Validity and reproducibility of a physical activity questionnaire in women

Associations of pre-diagnosis physical activity with treatment tolerance and treatment efficacy in breast cancer patients with neoadjuvant chemotherapy

PURPOSE

Higher pre-diagnosis physical activity (PA) is associated with lower all-cause mortality in breast cancer (BCa) patients. However, the association with pathological complete response (pCR) is unclear. We investigated the association between pre-diagnosis PA level and chemotherapy completion, dose delay, and pCR in BCa patients receiving neoadjuvant chemotherapy (NACT).

METHODS

180 stage I-III BCa patients receiving NACT (mean [SD] age of diagnosis: 60.8 [8.8] years) in the Sister Study were included. Self-reported recreational and total PA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). The pCR was defined as no invasive or in situ residual in breast or lymph node (ypT0 ypN0). Multivariable logistic regression analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs) for treatment outcomes.

RESULTS

In this sample, 45 (25.0%) BCa patients achieved pCR. Higher pre-diagnosis recreational PA was not associated with lower likelihood of chemotherapy completion (highest vs. lowest tertile: OR = 0.87, 95% CI = 0.30-2.56; Ptrend = 0.84), greater dose delay (OR = 1.45, 95% CI = 0.54-3.92; Ptrend = 0.46), or greater odds of pCR (OR = 1.28, 95% CI = 0.49-3.34; Ptrend = 0.44). Associations were similar for pre-diagnosis total PA. Meeting the recommended level of recreational PA was not associated with pCR overall (≥ 7.5 vs. < 7.5 MET-hrs/wk: OR = 1.33, 95% CI = 0.59-3.01).

CONCLUSIONS

Although small sample size and limited information on exercise closer to time of diagnosis limit interpretation, pre-diagnosis PA was not convincingly associated with treatment tolerance or treatment efficacy in BCa patients receiving NACT. Future investigations are needed to better understand the impact of pre-diagnosis PA on BCa treatment.

Associations of dietary sugar types with coronary heart disease risk: a prospective cohort study

BACKGROUND

Higher intake of total sugar has been linked with coronary heart disease (CHD) risk, but the role of individual sugars, particularly fructose, is uncertain.

OBJECTIVES

This study aimed to investigate the associations of individual dietary sugars with CHD risk.

METHODS

In prospective cohort studies, we followed 76,815 women (Nurses' Health Study, 1980-2020) and 38,878 men (Health Professionals Follow-up Study, 1986-2016). Sugar and carbohydrate intake, including total fructose equivalents ([TFE] from fructose monosaccharides and sucrose), total glucose equivalents ([TGE] from glucose monosaccharides, disaccharides, and starch), and other sugar types, was measured every 2 to 4 y by semiquantitative food frequency questionnaires.

RESULTS

We documented 9,723 incident CHD cases over 40 years. In isocaloric substitution models with total fat as a comparison nutrient, comparing extreme quintiles of intake, hazard ratios (HRs), 95% confidence interval [CI]) for CHD risk were 1.31 (1.20 to 1.42; Ptrend < 0.001) for TGE and 1.03 (0.94 to 1.11; Ptrend = 0.25) for TFE. TFE from fruits and vegetables was not associated with CHD risk (Ptrend = 0.70), but TFE from added sugar and juice was associated with CHD risk (HR: 1.12, 95% CI: 1.04 to 1.20; Ptrend < 0.01). Intakes of total sugars and added sugar were positively associated with CHD risk (HRs: 1.16, 95% CI: 1.07 to 1.26, Ptrend < 0.001; 1.08, 95% CI: 0.99 to 1.16, Ptrend = 0.04).

CONCLUSIONS

Intakes of TGE, total sugar, added sugar, and fructose from added sugar and juice were associated with higher CHD risk, but TFE and fructose from fruits and vegetables were not.

Reliability and Validity of Common Subjective Instruments in Assessing Physical Activity and Sedentary Behaviour in Chinese College Students

The reliability and validity of common physical activity (PA) questionnaires are not well investigated in college students. This study aims to evaluate the reliability and validity of common subjective instruments in measuring PA and sedentary behaviour (SB) among college students. A total of 142 college students were included through convenience sampling. Each participant was asked to wear Actigraph wGT3X-BT accelerometers and fill physical activity logs (PAL) for 7 consecutive days. The Global Physical Activity Questionnaire (GPAQ), the International Physical Activity Questionnaire long-form (IPAQ-LF), and short-form (IPAQ-SF) were interviewed by face-to-face at both day 0 and day 8. Reliability was evaluated by intraclass correlation coefficient (ICC), while the validity was evaluated by Spearman correlation coefficient and Bland–Altman statistics. The instruments showed moderate reliability in reporting total PA (ICC = 0.50–0.62) and SB (ICC = 0.47–0.52), while moderate validity in reporting moderate and vigorous PA (MVPA) (r = 0.37–0.42), but fair to poor validity in reporting SB (r = 0.09–0.28). Bland–Altman plots showed that all the instruments would underestimate MVPA and overestimate SB. Thus, in Chinese younger adults, the GPAQ, IPAQ-LF, IPAQ-SF, and PAL provide limited but acceptable reliability and validity in measuring MVPA and SB, among which GPAQ might be the most valid instrument.

Sociodemographic and Lifestyle Determinants of Adherence to Current Dietary Recommendations and Diet Quality in Middle-Aged Spanish Premenopausal Women

Background

A healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors.

Methods

This is a cross-sectional study based on 1251 premenopausal women, aged 39–50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model.

Results

Regarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0–7.0). Former smokers (OR: 1.38; 95%CI: 1.08–1.78), as well as those with higher educational level (OR_SSecondary:1.68; 95%CI: 0.97–2.93, OR_University:1.82; 95%IC: 1.05–3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR_{>2188.2kcal/day}: 8.22; 95%CI: 6.19–10.92) and with greater physical activity (OR_{≥21METS−h/week}: 1.29; 95%CI: 0.95-1.76) showed greater adherence.

Conclusions

Almost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.

Questionnaires measuring movement behaviours in adults and older adults: Content description and measurement properties. A systematic review

Background

Sleep, sedentary behaviour and physical activity are constituent parts of a 24h period and there are several questionnaires to measure these movement behaviours, the objective was to systematically review the literature on content and measurement properties of self- and proxy-reported questionnaires measuring movement behaviours in adults and older adults.

Methods

The databases PubMed, CINAHL, PsycINFO and SPORTDiscus were systematically searched until April 2021. Articles were included if: the questionnaires were design for adults and older adults; the sample size for validity studies had at least 50 participants; at least, both validity and test-retest reliability results of questionnaire that were developed specifically to measure the amount of sleep, sedentary behaviour or physical activity, or their combination were reported; and articles had to be written in English, Spanish, French, Portuguese, German, Italian or Chinese.

Findings and conclusions

Data extraction, results, studies’ quality, and risk of bias were evaluated using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Fifty-five articles were included in this review, describing 60 questionnaires. None of the questionnaires showed adequate criterion validity and adequate reliability, simultaneously; 68.3% showed adequate content validity. The risk of bias for criterion validity and reliability were very low in 72.2% and 23.6% of the studies, respectively. Existing questionnaires have insufficient measurement properties and frequent methodologic limitations, and none was developed considering the 24h movement behaviour paradigm. The lack of valid and reliable questionnaires assessing 24h movement behaviours in an integrated way, precludes accurate monitoring and surveillance systems of 24h movement behaviours.

The Association between Gender and Physical Activity Was Partially Mediated by Social Network Size during COVID-19

The COVID-19 pandemic has disrupted physical activity, particularly among women. Limited research has explored how social network support may explain gender-based variations in physical activity during COVID-19. The purpose of this study was to examine the mediating role of social networks in the association between gender and physical activity during a pandemic. This cross-sectional survey assessed whether social network characteristics (i.e., in-person social network size, frequency of in-person social network interactions, and online friend network size) mediate the relationship between gender and either past-week or past-year physical activity. Multiple mediation analyses were conducted to determine the indirect effect of gender on physical activity through social networks. Among 205 participants, women (n = 129) were significantly less physically active (β = −73.82; p = 0.02) than men (n = 76) and reported significantly more Facebook friends (β = 0.30; p < 0.001) than men, which was inversely associated with past-week physical activity (β = −64.49; p = 0.03). Additionally, the indirect effect of gender on past-week physical activity through Facebook friends was significant (β = −19.13; 95% CI [−40.45, −2.09]). Findings suggest that social media sites such as Facebook could be used to encourage physical activity among women during a pandemic.

Reliability and validity of the Mexican teachers' physical activity questionnaire (MTPAQ) in a subsample of female Mexican teachers

BACKGROUND

Reliable and valid instruments are needed to estimate physical activity levels. The purposes of this study were to estimate the reliability and validity of the Physical Activity Questionnaire (MTPAQ) in a subsample of the Mexican Teachers Cohort study.

METHODS

We completed telephone interviews and clinical examinations of 82 teachers. Two MTPAQ, five International Physical Activity Questionnaire (IPAQ)-long form, and two accelerometer (AC) measures were used to determine physical activity levels throughout 24 months. Moderate and walking physical activity (MWPA min/week), vigorous physical activity (VPA min/week), and moderate-to-vigorous physical activity minutes per week (MVPA min/week) were estimated for each instrument. Pearson, Intra-class correlations and deattenuated adjustments were used to determine the reliability and validity of MTPAQ.

RESULTS

MWPA and MVPA min/week of MTPAQs were moderately correlated (r ≥ 0.54) to min/week of IPAQ-long form. MWPA and MVPA min/week average MTPAQ and MTPAQ1 and average AC, AC1 and AC2 were fairly correlated (r ≥ 0.20). A higher correlation was observed when correlation coefficients were attenuated (r ≥ 0.32).

CONCLUSIONS

MTPAQ1 is a reliable and valid tool to measure physical activity levels.

Trajectories of alcohol consumption during life and the risk of developing breast cancer

Background

Whether there are lifetime points of greater sensitivity to the deleterious effects of alcohol intake on the breasts remains inconclusive.

Objective

To compare the influence of distinctive trajectories of alcohol consumption throughout a woman’s life on development of breast cancer (BC).

Methods

1278 confirmed invasive BC cases and matched (by age and residence) controls from the Epi-GEICAM study (Spain) were used. The novel group-based trajectory modelling was used to identify different alcohol consumption trajectories throughout women’s lifetime.

Results

Four alcohol trajectories were identified. The first comprised women (45%) with low alcohol consumption (<5 g/day) throughout their life. The second included those (33%) who gradually moved from a low alcohol consumption in adolescence to a moderate in adulthood (5 to <15 g/day), never having a high consumption; and oppositely, women in the third trajectory (16%) moved from moderate consumption in adolescence, to a lower consumption in adulthood. Women in the fourth (6%) moved from a moderate alcohol consumption in adolescence to the highest consumption in adulthood (≥15 g/day), never having a low alcohol consumption. Comparing with the first trajectory, the fourth doubled BC risk (OR 2.19; 95% CI 1.27, 3.77), followed by the third (OR 1.44; 0.96, 2.16) and ultimately by the second trajectory (OR 1.17; 0.86, 1.58). The magnitude of BC risk was greater in postmenopausal women, especially in those with underweight or normal weight. When alcohol consumption was independently examined at each life stage, ≥15 g/day of alcohol consumption in adolescence was strongly associated with BC risk followed by consumption in adulthood.

Conclusions

The greater the alcohol consumption accumulated throughout life, the greater the risk of BC, especially in postmenopausal women. Alcohol consumption during adolescence may particularly influence BC risk.

Transportation Physical Activity Earlier in Life and Areas of the Brain related to Dementia Later in Life

INTRODUCTION

Efforts to preserve brain function may be most effective when administered before there are changes in the brain, which may occur decades before the onset of Alzheimer's disease symptoms. White matter hyperintensities (WMH), a cardiovascular disease biomarker, are areas of hyperintense signals scattered in the white matter of the brain evident on magnetic resonance images. WMH increase with age and are associated with a higher risk of dementia. The purpose of this study was to determine if there was an association between different domains and intensities of physical activity earlier in life and lower risk of dementia later in life as indicated by less WMH.

METHODS

In this cross-sectional study, face-to-face interviews were conducted with the Lifetime Total Physical Activity Questionnaire. The metabolic equivalent of task (MET) hours/week/year of moderate (3.0-5.9 METs) and vigorous-intensity (≥6 METs) occupation, transportation, household and leisure-time physical activity was obtained across school-age (6-11), adolescence (12-18), young (19-39) and middle adulthood (40-64). WMH were calculated as the percent of intracranial volume in cognitively unimpaired middle (age 40-64) and older adults (age 65+). Simultaneous multiple linear regression determined associations between moderate and vigorous-intensity occupation, transportation, household and leisure-time physical activity across school-age, adolescence, young and middle adulthood with WMH.

RESULTS

Greater moderate-intensity transportation physical activity during young (b= -.09, p=.008) and middle adulthood (b= -.14, p=.013) was associated with lower WMH in middle and older adulthood, explaining 28% (p=.003) to 29% (p=.002) of the variance in WMH (n=54).

CONCLUSIONS

Changes to the physical environment that encourage walking, running or biking, such as sidewalks and bike paths, may be strategies to mitigate the age-related increases in WMH, areas of the brain associated with higher risk of dementia.

Serum Phospholipid Fatty Acids and Mammographic Density in Premenopausal Women

BACKGROUND

The role of fatty acids (FAs) on mammographic density (MD) is unclear, and available studies are based on self-reported dietary intake.

OBJECTIVES

This study assessed the association between specific serum phospholipid fatty acids (PLFAs) and MD in premenopausal women.

METHODS

The cross-sectional study DDM-Madrid recruited 1392 Spanish premenopausal women, aged 39-50 y, who attended a screening in a breast radiodiagnosis unit of Madrid City Council. Women completed lifestyle questionnaires and FFQs. Percentage MD was estimated using a validated computer tool (DM-Scan), and serum PLFA percentages were measured by GC-MS. Multivariable linear regression models were used to quantify the association of FA tertiles with MD. Models were adjusted for age, education, BMI, waist circumference, parity, oral contraceptive use, previous breast biopsies, and energy intake, and they were corrected for multiple testing.

RESULTS

Women in the third tertile of SFAs showed significantly higher MD compared with those in the first tertile (βT3vsT1 = 7.53; 95% CI: 5.44, 9.61). Elevated relative concentrations of palmitoleic (βT3vsT1 = 3.12; 95% CI: 0.99, 5.25) and gondoic (βT3vsT1 = 2.67; 95% CI: 0.57, 4.77) MUFAs, as well as high relative concentrations of palmitelaidic (βT3vsT1 = 5.22; 95% CI: 3.15, 7.29) and elaidic (βT3vsT1 = 2.69; 95% CI: 0.59, 4.79) trans FAs, were also associated with higher MD. On the contrary, women with elevated relative concentrations of n-6 (ω-6) linoleic (βT3vsT1 = -5.49; 95% CI; -7.62, -3.35) and arachidonic (βT3vsT1 = -4.68; 95% CI: -6.79, -2.58) PUFAs showed lower MD. Regarding desaturation indices, an elevated palmitoleic to palmitic ratio and a low ratio of oleic to steric and arachidonic to dihomo-γ-linolenic acids were associated with higher MD.

CONCLUSIONS

Spanish premenopausal women with high relative concentrations of most SFAs and some MUFAs and trans FAs showed an increased MD, whereas those with high relative concentrations of some n-6 PUFAs presented lower density. These results, which should be confirmed in further studies, underscore the importance of analyzing serum FAs individually.

How to Improve the Functional Capacity of Frail and Pre-Frail Elderly People? Health, Nutritional Status and Exercise Intervention. The EXERNET-Elder 3.0 Project

Aging is associated with the impairment of health and functional capacity, and physical exercise seems to be an effective tool in frailty prevention and treatment. The purpose of this study was to present the methodology used in the EXERNET-Elder 3.0 project that aims to evaluate the immediate and residual effects and of a multicomponent exercise training program called Elder-fit on frailty, fitness, body composition and quality of life, and also to analyse a possible dietary intake interaction according to health and metabolic status. A total of 110 frail and pre-frail elders participated in this study and were divided into a control group (CG = 52) and an intervention group (IG = 58). The IG performed a supervised multicomponent exercise training program of 6 months and 3 days per week, which included strength, endurance, balance, coordination and flexibility exercises, while the CG continued with their usual daily activities. Both groups received four speeches about healthy habits along the project. Four evaluations were performed: at baseline, after 3 months of training, at the end of the training program (6 months) and 4 months after the program had ended to examine the effects of detraining. Evaluating the efficacy, safety and feasibility of this program will help to develop efficacious physical interventions against frailty. Further, protocols should be described accurately to allow exercise programs to be successfully replicated.

Lifetime Physical Activity and White Matter Hyperintensities in Cognitively Intact Adults

BACKGROUND

White matter hyperintensities (WMHs) observed on magnetic resonance images are associated with depression and increase the risk of stroke, dementia, and death. The association between physical activity and WMHs has been inconsistently reported in the literature, perhaps because studies did not account for a lifetime of physical activity or depression.

OBJECTIVES

The aim of this study was to determine the extent to which a lifetime of leisure-time physical activity is associated with less WMHs while accounting for depression.

METHODS

Face-to-face interviews were conducted with the Lifetime Total Physical Activity Questionnaire, where the metabolic equivalent of task hours per week per year was calculated. Cognitively intact participants also underwent magnetic resonance imaging, where WMHs as a percentage of intracranial volume was obtained. Hierarchical multiple linear regression was performed to compare WMHs in a more active group with a group with no psychiatric history (n = 20, mean age = 62.2 years), with a less active group with no psychiatric history (n = 13, mean age = 64.0 years), and a less active group with history of late-onset depression (n = 14, mean age = 62.8 years).

RESULTS

There was not a statistically significant difference in WMHlg10 between the more and less active groups without a psychiatric history (b = .09, p > .05) or between the more active group without a psychiatric history and the less active group with a history of depression (b = .01, p > .05). The model was predictive of WMHlg10, explaining an adjusted 15% of the variance in WMHs (p = .041).

DISCUSSION

A lifetime of leisure-time physical activity was not associated with WMHs when accounting for depression.

Adult Physical Activity and Breast Cancer Risk in Women with a Family History of Breast Cancer

BACKGROUND

Recreational physical activity has been consistently associated with reduced breast cancer risk. Less is known about how family history of breast cancer affects the association and whether it varies by menopausal status.

METHODS

The Sister Study is a cohort of 50,884 women who had a sister with breast cancer but no prior breast cancer themselves at enrollment. Women reported all recreational sport/exercise activities they participated in over the past 12 months. Hours/week and MET-hours/week of physical activity were considered in association with breast cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated with Cox regression. Extent of family history, examined as a modifier, was characterized by a Bayesian score incorporating characteristics of the family structure.

RESULTS

During follow-up (average 8.4 years), 3,023 cases were diagnosed. Higher hours/week (HR_≥7vs<1 = 0.77; 95% CI, 0.66-0.90) and MET-hours/week (HR_quartile4vs1 = 0.75; 95% CI, 0.67-0.85) of physical activity were associated with reduced postmenopausal breast cancer risk. Hours/week and MET-hours/week were associated with suggestively increased premenopausal breast cancer risk (MET-hours/week HR_quartile4vs1 = 1.25; 95% CI, 0.98-1.60). Associations did not vary with extent of family history. However, the increased risk in premenopausal women may be limited to those with stronger family history.

CONCLUSIONS

In women with a family history of breast cancer, physical activity was associated with reduced postmenopausal, but not premenopausal, breast cancer risk and was not modified by extent of family history.

IMPACT

This was the first study to examine the association between physical activity and breast cancer risk in a large population with a family history of breast cancer.

Correctness of Self-Reported Task Durations: A Systematic Review

Objectives

Duration of tasks in a job is an essential interest in occupational epidemiology. Such duration is frequently measured using self-reports, which may, however, be associated with both bias and random errors. The present systematic literature review examines the correctness of self-reported durations of tasks, i.e. the extent to which they differ from more valid reference data due to either systematic or random errors, and factors influencing this correctness, with particular emphasis on the assessment of exposures of relevance to musculoskeletal disorders.

Methods

The search for relevant studies included the databases ISI Web of Science, MEDLINE, EBSCO HOST, Proquest, and Psycnet.

Results

Thirty-two articles were identified; of which, 23 examined occupational tasks and 9 examined non-occupational tasks. Agreement between self-reports and a more correct reference was reported for, in total, 182 tasks. Average proportional errors were, for most tasks, between -50% (i.e. underestimations) and +100%, with a dominance of overestimations; 22% of all results considered overestimations of 100% or more. For 15% of the 182 reported tasks, the mean difference between the self-reported and the reference duration value was <5%, and 20% of the 182 mean differences were between 5 and 20%. In general, respondents were able to correctly distinguish tasks of a longer duration from shorter tasks, even though the actual durations were not correct. A number of factors associated with the task per se appeared to influence agreement between self-reports and reference data, including type of task, true task duration, task pattern across time (continuous versus discontinuous), and whether the addressed task is composed of subtasks. The musculoskeletal health status of the respondent did not have a clear effect on the ability to correctly report task durations. Studies differed in key design characteristics and detail of information reported, which hampers a formal aggregation of results.

Conclusions

The correctness of self-reported task durations is, at the best, moderate at the individual level, and this may present a significant problem when using self-reports in task-based assessment of individual job exposures. However, average self-reports at the group level appear reasonably correct and may thus be a viable method in studies addressing, for instance, the relative occurrence of tasks in a production system. Due to the disparity of studies, definite conclusions on the quantitative effect on agreement of different modifiers are not justified, and we encourage future studies specifically devoted to understanding and controlling sources of bias in self-reported task durations. We also encourage studies developing decision support for when to apply or avoid self-reports to measure task durations, depending on study purpose and occupational setting.

Cross-sectional association of physical activity and periodontal antibodies

BACKGROUND

The objective of this study was to evaluate the cross-sectional association between physical activity and serum IgG antibodies against selected periodontal microorganisms.

METHODS

The study population consisted of 5,611 randomly selected US adults who participated in the National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994), who were 40 years and older with complete IgG antibody data against 19 oral microorganisms. We used cluster analysis to classify the 19 antibody titers into 4 mutually exclusive groups called "Orange-Red," "Red-Green," "Yellow- Orange," and "Orange-Blue," and calculated cluster scores by summing antibody titer z-scores for each of the four groups. Physical activity was evaluated based on reported frequency and intensity of physical activity conducted in the last month. Participants were grouped into three categories: adequately physically active, inadequately physically active, and inactive. The outcomes were IgG cluster scores with physical activity as the predictor. Multivariable models adjusted for age, sex, race, smoking status, waist circumference, education, poverty-income-ratio, alcohol, and diabetes.

RESULTS

In adjusted models, physical activity was positively associated with the antibodies in the Orange-Blue cluster (E. nodatum, A. naeslundii), a cluster that is associated with healthy periodontal states. The mean differences in cluster scores were 15.2 (95% CI -1.0, 31.4) for Model 3, and 7.0 (95% CI -8.3, 22.3) for Model 4 comparing the sufficiently active group to the inactive group.

CONCLUSIONS

Antibody titers against periodontal microorganisms reflecting good oral health trended higher among physically active individuals, but the results were not statistically significant at the 0.05 level.

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.

Physical activity patterns in healthy middle-aged women

Exercise in healthy female adults around the menopausal transition has been routinely examined in leisure activities alone, potentially discounting the physical activity (PA) that is accumulated in household and outdoor domains. The purpose of this study was to quantify PA in healthy middle-aged women and to examine the extent to which the Center for Disease Control (CDC) PA guidelines were met through leisure, household, and outdoor activities.

METHODS

440 healthy women, 51-64 years old, BMI ≥18.5 or < 40 kg/m², participated in the study using the Lifetime Physical Activity Questionnaire (LPAQ) to quantify PA.

RESULTS

25.91% met the CDC PA guidelines if leisure time alone was examined. When multiple domains were included, 73.41% of the women met the PA guidelines. This percentage is much higher than the reported 20.6% of U.S. adults who met the guidelines in 2011. PA in women may be underrepresented in data limited to leisure time PA.

Validity of Self-Reported Physical Fitness and Body Mass Index in a Military Population

Many epidemiological studies rely on valid physical fitness data. The purpose of this investigation was to assess the validity of self-reported Army Physical Fitness Test (APFT) data and determine whether men and women recall APFT performance differently. U.S. Army soldiers (N = 1,047) completed a survey, including questions on height, weight, and most recent APFT performance. Height, weight, and APFT performance were also obtained from unit records. The mean ± SDs for unit and self-reported push-up repetitions were 63.5 ± 13.1 and 66.3 ± 14.0 for men and 37.7 ± 12.8 and 40.2 ± 12.8 for women, respectively. The mean ± SD for unit- and self-reported sit-up repetitions were 66.3 ± 11.4 and 68.1 ± 12.1 for men and 64.2 ± 13.6 and 66.5 ± 12.9 for women, respectively. The mean ± SD unit- and self-reported 2-mile run times were 15.2 ± 1.8 and 14.9 ± 1.6 minutes for men, and 18.0 ± 2.9 and 17.4 ± 1.9 minutes for women, respectively. Unit- and self-reported body mass indices (BMIs) (calculated by height and weight) were 26.4 ± 3.4 and 26.3 ± 3.6 for men and 24.6 ± 2.8 and 24.2 ± 3.3 for women. Correlations between unit- and self-reported scores for push-ups, sit-ups, 2-mile run, height, weight, and BMI were 0.82, 0.78, 0.85, 0.87, 0.97, and 0.88 for men and 0.86, 0.84, 0.87, 0.78, 0.98, and 0.78 for women, respectively. On average, men and women slightly overreported performance on the APFT and overestimated height, resulting in underestimated BMI. There was no difference in recall ability between men and women (p > 0.05). The very good to excellent correlations (r = 0.78-0.98) between unit- and self-reported scores indicate that self-reported data are valid for capturing physical fitness performance in this population.

Lifetime physical activity and female stress urinary incontinence

OBJECTIVE

We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years.

STUDY DESIGN

Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures.

RESULTS

SUI odds increased slightly with overall lifetime activity (odds ratio [OR], 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval [CI], 1.02-1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99-1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09-1.71); OR, 1.75; 95% CI, 1.15-2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years.

CONCLUSION

In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.

Lifetime physical activity and pelvic organ prolapse in middle-aged women

OBJECTIVE

To determine, in a case-control study, whether pelvic organ prolapse (POP) is associated with overall lifetime physical activity (combined leisure, outdoor, household, occupational), and lifetime leisure, lifetime strenuous, and teen years strenuous activity.

STUDY DESIGN

One hundred ninety-one POP cases (defined as maximal vaginal descent ≥1 cm below the hymen) and 191 age and recruitment-site matched controls (defined as maximal vaginal descent ≤1 cm above the hymen) between 39-65 years with no or mild urinary incontinence, were recruited chiefly from primary care clinics. Participants completed Lifetime Physical Activity and Occupation Questionnaires, recalling activities during 4 age epochs. We performed separate logistic regression models for physical activity measures.

RESULTS

Compared with controls, POP cases had greater body mass index and parity. Median overall lifetime activity, expressed in metabolic equivalents-hours/week, did not differ significantly between cases and controls. In adjusted analyses, we observed no associations between odds of POP and overall lifetime physical activity, lifetime leisure activity, or lifetime strenuous activity. There was a marginally significant nonlinear relationship between teen strenuous activity and POP with an increase in the log-odds of POP for women reporting ≥21 hours/week of strenuous activity (P = .046).

CONCLUSION

Lifetime physical activity does not increase the odds of anatomic POP in middle-aged women not seeking care for POP. Strenuous activity during teenage years may confer higher odds of POP. This relationship and the potential role of physical activity and POP incidence should be evaluated prospectively.

Is lifelong knee joint force from work, home, and sport related to knee osteoarthritis?

Purpose. To investigate the association of cumulative lifetime knee joint force on the risk of self-reported medically-diagnosed knee osteoarthritis (OA). Methods. Exposure data on lifetime physical activity type (occupational, household, sport/recreation) and dose (frequency, intensity, duration) were collected from 4,269 Canadian men and women as part of the Physical Activity and Joint Heath cohort study. Subjects were ranked in terms of the "cumulative peak force index", a measure of lifetime mechanical knee force. Multivariable logistic regression was conducted to obtain adjusted effects for mean lifetime knee force on the risk of knee OA. Results. High levels of total lifetime, occupational and household-related force were associated with an increased in risk of OA, with odds ratio's ranging from approximately 1.3 to 2. Joint injury, high BMI and older age were related to risk of knee OA, consistent with previous studies. Conclusions. A newly developed measure of lifetime mechanical knee force from physical activity was employed to estimate the risk of self-reported, medically-diagnosed knee OA. While there are limitations, this paper suggests that high levels of total lifetime force (all domains combined), and occupational force in men and household force in women were risk factors for knee OA.

Exploring the association between lifetime physical activity and pelvic floor disorders: study and design challenges

BACKGROUND

One in four women has moderate to severe symptoms of at least one pelvic floor disorder. Lifetime physical activity, a modifiable risk factor, may theoretically predispose women to, or protect them from, developing pelvic floor disorders. It is neither feasible nor ethical to test this association using the most rigorous (level I) study design.

PURPOSE

The aim of this manuscript is to describe the methods for the PHysical ACtivity Study (PHACTS), which encompasses two case-control studies and the development of a registry, and to describe challenges and solutions to study progress to date. For each of the case-control studies, the primary aims are to determine, compared to controls with neither pelvic organ prolapse nor urinary incontinence, whether 1) pelvic organ prolapse or 2) stress urinary incontinence is associated with a) increased or decreased current leisure activity or b) increased or decreased overall lifetime activity (including leisure, household, outdoor, and occupational) measured in MET-hours per week, as well as in strenuous hours per week.

METHODS

To obtain 175 pelvic organ prolapse cases, 175 stress urinary incontinence cases, and an equal number of age, body mass index and recruitment site matched controls, we plan to enroll 1500 women from about 20 primary care level clinics.

RESULTS

We have encountered various challenges leading to lessons learned about minimizing bias, recruitment from community clinics, the lifetime physical activity instrument used, and data management.

CONCLUSIONS

Our experiences can help guide future investigators studying risk factors, particularly physical activity, and pelvic floor disorders.

Does a history of exercise in COPD patients affect functional status? A study using a lifetime physical activity questionnaire investigates a correlation between exercise and functional status as evidenced by six-minute walk distance

Recent studies have shown strong associations between chronic exercise and improved spirometric values. Building on these findings, we investigated whether habitual lifetime exercise influences six-minute walk test performance (6MWT) in subjects with at least 10 pack-years smoking history. The 6MWT was chosen for its correlation with performance on activities of daily living and predictive value for inactivity, morbidity and mortality in individuals with chronic obstructive pulmonary disease (COPD) versus spirometric values, which are less adept at predicting functional status. Because COPD is a global cause of disability, therapeutic measures that delay symptom-induced immobility are more cost-effective versus late-stage interventional therapies. Among 49 subjects, we compared lifetime exercise assessed with a validated physical activity questionnaire with six-minute walk distances (6MWD). The American College of Sports Medicine's (ACSM) recommended exercise levels (30 minutes/day, 1000 kcal/week) were used as a benchmark. Among subjects with spirometry-determined lung obstruction (n = 21), those who have not met at least half of ACSM guidelines (500 kcal/week) were classified as "Inactive," while others were "Active." A significant difference in 6MWD was found between Inactive and Active subjects: (1123.86ft vs. 1468.25ft, STDev = 210.07 vs. 240.25, p = 0.0045). This difference was not found in subjects without lung obstruction. Pack-years was a significant covariate: subjects who smoked less walked farther distances. No relation was found between exercise and predicted FEV(1)%. In summary, our case-control study suggests that meeting even half of ACSM exercise guidelines could improve functional status in smokers if habitual exercise is adopted early in life.

Leisure-time physical activity in pregnancy and the birth weight distribution: where is the effect?

BACKGROUND

Leisure-time physical activity (LTPA) is recommended during pregnancy and has been associated with lower risk of delivering a large infant. We sought to characterize the effect of LTPA across the entire birth weight distribution.

METHODS

Women enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study (1998-2004) were followed-up in 2007. Follow-up efforts were extensive for a subcohort and minimal for the remainder (nonsubcohort). Thus, 596 subcohort and 418 nonsubcohort women who delivered at term participated. Offspring were categorized as small-, appropriate-, or large-for-gestational-age (SGA, AGA, and LGA, respectively) based on gender and gestational age-specific birth weight z-scores (BWz). At follow-up, women recalled pregnancy LTPA and were classified as inactive, insufficiently active or meeting LTPA recommendations. Linear, logistic, and quantile regression analyses were conducted separately by subcohort status.

RESULTS

Meeting LTPA recommendations decreased odds of LGA significantly among the nonsubcohort (aOR = 0.30, 95% CI: 0.14-0.64) and nonsignificantly among the subcohort (aOR = 0.68, 95% CI: 0.34-1.34). In quantile regression, meeting LTPA recommendations reduced BWz among the upper quantiles in the nonsubcohort.

CONCLUSIONS

LTPA during pregnancy lowered odds of LGA and reduced BWz among the upper quantiles, without shifting the entire distribution. LTPA during pregnancy may be useful for reducing risks of large fetal size.

Effect of dietary and lifestyle factors on the risk of gestational diabetes: review of epidemiologic evidence

Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition in pregnancy, is a common pregnancy complication and a growing health concern. GDM has been related to significant short-term and long-term adverse health outcomes for both mothers and offspring. Importantly, this number is increasing with the increasing burden of obesity among women of reproductive age. Collectively, these data highlight the significance of understanding risk factors, in particular modifiable factors, for GDM and of preventing GDM among high-risk populations. Research in the past decade has identified a few diet and lifestyle factors that are associated with GDM risk. This review provides an overview of emerging diet and lifestyle factors that may contribute to the prevention of GDM. It also discusses major methodologic concerns about the available epidemiologic studies of GDM risk factors.

Reliability and validity of an internet-based questionnaire measuring lifetime physical activity

Lifetime exposure to physical activity is an important construct for evaluating associations between physical activity and disease outcomes, given the long induction periods in many chronic diseases. The authors' objective in this study was to evaluate the measurement properties of the Lifetime Physical Activity Questionnaire (L-PAQ), a novel Internet-based, self-administered instrument measuring lifetime physical activity, among Canadian men and women in 2005-2006. Reliability was examined using a test-retest study. Validity was examined in a 2-part study consisting of 1) comparisons with previously validated instruments measuring similar constructs, the Lifetime Total Physical Activity Questionnaire (LT-PAQ) and the Chasan-Taber Physical Activity Questionnaire (CT-PAQ), and 2) a priori hypothesis tests of constructs measured by the L-PAQ. The L-PAQ demonstrated good reliability, with intraclass correlation coefficients ranging from 0.67 (household activity) to 0.89 (sports/recreation). Comparison between the L-PAQ and the LT-PAQ resulted in Spearman correlation coefficients ranging from 0.41 (total activity) to 0.71 (household activity); comparison between the L-PAQ and the CT-PAQ yielded coefficients of 0.58 (sports/recreation), 0.56 (household activity), and 0.50 (total activity). L-PAQ validity was further supported by observed relations between the L-PAQ and sociodemographic variables, consistent with a priori hypotheses. Overall, the L-PAQ is a useful instrument for assessing multiple domains of lifetime physical activity with acceptable reliability and validity.

Lifetime trajectory of physical activity according to energy expenditure and joint force

OBJECTIVE

To develop and demonstrate the feasibility of a method for estimating lifetime hip and knee cumulative joint force using survey data on physical activity, and to construct and describe lifetime trajectories of energy expenditure and hip and knee joint force.

METHODS

Exposure data on lifetime physical activity, including type (occupational, household, and recreation) and dose (frequency, intensity, and duration), were collected from a Canada-wide population study of adults ages ≥45 years. Subjects were ranked in 2 ways: in terms of physical activity-related energy expenditure and in terms of a cumulative peak force index (CPFI) for the hip and knee, which is a measure of lifetime exposure and is a time/joint force product involving years of force and subject bodyweight. A relative joint loading index was calculated as the ratio of joint force (CPFI score) to energy expenditure.

RESULTS

A total of 4,269 subjects completed the baseline measurements. Lifetime energy expenditure and hip and knee CPFI scores were higher for occupational and household activity than sport. The mean lifetime energy expenditure from total physical activity in the study sample was 119.1 metabolic equivalent-hours/week. Women had slightly higher total lifetime energy expenditure and CPFI scores than men. The relative joint loading index was highest for male household and sport activity and lowest for female occupational activity.

CONCLUSION

Lifetime cumulative hip/knee joint force trajectories were successfully constructed from survey data and followed expected trends. Comparing energy expenditure with joint force revealed variation by age, sex, and activity type, indicating these measures may help distinguish the numerous benefits of physical activity from possible risks.

Physical activity questionnaires for adults: a systematic review of measurement properties

Many questionnaires have been developed to measure physical activity (PA), but an overview of the measurement properties of PA questionnaires is lacking. A summary of this information is useful for choosing the best questionnaire available. Therefore, the objective of this study was to evaluate and compare measurement properties of self-administered questionnaires assessing PA in adults. We searched MEDLINE, EMBASE and SportDiscus, using 'exercise', 'physical activity', 'motor activity' and 'questionnaire' as keywords. We included studies that evaluated the measurement properties of self-report questionnaires assessing PA. Article selection, data extraction and quality assessment were performed by two independent reviewers. The quality and results of the studies were evaluated using the Quality Assessment of Physical Activity Questionnaires (QAPAQ) checklist. Construct validity, reliability and responsiveness were rated as positive, negative or indeterminate, depending on the methods and results. We included 85 (versions of) questionnaires. Overall, the quality of the studies assessing measurement properties of PA questionnaires was rather poor. Information on content validity was mostly lacking. Construct validity was assessed in 76 of the questionnaires, mostly by correlations with accelerometer data, maximal oxygen uptake or activity diaries. Fifty-one questionnaires were tested for reliability. Only a few questionnaires had sufficient construct validity and reliability, but these need to be further validated. Responsiveness was studied for only two questionnaires and was poor. There is a clear lack of standardization of PA questionnaires, resulting in many variations of questionnaires. No questionnaire or type of questionnaire for assessing PA was superior and therefore could not be strongly recommended above others. In the future, more attention should be paid to the methodology of studies assessing measurement properties of PA questionnaires and the quality of reporting.

Physical activity and hypertensive complications during pregnancy: findings from 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System

BACKGROUND

Hypertensive complications during pregnancy occur in nearly 8 percent of pregnancies and account for 15 percent of all maternal mortalities in the United States. The purpose of this study was to investigate further the association between physical activity and hypertensive complications during pregnancy using data from a population-based surveillance system.

METHODS

This study included 3,348 participants from the 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System. Hypertensive complications during pregnancy were assessed using birth certificate data, and physical activity levels before pregnancy and during pregnancy were self-reported on questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders.

RESULTS

Although no strong association was found between physical activity before pregnancy and hypertensive complications during pregnancy, a dose-response relationship emerged for the physical activity during pregnancy-hypertensive complications association after adjustment for prepregnancy body mass index (physical activity for 1-4 days per week: OR=0.63, 95% CI: 0.45-0.90; physical activity for 5+ days per week: OR=0.46, 95% CI: 0.20-1.02). When levels of physical activity before and during pregnancy were combined, a statistically significant protective effect was seen only for women who indicated that they were physically active both before and during pregnancy (adjusted OR=0.65, 95% CI: 0.44-0.96).

CONCLUSIONS

In this population-based study, physical activity, particularly during pregnancy, was associated with a lower risk of hypertensive complications during pregnancy. During a healthy pregnancy, health care practitioners may recommend that women engage in physical activity as one way to potentially prevent the development of this critical condition.

Purposeful exercise and lifestyle physical activity in the lives of young adult women: findings from a diary study

It is important to know how physical activity is incorporated in women's lives to assess ways they can feasibly attain and maintain lifelong healthy practices. This study aimed to determine whether patterns of activity differed among young women whose physical activity met nationally recommended levels from those who did not. The sample was 42 women (aged 18-30 years) who had completed an exercise intervention (22 from the exercise group, 20 from the control group). Participants recorded pedometer steps and physical activities in diaries including form, duration and perceived exertion during 12 randomly assigned weeks over 26 weeks. We divided the sample into quartiles of moderate to vigorous physical activity to examine the composition of physical activities per quartile. Walking and shopping comprised the majority of physical activity in the lowest quartile of moderate to vigorous physical activity. In the second and third quartiles, walking and household/childcare together comprised more than two-thirds of all activities. Only in the highest quartile was cardio activity (not including walking, shopping and household/childcare) the largest proportion of activity; this category stood alone as varying significantly across quartiles of moderate to vigorous physical activity (p < 0.005). Among these young adult women, self-reported "lifestyle" physical activity was not sufficient to meet recommended levels of moderate to vigorous physical activity. The one-quarter who met recommended levels of moderate to vigorous physical activity did so largely through purposeful physical activities directly associated with exercise. Further research is needed to refine means of more fully measuring physical activities that women frequently perform, with particular attention to household work, childcare and shopping and to differing combinations of activities and levels of exertion by which diverse women can meet the recommended levels. The findings of this small scale study reinforce the ongoing benefit of recommending structured, planned physical activity at moderate and vigorous levels of intensity to young, healthy women to ensure they obtain the health benefits.

Assessment of physical activity using accelerometry, an activity diary, the heart rate method and the Indian migration study questionnaire in south Indian adults

OBJECTIVE

To validate questionnaire-based physical activity level (PAL) against accelerometry and a 24 h physical activity diary (24 h AD) as reference methods (Protocol 2), after validating these reference methods against the heart rate-oxygen consumption (HRVO2) method (Protocol 1).

DESIGN

Cross-sectional study.

SETTING

Two villages in Andhra Pradesh state and Bangalore city, South India.

SUBJECTS

Ninety-four participants (fifty males, forty-four females) for Protocol 2; thirteen males for Protocol 1.

RESULTS

In Protocol 2, mean PAL derived from the questionnaire (1.72 (sd 0.20)) was comparable to that from the 24 h AD (1.78 (sd 0.20)) but significantly higher than the mean PAL derived from accelerometry (1.36 (sd 0.20); P < 0.001). Mean bias of PAL from the questionnaire was larger against the accelerometer (0.36) than against the 24 h AD (-0.06), but with large limits of agreement against both. Correlations of PAL from the questionnaire with that of the accelerometer (r = 0.28; P = 0.01) and the 24 h AD (r = 0.30; P = 0.006) were modest. In Protocol 1, mean PAL from the 24 h AD (1.65 (sd 0.18)) was comparable, while that from the accelerometer (1.51 (sd 0.23)) was significantly lower (P < 0.001), than mean PAL obtained from the HRVO2 method (1.69 (sd 0.21)).

CONCLUSIONS

The questionnaire showed acceptable validity with the reference methods in a group with a wide range of physical activity levels. The accelerometer underestimated PAL in comparison with the HRVO2 method.

[Structured review of physical activity measurement with questionnaires and scales in older adults and the elderly]

OBJECTIVE

To characterize the distinct questionnaires and scales used to measure physical activity, their conceptual frameworks, psychometric properties and application norms.

METHOD

The review included original articles that used questionnaires or scales to assess physical activity in older adults or the elderly. The CINAHL and MEDLINE databases were consulted for the years 1993 to 2007. The studies selected had to provide information on the use, development and psychometric properties of the instruments. Instruments used in the population aged more than 45 years old were included. Articles that assessed physical activity by direct estimation, complex methods, or physical performance were excluded.

RESULTS

The search produced 166 references and 36 instruments were identified. Most of the studies quantified physical activity, and a minority assessed self-efficacy in physical activity performance and the stage of change. Half of the instruments were self-administered. The most frequently studied reliability was test-retest. Criterion validity was studied in 14 instruments, and 11 of these used at least two alternative methods of measurement. Construct validity was assessed in 26 instruments. Responsiveness was evaluated in only three instruments (YPAS, CHAMPS and Exercise Stage of Change) in addition to reliability and validity.

CONCLUSIONS

The Exercise Stage of Change questionnaire showed responsiveness and sufficient reliability to allow individual use. The 7Day PAR questionnaire and the Modified Baecke Questionnaire (Spanish version), which evaluate physical activity, can be used on an individual basis, although their responsiveness has not been studied. In general, the instruments analyzed do not assess mild intensity activities.

Validity of self-reported total physical activity questionnaire among older women

Aim of this study was to assess the validity of a short self-administered physical activity questionnaire, intended to measure past year total daily physical activity, by comparison with activity records and accelerometers. Over a 1-year period, data from a questionnaire, 7-day activity records and accelerometers were obtained from a subset of 116 women between the ages of 56 and 75 years from the population-based Swedish Mammography Cohort. We estimated concordance correlations as measure of validity, deattenuated for intraindividual variation in the reference method. Deattenuated concordance correlations comparing total daily activity measured by the questionnaire with the accelerometers and the records were 0.38 (95% CI: 0.22-0.54) and 0.64 (95% CI: 0.45-0.83), respectively. Validity of leisure-time activity (walking/bicycling and exercise) and inactivity (watching TV/reading) estimates comparing the records with the questionnaire were 0.42 (95% CI: 0.22-0.62) and 0.52 (95% CI: 0.36-0.69), respectively. These data indicate that the average past year total physical activity, leisure-time activity and inactivity can be estimated with a reasonable validity using our short self-administered questionnaire.

Factors associated with exercise participation in adults with arthritis

Most people with arthritis are not regularly active. Understanding what factors influence exercise is essential for designing programs to increase participation. The objective of this study was to examine the correlates of exercise in people with arthritis. Using a cross-sectional design, sociodemographic, health-related, and psychosocial variables were collected from community-dwelling individuals with arthritis (N = 141). Associations with exercise level were examined with bivariate statistics (ANOVAs, chi-squares) and logistic-regression analyses. Exercisers were less likely than nonexercisers and insufficiently active people to report that arthritis negatively affected their physical and social functioning, and they reported more positive affect and greater self-efficacy (p < .05). Exercisers also reported less pain than nonexercisers (p < .05). In multiple logistic-regression analyses, self-efficacy and physical limitations remained independent predictors of exercise. The results suggest the need to target exercise self-efficacy when designing exercise interventions. Results also suggest the need to tailor exercise programs to individuals' physical limitations.

Overweight and obesity as predictors of absenteeism in the working population of the Netherlands

OBJECTIVE

To determine the relation between body mass index (BMI) and absenteeism.

METHODS

Data were collected in a prospective cohort study (n = 1284). Multilevel analyses (linear mixed model with random intercept) with two levels (employee and company) were used to test whether BMI was related to duration and frequency of absenteeism and whether this relation was influenced by sports participation.

RESULTS

Obese employees were absent 14 days a year more than normal-weight employees. Also the frequency of absenteeism of more than 7 days was significantly higher. The differences in absenteeism between obese and normal-weight employees were larger for employees who did not practice sport regularly.

CONCLUSIONS

Obese employees are more often absent and are absent longer, especially when they do not practice sport regularly. An active company policy to prevent obesity is needed, both from a health and a business efficiency perspective.

Criterion-related validity of the last 7-day, short form of the International Physical Activity Questionnaire in Swedish adults

Objective

To examine the validity of the short, last 7-day, self-administered form of the International Physical Activity Questionnaire (IPAQ).

Design

All subjects wore an accelerometer for seven consecutive days and completed the IPAQ questionnaire on the eighth day. Criterion validity was assessed by linear regression analysis and by modified Bland–Altman analysis. Specificity and sensitivity were calculated for classifying respondents according to the physical activity guidelines of the American College of Sports Medicine/Centers for Disease Control and Prevention.

Setting

Workplaces in Uppsala, Sweden.

Subjects

One hundred and eighty-five (87 males) participants, aged 20 to 69 years.

Results

Total self-reported physical activity (PA) (MET-min day−1) was significantly correlated with average intensity of activity (counts min−1) from accelerometry (r=0.34, P<0.001). Gender, age, education and body mass index did not affect this relationship. Further, subcomponents of self-reported PA (time spent sitting, time in PA, time in moderate and vigorous activity (MVPA)) were significantly correlated with objectively measured PA (P<0.05). Self-reported time in PA was significantly different from time measured by accelerometry (mean difference: −25.9 min day−1; 95% limits of agreement: −172 to 120 min day−1; P<0.001). IPAQ identified 77% (specificity) of those who met the current PA guidelines of accumulating more than 30 min day−1 in MVPA as determined by accelerometry, whereas only 45% (sensitivity) of those not meeting the guidelines were classified correctly.

Conclusions

Our results indicate that the short, last 7-days version of the IPAQ has acceptable criterion validity for use in Swedish adults. However, the IPAQ instrument significantly overestimated self-reported time spent in PA. The specificity to correctly classify people achieving current PA guidelines was acceptable, whereas the sensitivity was low.

Work-related repetitive strain injury and leisure-time physical activity

OBJECTIVE

To investigate the relationship between leisure-time physical activity and work-related repetitive strain injury (RSI), adjusted for sociodemographic characteristics and work-related physical and stress factors.

METHODS

The data source was the 2003 Canadian Community Health Survey, a national cross-sectional survey of 134,072 respondents. The analysis was limited to a sample of the survey population reporting full-time work during the past 12 months (n = 58,622). The outcome of interest was work-related RSI of the upper body. Multiple logistic regression was used to examine the relationship between the outcome and leisure-time physical activity level, adjusted for sociodemographic, health, and occupational characteristics. The potential effect of leisure-time physical activity with a high upper-body load was investigated in a secondary analysis.

RESULTS

The prevalence of upper-body work-related RSI was 5.9% in the Canadian population in 2003. An active lifestyle during leisure time was associated with a lower prevalence of work-related upper-body RSI (odds ratio 0.84, 99% confidence interval 0.75-0.95), after adjustment for work physical demands and other covariates. Female sex, obesity, smoking, age, work-related stress, and work physical demands were associated with RSI. In the secondary analysis, we did not find that participating in leisure-time activities with a high upper-body load was a risk factor for RSI.

CONCLUSION

Our study results indicate that being physically active during leisure time is associated with a decreased risk of upper-body occupational RSI, adding another potential health benefit to participation in leisure-time physical activity.

The association between recreational physical activity and mammographic density

Physical activity has been associated with a reduced risk of breast cancer. However, little is known about the association between recreational physical activity and mammographic density. We examined the association between recreational physical activity and mammographic density using mammograms from 375 white and African American women without breast cancer who served as controls in the Los Angeles component of the Women's Contraceptive and Reproductive Experiences Study. We used data from 5 time periods of activity in the statistical analysis: from menarche to mammogram screening, the first 3 and 10 years after menarche, the most recent 10 years and the 3 years prior to mammogram screening. Lifetime history of recreational physical activity was obtained through interviews using a structured questionnaire. We used multiple linear regression to estimate least-squared mean values of absolute and percent mammographic density within categories of physical activity. Overall, we found no statistically significant evidence that physical activity reduced absolute or percent mammographic density. We observed a modest positive association between lifetime physical activity and percent mammographic density (p for trend = 0.04) among younger women, and between recent physical activity and percent density among both younger (<50 years, p for trend = 0.09) and older (> or =50 years, p for trend = 0.06) women, but these associations diminished after additionally adjusting for body mass index (BMI) (all p > or = 0.10). However, among women younger than 50 years, we found some evidence for a protective effect of "strenuous" physical activity in the first 3 years after menarche, with a nonstatistically significant inverse association with both absolute (p for trend = 0.07) and percent (p for trend = 0.08) mammographic density after adjustment for BMI. Our results suggest that physical activity is not a strong predictor of mammographic density.

Reliability and validity of the Past Year Total Physical Activity Questionnaire

The authors determined the validity and reliability of their Past Year Total Physical Activity Questionnaire (PYTPAQ), which assesses the frequency, duration, and intensity of occupational, household, and recreational activities performed over the past year. The PYTPAQ was completed twice at baseline, 9 weeks apart (on average), by 154 healthy Canadian men and women aged 35-65 years for assessment of reliability. The PYTPAQ was completed again 1 year later as a self-administered questionnaire. Four times during the year, participants wore an accelerometer for 7 days and completed 7-day physical activity logs. The authors assessed validity by comparing PYTPAQ summary values with 1-year averages of the physical activity logs and accelerometer data and with physical fitness and anthropometric data measured at baseline and 1 year. Spearman correlations for reliability (metabolic equivalent-hours/week) were 0.64 for total activity, 0.70 for occupational activity, 0.73 for recreational activity, and 0.65 for household activity. For total activity, the intraclass correlation coefficient for correlation between the PYTPAQ and the 7-day physical activity logs was 0.42 (95% confidence interval: 0.28, 0.54), and for the accelerometer data it was 0.18 (95% confidence interval: 0.03, 0.32). Spearman correlations between PYTPAQ hours/week of vigorous activity and maximal oxygen uptake were 0.37 and 0.32 at baseline and follow-up, respectively. In general, the PYTPAQ has acceptable reliability and validity for measurement of past-year physical activity that is comparable to that of similar questionnaires.

Low Plasma Adiponectin Levels and Risk of Colorectal Cancer in Men: A Prospective Study

BACKGROUND

Adiponectin is an insulin-sensitizing hormone secreted by adipocytes. Levels of adiponectin are inversely associated with adiposity and insulin resistance. Because both adiposity and insulin resistance have been associated with risk of colorectal cancer, we hypothesized that adiponectin is associated with colorectal carcinogenesis.

METHODS

We evaluated the association between adiponectin and colorectal cancer among 18 225 men in the Health Professionals Follow-up Study who provided blood samples in 1994. Between blood collection and January 31, 2002, 179 incident colorectal cancer cases occurred. Each case patient was matched to two control subjects on year of birth and date of blood draw. Information on lifestyle factors and diet was collected using biennial questionnaires and food frequency questionnaires. Logistic regression models were used to estimate relative risks (RRs) and confidence intervals (CIs). All statistical tests were two-sided.

RESULTS

We observed a statistically significant inverse association between plasma adiponectin levels and risk of colorectal cancer (for the highest quintile [Q5] versus the lowest quintile [Q1], RR = 0.42, 95% CI = 0.23 to 0.78; P(trend) = .01). The association was only slightly attenuated after adjustment for body mass index (Q5 versus Q1, RR = 0.48, 95% CI = 0.25 to 0.90; P(trend) = .04) or for body mass index and other major risk factors for colorectal cancer (family history, physical activity, multivitamin use, smoking, alcohol, aspirin use, history of endoscopy, dietary calcium, folate, vitamin E, and vitamin D; Q5 versus Q1, multivariable RR = 0.50, 95% CI = 0.26 to 0.97; P(trend) = .08). Relative risks were not linear in any of the analyses; the second quintile had a lower relative risk than the lowest quintile, but further decreases in risk were not evident with increasing levels of adiponectin.

CONCLUSIONS

In this prospective nested case-control study, men with low plasma adiponectin levels had a higher risk of colorectal cancer than men with higher levels. More prospective observational studies, particularly in women, and mechanistic studies are required to fully understand the relationship between adiponectin and carcinogenesis.

The effect of physical activity in leisure time on neck and upper limb symptoms

BACKGROUND

: Little is known of the preventive effects of physical activity in leisure time on neck and upper limb symptoms.

METHODS

: A cohort of 1742 employees was selected from a prospective cohort study with a follow-up period of 3 years. Independent variables were sporting activities and physically active commuting. Outcome measures were neck/shoulder symptoms and elbow/wrist/hand symptoms as well as sickness absence due to these symptoms. To analyze the data, the generalized estimating equation (GEE) method was used, with adjustment for individual characteristics, such as age, gender, lifestyle, and the outcome at baseline.

RESULTS

: Practicing sports for at least 10 months a year decreased the risk of neck/shoulder symptoms (OR: 0.82; CI: 0.67-0.99), sickness absence (OR: 0.48; CI: 0.28-0.84), and long-term sickness absence (OR: 0.37; CI: 0.17-0.84) due to neck or upper limb symptoms. A high mean intensity (> or = 3 h per week) of sporting activities had less effect than the continuation of these activities throughout the year.

CONCLUSION

: Sustained sporting activities have a favorable effect on neck/shoulder symptoms and on sickness absence due to neck or upper limb symptoms. An effect of physically active commuting could not be demonstrated, although there was a tendency towards a favorable effect on sickness absence.

Diagnose körperlich-sportlicher Aktivität im Erwachsenenalter

Zusammenfassung. Vor dem Hintergrund der Suche nach effektiven Maßnahmen in der Prävention und Therapie von Krankheiten einerseits sowie der Frage nach der Bedeutung von körperlich-sportlichen Aktivitäten für eine gesunde Entwicklung über die Lebensspanne hinweg andererseits wird der Beziehung von körperlich-sportlicher Aktivität und Gesundheit seit Jahren nachgegangen. Dabei stellt sich bei vielen Untersuchungen vielfach das Problem, Art und Ausmaß körperlicher bzw. sportlicher Aktivitäten des jeweils interessierenden Personenkreises zu eruieren. Im vorliegenden Beitrag wird zunächst ein Beitrag zur Konzeptualisierung von körperlich-sportlicher Aktivität geleistet und verschiedene Facetten körperlich-sportlicher Aktivität unter einer gesundheitsorientierten Perspektive abgegrenzt. Diverse methodische Zugangswege zur Erfassung körperlich-sportlicher Aktivität werden vorgestellt und im Hinblick auf ihre Vor- und Nachteile diskutiert. Der Zugangsweg der Erfassung über Selbstaussagen mittels Fragebogen bei Personen im Erwachsenenalter wird dabei einer besonders intensiven Betrachtung unterzogen. Die empirischen Studien zur Entwicklung von Fragebogen haben in den letzten fünf Jahren vor allem im internationalen Bereich stark zugenommen. Im deutschsprachigen Bereich besteht hingegen noch deutlich Nachholbedarf. Perspektiven - insbesondere für die sportpsychologische Forschung - bestehen in der Entwicklung von Fragebogen, die über die Erhebung des Energieverbrauchs durch körperlich-sportliche Aktivität hinausgehen und vor dem Hintergrund eines biopsychosozialen Gesundheitsverständnisses auch biopsychosoziale Aspekte von körperlich-sportlicher Aktivität in die Erfassung einbeziehen.

Leisure physical activity is associated with quantitative ultrasound measurements independently of bone mineral density in postmenopausal women

The purpose of this study was to assess the magnitude of the relationship between leisure physical activity and bone status as measured either by an Achilles ultrasound bone densitometer (QUS) or dual-energy X-ray absorptiometry (DXA) in postmenopausal women. We studied 1162 French Canadian postmenopausal women, aged 33-84 years (mean age 58 years), for QUS parameters [broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI)] measured at the right calcaneus, and bone mineral density (BMD) measured at the lumbar spine and femoral neck. Multivariate regression analyses revealed that leisure physical activity level was an independent predictor of the heel QUS parameters and of femoral neck BMD. No such association was observed for BMD of the lumbar spine. Heel QUS parameters (BUA, SOS, SI) and femoral neck BMD adjusted for interfering covariables showed a statistically significant difference between sedentary (less than three sessions/month) and active women (three or more sessions/week) (P < or = 0.001). Furthermore, after adjusting each heel QUS parameters for the mean lumbar spine BMD value, the association observed between leisure physical activity and QUS remained significant. These results suggest that regular leisure physical activity could influence QUS parameters, independently of BMD, and that quantitative ultrasound could be a suitable outcome measure in exercise studies in postmenopausal women.

Estimating physical activity using the CSA accelerometer and a physical activity log

PURPOSE

To compare two methods for measuring time spent in physical activity of differing absolute intensities.

METHODS

Over a 7-d period, 59 women wore Computer Science and Applications, Inc. (CSA) accelerometers and recorded their activity in physical activity logs (PAL) at 15-min intervals. Three published cut points were used to classify CSA data into resting/light, moderate, and vigorous intensity categories. Data were analyzed using descriptive statistics, Spearman rank-order correlations, and Bland-Altman plots.

RESULTS

The CSA estimates of total (moderate plus vigorous) physical activity using the three cut points ranged from a mean (+/- SD) of 38.1 (+/-26.8) min.d-1 to 312.6 (+/- 101.1) min.d-1. Using the PAL, women self-reported a mean (+/- SD) of 75.1 (+/- 51.7) min.d-1 of total activity. There was fair to modest rank-order agreement between each of the three CSA measures and the PAL measure of total activity, with correlations ranging from r = 0.15 to 0.24. Correlations between CSA and PAL estimates of total activity were higher in women with body mass index values (BMI) below 25 kg.m-2 (r = 0.23-0.38) compared with women with BMI > or = 25 kg.m-2 (r = 0.06-0.08) but did not differ according to age. Correlations between the three CSA cut points ranged from r = 0.45 to 0.86.

CONCLUSIONS

Three published cut points designed to classify CSA output by intensity level produced different estimates of physical activity participation. Correlations between CSA and PAL measures of activity intensity were fair overall but higher among leaner women.