevention Study had 576 participants with impaired glucose tolerance (IGT) randomized to diet-only, exercise-only and diet-plus-exercise intervention group and control group. The participants underwent lifestyle interventions for 6 years. The subsequent Da Qing Diabetes Prevention Outcome Study was a prospective cohort study to follow-up the participants for up to 24 years after the end of 6-year intervention. In total, 540 participants completed the follow-up, while 36 subjects lost in follow-up. Cox proportional hazards analysis was applied to assess the influence of lifestyle interventions on targeted outcomes.

RESULTS

Compared with controls, the diet-only intervention in people with IGT was significantly associated with a reduced risk of all-cause death [hazard ratio (HR) 0.77, 95% confidence interval (CI) (0.61-0.97)], CVD death [HR 0.67, 95% CI (0.46-0.97)] and CVD events [HR 0.72, 95% CI (0.54-0.96)]. The diet-plus-exercise intervention was significantly associated with a decreased risk of all-cause death [HR 0.64, 95% CI (0.48-0.84)], CVD death [HR 0.54, 95% CI (0.30-0.97)] and CVD events [HR 0.68, 95% CI (0.52-0.90)]. Unexpectedly, the exercise-only intervention was not significantly associated with the reduction of any of these outcomes, although there was a consistent trend towards reduction.

CONCLUSIONS

A diet-only intervention and a diet-plus-exercise intervention in people with IGT were significantly associated with a reduced risk of all-cause death, CVD death and CVD events, while an exercise-only intervention was not. It suggests that diet-related interventions may have a potentially more reliable influence on long-term vascular complications and mortality.

Modification of incident cancer risk with changes in metabolic syndrome status: A prospective cohort study in Taiwan

PURPOSE

We aimed to investigate the effect of altered metabolic syndrome (MetS) status on cancer risk.

METHODS

From 2002 through 2008 of the Taiwan MJ cohort, there were 111,616 adults who had repeated MetS measurements performed 3.3 years apart and were followed up for cancer incidence over 11.8 years. Cancer was confirmed based on histopathological reports.

RESULTS

Participants were categorized as MetS-free (n = 80,409; no MetS at the first or last health screening), MetS-developed (n = 9833; MetS absence at the first screening and presence at the last screening), MetS-recovered (n = 8958; MetS presence at the first screening and absence at the last screening), and MetS-persisted (n = 12,416; MetS presence at the first and last screenings). We used the Fine-Gray sub-distribution method, with death as competing risk, to determine the association between MetS changes and incident cancer risk. During 1320,796 person-years of follow-up, 5862 individuals developed cancer. The incidence rate of cancer per 1000 person-years was 3.89 in the MetS-free, 5.26 in MetS-developed, 4.61 in MetS-recovered, and 7.33 in MetS-persisted groups (P < .001). Compared with the MetS-free group, MetS-persisted individuals had a higher risk of incident cancer.

CONCLUSIONS

Persistent MetS was found to be associated with a high risk of incident cancer.

Immunometabolic and Vascular Health Responses among High Endurance Trained Subjects

In this study, we aimed to examine the impact of high endurance training on vascular health parameters and immune-endocrine responses against modified low-density lipoprotein (LDL) particles. This observational, cross-sectional study included high endurance-trained and healthy non-trained subjects. Vascular ultrasound was used to assess vascular health parameters based on carotid intima-media thickness and endothelial function (flow-mediated dilation). Enzyme-linked immunosorbent assays were used to measure interleukin (IL)-8 and IL-10, autoantibody isotypes anti-oxidized LDL (oxLDL) and anti-apolipoprotein B (ApoB-D) peptide. Plasma levels of the corticosterone and 17 α-hydroxyprogesterone hormones were analyzed by mass spectrometry. This study enrolled 96 subjects, of whom 44 were high endurance trained and 52 were healthy non-trained individuals. Smaller carotid intima-media thickness values were observed in the high-endurance trained than in the healthy non-trained males, while no differences were observed between female groups. Flow-mediated dilation measurements did not differ by training or sex. The humoral immune responses to IgG anti-oxLDL and IgM anti-ApoB-D autoantibodies showed an isotype imbalance between the high-endurance trained and the non-trained groups. Immunoendocrine parameters showed inverse correlations between 17 α-hydroxyprogesterone concentrations and carotid intima-media thickness measurements. Direct correlations were found between IL-10 concentrations and flow-mediated dilation measurements. Chronic high-endurance exercise modulates immune-endocrine and vascular health parameters, in a sex-dependent manner.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes: Cross-country comparison of cohort studies

PURPOSE

This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity (PA) to prevent mortality and cardiovascular disease in adults with type 2 diabetes.

METHODS

Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China. Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week (MET-h/week) according to World Health Organization recommendations: none, below recommendation (>0-7.49 MET-h/week); at recommended level (7.5-14.9 MET-h/week); above recommendation (≥15 MET-h/week). Mortality and cardiovascular disease data were obtained from national registries.

RESULTS

During a median follow-up of 12.4 and 9.7 years, in the UK and China cohorts, repectively, higher levels of leisure-time PA were inversely associated with all-cause (1571 and 2351 events) and cardiovascular mortality (392 and 1060 events), mostly consistent with a linear dose-response relationship. PA below, at, and above recommendations, compared with no activity, yielded all-cause mortality hazard ratios of 0.94 (95% confidence interval (95%CI): 0.79-1.12), 0.90 (95%CI: 0.74-1.10), and 0.85 (95%CI: 0.70-1.02) in British adults and 0.87 (95%CI: 0.68-1.10), 0.88 (95%CI: 0.74-1.03), and 0.77 (95%CI: 0.70-0.85) in Chinese adults. Associations with cardiovascular mortality were more pronounced in British adults (0.80 (95%CI: 0.58-1.11), 0.75 (95%CI: 0.52-1.09), and 0.69 (95%CI: 0.48-0.97)) but less pronounced in Chinese adults (1.06 (95%CI: 0.76-1.47), 1.01 (95%CI: 0.80-1.28), and 0.79 (95%CI: 0.69-0.92)). PA at recommended levels was not associated with lower rates of major adverse cardiovascular events (2345 and 4458 events).

CONCLUSION

Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes. Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

Exposure to Neighborhood Greenness and Hypertension Incidence in Adults: A Longitudinal Cohort Study in Taiwan

BACKGROUND

There are few studies on the health effects of long-term exposure to neighborhood greenness in a longitudinal setting, especially in Asian countries with high population densities.

OBJECTIVES

This study investigates the association between long-term exposure to neighborhood greenness and hypertension among adults in Taiwan.

METHODS

We selected 125,537 participants (≥ 18  years of age) without hypertension from Taiwan who had joined the standard medical examination program between 2001 and 2016. Neighborhood greenness was estimated using the normalized difference vegetation index (NDVI), derived from satellite images at a resolution of 250   m 2 . The 2-y average NDVI value within a 500 -m circular buffer around participants' residences was calculated. A time-varying Cox regression model was used to investigate the association between neighborhood greenness and incident hypertension. Mediation analyses were performed to examine whether the association was explained by air pollution, leisure-time physical exercise, or body mass index (BMI).

RESULTS

Compared with living in areas within the first quartile of neighborhood greenness, living in areas within the second, third, and fourth quartiles of neighborhood greenness was found to be associated with a lower risk of hypertension, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.95 (95% CI: 0.91, 1.00), 0.95 (95% CI: 0.90, 0.99), and 0.93 (95% CI: 0.88, 0.97), respectively. Each 0.1-unit increase in the NDVI was associated with a 24% lower risk of developing hypertension (HR = 0.76; 95% CI: 0.66, 0.87), with this associations being stronger among males and those with higher education levels. This association was slightly mediated by BMI but not by air pollution or leisure-time physical exercise.

DISCUSSION

Our findings suggest the protective effects of neighborhood greenness on hypertension development, especially in males and well-educated individuals. Our results reinforced the importance of neighborhood greenness for supporting health. https://doi.org/10.1289/EHP13071.

Transcription factor MYB8 regulates iron deficiency stress response in Arabidopsis

Iron (Fe) is a crucial microelement for humans, animals, and plants. Insufficient Fe levels in plants impede growth and diminish photosynthesis, thus decreasing crop production. Notably, approximately one-third of the soil worldwide is alkaline and prone to Fe deficiency. Therefore, understanding the mechanisms underlying Fe absorption and transportation in plants can enhance Fe bioavailability in crops. In this study, the role of the transcription factor MYB8 in plant response to Fe deficiency in Arabidopsis was investigated via reverse genetics. Phenotype analysis revealed that the functional deletion mutant of MYB8 gene exhibited sensitivity to Fe deficiency stress, as indicated by shorter root length, lower chlorophyll content, and Fe concentration. Conversely, MYB8 overexpression strain showed a tolerant phenotype. Furthermore, qRT-PCR identified possible downstream MYB8-regulated genes. Moreover, MYB8 regulated the expression of iron-regulated transporter 1 (IRT1) by binding to the MYB binding sites motif ('AACAAAC') in its promoter.

Physical activity on prescription in Swedish primary care: a survey on use, views, and implementation determinants amongst general practitioners

INTRODUCTION

Swedish Physical Activity on Prescription (PAP) has been shown to increase physical activity levels, which is known to lead to positive health effects. PAP is being implemented in Swedish healthcare to various extents. However, there is a lack of knowledge about how Swedish general practitioners (GPs) work with PAP and what hinders and facilitates wider implementation.

AIMS

This study aimed to survey GPs' use and views of PAP, identify barriers and facilitators for implementing PAP, and explore associations to gender, practice location, and experience.

METHODS

The study was framed by the Normalization Process Theory. A survey was sent to 463 GPs at 69 different healthcare centres in Region Västra Götaland. Data were analysed using multiple logistic and linear regressions.

RESULTS

A total of 143 GPs completed the survey (response rate 31%). Views on PAP were generally positive amongst respondents, but only 27% reported using PAP regularly. The most prominent reported barriers were insufficient training and resources. Positive views and willingness to collaborate in using PAP were identified as facilitators. Responding GPs in Gothenburg used PAP more often (OR 6.4; 95% CI 2.7-14.8) and were significantly more positive to the method than GPs in other areas of the region. GPs with more than 10 years of practice used PAP more often (OR 2.5; 95% CI 1.1-6.0) than less experienced GPs. Few of the investigated variables were associated with gender.

CONCLUSIONS

The positive views amongst responding GPs are helpful, but more education, training and resources are needed for successful implementation of PAP in Swedish primary health care.