Comparison of energy expenditure estimates from 4 physical activity questionnaires with doubly labeled water estimates in postmenopausal women

Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes

Background

Physical activity (PA) is important for those with type 1 diabetes (T1DM); however, accurate information on PA in people with T1DM is limited.

Aims

This study assessed adherence to PA guidelines using both objective and subjective PA measures and evaluated the relationship between accelerometer-measured PA and cardiovascular disease (CVD) risk factors. Barriers to PA were also assessed.

Methods

Using an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using an accelerometer (ActiGraph) and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to PA were assessed using the Barriers to Physical Activity in Diabetes (type 1) scale. Multiple linear regression models assessed the influence of PA on HbA1c and CVD risk factors.

Results

Mean age ± SD was 40.9 ± 12.9 years, diabetes duration was 18 ± 11.6 years, and HbA1c was 65 ± 14 mmol/mol /8.0 ± 1.3%. Twenty-three (32%) participants exercised according to PA recommendations as measured by an accelerometer. Sixty-nine (97%) participants reported meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p = 0.001), BMI (p = 0.032), waist circumference (p = 0.006), and fat mass (p = 0.032) and a greater number of hypoglycaemic events (p = 0.004). Fear of hypoglycaemia was the strongest barrier to PA (mean 3.4 ± 2.0).

Conclusion

The majority of participants failed to meet PA recommendations. Meeting the recommendations was associated with healthier CVD risk factor profiles. Individuals with T1DM possibly overestimate their PA using self-reported measures and require support and education to safely improve activity levels.

Long-Term Weight Loss Strategies for Obesity

CONTEXT

Obesity is a chronic disease that is difficult to manage without holistic therapy. The therapeutic armamentarium for obesity primarily consists of 4 forms of therapy: lifestyle modification (ie, diet and exercise), cognitive behavioral therapy, pharmacotherapy, and bariatric surgery.

EVIDENCE ACQUISITION

Evidence was consolidated from randomized controlled trials, observational studies, and meta-analyses.

EVIDENCE SYNTHESIS

After 2 years, lifestyle interventions can facilitate weight loss that equates to ~5%. Even though lifestyle interventions are plagued by weight regain, they can have substantial effects on type 2 diabetes and cardiovascular disease risk. Although 10-year percentage excess weight loss can surpass 50% after bariatric surgery, weight regain is likely. To mitigate weight regain, instituting a multifactorial maintenance program is imperative. Such a program can integrate diet, exercise, and pharmacotherapy. Moreover, behavioral therapy can complement a maintenance program well.

CONCLUSIONS

Obesity is best managed by a multidisciplinary clinical team that integrates diet, exercise, and pharmacotherapy. Bariatric surgery is needed to manage type 2 diabetes and obesity in select patients.

Comparison of total and activity energy expenditure estimates from physical activity questionnaires and doubly labelled water: a systematic review and meta-analysis

Physical activity questionnaires (PAQ) could be suitable tools in free-living people for measures of physical activity, total and activity energy expenditure (TEE and AEE). This meta-analysis was performed to determine valid PAQ for estimating TEE and AEE using doubly labelled water (DLW). We identified data from relevant studies by searching Google Scholar, PubMed and Scopus databases. This revealed thirty-eight studies that had validated PAQ with DLW and reported the mean differences between PAQ and DLW measures of TEE (TEEDLW - TEEPAQ) and AEE (AEEDLW - AEEPAQ). We assessed seventy-eight PAQ consisting of fifty-nine PAQ that assessed TEE and thirty-five PAQ that examined AEE. There was no significant difference between TEEPAQ and TEEDLW with a weighted mean difference of -243·3 and a range of -841·4 to 354·6 kJ/d, and a significant weighted mean difference of AEEDLW - AEE PAQ 414·6 and a range of 78·7-750·5. To determine whether any PAQ was a valid tool for estimating TEE and AEE, we carried out a subgroup analysis by type of PAQ. Only Active-Q, administered in two seasons, and 3-d PA diaries were correlated with TEE by DLW at the population level; however, these two PAQ did not demonstrate an acceptable limit of agreement at individual level. For AEE, no PAQ was correlated with DLW either at the population or at the individual levels. Active-Q and 3-d PA diaries were identified as the only valid PAQ for TEE estimation. Further well-designed studies are needed to verify this result and identify additional valid PAQ.

The association of sleep duration and feeling rested with health in U.S. Hispanic women

This study aims to understand the health correlates of sleep deficiencies in non-elderly U.S. Hispanic¹ women. Data from a sample of U.S. Hispanic women (n = 1531; ages 18-65 [M = 39.98; SD = 12.85]) who completed the 2017 National Health Interview Survey were analyzed to understand (1) sleep duration and quality; (2) the association of sleep patterns with key health indicators; and (3) whether these relationships are mediated by health behaviors (ie, healthy eating and physical activity). Shorter sleep duration was associated with a higher likelihood of often feeling anxious and having hypertension. Worse sleep quality was associated with a higher likelihood of being overweight, having fair or poor health status, often feeling depressed, often feeling anxious, having high cholesterol, and having asthma. Doctor's recommendation to engage in physical activity and to decrease calorie intake served as mediators in some of these relationships. Results indicate that among Hispanic women: (1) sleep is an important determinant of a variety of health outcomes and (2) the association of sleep and many health outcomes are mediated by healthy eating and physical activity. Further research on the association of sleep and risk of chronic disease among Hispanic women is needed.

A proper reference metabolic equivalent value to assess physical activity intensity in Japanese female nurses

Background

Various questionnaires have been developed to assess physical activity, but only a few simple questionnaires are suitable for self-administration in large groups of midlife working women. This study examined the usefulness of the Japan Nurses’ Health Study (JNHS) questionnaire for self-administered physical activity surveys.

Methods

The JNHS physical activity questionnaire consisted of items covering seven degrees of intensity. The metabolic equivalents (METs) for the physical activity intensity of the questionnaire were estimated from energy expenditure as measured by a uniaxial accelerometer with the Markov Chain Monte Carlo (MCMC) simulation. The estimated METs were then assigned to the JNHS baseline survey data, and the total energy expenditure (TEE) and the time spent performing ≥3 METs hour of physical activity, called moderate to vigorous intensity physical activity (MVPA), were calculated.

Results

For working situations, application of the MCMC simulation resulted in estimated reference values of 1.2 METs for “sitting work”, 1.6 METs for “standing work”, 1.8 METs for “walking work”, and 4.5 METs for “heavy work”. For non-working situations, the estimated values were 1.1 METs for sedentary time, 2.4 METs for “moderate physical activity”, 4.4 METs for “vigorous physical activity”, and 9.4 METs for “very vigorous physical activity”. When these estimated METs were used, the mean TEE/day was 1808 kcal. This corresponded to − 3.0% of the TEE/day generated by the accelerometer. These estimated MET values showed similar results as a previous study measuring activity using the doubly-labeled water method. The number of hours per week of MVPA significantly decreased with age, which is also consistent with previous findings.

Conclusions

Estimated reference MET values in this study were similar to those in previous studies of Japanese women. The JNHS questionnaire is therefore useful for epidemiological surveys of midlife working women because it assigns estimated MET values as physical activity intensities.

Physical Activity, Sport Participation, and Perceived Barriers to Engagement in First-Year Canadian University Students

Background: Physical activity (PA) declines during early adulthood with higher rates of inactivity in university students. The authors aimed to examine the frequency, intensity, time, type of PA, and the barriers to PA participation in Canadian students during the first year of university. Methods: Questionnaires assessing PA variables were administered to 301 first-year students at the beginning and end of the academic year. Results: PA decreased over a year. Males engaged in more vigorous activity minutes, more strength training, and more organized sports than females (P < .05). Females participated in more fitness activities than males (P < .05). Intramural (noncompetitive and school organized) sport participation remained constant throughout the year. Significant intrapersonal barriers to PA engagement included stress and perceived self-skill; significant interpersonal barriers included lack of friends and peer influence; and significant structural barriers included homework, class schedule, and overcrowded facilities. Conclusion: PA and sport participation declined, and some differences existed between the sexes. Focus should be placed on reducing the barriers that students' experience that may impact their PA. Interventions/programming to promote different aspects of PA should focus on noncompetitive sport and recreation activities, as well as activities that students can do on their own time. Ensuring the availability of adequate campus facilities is also important.

Comparison of psychometric properties between recall methods of interview-based physical activity questionnaires: a systematic review

BACKGROUND

This systematic review examined the methodological quality of studies and assessed the psychometric qualities of interview-administered Past-week and Usual-week Physical Activity Questionnaires (PAQs). Pubmed and Embase were used to retrieve data sources.

METHODS

The studies were selected using the following eligibility criteria: 1) psychometric properties of PAQs were assessed in adults; 2) the PAQs either consisted of recall periods of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were interview-administered. The COSMIN taxonomy was utilised to critically appraise study quality and a previously established psychometric criteria employed to evaluate the overall psychometric qualities.

RESULTS

Following screening, 42 studies were examined to determine the psychometric properties of 20 PAQs, with the majority of studies demonstrating good to excellent ratings for methodological quality. For convergent validity (i.e., the relationship between PAQs and other measures), similar overall associations were found between Past-week PAQs and Usual-week PAQs. However, PAQs were more strongly associated with direct measures of physical activity (e.g., accelerometer) than indirect measures of physical activity (i.e., physical fitness), irrespective of recall methods. Very few psychometric properties were examined for each PAQ, with the majority exhibiting poor ratings in psychometric quality. Only a few interview-administered PAQs exhibited positive ratings for a single psychometric property, although the other properties were either rated as poor or questionable, demonstrating the limitations of current PAQs.

CONCLUSION

Accordingly, further research is necessary to explore a greater number of psychometric properties, or to develop new PAQs by addressing the psychometric limitations identified in the current review.

Canadian-French adaptation and test-retest reliability of the leisure time physical activity questionnaire for people with disabilities

OBJECTIVES

The Leisure Time Physical Activity Questionnaire (LTPAQ) measures the duration of physical activities performed during the past 7 days, and results are expressed in minutes. This study aimed to translate this questionnaire into Canadian-French and to evaluate the content validity and its test-retest reliability in people with physical disabilities.

METHODS

The LTPAQ was translated from English to French by forward and backward translation. To assess content validity, 9 adults with physical disabilities read and provided comments regarding the relevance, wording and understanding of the items of the preliminary Canadian-French version of the questionnaire. For test-retest reliability, 37 adults with physical disabilities completed the questionnaire 2 or 3 times at T1 (baseline), T2 (2 days from baseline) and T3 (7 days from baseline). The test-retest reliability was investigated by intra-class correlation coefficients (ICCs), paired t test and Bland and Altman tests.

RESULTS

The translation and the content validation process resulted in a Canadian-French version of the LTPAQ (LTPAQ-CF). Total LTPAQ-CF scores between T1-T2 and T1-T3 featured strong ICCs, 0.90 and 0.75 (P≤0.01). Paired t tests and Bland and Altman analyses confirmed the good reproducibility of results.

CONCLUSION

The LTPAQ-CF has good test-retest reliability when self-administered or administered by interview to people with physical disabilities.

Daily Yogurt Consumption Improves Glucose Metabolism and Insulin Sensitivity in Young Nondiabetic Japanese Subjects with Type-2 Diabetes Risk Alleles

This study investigated whether the association between postprandial plasma glucose (PPG) is affected by five type 2 diabetes mellitus (T2DM) susceptibility genes, and whether four weeks of yogurt consumption would affect these responses. We performed a single-arm intervention study in young nondiabetic Japanese participants, who consumed 150 g yogurt daily for four weeks, after which a rice test meal containing 50 g carbohydrate was administered. PPG and postprandial serum insulin (PSI) were measured between 0 and 120 mins at baseline and after the intervention. Genetic risk was evaluated by weighted genetic risk score (GRS) according to published methodology, and participants were assigned to one of two groups (n = 17: L-GRS group and n = 15: H-GRS group) according to the median of weighted GRS. At baseline, the H-GRS group had higher glucose area under the curve_{0–120 min} after intake of the test meal than the L-GRS group (2175 ± 248 mg/dL.min vs. 1348 ± 199 mg/dL.min, p < 0.001), but there were no significant differences after the yogurt intervention. However, there was an improvement in PSI in the H-GRS group compared with baseline. These results suggest that habitual yogurt consumption may improve glucose and insulin responses in nondiabetic subjects who have genetically higher PPG.

FACTOR ANALYSIS OF THE MINNESOTA LEISURE TIME ACTIVITIES QUESTIONNAIRE - BRAZILIAN PORTUGUESE

ABSTRACT Introduction: Accurate measures of physical activity to establish dose-response relationship in health outcomes are still controversial. Scales that estimate caloric expenditure are proposed with a view to categorizing the phenomenon globally. Objective: To carry out a factor analysis of the structure of the Minnesota Leisure Time Activities Questionnaire - Brazilian Portuguese, and propose a new adapted version for the Brazilian elderly community. Methods: Participants were elderly female members of the community, without any distinction in terms of ethnic group and/or social class, who frequented extension projects of two higher education institutions. Those with cognitive impairments; dependence on walking aids; musculoskeletal pain in the last two weeks and neurological diseases were excluded from the study. All participants answered the questionnaire with sociodemographic and clinical data and the Minnesota Leisure Time Activities Questionnaire - Brazilian Portuguese version. We determined whether each activity had been undertaken by the participants and the average number of times it was performed over the last two weeks, considering average time, in minutes, on each occasion. Each activity was considered a single item and energy expenditure was calculated according to the authors’ instructions. We used factor analysis with Varimax orthogonal rotation, excluding items whose variance was equal to zero. Correlation between items was determined using the Pearson correlation matrix. Internal consistency between items, before and after the factor analysis, was verified using Cronbach’s α coefficient. 5% significance level. Results: Participants were 220 women (70.8 ± 5.9 years). The factor analysis resulted in 10 components, which explained, in total, 61.87% of the variance of the total score on the scale. Each component was composed of one, two or three aggregate items. Internal consistency by Cronbach’s α coefficient was 0.30. Conclusion: The factor analysis of the structure of the Minnesota Leisure Time Activities Questionnaire - Brazilian Portuguese- has shown a new range with 10 components, which explained, in total, more than 60% of the variance of the total score on the scale, yet with low internal consistency. Level of Evidence III; Study of nonconsecutive patients; without consistently applied reference ‘‘gold’’ standard.

A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study

The links between increased participation in Physical Activity (PA) and improvements in health are well established. As this body of evidence has grown, so too has the search for measures of PA with high levels of methodological effectiveness (i.e. validity, reliability and responsiveness to change). The aim of this “review of reviews” was to provide a comprehensive overview of the methodological effectiveness of currently employed measures of PA, to aid researchers in their selection of an appropriate tool. A total of 63 review articles were included in this review, and the original articles cited by these reviews were included in order to extract detailed information on methodological effectiveness.

Self-report measures of PA have been most frequently examined for methodological effectiveness, with highly variable findings identified across a broad range of behaviours. The evidence-base for the methodological effectiveness of objective monitors, particularly accelerometers/activity monitors, is increasing, with lower levels of variability observed for validity and reliability when compared to subjective measures. Unfortunately, responsiveness to change across all measures and behaviours remains under-researched, with limited information available.

Other criteria beyond methodological effectiveness often influence tool selection, including cost and feasibility. However, researchers must be aware of the methodological effectiveness of any measure selected for use when examining PA. Although no “perfect” tool for the examination of PA in adults exists, it is suggested that researchers aim to incorporate appropriate objective measures, specific to the behaviours of interests, when examining PA in free-living environments.

Energy expenditure estimation from respiration variables

The aim of this study was to develop and cross-validate two models to estimate total energy expenditure (TEE) based on respiration variables in healthy subjects during daily physical activities. Ninety-nine male and female subjects systematically varying in age (18-60 years) and body mass index (BMI; 17-36 kg*m-2) completed eleven aerobic activities with a portable spirometer as the criterion measure. Two models were developed using linear regression analyses with the data from 67 randomly selected subjects (50.0% female, 39.9 ± 11.8 years, 25.1 ± 5.2 kg*m-2). The models were cross-validated with the other 32 subjects (49% female, 40.4 ± 10.7 years, 24.7 ± 4.6 kg*m-2) by applying equivalence testing and Bland-and-Altman analyses. Model 1, estimating TEE based solely on respiratory volume, respiratory rate, and age, was significantly equivalent to the measured TEE with a systematic bias of 0.06 kJ*min-1 (0.22%) and limits of agreement of ±6.83 kJ*min-1. Model 1 was as accurate in estimating TEE as Model 2, which incorporated further information on activity categories, heart rate, sex, and BMI. The results demonstrated that respiration variables and age can be used to accurately determine daily TEE for different types of aerobic activities in healthy adults across a broad range of ages and body sizes.

Telemedical assessment of the level of energy expenditure in overweight and obese individuals

Introduction

Increasing the energy expenditure above the elementary level of metabolism by undertaking regular physical activity causes body mass reduction and its maintenance at a healthy level.

Aim

To remote assessment of the level of physical activity in a group of overweight and obese individuals.

Material and methods

The research was conducted in the Department of Rehabilitation at the Institute of Rural Health, Lublin, Poland, and included a group of 514 volunteers of both genders (38 ±12 years). The examined group was divided into three subgroups depending on the body mass index (BMI) level (I – normal, II – overweight, III – obese). The level of physical activity at home was assessed based of the short version of the International Physical Activity Questionnaire (IPAQ), conducted by means of a mobile application, and was compared with data registered by the accelerometer of a smartphone.

Results

The IPAQ-assessed level of the physical activity expressed in MET-min/week amounted to the following values: group I: 5190.38 ±6629.84, group II: 5099.53 ±6380.97, group III: 3939.31 ±4000.73; and the caloric cost (cal × week^–1) amounted to: group I: 5825.47 ±7512.99, group II: 7204.09 ±9187.96), and group III: 7002.10 ±7296.22. Registered levels of physical activity (MET-min/week) were lower than IPAQ-assessed: in group I (3741.24 ±3958.29), in group II (2447.72 ±2156.44) and in group III (1927.42 ±1790.85) (p < 0.05).

Conclusions

The average values of energy expenditure showed a declining tendency, together with an increase in the BMI. On the other hand, the total weekly caloric cost showed the lowest average values in the group with normal body mass.

Outcomes of a community-based lifestyle programme for adults with diabetes or pre-diabetes

INTRODUCTION Diabetes, a long-term condition increasing in prevalence, requires ongoing healthcare management. Exercise alongside lifestyle education and support is effective for diabetes management. AIM To investigate clinical outcomes and acceptability of a community-based lifestyle programme for adults with diabetes/prediabetes at programme completion and 3-month follow-up. METHODS The 12-week community programme included twice-weekly sessions of self-management education and exercise, supervised by a physiotherapist, physiotherapy students and a nurse. Clinical outcomes assessed were cardiorespiratory fitness, waist circumference, exercise behaviour and self-efficacy. A standardised evaluation form was used to assess programme acceptability. RESULTS Clinically significant improvements were found from baseline (n = 36) to programme completion (n = 25) and 3-months follow-up (n = 20) for the six minute walk test (87 m (95%CI 65-109; p ≤ 0.01), 60 m (95%CI 21-100; p ≤ 0.01)), waist circumference (-3 cm (95%CI -6 to -1), -3 cm (95%CI -6 to 1)), exercise behaviour (aerobic exercise 53 min/week (95%CI 26 to 81; p ≤ 0.01), 71 min/week (95%CI 25 to 118; p ≤ 0.01)) and self-efficacy (0.7 (95%CI -0.2 to 1.6), 0.8 (95%CI 0.04 to 1.5)). Good programme acceptability was demonstrated by themes suggesting a culturally supportive, motivating, friendly, informative atmosphere within the programme. The attrition rate was 30% but there were no adverse medical events related to the programme. DISCUSSION The programme was safe and culturally acceptable and outcomes demonstrated clinical benefit to participants. The attrition rate was largely due to medical reasons unrelated to the programme. This model of a community-based lifestyle programme has the potential to be reproduced in other regions and in adults with similar long-term conditions. KEYWORDS Diabetes Mellitus Type II; Prediabetic state; Co-morbidity; Exercise; Self-management.

A Comparison of Biological and Physical Risk Factors for Cardiovascular Disease in Overweight/Obese Individuals With and Without Prediabetes

Compared with type 2 diabetes, evaluating the direct biological and physical risk factors for cardiovascular disease (CVD) in overweight/obese adults with and without prediabetes is less understood. Therefore, the aim of the study was to compare baseline biological and physical risk factors for CVD among overweight/obese adults with and without prediabetes. A secondary data analysis was performed. Three hundred forty-one overweight/obese participants were included in the analysis. Compared with non-prediabetics, prediabetics had higher fasting blood glucose, body mass index, waist-to-hip ratio, and triglycerides. Prediabetics were also more likely to be insulin resistant than non-prediabetics. Participants with prediabetes had much lower cardiorespiratory fitness than those without prediabetes. Findings from this study suggest that healthy overweight/obese adults with prediabetes were likely at higher biological and physical risk of CVD at baseline compared with those without prediabetes. Early intervention to improve CVD risk progression among persons with prediabetes is essential.

Using kernel density estimation to understand the influence of neighbourhood destinations on BMI

OBJECTIVES

Little is known about how the distribution of destinations in the local neighbourhood is related to body mass index (BMI). Kernel density estimation (KDE) is a spatial analysis technique that accounts for the location of features relative to each other. Using KDE, this study investigated whether individuals living near destinations (shops and service facilities) that are more intensely distributed rather than dispersed, have lower BMIs.

STUDY DESIGN AND SETTING

A cross-sectional study of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia.

METHODS

Destinations were geocoded, and kernel density estimates of destination intensity were created using kernels of 400, 800 and 1200 m. Using multilevel linear regression, the association between destination intensity (classified in quintiles Q1(least)-Q5(most)) and BMI was estimated in models that adjusted for the following confounders: age, sex, country of birth, education, dominant household occupation, household type, disability/injury and area disadvantage. Separate models included a physical activity variable.

RESULTS

For kernels of 800 and 1200 m, there was an inverse relationship between BMI and more intensely distributed destinations (compared to areas with least destination intensity). Effects were significant at 1200 m: Q4, β -0.86, 95% CI -1.58 to -0.13, p=0.022; Q5, β -1.03 95% CI -1.65 to -0.41, p=0.001. Inclusion of physical activity in the models attenuated effects, although effects remained marginally significant for Q5 at 1200 m: β -0.77 95% CI -1.52, -0.02, p=0.045.

CONCLUSIONS

This study conducted within urban Melbourne, Australia, found that participants living in areas of greater destination intensity within 1200 m of home had lower BMIs. Effects were partly explained by physical activity. The results suggest that increasing the intensity of destination distribution could reduce BMI levels by encouraging higher levels of physical activity.

Validity of 24-h physical activity recall: physical activity measurement survey

PURPOSE

The primary purpose of this study was to evaluate the validity of an interviewer-administered, 24-h physical activity recall (PAR) compared with that of the SenseWear Armband (SWA) for estimation of energy expenditure (EE) and moderate-to-vigorous physical activity (MVPA) in a representative sample of adults. A secondary goal was to compare measurement errors for various demographic subgroups (gender, age, and weight status).

METHODS

A sample of 1347 adults (20-71 yr, 786 females) wore an SWA for a single day and then completed a PAR, recalling the previous day's physical activity. The participants each performed two trials on two randomly selected days across a 2-yr time span. The EE and MVPA values for each participant were averaged across the 2 d. Group-level and individual-level agreement were evaluated using 95% equivalence testing and mean absolute percent error, respectively. Results were further examined for subgroups by gender, age, and body mass index.

RESULTS

The PAR yielded equivalent estimates of EE (compared with those in the SWA) for almost all demographic subgroups, but none of the comparisons for MVPA were equivalent. Smaller mean absolute percent error values were observed for EE (ranges from 10.3% to 15.0%) than those for MVPA (ranges from 68.6% to 269.5%) across all comparisons. The PAR yielded underestimates of MVPA for younger, less obese people but overestimates for older, more obese people.

CONCLUSIONS

For EE measurement, the PAR demonstrated good agreement relative to the SWA. However, the use of PAR may result in biased estimates of MVPA both at the group and individual level in adults.

Self-Directed Weight Loss Strategies: Energy Expenditure Due to Physical Activity Is Not Increased to Achieve Intended Weight Loss

Reduced physical activity and almost unlimited availability of food are major contributors to the development of obesity. With the decline of strenuous work, energy expenditure due to spontaneous physical activity has attracted increasing attention. Our aim was to assess changes in energy expenditure, physical activity patterns and nutritional habits in obese subjects aiming at self-directed weight loss.

METHODS

Energy expenditure and physical activity patterns were measured with a portable armband device. Nutritional habits were assessed with a food frequency questionnaire.

RESULTS

Data on weight development, energy expenditure, physical activity patterns and nutritional habits were obtained for 105 patients over a six-month period from an initial cohort of 160 outpatients aiming at weight loss. Mean weight loss was -1.5 ± 7.0 kg (p = 0.028). Patients with weight maintenance (n = 75), with substantial weight loss (>5% body weight, n = 20) and with substantial weight gain (>5% body weight, n = 10) did not differ in regard to changes of body weight adjusted energy expenditure components (total energy expenditure: -0.2 kcal/kg/day; non-exercise activity thermogenesis: -0.3 kcal/kg/day; exercise-related activity thermogenesis (EAT): -0.2 kcal/kg/day) or patterns of physical activity (duration of EAT: -2 min/day; steps/day: -156; metabolic equivalent unchanged) measured objectively with a portable armband device. Self-reported consumption frequency of unfavorable food decreased significantly (p = 0.019) over the six-month period.

CONCLUSIONS

An increase in energy expenditure or changes of physical activity patterns (objectively assessed with a portable armband device) are not employed by obese subjects to achieve self-directed weight loss. However, modified nutritional habits could be detected with the use of a food frequency questionnaire.

Objective and subjective measurement of energy expenditure in older adults: a doubly labeled water study

BACKGROUND/OBJECTIVES

Objective and subjective measurement instruments have been used to estimate energy expenditure (EE) as alternatives to the doubly labeled water (DLW) methodology, but their relative validity for older adults remains uncertain. The purpose of this study was to validate an objective monitor (SenseWear Mini Armband) and a self-report instrument (7-Day Physical Activity Recall, 7D-PAR) relative to the DLW under free-living conditions in older adults.

SUBJECTS/METHODS

Twenty-nine older adults (60-78 years) each wore the Mini for 14 consecutive days and completed two 7D-PARs after each week. For each measurement method, activity EE (AEE) was calculated as total EE (TEE)—measured resting metabolic rate (RMR)—diet induced thermogenesis (10% of TEE). TEE and AEE from the Mini and 7D-PAR were each compared with values from the DLW.

RESULTS

Equivalence testing indicated that estimates of TEE from the Mini and the 7D-PAR were statistically equivalent to those measured with DLW; however, differences were evident for estimates of AEE. The Mini had smaller mean absolute percent error for TEE (8.0%) and AEE (28.4%) compared with the 7D-PAR (13.8 and 84.5%, respectively) and less systematic bias in the estimates.

CONCLUSIONS

The Mini and 7D-PAR provided reasonably valid estimates of TEE but large errors in estimating AEE. The Mini and 7D-PAR have the potential to accurately estimate TEE for older adults.

Associations of physical activity with depressiveness and coping in subjects with high-grade obesity aiming at bariatric surgery: a cross-sectional study

Background

Reduced physical activity is supposed to be associated with depressiveness and more passive coping patterns. For further evaluation of this assumed relation we studied energy expenditure due to physical activity - usually referred to as activity thermogenesis (AT) - together with depressiveness (clinical diagnosis, depression module of the Patient Health Questionnaire), and coping behaviours (Brief COPE Inventory) in 50 patients with high-grade obesity (42 ± 12 years; 9 with II° and 41 with III° obesity) aiming at bariatric surgery.

Methods

AT was assessed with a portable armband device (SenseWear™ armband). Depressiveness and coping were assessed using validated questionnaires.

Results

Weight-adjusted non-exercise AT and intensity of physical activity (metabolic equivalent) correlated inversely with body mass index (non-exercise AT: r = −0.32, P < 0.05; mean metabolic equivalent: r = −0.37, P < 0.01) but not with depressiveness. The coping strategies “support coping” and “active coping” showed significant inverse correlations to a) weight-adjusted non-exercise AT (“support coping”: r = −0.34, P < 0.05; “active coping”: r = −0.36, P < 0.05), b) weight-adjusted exercise-related AT (“support coping”: r = −0.36, P < 0.05; “active coping”: r = −0.38, P < 0.01) and c) intensity of physical activity (for mean metabolic equivalent: “support coping”: r = −0.38, P < 0.01; “active coping”: r = −0.40, P < 0.01; for duration of exercise-related AT: “support coping”: r = −0.36, P < 0.05; “active coping”: r = −0.38, P < 0.01).

Conclusions

AT was not associated with depressiveness. Furthermore, supposed adaptive coping strategies of individuals aiming at bariatric surgery were negatively associated with AT.

Fine Mapping of a GWAS-Derived Obesity Candidate Region on Chromosome 16p11.2

INTRODUCTION

Large-scale genome-wide association studies (GWASs) have identified 97 chromosomal loci associated with increased body mass index in population-based studies on adults. One of these SNPs, rs7359397, tags a large region (approx. 1MB) with high linkage disequilibrium (r2>0.7), which comprises five genes (SH2B1, APOBR, sulfotransferases: SULT1A1 and SULT1A2, TUFM). We had previously described a rare mutation in SH2B1 solely identified in extremely obese individuals but not in lean controls.

METHODS

The coding regions of the genes APOBR, SULT1A1, SULT1A2, and TUFM were screened for mutations (dHPLC, SSCP, Sanger re-sequencing) in 95 extremely obese children and adolescents. Detected non-synonymous variants were genotyped (TaqMan SNP Genotyping, MALDI TOF, PCR-RFLP) in independent large study groups (up to 3,210 extremely obese/overweight cases, 485 lean controls and 615 obesity trios). In silico tools were used for the prediction of potential functional effects of detected variants.

RESULTS

Except for TUFM we detected non-synonymous variants in all screened genes. Two polymorphisms rs180743 (APOBR p.Pro428Ala) and rs3833080 (APOBR p.Gly369_Asp370del9) showed nominal association to (extreme) obesity (uncorrected p = 0.003 and p = 0.002, respectively). In silico analyses predicted a functional implication for rs180743 (APOBR p.Pro428Ala). Both APOBR variants are located in the repetitive region with unknown function.

CONCLUSION

Variants in APOBR contributed as strongly as variants in SH2B1 to the association with extreme obesity in the chromosomal region chr16p11.2. In silico analyses implied no functional effect of several of the detected variants. Further in vitro or in vivo analyses on the functional implications of the obesity associated variants are warranted.

The Relationship between Intramuscular Adipose Tissue, Functional Mobility, and Strength in Postmenopausal Women with and without Type 2 Diabetes

Objectives. To determine (1) whether intramuscular adipose tissue (IntraMAT) differs between women with and without type 2 diabetes and (2) the association between IntraMAT and mobility and strength. Methods. 59 women ≥ 65 years with and without type 2 diabetes were included. A 1-Tesla MRI was used to acquire images of the leg. Timed-up-and-go (TUG) and grip strength were measured. Regression was used to determine associations between the following: (1) type 2 diabetes and IntraMAT (covariates: age, ethnicity, BMI, waist : hip ratio, and energy expenditure), (2) IntraMAT and TUG (covariates: diabetes, age, BMI, and energy expenditure), and (3) IntraMAT and grip strength (covariates: diabetes, age, height, and lean mass). Results. Women with diabetes had more IntraMAT. After adjustment, IntraMAT was similar between groups (diabetes mean [SD] = 13.2 [1.4]%, controls 11.8 [1.3]%, P = 0.515). IntraMAT was related to TUG and grip strength, but the relationships became nonsignificant after adjustment for covariates (difference/percent IntraMAT [95% CI]: TUG = 0.041 seconds [-0.079-0.161], P = 0.498, grip strength = -0.144 kg [-0.335-0.066], P = 0.175). Conclusions. IntraMAT alone may not be a clinically important predictor of functional mobility and strength; however, whether losses in functional mobility and strength are promoted by IntraMAT accumulation should be explored.

Accelerometer-based measures in physical activity surveillance: current practices and issues

OBJECTIVE

Self-reports of physical activity (PA) have been the mainstay of measurement in most non-communicable disease (NCD) surveillance systems. To these, other measures are added to summate to a comprehensive PA surveillance system. Recently, some national NCD surveillance systems have started using accelerometers as a measure of PA. The purpose of this paper was specifically to appraise the suitability and role of accelerometers for population-level PA surveillance.

METHODS

A thorough literature search was conducted to examine aspects of the generalisability, reliability, validity, comprehensiveness and between-study comparability of accelerometer estimates, and to gauge the simplicity, cost-effectiveness, adaptability and sustainability of their use in NCD surveillance.

CONCLUSIONS

Accelerometer data collected in PA surveillance systems may not provide estimates that are generalisable to the target population. Accelerometer-based estimates have adequate reliability for PA surveillance, but there are still several issues associated with their validity. Accelerometer-based prevalence estimates are largely dependent on the investigators' choice of intensity cut-off points. Maintaining standardised accelerometer data collections in long-term PA surveillance systems is difficult, which may cause discontinuity in time-trend data. The use of accelerometers does not necessarily produce useful between-study and international comparisons due to lack of standardisation of data collection and processing methods. To conclude, it appears that accelerometers still have limitations regarding generalisability, validity, comprehensiveness, simplicity, affordability, adaptability, between-study comparability and sustainability. Therefore, given the current evidence, it seems that the widespread adoption of accelerometers specifically for large-scale PA surveillance systems may be premature.

Estimating energy expenditure from heart rate in older adults: a case for calibration

Background

Accurate measurement of free-living energy expenditure is vital to understanding changes in energy metabolism with aging. The efficacy of heart rate as a surrogate for energy expenditure is rooted in the assumption of a linear function between heart rate and energy expenditure, but its validity and reliability in older adults remains unclear.

Objective

To assess the validity and reliability of the linear function between heart rate and energy expenditure in older adults using different levels of calibration.

Design

Heart rate and energy expenditure were assessed across five levels of exertion in 290 adults participating in the Baltimore Longitudinal Study of Aging. Correlation and random effects regression analyses assessed the linearity of the relationship between heart rate and energy expenditure and cross-validation models assessed predictive performance.

Results

Heart rate and energy expenditure were highly correlated (r = 0.98) and linear regardless of age or sex. Intra-person variability was low but inter-person variability was high, with substantial heterogeneity of the random intercept (s.d. = 0.372) despite similar slopes. Cross-validation models indicated individual calibration data substantially improves accuracy predictions of energy expenditure from heart rate, reducing the potential for considerable measurement bias. Although using five calibration measures provided the greatest reduction in the standard deviation of prediction errors (1.08 kcals/min), substantial improvement was also noted with two (0.75 kcals/min).

Conclusion

These findings indicate standard regression equations may be used to make population-level inferences when estimating energy expenditure from heart rate in older adults but caution should be exercised when making inferences at the individual level without proper calibration.

Short sleep duration is associated with higher energy intake and expenditure among African-American and non-Hispanic white adults

Habitual short sleep duration appears to increase the risk of obesity. The objective of this paper is to investigate the association of habitual sleep duration with objective measures of energy balance. One hundred twelve African-American and 111 non-Hispanic whites aged 21-69 y participated in a cross-sectional study of dietary assessment and biomarkers. Participants reported the mean number of hours per day spent sleeping over the past year. Short sleep duration was defined as ≤6 h/d of sleep. Energy intake (kilocalories) was objectively assessed using the 2-point doubly labeled water technique to determine total energy expenditure, which is approximately equal to energy intake. Physical activity energy expenditure (kilocalories) was estimated as total energy expenditure minus each participant's calculated basal metabolic rate and the thermogenic effect of food. Compared with participants who slept ≤6 h, individuals who slept 8 h were significantly less likely to be obese (OR: 0.33; 95% CI: 0.14, 0.79). However, this association was not linear across 6-9 h of sleep (P-trend = 0.16). There was an inverse association between sleep and energy intake (P-trend = 0.07): compared with ≤6 h/d, adults who reported ≥9 h sleep consumed 178 fewer kcal/d. There was also an inverse association between sleep and physical activity (P-trend = 0.05): compared with ≤6 h/d of sleep, adults who reported 9 h of usual sleep expended 113 fewer kcal/d in physical activity. These data indicate that, compared with longer sleep duration, adults who report habitual short sleep duration have somewhat higher physical activity energy expenditure but considerably higher energy intake. Habitual short sleep duration appears to be 1 of the facets of modern life leading to a mismatch between energy intake and physical activity.

Frailty assessment in the cardiovascular care of older adults

Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty-slow walking speed, weakness, inactivity, exhaustion, and shrinking-as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.

Detecting periods of eating during free-living by tracking wrist motion

This paper is motivated by the growing prevalence of obesity, a health problem affecting over 500 million people. Measurements of energy intake are commonly used for the study and treatment of obesity. However, the most widely used tools rely upon self-report and require a considerable manual effort, leading to underreporting of consumption, noncompliance, and discontinued use over the long term. The purpose of this paper is to describe a new method that uses a watch-like configuration of sensors to continuously track wrist motion throughout the day and automatically detect periods of eating. Our method uses the novel idea that meals tend to be preceded and succeeded by the periods of vigorous wrist motion. We describe an algorithm that segments and classifies such periods as eating or noneating activities. We also evaluate our method on a large dataset (43 subjects, 449 total h of data, containing 116 periods of eating) collected during free-living. Our results show an accuracy of 81% for detecting eating at 1-s resolution in comparison to manually marked event logs of periods eating. These results indicate that vigorous wrist motion is a useful indicator for identifying the boundaries of eating activities, and that our method should prove useful in the continued development of body-worn sensor tools for monitoring energy intake.

Socio-demographic and behavioural correlates of physical activity perception in individuals with recently diagnosed diabetes: results from a cross-sectional study

Background

Physical activity (PA) levels in type 2 diabetes mellitus (T2DM) patients are generally low. Poor PA perception may impede healthy behaviour change in this high risk group. We describe (i) objective PA levels, (ii) the difference between objective and self-reported PA (‘PA disparity’) and the correlates of (iii) PA disparity and (iv) overestimation in recently diagnosed T2DM patients.

Methods

Cross-sectional analysis of 425 recently diagnosed T2DM patients aged 42 to 71, participating in the ADDITION-Plus study in Eastern England, UK. We define ‘PA disparity’ as the non-negative value of the difference (in mathematical terms the absolute difference) between objective and self-reported physical activity energy expenditure (PAEE in kJ · kg^-1 · day^-1). ‘Overestimators’ comprised those whose self-reported- exceeded objective-PAEE by 4.91 kJ · kg^-1 · day^-1(the equivalent of 30 minutes moderate activity per day). Multivariable linear regression examined the association between PA disparity (continuous) and socio-demographic, clinical, health behaviour, quality of life and psychological characteristics. Logistic regression examined the association between PA overestimation and individual characteristics.

Results

Mean objective and self-reported PAEE levels ± SD were 34.4 ± 17.0 and 22.6 ± 19.4 kJ · kg^-1 · day^-1, respectively (difference in means =11.8; 95% CI = 9.7 to 13.9 kJ · kg^-1 · day^-1). Higher PA disparity was associated with male sex, younger age, lower socio-economic status and lower BMI. PA overestimators comprised 19% (n = 80), with those in routine/manual occupations more likely to be overestimators than those in managerial/professional occupations.

Conclusions

T2DM patients with poor physical activity perception are more likely to be male, younger, from a lower socio-economic class and to have a lower BMI. PA overestimators were more likely to be in lower socio-economic categories. Self-monitoring and targeted feedback, particularly to those in lower socio-economic categories, may improve PA perceptions and optimise interventions in T2DM patients. Our findings suggest that strategies for enabling realistic assessment of physical activity levels, through self-monitoring or feedback, warrant further investigation and may help refine and improve physical activity interventions.

Physical activity assessment: biomarkers and self-report of activity-related energy expenditure in the WHI

We used a biomarker of activity-related energy expenditure (AREE) to assess measurement properties of self-reported physical activity and to determine the usefulness of AREE regression calibration equations in the Women's Health Initiative. Biomarker AREE, calculated as the total energy expenditure from doubly labeled water minus the resting energy expenditure from indirect calorimetry, was assessed in 450 Women's Health Initiative participants (2007-2009). Self-reported AREE was obtained from the Arizona Activity Frequency Questionnaire (AAFQ), the 7-Day Physical Activity Recall (PAR), and the Women's Health Initiative Personal Habits Questionnaire (PHQ). Eighty-eight participants repeated the protocol 6 months later. Reporting error, measured as log(self-report AREE) minus log(biomarker AREE), was regressed on participant characteristics for each instrument. Body mass index was associated with underreporting on the AAFQ and PHQ but overreporting on PAR. Blacks and Hispanics underreported physical activity levels on the AAFQ and PAR, respectively. Underreporting decreased with age for the PAR and PHQ. Regressing logbiomarker AREE on logself-reported AREE revealed that self-report alone explained minimal biomarker variance (R(2) = 7.6, 4.8, and 3.4 for AAFQ, PAR, and PHQ, respectively). R(2) increased to 25.2, 21.5, and 21.8, respectively, when participant characteristics were included. Six-month repeatability data adjusted for temporal biomarker variation, improving R(2) to 79.4, 67.8, and 68.7 for AAFQ, PAR, and PHQ, respectively. Calibration equations "recover" substantial variation in average AREE and valuably enhance AREE self-assessment.

Dietary fibre consumption and insulin resistance - the role of body fat and physical activity

The present study was conducted to determine the association between fibre intake and insulin resistance in 264 women using a cross-sectional design. Insulin resistance was indexed using homeostasis model assessment of insulin resistance (HOMA-IR) (US formula: fasting insulin (μU/ml) × fasting glucose (mg/dl)/405 international formula: fasting glucose (mmol/l) × fasting insulin (μU/l)/22.5). Fibre and energy consumption were assessed using 7 d weighed food records. Fibre was expressed as g/4184 kJ (1000 kcal). Body fat percentage (BF%) was measured using the BOD POD, and physical activity (PA) was ascertained using Actigraph accelerometers (Health One Technology) worn for seven consecutive days. Women with high total fibre intakes (F= 4·58, P= 0·0332) or high soluble fibre intakes (F= 7·97, P= 0·0051) had significantly less insulin resistance than their counterparts. Participants with high insoluble fibre intakes did not differ from their counterparts (F= 0·7, P= 0·6875). Adjusting for either PA or BF% weakened the relationships significantly. Controlling for BF% nullified the total fibre–HOMA-IR link (F= 1·96, P= 0·1631) and attenuated the association between soluble fibre and HOMA-IR by 32 % (F= 6·86, P= 0·0094). To create dichotomous variables, fibre intake and HOMA-IR were each divided into two categories using the median (low and high). In women who had high soluble fibre intake (upper 50 %), the OR of having an elevated HOMA-IR level was 0·58 (95 % CI 0·36, 0·94) times that of women with low soluble fibre intake (lower 50 %). After controlling for all of the potential confounding factors simultaneously, the OR was 0·52 (95 % CI 0·29, 0·93). High fibre intake, particularly soluble fibre, is significantly related to lower levels of insulin resistance in women. Part of this association is a function of differences in PA and BF%.

Validation of Web-based physical activity measurement systems using doubly labeled water

BACKGROUND

Online or Web-based measurement systems have been proposed as convenient methods for collecting physical activity data. We developed two Web-based physical activity systems-the 24-hour Physical Activity Record Web (24hPAR WEB) and 7 days Recall Web (7daysRecall WEB).

OBJECTIVE

To examine the validity of two Web-based physical activity measurement systems using the doubly labeled water (DLW) method.

METHODS

We assessed the validity of the 24hPAR WEB and 7daysRecall WEB in 20 individuals, aged 25 to 61 years. The order of email distribution and subsequent completion of the two Web-based measurements systems was randomized. Each measurement tool was used for a week. The participants' activity energy expenditure (AEE) and total energy expenditure (TEE) were assessed over each week using the DLW method and compared with the respective energy expenditures estimated using the Web-based systems.

RESULTS

The mean AEE was 3.90 (SD 1.43) MJ estimated using the 24hPAR WEB and 3.67 (SD 1.48) MJ measured by the DLW method. The Pearson correlation for AEE between the two methods was r = .679 (P < .001). The Bland-Altman 95% limits of agreement ranged from -2.10 to 2.57 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .874 (P < .001). The mean AEE was 4.29 (SD 1.94) MJ using the 7daysRecall WEB and 3.80 (SD 1.36) MJ by the DLW method. The Pearson correlation for AEE between the two methods was r = .144 (P = .54). The Bland-Altman 95% limits of agreement ranged from -3.83 to 4.81 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .590 (P = .006). The average input times using terminal devices were 8 minutes and 10 seconds for the 24hPAR WEB and 6 minutes and 38 seconds for the 7daysRecall WEB.

CONCLUSIONS

Both Web-based systems were found to be effective methods for collecting physical activity data and are appropriate for use in epidemiological studies. Because the measurement accuracy of the 24hPAR WEB was moderate to high, it could be suitable for evaluating the effect of interventions on individuals as well as for examining physical activity behavior.

A systematic review of reliability and objective criterion-related validity of physical activity questionnaires

Physical inactivity is one of the four leading risk factors for global mortality. Accurate measurement of physical activity (PA) and in particular by physical activity questionnaires (PAQs) remains a challenge. The aim of this paper is to provide an updated systematic review of the reliability and validity characteristics of existing and more recently developed PAQs and to quantitatively compare the performance between existing and newly developed PAQs.

A literature search of electronic databases was performed for studies assessing reliability and validity data of PAQs using an objective criterion measurement of PA between January 1997 and December 2011. Articles meeting the inclusion criteria were screened and data were extracted to provide a systematic overview of measurement properties. Due to differences in reported outcomes and criterion methods a quantitative meta-analysis was not possible.

In total, 31 studies testing 34 newly developed PAQs, and 65 studies examining 96 existing PAQs were included. Very few PAQs showed good results on both reliability and validity. Median reliability correlation coefficients were 0.62–0.71 for existing, and 0.74–0.76 for new PAQs. Median validity coefficients ranged from 0.30–0.39 for existing, and from 0.25–0.41 for new PAQs.

Although the majority of PAQs appear to have acceptable reliability, the validity is moderate at best. Newly developed PAQs do not appear to perform substantially better than existing PAQs in terms of reliability and validity. Future PAQ studies should include measures of absolute validity and the error structure of the instrument.

Reliability and validity of the 7-day Physical Activity Recall interview in a Spanish population

The aim of this study was to assess the reliability and convergent validity of the 7-day Physical Activity Recall (7-day PAR) interview in a sample of the Spanish population. Valid 7-day PAR interviews were conducted and RT3 accelerometer measurements taken for 160 subjects from the primary care population aged 24-83, 75 men and 85 women. Two 7-day PAR interviews were conducted, with a one-week interval, with 147 of these participants. Test-retest reliability was assessed using intraclass correlation coefficients. Convergent validity between the 7-day PAR and the accelerometer data were examined using Spearman's correlation coefficients, and the kappa index of agreement was calculated. The 7-day PAR reliability coefficients were 0.68 (95%CI: 0.58-0.76) for total energy expenditure, 0.65 (95%CI: 0.54-0.73) for the activity dose, and 0.61 (95%CI: 0.50-0.70) and 0.75 (95%CI: 0.67-0.81) for time spent on moderate and vigorous-intensity activity, respectively. These coefficients ranged from 0.91 to 0.96 in participants who reported a typical week in both interviews. Convergent validity ranged from 0.25 for time spent on vigorous activity to 0.52 for the activity dose, and the kappa index was 0.43 (95%CI: 0.30-0.56). Reliability and convergent validity coefficients in the Spanish population were generally moderate and similar to those found in other studies.

Lifestyle physical activity among urban Palestinians and Israelis: a cross-sectional comparison in the Palestinian-Israeli Jerusalem risk factor study

BACKGROUND

Urban Palestinians have a high incidence of coronary heart disease, and alarming prevalences of obesity (particularly among women) and diabetes. An active lifestyle can help prevent these conditions. Little is known about the physical activity (PA) behavior of Palestinians. This study aimed to determine the prevalence of insufficient PA and its socio-demographic correlates among urban Palestinians in comparison with Israelis.

METHODS

An age-sex stratified random sample of Palestinians and Israelis aged 25-74 years living in east and west Jerusalem was drawn from the Israel National Population Registry: 970 Palestinians and 712 Israelis participated. PA in a typical week was assessed by the Multi-Ethnic Study of Atherosclerosis (MESA) questionnaire. Energy expenditure (EE), calculated in metabolic equivalents (METs), was compared between groups for moderate to vigorous-intensity physical activity (MVPA), using the Wilcoxon rank-sum test, and for domain-specific prevalence rates of meeting public health guidelines and all-domain insufficient PA. Correlates of insufficient PA were assessed by multivariable logistic modeling.

RESULTS

Palestinian men had the highest median of MVPA (4740 METs-min*wk-1) compared to Israeli men (2,205 METs-min*wk-1 p < 0.0001), or to Palestinian and Israeli women, who had similar medians (2776 METs-min*wk-1). Two thirds (65%) of the total MVPA reported by Palestinian women were derived from domestic chores compared to 36% in Israeli women and 25% among Palestinian and Israeli men. A high proportion (63%) of Palestinian men met the PA recommendations by occupation/domestic activity, compared to 39% of Palestinian women and 37% of the Israelis. No leisure time PA was reported by 42% and 39% of Palestinian and Israeli men (p = 0.337) and 53% and 28% of Palestinian and Israeli women (p < 0.0001). Palestinian women reported the lowest level of walking. Considering all domains, 26% of Palestinian women were classified as insufficiently active versus 13% of Palestinian men (p < 0.0001) who did not differ from the Israeli sample (14%). Middle-aged and elderly and less educated Palestinian women, and unemployed and pensioned Palestinian men were at particularly high risk of inactivity. Socio-economic indicators only partially explained the ethnic disparity.

CONCLUSIONS

Substantial proportions of Palestinian women, and subgroups of Palestinian men, are insufficiently active. Culturally appropriate intervention strategies are warranted, particularly for this vulnerable population.

Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis

BACKGROUND

Leisure time physical activity reduces the risk of premature mortality, but the years of life expectancy gained at different levels remains unclear. Our objective was to determine the years of life gained after age 40 associated with various levels of physical activity, both overall and according to body mass index (BMI) groups, in a large pooled analysis.

METHODS AND FINDINGS

We examined the association of leisure time physical activity with mortality during follow-up in pooled data from six prospective cohort studies in the National Cancer Institute Cohort Consortium, comprising 654,827 individuals, 21-90 y of age. Physical activity was categorized by metabolic equivalent hours per week (MET-h/wk). Life expectancies and years of life gained/lost were calculated using direct adjusted survival curves (for participants 40+ years of age), with 95% confidence intervals (CIs) derived by bootstrap. The study includes a median 10 y of follow-up and 82,465 deaths. A physical activity level of 0.1-3.74 MET-h/wk, equivalent to brisk walking for up to 75 min/wk, was associated with a gain of 1.8 (95% CI: 1.6-2.0) y in life expectancy relative to no leisure time activity (0 MET-h/wk). Higher levels of physical activity were associated with greater gains in life expectancy, with a gain of 4.5 (95% CI: 4.3-4.7) y at the highest level (22.5+ MET-h/wk, equivalent to brisk walking for 450+ min/wk). Substantial gains were also observed in each BMI group. In joint analyses, being active (7.5+ MET-h/wk) and normal weight (BMI 18.5-24.9) was associated with a gain of 7.2 (95% CI: 6.5-7.9) y of life compared to being inactive (0 MET-h/wk) and obese (BMI 35.0+). A limitation was that physical activity and BMI were ascertained by self report.

CONCLUSIONS

More leisure time physical activity was associated with longer life expectancy across a range of activity levels and BMI groups. Please see later in the article for the Editors' Summary.

The Barriers to Physical Activity in Type 1 Diabetes (BAPAD-1) scale: predictive validity and reliability

AIM

Perceived barriers are one determinant of physical activity. Depending on the study population, these barriers can vary. The aim of this study was to assess the reliability and predictive validity of the 'Barriers to Physical Activity in Type 1 Diabetes' (BAPAD-1) scale, developed by Dubé et al.

METHODS

A total of 77 adults (48% women; age: 43.5±10.4; body mass index: 25.2±4.3kg/m(2); HbA(1c): 7.6±1.3%) with type 1 diabetes completed the questionnaire and an evaluation of their physical activity using an accelerometer (8.4±1.2 days) and cardiorespiratory fitness assessment (VO(2)(peak)). To evaluate the temporal stability of the questionnaire, a subgroup of 17 participants answered the BAPAD-1 scale on both visits required by the protocol (10±4 days).

RESULTS

The BAPAD-1 scale showed good internal validity with an inter-items correlation coefficient (Cronbach's correlation) of 0.85. The intraclass correlation coefficient for the two times the scales were completed was 0.80. The BAPAD-1 score was negatively correlated with both physical activity energy expenditure (r=-0.25; P=0.03) and VO(2)(peak) adjusted for gender and age (r=-0.27; P=0.02).

CONCLUSION

The BAPAD-1 scale is a reliable and valid tool for assessing salient barriers to physical activity. In future, this scale could be used to describe the factors accounting for physical activity, and for planning interventions aimed at promoting physical activity among adults with type 1 diabetes.

Comparative validity of physical activity measures in older adults

PURPOSE

To compare the validity of various physical activity measures with doubly labeled water (DLW)-measured physical activity energy expenditure (PAEE) in free-living older adults.

METHODS

Fifty-six adults aged ≥65 yr wore three activity monitors (New Lifestyles pedometer, ActiGraph accelerometer, and a SenseWear (SW) armband) during a 10-d free-living period and completed three different surveys (Yale Physical Activity Survey (YPAS), Community Health Activities Model Program for Seniors (CHAMPS), and a modified Physical Activity Scale for the Elderly (modPASE)). Total energy expenditure was measured using DLW, resting metabolic rate was measured with indirect calorimetry, the thermic effect of food was estimated, and from these, estimates of PAEE were calculated. The degree of linear association between the various measures and PAEE was assessed, as were differences in group PAEE, when estimable by a given measure.

RESULTS

All three monitors were significantly correlated with PAEE (r=0.48-0.60, P<0.001). Of the questionnaires, only CHAMPS was significantly correlated with PAEE (r=0.28, P=0.04). Statistical comparison of the correlations suggested that the monitors were superior to YPAS and modPASE. Mean squared errors for all correlations were high, and the median PAEE from the different tools was significantly different from DLW for all but the YPAS and regression-estimated PAEE from the ActiGraph.

CONCLUSIONS

Objective devices more appropriately rank PAEE than self-reported instruments in older adults, but absolute estimates of PAEE are not accurate. Given the cost differential and ease of use, pedometers seem most useful in this population when ranking by physical activity level is adequate.

Test-retest reliability of a portable monitor to assess energy expenditure

The ability of the SenseWear Armband (SWA) to estimate energy expenditure (EE) in adults is established. However, except for resting metabolic rate, the test-retest reliability of the SWA for the estimation of EE in adults is unknown. To explore reliability, 34 healthy adults (50% women; age, 26.7 ± 6.1 years; body mass index, 23.6 ± 3.3 kg·m(-2)) completed a 2-day study protocol. During 13 h of direct supervision, subjects completed, each day, 60 min of lying awake rest, 30 min of structured sedentary activity, 45 min of walking circuit, and 45 min of ergocycling at 50% of their peak oxygen uptake. For the remaining 10 h, subjects remained seated. The SWA showed significant intraclass correlations between the 2 days of testing for the overall 13 h of direct supervision (r = 0.97; p < 0.001), the lying awake rest (r = 0.98; p < 0.001), the structured sedentary activity (r = 0.62; p < 0.05), the walking circuit (r = 0.95; p < 0.001), and the standardized physical activity (r = 0.85; p < 0.001). The results of this study indicate that the SWA is a reliable tool to estimate EE during multiple activities. These data provide additional evidence of the usefulness of the SWA in monitoring EE in healthy adults.

Lifestyle interaction with fat mass and obesity-associated (FTO) genotype and risk of obesity in apparently healthy U.S. women

OBJECTIVE

Variation in the fat mass and obesity-associated (FTO) gene is associated with obesity. The extent to which separate and combined effects of physical activity and caloric intake modify this association remains unclear.

RESEARCH DESIGN AND METHODS

FTO polymorphism rs8050136 was measured, and physical activity, caloric intake, and anthropometrics were self-reported in 21,675 apparently healthy Caucasian women.

RESULTS

The effect of the risk allele (A) on BMI was larger among inactive or higher intake women, with additive effects of inactivity and high intake on the associated genetic risk. Specifically, each A allele was associated with mean BMI difference of +0.73 (SE 0.08) kg/m(2) among inactive women (≤ median, 8.8 MET-hours/week), compared with +0.31 (0.06) kg/m(2), P < 0.0001, among active women (>8.8 MET-hours/week). Similarly, each A allele was associated with mean BMI difference of +0.65 (0.07) among high intake women (>median, 1,679 kcals/day), compared with +0.38 (0.07) kg/m(2), P = 0.005, among low intake women (≤ 1,679 kcals/day). Among inactive/high intake women, each A allele was associated with mean BMI difference of +0.97 (0.11) kg/m(2) vs. +0.22 (0.08) kg/m(2) among inactive/low intake women, P < 0.0001. Among inactive/high intake women, each A allele carried increased risk of obesity (odds ratio 1.39, 95% CI 1.27-1.52) and diabetes (odds ratio 1.36, 95% CI 1.07-1.73).

CONCLUSIONS

In this study, lifestyle factors modified the genetic risk of FTO on obesity phenotypes, particularly among women who were both inactive and had high intake. Healthier lifestyle patterns blunted but did not completely eliminate the associated genetic risk.

Misreporting of energy intake in the elderly using doubly labeled water to measure total energy expenditure and weight change

BACKGROUND

One of the major problems in dietary assessment is inaccuracy in reporting diet.

OBJECTIVE

To examine the association between self-reported energy intake (EI) by food frequency questionnaire (FFQ) and energy expenditure (EE), measured by doubly labeled water (DLW), among older persons.

DESIGN

EE was assessed in 298 high-functioning, community-dwelling older adults (70-79 years of age) over a 2-week period using DLW. Dietary intake was assessed using a Block FFQ. The ratio between reported EI and total energy expenditure (TEE) was calculated. Misreporting was defined as follows: participants with an EI/TEE ratio of <0.77 were categorized as low energy reporters, while participants with an EI/TEE ratio >1.28 were categorized as high energy reporters. Participants with an EI/TEE ratio of 0.77-1.28 were categorized as "true" energy reporters. One-year percent weight change prior to EE visit was used as another validation indicator. Participants who were low energy reporters but lost >2% of their body weight were categorized as undereaters.

RESULTS

Two hundred ninety-six participants provided both FFQ and DLW measurements. Forty-three percent of participants were low energy reporters; among them, almost 30% lost weight and, therefore, were categorized as undereaters. The undereaters consumed significantly fewer calories. No difference in the frequency of low energy reporting was detected between genders or racial groups. Underreporters had significantly higher body weight than "true" or high reporters. Undereaters tended to have higher body mass index than the underreporters.

CONCLUSIONS

Undereating is prevalent in the elderly and may be falsely perceived as underreporting. It should be further addressed and characterized in future studies.

Physical activity energy expenditure of adolescents in India

Physical activity (PA) has rarely been quantified in adolescent populations undergoing economic transition; therefore relationships with disease still remain uncertain. This study assessed whether absolute PA energy expenditure (PAEE), PAEE/kg, and PAEE/kg(FFM) could be accurately estimated using accelerometry and a questionnaire in Indian adolescents and how these values compared to those of other populations. PAEE was assessed using doubly labeled water (DLW) in 30 adolescents from Chennai, India, over seven consecutive days, simultaneous with the measurement of PA using accelerometry and a previous-week recall questionnaire. Accelerometry counts (regression analysis) and questionnaire data were used to estimate PAEE; estimates were cross-validated using the Bland-Altman method. Accelerometry data and DLW-derived PAEE were visually compared to values from four North American and European populations. For boys, 49% of the variance in DLW-derived PAEE was explained with an equation including accelerometry counts and fat-free mass (FFM). Questionnaire-derived estimates did not contribute to the explained variance in DLW derived PAEE. The group-level PA of these Indian adolescents was successfully assessed using accelerometry, but not questionnaire. DLW-derived PAEE/kg(FFM) (mean (s.d.): 53.0 (27.5) kJ/kg(FFM)/day) was lower in this group than other adolescent populations in Europe and similar to those in North America. Additionally, four boys and none of the girls accumulated ≥60 min/day of accelerometry-derived moderate intensity activity, indicating low levels of PAEE and PA in these adolescents. Further research is necessary to investigate the association between PA and health outcomes in Indian adolescents.

Differences of energy expenditure and physical activity patterns in subjects with various degrees of obesity

BACKGROUND & AIMS

An imbalance of energy intake and energy expenditure leads to obesity. However, little detailed information of energy expenditure and physical activity patterns in obese subjects is available. Therefore, we assessed total energy expenditure (TEE) with its components resting energy expenditure (REE) and activity thermogenesis (AT) and the patterns of physical activity in non-obese and in subjects with different degrees of obesity.

METHODS

TEE and activity pattern were assessed with the SenseWear™ armband in 78 subjects (46 ± 12 years; 28 with normal weight/overweight, 13 each with obesity I° and II°, and 24 with obesity III°). In addition, REE was measured by indirect calorimetry and AT was calculated.

RESULTS

Although TEE (and REE) increased with increasing weight category from 2567 (1437) kcal/d in non-obese subjects to 3033 (1931) kcal/d in subjects with obesity III° (p=0.016, p<0.001, respectively) body weight adjusted TEE decreased from 33.1 to 22.1 kcal/kg/d (p<0.001). This was mainly due to decreased body weight adjusted AT (11.3-5.8 kcal/kg/d, p<0.001). AT consisted almost completely of non-exercise AT. In particular, for obese subjects exercise-related AT was negligible.

CONCLUSIONS

Higher degrees of obesity are associated with decreased body weight adjusted AT. These differences have to be considered for therapeutic strategies.

Accelerometer-measured physical activity in Chinese adults

BACKGROUND

Following adoption of a Western lifestyle, China is experiencing a decline in physical activity levels, which is projected to contribute to future increases in the burden of chronic diseases.

PURPOSE

This study aims to target public health interventions and identify personal characteristics associated with physical activity and sedentary behavior in urban Chinese adults.

METHODS

In a sample of 576 men and women aged 40-74 years from Shanghai, multiple logistic regression was used to examine demographic, anthropometric, and lifestyle factors in relation to levels of physical activity and sedentary behavior assessed by Actigraph accelerometers.

RESULTS

Participants spent 317 minutes/day in physical activity and 509 minutes/day sedentary. In multivariate models, people aged > or =60 years were significantly less likely than those aged <50 years to engage in physical activity (OR=0.29, 95% CI=0.17, 0.49) and more likely to spend time sedentary (OR=2.77, 95% CI=1.53, 5.05). Similarly, obese individuals were less likely to be physically active (OR=0.34, 95% CI=0.17, 0.66) and they were suggestively more likely to be sedentary (OR=1.87, 95% CI=0.94, 3.71) than normal-weight individuals. Furthermore, current cigarette smokers were less physically active than those who formerly or never smoked (OR=0.47, 95% CI=0.28, 0.78).

CONCLUSIONS

Physical activity promotion programs in urban China should target older people, obese individuals, and cigarette smokers, as these population subgroups exhibited low levels of physical activity.

Overweight, obesity, high blood pressure and lifestyle factors among Mexican children and their parents

OBJECTIVE

The objective of this study was to identify associations in the prevalence of overweight, obesity and high blood pressure between children and their parents, as well as their eating and physical patterns.

METHODS

In this cross-sectional study, we obtained data on 83 pairs of school-aged children and one of their parents relating to dietary habits and various physical parameters, including the body mass index (BMI) and blood pressure of the children, which were adjusted by age and gender. Both the children and the parents were asked to complete a questionnaire aimed at providing measures of eating behavior. The questions focused on the consumption of fruit and vegetables and soda drinks as well as on physical activity patterns. Parent BMI was calculated from self-reported height and weight values.

RESULTS

Obesity was diagnosed in 10.8% of the children, and the prevalence of overweight was 28.9%. There was a relationship between a child's weight status and that of his/her parent according to the BMI; 45% of overweight/obese children had overweight/obese parents. In addition, a parent's fruit and vegetable consumption was associated with his/her child's fruit and vegetable consumption (r = 0.47, p < 0.001), and both were associated with soda drink consumption in both parents and children (r = 0.30, p < 0.001).

CONCLUSION

Our results confirmed that there is a relationship between the weight status, fruit and vegetable consumption and soda drink intake of children and those of their parents.

Association between physical activity energy expenditure and inflammatory markers in sedentary overweight and obese women

OBJECTIVE

Chronic subclinical inflammation and regular physical activity have opposing relationships to obesity-related metabolic diseases. Yet, the association between chronic inflammation and physical activity has rarely been examined in obese subjects. We examined the association between physical activity energy expenditure (PAEE), total (TEE) and resting energy expenditure (REE) and cardiorespiratory fitness (VO(2)peak) with inflammatory markers in overweight/obese women.

DESIGN

Cross-sectional study.

METHODS

The study included 152 overweight/obese postmenopausal women who were sedentary and free of chronic/inflammatory diseases (mean age: 57.5 (95% confidence interval (CI) 56.7-58.3) years, body mass index (BMI): 32.5 (95% CI 31.8-33.2) kg m(-2)). The following parameters were measured: TEE (doubly labeled water), REE (indirect calorimetry), PAEE (as (TEE x 0.90)-REE), VO(2)peak (ergocycle) and serum high-sensitive C-reactive protein (hsCRP), haptoglobin, soluble tumor necrosis factor-α receptor 1 (sTNFR1), interleukin-6, orosomucoid and white blood cells.

RESULTS

Sedentary women with the highest tertile of PAEE (1276 (1233-1319) kcal day(-1)) had lower concentrations of hsCRP and haptoglobin than those in the lowest tertile (587 (553-621) kcal day(-1)) after adjustment for fat mass (P<0.05). Soluble TNFR1 was positively correlated with VO(2)peak, TEE and REE (P<0.05), and hsCRP and orosomucoid were positively associated with REE (P<0.01), whereas haptoglobin was negatively associated with PAEE (P<0.05). In stepwise regression analyses that examined the concomitant associations of components of energy expenditure with inflammatory markers, PAEE remained the only predictor of hsCRP and haptoglobin (P<0.05), explaining 14 and 5%, respectively, of their variation,whereas REE was the only predictor of orosomucoid (r (2) = 0.05, P = 0.02) after adjustment for fat mass. Adding leptin to the regression models results in similar relationships between inflammatory markers and components of energy expenditure.

CONCLUSION

PAEE is an independent predictor of hsCRP and haptoglobin in sedentary overweight/obese postmenopausal women free of chronic disease. Our data support the role of physical activity in reducing subclinical inflammation and risk of metabolic and cardiovascular diseases.

Measures of physical activity using cell phones: validation using criterion methods

Background

Physical activity is associated with reduced risks of many chronic diseases. Data collected on physical activity in large epidemiological studies is often based on paper questionnaires. The validity of these questionnaires is debated, and more effective methods are needed.

Objective

This study evaluates repeated measures of physical activity level (PAL) and the feasibility of using a Java-based questionnaire downloaded onto cell phones for collection of such data. The data obtained were compared with reference estimates based on the doubly labeled water method and indirect calorimetry (PAL_ref).

Method

Using a Java-based cell phone application, 22 women reported their physical activity based on two short questions answered daily over a 14-day period (PAL_cell). Results were compared with reference data obtained from the doubly labeled water method and indirect calorimetry (PAL_ref). Results were also compared against physical activity levels assessed by two regular paper questionnaires completed by women at the end of the 14-day period (PAL_quest1 and PAL_quest2). PAL_cell, PAL_quest1, and PAL_quest2 were compared with PAL_ref using the Bland and Altman procedure.

Results

The mean difference between PAL_cell and PAL_ref was small (0.014) with narrow limits of agreement (2SD = 0.30). Compared with PAL_ref, the mean difference was also small for PAL_quest1 and PAL_quest2 (0.004 and 0.07, respectively); however, the limits of agreement were wider (PAL_quest1, 2SD = 0.50 and PAL_quest2, 2SD = 0.90). The test for trend was statistically significant for PAL_quest1 (slope of regression line = 0.79, P = .04) as well as for PAL_quest2 (slope of regression line = 1.58, P < .001) when compared with PAL_ref.

Conclusion

A Java-based physical activity questionnaire administered daily using cell phones produced PAL estimates that agreed well with PAL reference values. Furthermore, the limits of agreement between PAL obtained using cell phones, and reference values were narrower than for corresponding estimates obtained using paper questionnaires. Java-based questionnaires downloaded onto cell phones may be a feasible and cost-effective method of data collection for large-scale prospective studies of physical activity.