Assessment of physical activity – a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation

Ecological momentary assessment of physical activity and sedentary behaviour in shift workers and non-shift workers: Validation study

This study examined the criterion validity of an ecological momentary assessment (EMA)-reported physical activity and sedentary time compared with accelerometry in shift workers and non-shift workers. Australian workers (n = 102) received prompts through a mobile EMA app and wore the Actigraph accelerometer on the right hip for 7-10 days. Participants received five EMA prompts per day at 3-hour intervals on their mobile phones. EMA prompts sent to shift workers (SW-T) were tailored according to their work schedule. Non-shift workers (NSW-S) received prompts at standardised times. To assess criterion validity, the association of EMA-reported activities and the Actigraph accelerometer activity counts and number of steps were used. Participants were 36 ± 11 years and 58% were female. On occasions where participants reported physical activity, acceleration counts per minute (CPM) and steps were significantly higher (β = 1184 CPM, CI 95%: 1034, 1334; β = 20.9 steps, CI 95%: 18.2, 23.6) than each of the other EMA activities. Acceleration counts and steps were lower when sitting was reported than when no sitting was reported by EMA. Our study showed that EMA-reported physical activity and sedentary time was significantly associated with accelerometer-derived data. Therefore, EMA can be considered to assess shift workers' movement-related behaviours with accelerometers to provide rich contextual data.

Objectively measured physical activity among people with and without HIV in Uganda: associations with cardiovascular risk and coronary artery disease

Background

Africa has a disproportionate burden of HIV-related cardiovascular disease. We aimed to describe physical activity in people living with HIV (PLHIV) and people without HIV (PWOH) in Uganda and characterize its relationship with the presence of computed tomography angiography-detected (CCTA) coronary artery disease (CAD).

Methods

We performed a cross-sectional analysis of the Ugandan Study of HIV Effects on the Myocardium and Atherosclerosis using Computed Tomography (mUTIMA-CT) cohort. From 2017-2019, physical activity in PLHIV and PWOH was assessed by accelerometry over seven days. Participants additionally underwent CCTA. Univariable and multivariable modified Poisson regression was used to analyze the relationship between physical activity and CAD presence.

Results

168 participants were analyzed. The median (IQR) age was 57 (53-58) years old and 64% were female. Males had more moderate-to-vigorous physical activity per week [68 minutes (12-144) vs 15 minutes (0-50), P<0.001] and less light physical activity [788 minutes (497-1,202) vs [1,059 (730-1490), P=0.001] compared to females, but there was no difference by HIV status. After adjusting for age, which accounted for 10% of the variation in steps taken, and sex, no significant associations were found between physical activity and coronary plaque.

Conclusion

Objectively measured physical activity was low compared to guideline recommendations, with males being somewhat more active than females and without significant differences by HIV status. Physical activity was not associated with the presence of CAD independently of age and sex.

Social Representativeness and Intervention Adherence-A Systematic Review of Clinical Physical Activity Trials in Breast Cancer Patients

Objectives

Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence.

Methods

Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups.

Results

A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship.

Conclusion

Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.

Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food-Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study

BACKGROUND

Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines.

OBJECTIVE

The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated.

METHODS

In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food-based dietary guidelines (FBDGs) in addition to lifestyle factors.

RESULTS

At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except "water" (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in "moderate to vigorous intensity" was underestimated with the DIGIKOST-FFQ. However, estimated time in "moderate to vigorous intensity," "vigorous intensity," and "sedentary time" showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations.

CONCLUSIONS

The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in "moderate to vigorous physical activity," "sedentary time," and "sleep."

Effects on physical activity, physical fitness and well-being in a 36-months randomized controlled study, comparing a multimodal hospital-based intervention programme for primary cardiovascular prevention with usual care

BACKGROUND

Cardiovascular disease is a major cause of mortality and morbidity worldwide, and primary prevention efforts are poorly developed in people at high cardiovascular risk. On this background, we performed the Hjerteløftet Study and demonstrated that participation over 36 months in a multimodal primary prevention programme, significantly reduced validated cardiovascular risk scores. In the current substudy we aimed to further explore several elements and effects following the intervention programme.

METHODS

A random sample from the original Hjerteløftet Study was included for further examinations (n = 255, 40% women), and these patients were already randomized to an intervention group (IG) (n = 127), or a control group (CG) (n = 128). We compared changes from baseline to 36-months follow-up in physical activity, cardiorespiratory fitness, psychological well-being (WHO-5), cardiovascular medication use, smoking habits, and cardiometabolic risk factors (blood pressure, lipids, blood glucose, HbA1c, Apolipoprotein A-I, Apolipoprotein B and high-sensitive C-reactive protein).

RESULTS

Self-reported physical activity increased significantly with absolute difference in mean delta Physical Activity Index score in the IG compared to the CG: 0.90, 95% CI: 0.10 to 1.70, p = 0.028 (ANCOVA). There were no corresponding differences in cardiorespiratory fitness. The participation resulted in psychological well-being improvement in both groups with a larger increase in the IG compared to the CG. The mean difference in delta WHO-5 score was 5.06, 95% CI: 0.68 to 9.45, p = 0.024, and 3.28, 95% CI: -0.69 to 5.25, p = 0.104 when controlled for baseline values (ANCOVA). The use of antihypertensive medication increased significantly more in the CG (p = 0.044). Only minor, nonsignificant changes were observed for traditional risk factors and cardiometabolic variables.

CONCLUSIONS

Participation in the Hjerteløftet Study intervention programme resulted in an improved physical activity level, but without changing cardiorespiratory fitness. Participation in the programme also tended to improve psychological well-being, possibly related to increased physical activity, less smoking and less use of cardiovascular medication. Concerning the metabolic status, no major differences were observed, but minor changes may have been concealed by a larger increase in cardiovascular medication use in the control group.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01741428), 04/12/2012.

Accuracy of Apple Watch to Measure Cardiovascular Indices in Patients with Chronic Diseases: A Cross Sectional Study

Background

The validity of the Apple Watch to measure the heart rate (HR) and oxygen saturation (Spo2) for patients with chronic diseases such as diabetes mellitus (DM), dyslipidemia, and hypertension is still unclear. Therefore, this study aims to investigate the accuracy of the Apple Watch in measuring the Spo2 and HR in patients with chronic diseases.

Methods

Forty-one patients with chronic diseases, including 20 with hypertension, 10 with diabetes, and 11 with dyslipidemia, completed a cross-sectional study. All participants used the Apple Watch against the Polar chest strap and the pulse oximeter at rest and during moderate intensity exercise sessions to measure HR and the SpO2 at rest for 5 minutes, during exercise for 16 minutes, and followed by 3 minutes of rest. The HR was measured during all previous periods, but evaluation of the Spo2 included 5 measures, done only before and after exercise, with a minute interval between each measure.

Results

Overall, a strong correlation exists between measuring the SpO2 using the Apple Watch against the pulse oximeter (Contec) at rest (r = 0.92, p < 0.001) and after exercise (r = 0.86, p < 0.001) in all patients. The HR had a very strong correlation between the Apple Watch and the Polar chest strap (r = 0.99, p < 0.001) in all patients. There was no significant difference (p = 0.76) between the twenty-seven white and fourteen brown-skinned patients.

Conclusion

The Apple Watch is valid to measure the HR and SpO2 in patients with chronic diseases.

Clinical Trial Registration No

NCT05271864.

Potential causal associations between leisure sedentary behaviors, physical activity, sleep traits, and myopia: a Mendelian randomization study

BACKGROUND

Myopia is the most prevalent refractive error and a growing global health concern that significantly affects visual function. Researchers have recently emphasized considerably on the influence of lifestyle on myopia incidence and development. This study investigates the relationship between leisure sedentary behaviors (LSB)/physical activity (PA)/sleep traits and myopia.

METHODS

LSB, PA, and sleep trait-associated genetic variants were used as instrument variables in a Mendelian randomization (MR) study to examine their causal effects on myopia. Summary genome-wide association studies (GWASs) statistical data for LSB and PA were obtained from UK Biobank, and the data of sleep traits was obtained from UK Biobank, UK Biobank and 23andMe, and FinnGen. We used summary statistics data for myopia from MRC IEU. The MR analyses was performed using the inverse variance-weighted (IVW), MR-Egger, weighted median, and MR Pleiotropy RESidual Sum and Outlier methods.

RESULTS

Computer use was genetically predicted to increase the myopia risk [IVW odds ratio (OR) = 1.057; 95% confidence interval (CI), 1.038-1.078; P = 7.04 × 10- 9]. The self-reported moderate-to-vigorous physical activity (MVPA) (IVW OR = 0.962; 95% CI, 0.932-0.993; P = 1.57 × 10- 2) and television watching (IVW OR = 0.973; 95% CI, 0.961-0.985, P = 1.93 × 10- 5) were significantly associated with a lower myopia risk. However, genetically predicted sleep traits or accelerometer-measured physical activity had no significant associations with myopia.

CONCLUSION

Our results indicated that computer use is a risk factor for myopia, whereas television watching and MVPA may protect against myopia. These findings shed new light on possible strategies for reducing the prevalence of myopia.

Association of physical behaviours with sarcopenia in older adults: a systematic review and meta-analysis of observational studies

BACKGROUND

Physical behaviours (ie, physical activity and sedentary behaviour) might have a role in the development of sarcopenia, although the evidence is unclear. We aimed to explore the association of total and intensity-specific levels of physical activity and sedentary behaviour with sarcopenia and its components (ie, muscle mass, muscle strength, and physical performance) in older adults.

METHODS

We conducted a systematic review and meta-analysis and searched MEDLINE (via PubMed), Scopus, and Web of Science from inception to July 26, 2022, for peer-reviewed, observational studies or baseline data from randomised clinical trials conducted in older adults (ie, individual age ≥60 years or mean age ≥65 years) and published in English that reported on the association of physical activity or sedentary behaviour or both with sarcopenia (or its determinants: muscle mass or strength, and physical performance). Physical activity and sedentary behaviour were measured by any method. The main outcome was sarcopenia, which could be diagnosed by any means. Estimates were extracted and pooled using Bayesian meta-analytic models and publication bias was assessed using the Egger's test. This study is registered with PROSPERO, CRD42022315865.

FINDINGS

We identified 15 766 records, of which 124 studies (230 174 older adults; 121 301 [52·7%] were female and 108 873 [47·3%] were male) were included in the systematic review. 86 studies were subsequently included in the meta-analysis. Higher levels of total physical activity were inversely associated with sarcopenia both cross-sectionally (21 studies, n=59 572; odds ratio 0·49, 95% credible interval 0·37-0·62) and longitudinally (four studies, n=7545; 0·51, 0·27-0·94). A protective association was also identified for moderate-to-vigorous physical activity in cross-sectional research (five studies, n=6787; 0·85, 0·71-0·99), whereas no association was identified for the remaining physical behaviours (ie, steps, light physical activity, or sedentary behaviour).

INTERPRETATION

Total and moderate-to-vigorous physical activity are inversely associated with sarcopenia. These findings might support the importance of moderate-to-vigorous, rather than light, intensity physical activity-based interventions to prevent sarcopenia.

FUNDING

None.

TRANSLATION

For the Spanish translation of the abstract see Supplementary Materials section.

Long-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: A randomized controlled trial

BACKGROUND

Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period.

METHODS

Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes.

RESULTS

At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups.

CONCLUSION

The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.

The Relationship between Physical Activity and Health-Related Quality of Life in Korean Adults: The Eighth Korea National Health and Nutrition Examination Survey

This study used the raw data from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES-VIII), conducted under the supervision of the Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention in 2019. It was conducted to identify a significant correlation between physical activity (PA) and health-related quality of life (HR QOL) in the Korean population. In 2019, the KNHANES-VIII added the Health-related Quality of Life Instrument with 8 items (HINT-8) to assess the HR QOL. The independent variable is related to PA, specifically the presence or absence of PA, type of PA, and the frequency of PA. The dependent variable is HR QOL, measured either as the total score or specific items (e.g., pain, vitality, and memory) using the HINT-8 measurement tool. Demographic characteristics and health status may directly or indirectly influence the relationship between PA and HR QOL, which were used as covariates. A total of 4357 participants were included in the current study. The mean HINT-8 scores were significantly higher in the participants who performed PA on a weekly basis, leisure-related PA or MSPA, as compared with those who did not (p = 0.01 and <0.0001, respectively). In both the unadjusted and adjusted models, the mean HINT-8 scores were significantly higher in the participants who performed ≥500 MET-min/week of leisure-related PA as compared with those who did not (95% CI: 1.017-1.033; p < 0.001 and 95% CI: 1.005-1.02; p = 0.001, respectively). In both the unadjusted and adjusted models, the mean HINT-8 scores were significantly higher (95% CI: 1.015-1.03; p < 0.001 and 95% CI: 1.004-1.018; p = 0.003, respectively) in the participants who performed MSPA for ≥2 days/week as compared with those who did not. The current results confirmed that there is a significant positive correlation between the PA and HR QOL based on the HINT-8 scores. Because the HINT-8 was developed to assess the HR QOL in Koreans, however, further studies are warranted to evaluate its applicability to other ethnic populations.

Associations between physical activity, physical fitness, and body composition in adults living in Germany: A cross-sectional study

BACKGROUND & AIMS

Body composition (BC) changes with age and is associated with morbidity and mortality. A physically active lifestyle influences BC and represents an important predictor of successful aging. To emphasize this, the World Health Organization established activity recommendations for all age groups. We describe BC during adulthood using a cross-sectional sample from a German community and investigate the associations between physical activity (PA), physical fitness (PF), and BC.

METHODS

Data from 329 men and women aged 35 to 86 years were analyzed. PA was measured by questionnaire and classified into sport activity and habitual activity. PF was measured through physical performance tests and BC by bioelectrical impedance analysis. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated to represent height-adjusted BC. Associations between PA, PF, and BC were analyzed using linear regression models.

RESULTS

For both sexes, strength was positively associated with FFMI (♂: ß = 0.313; ♀: ß = 0.213) and phase angle (♂: ß = 0.357; ♀: ß = 0.409). For FMI, a significant negative association with strength was found only in women (ß = -0.189). Cardiorespiratory fitness showed a negative association with FMI (ß = -0.312) and FFMI (ß = -0.201) for men, while in women a positive association was found for FFMI (ß = 0.186). For coordination, a significant association with FMI was observed only in women (ß = -0.190). Regarding PA only one significant relationship between sport activity and FMI among women (ß = -0.170) was found.

CONCLUSIONS

In our sample, PF was closer related to BC than PA. Strength and cardiorespiratory fitness were the strongest predictors for BC. This supports the World Health Organization's activity recommendations to include both resistance and endurance training in the weekly sports program to maintain a healthy BC.

Psychological Distress and Self-Management in CKD: A Cross-Sectional Study

Rationale & Objective

Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations.

Study Design

Cross-sectional online questionnaire data as part of the E-GOAL study.

Setting & Participants

Patients with CKD (estimated glomerular filtration rate, 20-89 mL/min/1.73 m2) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires.

Exposures

Psychological distress, depressive symptoms, and anxiety symptoms.

Outcomes

Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors).

Analytical Approach

Adjusted multivariable regression and ordinal logistic regression analyses.

Results

In our sample (N = 460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (βadj, -0.13; 95% CI, -0.23 to -0.04), less physical activity (βadj, -0.13; 95% CI, -0.22 to -0.03), and lower medication adherence (βadj, -0.15; 95% CI, -0.24 to -0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07).

Limitations

Cross-sectional design, possible residual confounding, and self-report.

Conclusions

Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management.

Plain-Language Summary

This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.

Associations between sedentary behavior and health and the moderating role of physical activity in young people within a cross-sectional investigation

The purpose of this study was to determine the influence of sedentary behavior (SB) on the frequency of health complaints (fHC) as well as on self-rated health (SRH) and body mass index (BMI), and to determine whether physical activity (PA) moderated this influence. Data were obtained from the Youth Survey Luxembourg 2019 (N = 2,802), a nationally representative stratified random sample of all youths aged 16 to 29 years who were living in Luxembourg. fHC is a composite measure of eight common psychosomatic health complaints, SRH was measured on a five-point scale, and BMI was calculated by dividing participants' body weight by the square of their body height (kg/m2). PA and SB values were obtained from factor analyses of the relevant questionnaire items. SB was evaluated as both leisure-time SB and gaming-associated SB. Multiple regression analyses adjusted for age, sex, socioeconomic status, and migration status were used to determine the association between SB, fHC, BMI, and SRH. We found that leisure-time SB was positively associated with fHC, but not with SRH or BMI. Gaming-associated SB was positively associated with fHC and BMI but was negatively associated with SRH. PA was negatively associated with fHC, BMI and SRH. No statistically significant moderating effects were observed. We found that both leisure-time and gaming-associated SB showed statistically significant impacts on health. Although PA is known to be beneficial to health, we conclude that its potential to mitigate the negative effects of SB is limited in young people.

Commercial Smart Watches and Heart Rate Monitors: A Concurrent Validity Analysis

ABSTRACT

Montalvo, S, Martinez, A, Arias, S, Lozano, A, Gonzalez, MP, Dietze-Hermosa, MS, Boyea, BL, and Dorgo, S. Smartwatches and commercial heart rate monitors: a concurrent validity analysis. J Strength Cond Res 37(9): 1802-1808, 2023-The purpose of this study was to explore the concurrent validity of 2 commercial smartwatches (Apple Watch Series 6 and 7) against a clinical criterion device (12-lead electrocardiogram [ECG]) and a field criterion device (Polar H-10) during exercise. Twenty-four male collegiate football players and 20 recreationally active young adults (10 men and 10 women) were recruited and participated in a treadmill-based exercise session. The testing protocol included 3 minutes of standing still (resting), then walking at low intensity, jogging at a moderate intensity, running at a high intensity, and postexercise recovery. The intraclass correlation (ICC 2,k ), and Bland-Altman plot analyses showed a good validity of the Apple Watch Series 6 and Series 7 with increased error (bias) as jogging and running speed increased in the football and recreational athletes. The Apple Watch Series 6 and 7 are highly valid smartwatches at rest and different exercise intensities, with validity decreasing with increased running speed. Strength and conditioning professionals and athletes can confidently use the Apple Watch Series 6 and 7 when tracking heart rate; however, caution must be taken when running at moderate or higher speeds. The Polar H-10 can surrogate a clinical ECG for practical applications.

Observational longitudinal association between waking movement behaviours and psychological distress among adolescents using isotemporal analysis: DADOS study

This study aimed to examine the impact of reallocating time spent in waking movement behaviours at baseline on indicators of psychological distress at 24-month follow-up using isotemporal substitution regression models among a sample of Spanish adolescents. The DADOS (Deporte, ADOlescencia y Salud) study is a 3-year longitudinal observational research project carried out between years 2015-2017. The analyses included 197 adolescents (91 girls) aged 13.9 ± 0.3 years at baseline. Waking movement behaviours were assessed by a wrist-worn GENEActiv triaxial accelerometer and expressed as minutes/day of light physical activity (LPA), moderate-vigorous physical activity (MVPA) and time spent in sedentary behaviour (SB). The Behaviour Assessment System for Children and Adolescents (level 3 for adolescents) was used to assess psychological distress indicators (i.e., anxiety, social stress, and risk of depression). Results showed significant associations only for girls. The substitution of 10 min/day of SB or LPA at baseline with 10 min/day of MVPA was associated with lower levels of anxiety (both p ≤ 0.01) and social stress (both p < 0.05) at follow-up. The substitution of 10 min/day of SB with 10 min/day of LPA was associated with higher levels of anxiety at follow-up (p = 0.01). These findings highlight the need of specific physical activity recommendations for mental health paying special attention to sex-differences.

Intensity of a Physical Exercise Programme Executed through Immersive Virtual Reality

Evidence suggests that moderate to vigorous physical activity (MVPA) is necessary for health benefits. Immersive virtual reality is a technology that uses images, sounds, and tactile sensations from a simulated world to encourage healthy behaviours and physical activity. The aims of this research are (1) to determine the duration and intensity of physical activity performed through immersive virtual reality; (2) to determine differences in physical activity intensity according to gender.

METHODS

A nonprobabilistic convenience sample composed of 39 university students of physical education pedagogy, who performed, through immersive virtual reality, a physical activity programme composed of three levels that progressively increased in complexity. Physical activity intensity was measured using accelerometers.

RESULTS

Of the three levels, the most complex was not the one that produced the most minutes of MVPA. The three levels added up to 08:53 min of MVPA. No significant differences were found when comparing them by sex.

CONCLUSIONS

The results of this study suggest that an exercise programme delivered through immersive virtual reality generates MVPA levels, with no major differences between sexes. Further research is needed to confirm the contribution of immersive virtual reality to physical activity.

Do associations of physical activity and sedentary behaviour with cardiovascular disease and mortality differ across socioeconomic groups? A prospective analysis of device-measured and self-reported UK Biobank data

OBJECTIVE

To examine if individual-level and area-level socioeconomic status (SES) modifies the association of moderate-to-vigorous physical activity (MVPA), domain-specific physical activity and sedentary behaviour with all-cause mortality (ACM) and incident cardiovascular disease (CVD).

METHODS

We used self-reported (International Physical Activity Questionnaire short form) and accelerometer-measured physical activity and sedentary behaviour data from the UK Biobank. We created an individual-level composite SES index using latent class analysis of household income, education and employment status. The Townsend Index was the measure of area-level SES. Cox proportional hazards regression models stratified across SES were used.

RESULTS

In 328 228 participants (mean age 55.9 (SD 8.1) years, 45% men) with an average follow-up of 12.1 (1.4) years, 18 033 deaths and 98 922 incident CVD events occurred. We found an increased ACM risk of low physical activity and high sedentary behaviour and an increased incident CVD risk of low accelerometer-measured moderate-to-vigorous physical activity (ACCEL_MVPA) and high sitting time. We observed statistically significant interactions for all exposures in ACM analyses by individual-level SES (p<0.05) but only for screen time in area-level SES-ACM analysis (p<0.001). Compared with high self-reported moderate-to-vigorous physical activity (IPAQ_MVPA), adjusted ACM HRs for low IPAQ_MVPA were 1.14 (95% CI 1.05 to .25), 1.15 (95% CI 1.06 to 1.24) and 1.22 (95% CI 1.13 to 1.31) in high, medium and low individual-level SES, respectively. There were higher detrimental associations of low ACCEL_MVPA with decreasing area-level SES for both outcomes and of high screen time with ACM in low area-level SES.

CONCLUSION

We found modest evidence suggesting that the detrimental associations of low MVPA and high screen time with ACM and incident CVD are accentuated in low SES groups.

Cross-sectional and longitudinal associations of domain-specific physical activity composition with health-related quality of life in childhood and adolescence in Australia

BACKGROUND

Health benefits have been linked with physical activity (PA), as well as some domains of PA among youth (e.g. organized PA and active transport). However, less is known about whether some PA domains are more beneficial than others. There is also a lack of evidence about whether health outcomes are related to the composition of PA (i.e. the share of PA spent in different domains). This study aimed to identify: (1) how the absolute durations of organized PA, non-organized PA, active transport and active chores/work at 10-11y are individually associated with physical, psychosocial and total health-related quality of life (HRQOL) at 10-11y and 12-13y; and (2) how the domain-specific composition of PA at 10-11y is associated with HRQOL at 10-11y and 12-13y.

METHODS

Data from the Longitudinal Study of Australian Children were used in cross-sectional (n ≥ 2730) and longitudinal analyses (n ≥ 2376). Measurement included the Pediatric Quality of Life Inventory (PedsQL™) for HRQOL domains and one-day time-use diaries (TUDs) for PA domains. Robust linear regression models were used, controlling for age, sex, pubertal status, socioeconomic position, body mass index and TUD context (season and school attendance). Compositional models additionally adjusted for total PA duration and longitudinal models controlled for baseline PedsQL™ scores.

RESULTS

Non-compositional models indicated that the duration of organized PA, and to a lesser extent non-organized PA, were positively but weakly associated with some HRQOL outcomes at 10-11y. These trends were not reflected in longitudinal models, although a 30-min increase in non-organized PA per day did predict marginally better psychosocial HRQOL at 12-13y (+ 0.17%; 95%CI =  + 0.03%, + 0.32%). Compositional models revealed that a 30-min increase in organized PA relative to other domains was positively but weakly associated with physical (+ 0.32%; 95%CI =  + 0.01%, + 0.63%), psychosocial (+ 0.41%; 95%CI =  + 0.11%, + 0.72%) and total HRQOL (+ 0.39%; 95%CI =  + 0.12%, + 0.66%) at 10-11y. However, the overall PA composition at 10-11y was not related to HRQOL at 12-13y.

CONCLUSIONS

Non-compositional and compositional models generally concurred on the direction of cross-sectional and longitudinal relationships (and lack thereof) between PA domains and HRQOL outcomes. The strongest associations were cross-sectional between organized PA and HRQOL at 10-11y. However, all associations between PA domains and HRQOL outcomes were weak and may not be clinically meaningful.

A Wrinkle in Measuring Time Use for Cognitive Health: How should We Measure Physical Activity, Sedentary Behaviour and Sleep?

One new case of dementia is detected every 4 seconds and no effective drug therapy exists. Effective behavioural strategies to promote healthy cognitive ageing are thus essential. Three behaviours related to cognitive health which we all engage in daily are physical activity, sedentary behaviour and sleep. These time-use activity behaviours are linked to cognitive health in a complex and dynamic relationship not yet fully elucidated. Understanding how each of these behaviours is related to each other and cognitive health will help determine the most practical and effective lifestyle strategies for promoting healthy cognitive ageing. In this review, we discuss methods and analytical approaches to best investigate how these time-use activity behaviours are related to cognitive health. We highlight four key recommendations for examining these relationships such that researchers should include measures which (1) are psychometrically appropriate; (2) can specifically answer the research question; (3) include objective and subjective estimates of the behaviour and (4) choose an analytical method for modelling the relationships of time-use activity behaviours with cognitive health which is appropriate for their research question.

[Work-related sedentary behavior]

Background

Sedentary behavior is associated with an increased risk of chronic diseases, such as metabolic syndrome and type 2 diabetes and all-cause mortality. Occupational sitting time contributes to large amounts of daily sedentary behavior, especially in office workers.

Objective

This study investigated the amount of time spent in sedentary behavior during different tasks at work and while commuting of administrative personnel of a university hospital in Germany.

Material and methods

A cross-sectional questionnaire-based study of administrative employees at the University Hospital Regensburg, Germany was carried out to assess work-related sedentary behavior. Descriptive and exploratory statistical analyses were performed.

Results

The study population consisted of 159 participants (54.1% women, 51.6% older than 40 years), which corresponds to a response rate of 26%. The median daily sitting time in the office was 7.0 h (interquartile range, IQR 6.0-7.5 h) and mostly occurred during computer work (57.3%), telephone calls (13.2%) and meetings (11.7%). Median standing time at work was 0.8 h (IQR 0.3-1.4 h). Administrative staff spent a median of 0.7 h (IQR 0.3-1.0 h) per day sedentary while commuting, with 67.3% of respondents commuting by car, motorbike or scooter. The participants were of the opinion that sitting for long uninterrupted periods had negative (69.6%) or relatively negative (29.7%) effects on health.

Conclusion

Administrative staff in hospitals spend large amounts of the daily working time with sedentary behavior. Interventions that enable working both in sitting and standing positions can lead to reduced work-related sitting time and thereby could improve occupational and, in a broader sense, public health.

Joint associations of physical activity and sedentary time with body mass index: A prospective study of mortality risk

Device-measured physical activity and sedentary time are suggested to be more important determinants of all-cause mortality compared to body mass index (BMI) in mainly older adults. However, the joint associations of physical activity and sedentary time with BMI in relation to mortality risk in relatively healthy middle-aged individuals are unclear. We followed 770 adults (56% women, mean age 55.6 years) from a population-based cohort study for up to 15.3 years. BMI categories were combined with tertiles of total, light, and moderate-to-vigorous physical activity and sedentary time. Cox proportional hazards models estimated hazard ratios (HR) of all-cause mortality with 95% confidence intervals (CI). High total and light intensity physical activity and low sedentary time were associated with a lower risk of mortality in normal weight individuals compared with low active overweight/obese; HR: 0.35 (CI: 0.14, 0.86), HR: 0.33 (CI: 0.12, 0.89), and HR: 0.34 (CI: 0.13, 0.92). Among overweight/obese individuals, those who were medium active in light physical activity had a lower mortality risk, HR: 0.36 (CI: 0.15, 0.83), compared with low active. Medium sedentary individuals had a lower risk, HR: 0.43 (CI: 0.20, 0.94) compared with those who were most sedentary. Associations among the most active or least sedentary tertiles were similar irrespective of BMI category. In conclusion, higher physical activity and lower sedentary time were associated with lower mortality risk irrespective of BMI. Physical activity should be promoted and prescribed to individuals with low physical activity levels irrespective of weight status.

Physical Activity and Mental Health in Undergraduate Students

Most research support positive relationships between physical activity and mental health. However, possible moderating variables of these relationships have also been identified, such as age, gender, level of physical activity, and the scope of physical activity. This study aimed to analyze the relationships between physical activity and mental health levels in undergraduate students, assessing whether these associations can change depending on the level of physical activity (low, medium, or high) and the setting (occupational, commuting, or leisure time physical activity) in which it was performed. A descriptive and cross-sectional study was conducted. The sample comprised 847 undergraduate students. Physical activity and mental health were measured by the Global Physical Activity Questionnaire (GPAQv2) and the General Health Questionnaire (GHQ-12). We found relationships between students' physical activity level and their mental health status. The higher the total physical activity, the better their mental health scores. High levels of commuting and leisure time physical activity is also associated with better mental health, while only moderate levels of occupational physical activity are associated with better mental health status. Regarding the possible associations between physical activity and vulnerability to mental health problems, with the fully adjusted regression model, leisure time and occupational physical activity remain protective of a poor state of mental health. Leisure time physical activity, performed at a high level, and moderate occupational physical activity seems to be the best combination of physical activity to reduce students' vulnerability to potential mental health problems.

Fatness, fitness and the aging brain: A cross sectional study of the associations between a physiological estimate of brain age and physical fitness, activity, sleep, and body composition

Introduction

Changes in brain structure and function occur with aging. However, there is substantial heterogeneity both in terms of when these changes begin, and the rate at which they progress. Understanding the mechanisms and/or behaviors underlying this heterogeneity may allow us to act to target and slow negative changes associated with aging.

Methods

Using T1 weighted MRI images, we applied a novel algorithm to determine the physiological age of the brain (brain-predicted age) and the predicted age difference between this physiologically based estimate and chronological age (BrainPAD) to 551 sedentary adults aged 65 to 84 with self-reported cognitive complaint measured at baseline as part of a larger study. We also assessed maximal aerobic capacity with a graded exercise test, physical activity and sleep with accelerometers, and body composition with dual energy x-ray absorptiometry. Associations were explored both linearly and logistically using categorical groupings.

Results

Visceral Adipose Tissue (VAT), Total Sleep Time (TST) and maximal aerobic capacity all showed significant associations with BrainPAD. Greater VAT was associated with higher (i.e,. older than chronological) BrainPAD (r = 0.149 p = 0.001)Greater TST was associated with higher BrainPAD (r = 0.087 p = 0.042) and greater aerobic capacity was associated with lower BrainPAD (r = - 0.088 p = 0.040). With linear regression, both VAT and TST remained significant (p = 0.036 and 0.008 respectively). Each kg of VAT predicted a 0.741 year increase in BrainPAD, and each hour of increased TST predicted a 0.735 year increase in BrainPAD. Maximal aerobic capacity did not retain statistical significance in fully adjusted linear models.

Discussion

Accumulation of visceral adipose tissue and greater total sleep time, but not aerobic capacity, total daily physical activity, or sleep quantity and/or quality are associated with brains that are physiologically older than would be expected based upon chronological age alone (BrainPAD).

Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study

Aims

Endurance sport practice is associated with a high prevalence of atrial fibrillation (AF), which increases the risk of stroke in the general population. However, stroke risk in endurance athletes with AF is sparsely investigated. Most studies have been limited by design and are largely restricted to younger and middle-aged populations. Thus, we aimed to investigate AF and stroke risk in older athletes exposed to prolonged endurance training.

Method

During a 10-year period, 505 male athletes aged ≥65 years frequently participating in a long-distance ski race were compared with 1867 men of the same age from the general population. The main exposure was endurance sport practice with self-reported AF and stroke as outcomes. Stroke risk was further examined by joint modelling of AF and endurance practice. Statistical analysis was conducted with a modified Poisson model.

Results

Athletes (median age: 68, range: 65–90) participated in a long-distance ski race over a median of 14 years (range: 1–53). Prevalence (28.5% vs 17.8%) and adjusted risk of AF (risk ratio (RR): 1.88, 95% CI: 1.49 to 2.37) were higher in athletes compared with non-athletes, whereas the prevalence (5.4% vs 9.7%) and risk of stroke were lower (RR: 0.60, 95% CI: 0.37 to 0.95). Compared with athletes without AF, risk of stroke was twofold in athletes (RR: 2.38, 95% CI: 1.08 to 5.24) and nearly fourfold in non-athletes (RR: 3.87, 95% CI: 1.98 to 7.57) with AF.

Conclusion

Although older male endurance athletes experienced an increased risk of AF, the long-term risk of stroke was substantially reduced compared with non-athletes.

Finally, some “me time”: A new theoretical perspective on the benefits of commuting

Most research on commuting has focused on its negative aspects and consequences (i.e., stress). However, some work has also begun to recognize that there may be positive aspects to commuting. In this paper, we develop a perspective that has so far received limited attention, highlighting how the commute can be experienced as desired and beneficial “me time”, due to the fact that it inhabits a “third space” that is less associated with work or home role requirements. Drawing upon and integrating theories and research on commuting, leisure, recovery, and identity, we first define this construct and then develop a theoretical model that aims to address key questions regarding predicting motivation to engage in “me time”, beneficial outcomes of “me time”, and potential moderators of these effects. Consequently, our proposed model offers both research and practical implications for commuting employees as well as their employers, families, and society.

Plain Language Summary

The majority of research on commuting has focused on its negative aspects and consequences (i.e., stress). However, increasingly, some work has also begun to recognize that there may be some positive aspects of commuting. Despite some scholars acknowledging the potential benefits of commuting, most still conceptualize the commute as simply a necessary transition between domains (i.e., work and home). In this paper, we seek to bring a new perspective to the literature, highlighting how the commute can be experienced as desired “time to myself”. We therefore develop a theoretical model that aims to address key questions surrounding this phenomenon, including what is “me time” during the commute, who is more likely to uses the commute for “me time”, what are the situational factors that facilitate or inhibit choosing “me time”, what positive outcomes can be expected when engaging in “me time”, and what conditions are likely to affect this process. We also discuss the underlying mechanisms for this process. As a result, our proposed model presents both research and practical implications for commuting employees as well as their employers, families, and society.

Development of the Children and Adolescents Physical Activity and Sedentary Questionnaire (CAPAS-Q): Psychometric Validity and Clinical Interpretation

BACKGROUND

Pediatricians' clinical practice and health interventions in youths require instruments with adequate psychometric properties to assess physical activity (PA), sedentary behaviors (SB), and their subdomains.

OBJECTIVE

To assess the psychometric properties of the Children and Adolescents Physical Activity and Sedentary-Questionnaire (CAPAS-Q) in healthy French children and adolescents.

METHODS

The CAPAS-Q has been developed through a rigorous collective procedure and consists of a 31 items self-administered questionnaire evaluating children's 7-day PA and SB dimensions and subdomains. Participants (n = 103, aged 8-18 years old) completed the questionnaire twice (7 days apart) and wore an ActiGraph GT3X&nbsp;+ accelerometer for 7 days. Anthropometric measurements and body composition were assessed.

RESULTS

Cronbach alpha for PA and SB dimensions were 0.71 and 0.68, respectively. Reproducibility was found moderate to good, with Lin's coefficients of 0.69 and 0.68 for PA and SB dimensions, respectively. Reproducibility was higher for adolescents compared to children. PA dimension was positively correlated with moderate PA, vigorous PA, moderate to vigorous PA, and total PA times and negatively correlated with SB time (p < 0.05). SB dimension and screen time were positively correlated with SB time and negatively correlated with LPA, MPA, MVPA, and total PA times (p < 0.05). Spearman correlation coefficients were fair to moderate, ranging between 0.23-0.45.

CONCLUSION

The CAPAS-Q proposes a reliable and valid evaluation of French children and adolescents' PA and SB, providing clinicians with potential intervention levels to improve youth movement behaviors.

Accelerometer-measured physical activity in mid-age Australian adults

Background

Raw data from accelerometers can provide valuable insights into specific attributes of physical activity, such as time spent in intensity-specific activity. The aim of this study was to describe physical activity assessed with raw data from triaxial wrist-worn accelerometers in mid-age Australian adults.

Methods

Data were from 700 mid-age adults living in Brisbane, Australia (mean age: 60.4; SD:7.1 years). Data from a non-dominant wrist worn triaxial accelerometer (Actigraph wGT3X-BT), expressed as acceleration in gravitational equivalent units (1 mg = 0.001 g), were used to estimate time spent in moderate-vigorous intensity physical activity (MVPA; >100 mg) using different bout criteria (non-bouted, 1-, 5-, and 10-min bouts), and the proportion of participants who spent an average of at least one minute per day in vigorous physical activity.

Results

Mean acceleration was 23.2 mg (SD: 7.5) and did not vary by gender (men: 22.4; women: 23.7; p-value: 0.073) or education (p-value: 0.375). On average, mean acceleration was 10% (2.5 mg) lower per decade of age from age 55y. The median durations in non-bouted, 1-min, 5-min and 10-min MVPA bouts were, respectively, 68 (25th -75th : 45–99), 26 (25th -75th : 12–46), 10 (25th -75th : 3–24) and 8 (25th -75th : 0–19) min/day. Around one third of the sample did at least one minute per day in vigorous intensity activities.

Conclusion

This population-based cohort provided a detailed description of physical activity based on raw data from accelerometers in mid-age adults in Australia. Such data can be used to investigate how different patterns and intensities of physical activity vary across the day/week and influence health outcomes.

Prediction of activity-related energy expenditure under free-living conditions using accelerometer-derived physical activity

The purpose of the study was to develop prediction models to estimate physical activity (PA)-related energy expenditure (AEE) based on accelerometry and additional variables in free-living adults. In 50 volunteers (20–69 years) PA was determined over 2 weeks using the hip-worn Actigraph GT3X + as vector magnitude (VM) counts/minute. AEE was calculated based on total daily EE (measured by doubly-labeled water), resting EE (indirect calorimetry), and diet-induced thermogenesis. Anthropometry, body composition, blood pressure, heart rate, fitness, sociodemographic and lifestyle factors, PA habits and food intake were assessed. Prediction models were developed by context-grouping of 75 variables, and within-group stepwise selection (stage I). All significant variables were jointly offered for second stepwise regression (stage II). Explained AEE variance was estimated based on variables remaining significant. Alternative scenarios with different availability of groups from stage I were simulated. When all 11 significant variables (selected in stage I) were jointly offered for stage II stepwise selection, the final model explained 70.7% of AEE variance and included VM-counts (33.8%), fat-free mass (26.7%), time in moderate PA + walking (6.4%) and carbohydrate intake (3.9%). Alternative scenarios explained 53.8–72.4% of AEE. In conclusion, accelerometer counts and fat-free mass explained most of variance in AEE. Prediction was further improved by PA information from questionnaires. These results may be used for AEE prediction in studies using accelerometry

Impact of a COVID-19 infection on exercise levels of recreational athletes one- and three-months post-infection

We examined the effect of a COVID-19 infection on changes in exercise levels in recreational athletes in the first three months after infection, and identified personal factors associated with a larger change in exercise level and recovery time. Recreational athletes (n=4360) completed an online questionnaire on health and exercise levels. 601 Athletes have had a diagnostically confirmed COVID-19 infection, while 3479 athletes did not (non-COVID-19 group). Exercise levels (in MET-min/week) were examined prior to (2019) and during the COVID-19 pandemic (2020) for the non-COVID-19 group, and in 2019, 1-month pre-COVID-19 infection, 1-month post-COVID-19 infection and 3 months post-COVID-19 infection in the COVID-19 group. Median exercise level at baseline in the COVID-19 group was 3528 (IQR=1488-5760) MET-min/week. One-month post-COVID-19 infection, exercise level dropped 58% (2038 MET-min/week), which partly stabilized to 36% (1256 MET-min/week) below baseline values 3 months post-COVID-19 infection. Moreover, in both the COVID-19 (pre-COVID-19 infection) and non-COVID-19 group exercise levels during the pandemic decreased with ~260 MET-min/week. These results illustrate that even a relatively physically active population of recreational athletes is significantly affected by a COVID-19 infection, particularly those athletes who are overweight. COVID-19 disease burden, age, sex, comorbidities and smoking were not associated with reduced exercise levels.

The mediation function of resting heart rate in how physical activity improves all-cause mortality: Continuous and automatic measurement via cardiac implantable electronic devices

Background

Physical activity (PA) and resting heart rate (RHR) are connected with all-cause mortality. Moreover, there was an inverse correlation between PA and RHR. However, the causal relationship between PA, RHR, and long-term mortality has been rarely evaluated and quantified, particularly the mediation effect of RHR in the association between PA and all-cause mortality.

Objective

To describe the relationship between PA and RHR when consistently measured via cardiac implantable electronic devices (CIED) and further explore the mediation effect of PA on all-cause mortality through RHR.

Materials and methods

Patients who underwent CIED implantation and received remote home monitoring services were included. During the first 30–60 days after CIED implantation, daily PA and RHR were continuously measured and automatically transmitted by CIED. The primary endpoint was all-cause mortality. The multiple linear regression model was used to confirm the relationship between PA and RHR. The predictive values of both PA and RHR for all-cause mortality were assessed by multivariable Cox proportional hazards models. The causal mediation model was further established to verify and quantify the mediation effect of RHR in the association between PA and all-cause mortality.

Results

A total of 730 patients with CIED were included. The mean daily PA and RHR were 10.7 ± 5.7% and 61.3 ± 9.1 bpm, respectively. During a mean follow-up period of 55.8 months, 187 (26.5%) death was observed. A negative linear relationship between PA and RHR was demonstrated in the multiple regression model (β = −0.260; 95% CI: −0.377 to −0.143, p < 0.001). Multivariable Cox proportional hazards analysis showed that both lower levels of PA (HR = 0.907; 95% CI: 0.878–0.936, p < 0.001) and higher RHR (HR = 1.016; 95% CI: 1.001–1.032, P = 0.031) were independent risk factors of all-cause mortality. Causal mediation analysis further confirmed and quantified the mediation function of RHR in the process of PA improving all-cause mortality (mediation proportion = 3.9%; 95% CI: 0.2–10.0%, p = 0.036).

Conclusion

The effects of the higher level of PA on improving life prognosis may be partially mediated through RHR among patients with CIED. It indicates that changes in the autonomic nervous function during postoperative rehabilitation exercises should get more attention.

Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: A prospective cohort study

PURPOSE

This study aimed to examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults.

METHODS

This prospective cohort study involved 768 community-dwelling Spanish older adults (78.8 ± 4.9 years, mean ± SD; 53.9% females) from the Toledo Study for Healthy Aging (2012-2017). The number of steps per day and step cadence (steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline. Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality. Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality.

RESULTS

Included participants walked 5835 ± 3445 steps/day with an intensity of 7.3 ± 4.1 steps/min. After adjusting for age, sex, body mass index (BMI), education, income, marital status and comorbidities, higher step count (hazard ratio (HR) = 0.95, 95% confidence interval (95%CI: 0.90-1.00, and HR = 0.87, 95%CI: 0.81-0.95 per additional 1000 steps) and higher step intensity (HR = 0.95, 95%CI: 0.91-0.99, and HR = 0.89, 95%CI: 0.84-0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk, respectively. Compared to the group having low step volume and intensity, individuals in the group having high step volume and intensity had a lower risk of hospitalization (HR = 0.72, 95%CI: 0.52-0.98) and all-cause mortality (HR = 0.60, 95%CI: 0.37-0.98).

CONCLUSION

Among older adults, both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk. Increasing step volume and intensity may benefit older people.

Physical activity across days of week, video games, and laptop use are more likely to influence weight gain among Saudi Youth

Purpose

The purpose of this study was to determine the extent and prevalence of daily PA and the sedentary behavior during inactive spare-time among young Saudis and their effect on overweight and obesity.

Methods

A total of 357 students completed all stages of this study. They included 282 boys aged 11.95 ± 0.73 years (213 children aged 11.62 ± 0.506 years and 69 adolescents aged 13.16 ± 0.373 years) and 75 girls (16 children aged 11.94 ± 0.236 years and 59 adolescents aged 13.47 ± 0.626 years). For each participant, height and weight were measured, and BMI was calculated. A questionnaire asking about daily PA and sedentary habits during the previous 7 days was also used. Multiple comparisons were performed to test for differences between groups by sex and age category, and stepwise multiple regression analysis was used to determine which variables significantly affected BMI.

Results

The overall prevalence of overweight and obesity was 17.02 and 28.37% in boys and 9.33 and 0% in girls, respectively. The patterns of PA were changing within elements and between sexes. Both groups of boys were more active than girls during breakfast and lunch periods (p < 0.001 for all). A significant difference in favor of boys was also observed between the two groups of boys and the group of adolescent girls regarding after-school physical activity (p < 0.05 for all). Prepubescent boys reported being generally less active during the previous 7 days than their female counterparts and adolescent peers. Sedentary behaviors did not differ between all groups. Playing video games and using laptops were the parameters significantly associated with BMI.

Conclusions

This study noted that the prevalence of overweight and obesity was more pronounced in boys than in girls. However, boys were more active but had the same degree of sedentary behavior as girls. Physical activity across the days of weekly, video games, and laptop use were the parameters that most affected BMI.

How adherence to the updated physical activity guidelines should be assessed with accelerometer?

Background

The aerobic part of the recently updated physical activity (PA) guidelines for adults recommends at least 150 min of moderate or at least 75 of vigorous-intensity PA or an equivalent combination of both. PA can be accumulated of any bout duration. On an absolute scale, moderate-intensity threshold is 3 metabolic equivalents (METs) and vigorous 6 METs. On a scale relative to individual’s personal capacity, moderate-intensity threshold is 40% and vigorous 60% of the oxygen uptake reserve. In this study, the adherence to the new guidelines was evaluated using both absolute and relative thresholds.

Methods

Totally, 1645 adults aged 20–64 years, participated in this population-based study and their cardiorespiratory fitness (CRF) was estimated with 6-min walking test. The participants with estimated maximal oxygen uptake <7.9 MET were categorized as low CRF group and the others as adequate CRF group. The participants were instructed to wear a triaxial hip-worn accelerometer for 1 week and their adherence to PA guidelines was assessed from the accelerometer data.

Results

The adequate CRF group had higher adherence to PA guidelines with the absolute thresholds, but the use of relative thresholds inverted the results. The adherence varied from 20% to 99% in the total sample depending on the analysis parameters of accelerometer data.

Conclusions

The absolute thresholds provide a more appropriate basis to assess the adherence to PA guidelines in population-based samples and interventions. The use of individually determined relative thresholds may be more useful for individual exercise prescriptions in PA counseling.

The association of physical activity and cardiorespiratory fitness with β-cell dysfunction, insulin resistance, and diabetes among adults in north-western Tanzania: A cross-sectional study

Introduction

Research on the associations of physical activity and cardiorespiratory fitness with β-cell dysfunction and insulin resistance among adults in Sub-Saharan Africa (SSA) is limited. We assessed the association of physical activity and cardiorespiratory fitness with β-cell function, insulin resistance and diabetes among people living with HIV (PLWH) ART-naïve and HIV-uninfected Tanzanian adults.

Method

In a cross-sectional study, we collected data on socio-demography, anthropometry, fat mass and fat free mass and C-reactive protein. Data on glucose and insulin collected during an oral glucose tolerance test were used to assess β-cell dysfunction (defined as insulinogenic index <0.71 (mU/L)/(mmol/L), HOMA-β index <38.3 (mU/L)/(mmol/L), and overall insulin release index <33.3 (mU/L)/(mmol/L)), oral disposition index <0.16 (mU/L)/(mg/dL)(mU/L)-1, insulin resistance (HOMA-IR index >1.9 (mU/L)/(mmol/L) and Matsuda index <7.2 (mU/L)/(mmol/L), prediabetes and diabetes which were the dependent variables. Physical activity energy expenditure (PAEE), sleeping heart rate (SHR), and maximum uptake of oxygen during exercise (VO2 max) were the independent variables and were assessed using a combined heart rate and accelerometer monitor. Logistic regressions were used to assess the associations.

Results

Of 391 participants, 272 were PLWH and 119 HIV-uninfected. The mean age was 39 ( ± 10.5) years and 60% (n=235) were females. Compared to lower tertile, middle tertile of PAEE was associated with lower odds of abnormal insulinogenic index (OR=0.48, 95%CI: 0.27, 0.82). A 5 kj/kg/day increment of PAEE was associated with lower odds of abnormal HOMA-IR (OR=0.91, 95%CI: 0.84, 0.98), and reduced risk of pre-diabetes (RRR=0.98, 95%CI: 0.96, 0.99) and diabetes (RRR=0.92, 95%CI: 0.88, 0.96). An increment of 5 beats per min of SHR was associated with higher risk of diabetes (RRR=1.06, 95%CI: 1.01, 1.11). An increase of 5 mLO2/kg/min of VO2 max was associated with lower risk of pre-diabetes (RRR=0.91, 95%CI: 0.86, 0.97), but not diabetes. HIV status did not modify any of these associations (interaction, p>0.05).

Conclusion

Among Tanzanian adults PLWH and HIV-uninfected individuals, low physical activity was associated with β-cell dysfunction, insulin resistance and diabetes. Research is needed to assess if physical activity interventions can improve β-cell function and insulin sensitivity to reduce risk of diabetes and delay progression of diabetes in SSA.

Impact of talk test based aerobic exercise on glycaemic control and anthropometric measures among patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is characterised by the chronic hyperglycaemia which leads to various micro and macrovascular complications. The aim of present study was to evaluate the impact of talk test based aerobic exercise on glycaemic control and anthropometric measures among adults with (T2DM). In this double blind randomised controlled trial (RCT), aerobic exercises/walking was used as intervention. The patients were divided into three groups based on the tool of exercise intensity prescription: a talk test-based group (TTG, n=30), a rating of perceived exertion-based group (RPEG, n=30), and a control group (CG, n=30). Glycated haemoglobin (HbA1c) was evaluated at baseline and after 8 weeks. Anthropometric measures, i.e. body mass index (BMI), and waist circumference (WC) were evaluated at baseline, 4 weeks, and 8 weeks. Wilcoxon rank-sum/repeated measure of ANOVA and Kruskal-Wallis test/ANOVA were used for within and between group comparison, respectively, on the basis of normality of the data. The mean HbA1c change in TTG, RPEG, and CG was -0.29, -0.28, and -0.04, respectively, and it was significantly greater in TTG and RPEG as compared to CG. The reduction of HbA1c, BMI, and WC was reported in each group. However, the reduction in the experimental groups, i.e. TTG and RPEG was significantly greater than in the control group (P≤0.01). However, there was no significant difference found between the experimental groups (P>0.05). TT based aerobic exercise is effective in improving glycaemic control and anthropometric measures. Therefore, TT can be used for the exercise prescription of these patients.

The study is registered at the Clinical Trial Registry-India under no. CTRI/2019/02/017531.

Changes in subdomains of non-organized physical activity between childhood and adolescence in Australia: a longitudinal study

BACKGROUND

Physical activity (PA) participation among youth tends to be insufficient and is prone to decline with age. In Australia, this decline has been shown to particularly occur in the domain of non-organized PA (e.g. active play and informal sport) between childhood and adolescence. However, information about changes in more specific groupings of activities within non-organized PA (i.e. subdomains) is needed, as this could support more targeted intervention strategies. This study aimed to investigate changes in the duration of specific subdomains of non-organized PA between late childhood (10-11 years) and early adolescence (12-13 years) in Australia, as well as whether these changes are moderated by sex.

METHODS

Data were sourced from Waves 6 and 7 of the Longitudinal Study of Australian Children (n = 3614). Youth time-use diaries (24-h) were used to measure the duration of eight subdomains of non-organized PA at both waves (athletics/gymnastics, ball sports, cycling/motor/roller sports, fitness/gym/exercise, martial arts/dancing, water/ice/snow sports, active play and other outdoor/nature PA). Multilevel mixed modelling was used to explore longitudinal changes between waves and the potential moderation effect of sex.

RESULTS

Active play declined the most of all subdomains (β = -20.5 min/day; 95% CI = -23.4, -17.6, p < 0.001). A smaller decline was observed in the subdomain of non-organized ball sports (β = -4.1 min/day; 95% CI = -5.9, -2.3, p < 0.001). Other subdomains remained stable or had only very small changes in participation. The decline in active play was moderated by sex, with a steeper decline among girls. No other notable moderation effects were observed.

CONCLUSIONS

Future studies may seek to explore and test the acceptability of PA promotion strategies to encourage active play participation, such as 'reframing' childhood play activities to be appropriate for adolescents. Such studies might particularly seek the perspectives of girls in the transition to adolescence.

Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol

INTRODUCTION

Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness.

METHODS AND ANALYSIS

A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks).

ETHICS AND DISSEMINATION

The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05019157.

Is there an association between total physical activity level and VO2max among fitness club members? A cross-sectional study

Background

Since cardiorespiratory fitness is an important predictor for all-cause mortality, it is of interest to know if meeting the physical activity (PA) recommendations is associated with higher levels of maximal oxygen uptake (VO_2max). We aimed to investigate the association between total PA level given as counts per minute (cpm) and minutes in moderate-to-vigorous PA (MVPA), and VO_2max in new fitness club members.

Methods

A total of 62 men and 63 women (≥ 18 years), defined as healthy (no disease considered to hinder PA) participated in this study. VO_2max (mL kg⁻¹ min⁻¹) was measured with a cardiopulmonary exercise (modified Balke protocol), and total PA level was measured with ActiGraph GT1M for seven consecutive days. All participants accumulating ≥ 10 h of activity recordings ≥ 4 days were included in the data analysis. To examine associations between PA level and VO_2max, a Pearson correlation and a multiple linear regression analysis adjusted for covariates were used.

Results

VO_2max (mL kg⁻¹ min⁻¹) was 40.5 ± 7.2 in men and 35.1 ± 6.0 in women. Total PA level (cpm) and MVPA (min) were 352.4 ± 123.4 and 260.0 ± 132.6 in men and 361.4 ± 103.8 and 273.2 ± 137.0 in women. Total PA level (men: r = 0.346, p < 0.01, women: r = 0.267 p < 0.01) and MVPA (men: r = 0.359, p =  < 0.01, women: r = 0.236, p = 0.03) was associated with VO_2max. When adjusting for age and body fat percentage, total PA level and MVPA were no longer associated with VO_2max (men: p = 0.11 and p = 0.79, women: p = 0.40 and p = 0.61). In men, age (β = − 0.469 p < 0.01) and body fat percentage (β = − 0.483, p < 0.01) were the strongest predictor for VO_2max. For women, body fat percentage was the strongest predictor for VO_2max (β = − 0.483, p < 0.01).

Conclusions

Total PA level and MVPA were associated with VO_2max, but the association was low and diminished when adjusted for age and body fat percentage. Body fat percentage (men and women) and age (men) were more strongly associated with VO_2max than total PA level and MVPA.

Relations between physical activity, sedentary time, and body fat from childhood to adolescence: Do they differ by sex?

BACKGROUND

Efforts to reveal the direction of influence between physical activity (PA), sedentary time (ST) and body fat in youth have produced inconsistent results, possibly due to a lack of adjustment for confounders and other factors. Sex-specific associations have rarely been studied.

METHODS

A sample from two Norwegian birth cohorts (n = 809) were followed biennially over five waves from the age of 6-14 years. Physical activity and ST were recorded by accelerometers, and body fat was assessed by bioelectrical impedance measurements.

RESULTS

By applying a dynamic panel model (DPM) that adjusts for all time-invariant confounding factors, it was found that among boys, increased fat mass index (FMI) at ages 8, 10 and 12 years predicted decreased PA two years later (8-10 years: B = -0.67, (95% CI: -1.1, -0.24); 10-12 years: B = -0.33, (95% CI: -0.61, -0.05); 12-14 years: B = -0.29, (95% CI: -0.52, -0.06)). Regarding the opposite direction of influence, more PA at age 12 forecasted reduced FMI at age 14 (B = -0.16, (95% CI: -0.24, -0.07)), whereas increased FMI predicted increased ST across all time points in boys only (6-8 years: B = 0.23, (95% CI:0.02.43); 8-10 years: B = 0.23, (95% CI:.08.39); 10-12 years: B = 0.13, (95% CI:.03.23); 12-14 years: B = 0.17, (95% CI:.07, 26)). The revealed relationships were significantly stronger in boys compared to the (absent) relations in girls. Sensitivity analyses examining moderate to vigorous PA (MVPA) rather than total PA were in accordance with the main findings.

CONCLUSIONS

In boys, increased FMI predicted reduced PA and increased ST two years later from childhood to adolescence. The opposite direction of influence was evident from only ages 12-14. There were no prospective relationships between FMI and PA or ST among girls.

The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: a prospective cohort study with a one-year follow-up

BACKGROUND

Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation.

METHODS

This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI).

RESULTS

From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99).

CONCLUSIONS

Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.

Effects of physical activity on heart rate variability in children and adolescents: a systematic review and meta-analysis

The aim of the study was to investigate the effects of physical activity (PA) on heart rate variability (HRV) in children and adolescents. We conducted a research of Web of Science, PubMed, ScienceDirect, Springer-Link and EBSCO-host. The revised Newcastle-Ottawa Scale was used in an investigative analysis to assess bias risk. A total of 21 studies were included. Overall, medium-sized associations were found between PA and low frequency and high frequency in children and adolescents. High PA level had significantly higher standard deviation of RR intervals and root of the mean of the sum of the squares of differences between adjacent RR intervals in children and adolescents. The effects of PA on HRV were consistent in children and adolescents. Our systematic review and meta-analysis revealed medium-sized between PA and HRV in children and adolescents. Promoting children's and adolescents' participation in moderate-to-vigorous physical activity (MVPA) will increase parasympathetic nerve activity and decreased sympathetic nerve activity. Our findings support motivating children and adolescents to engage in more MVPA in their daily lives to improve autonomic nervous system function and promote cardiovascular safety.

Six-Minute Walk Performance and Related Factors in Pediatric-Onset Multiple Sclerosis

OBJECTIVE

To investigate functional exercise capacity and its relationship between physical activity levels, muscle strength, balance, fatigue, and quality of life in patients with pediatric-onset multiple sclerosis.

METHODS

Fifteen patients with pediatric-onset multiple sclerosis were included. The 6-minute walk test was used to determine functional exercise capacity and walking distance. The Godin Leisure-Time Exercise Questionnaire and pedometer were used to evaluate physical activity, Timed-Up and Go for dynamic balance, isokinetic testing for lower extremity muscle strength, Fatigue Severity Scale for fatigue, and the Pediatric Quality of Life Inventory (PedsQL) for quality of life.

RESULTS

The 6-minute walking distance was positively correlated with GLTEQ and the School-Work subgroup score of the PedsQL-Self-report, and negatively correlated with Timed-Up and Go and Fatigue Severity Scale. Dynamic balance, physical activity, and fatigue were significant predictors of 6-minute walking distance.

CONCLUSIONS

Our results showed that 6-minute walk test is influenced by physical activity, dynamic balance, and fatigue, and related to quality of life in patients with pediatric-onset multiple sclerosis.

Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial

Background

Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.

Objective

This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care).

Methods

All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables.

Results

There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic −27.7 vs −16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic −25.3 vs −16.4 mm Hg; P=.02, and diastolic −13.4 vs −9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25.

Conclusions

Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.

Trial Registration

ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-018-3118-1

Associations of changes in physical activity and discretionary screen time with incident obesity and adiposity changes: longitudinal findings from the UK Biobank

BACKGROUND

Physical activity (PA) and discretionary screen time (DST; television and computer use during leisure) are both associated with obesity risk, but little longitudinal evidence exists on their combined influence. This study examined the independent and joint associations of changes in PA and DST with incident obesity, body mass index (BMI) and waist circumference (WC).

METHODS

We analysed the data of individuals aged 40-69 years from the UK Biobank, a large-scale, population-based prospective cohort study. PA was measured using the International Physical Activity Questionnaire and DST was defined as the total of daily TV viewing and non-occupational computer use. Changes in PA and DST over time were defined using departure from sex-specific baseline tertiles and categorised as worsened (PA decreased/DST increased), maintained, and improved (PA increased/DST decreased). We then used each exposure change to define a joint PA-DST change variable with nine mutually exclusive groups. We used multivariable adjusted mixed-effects linear and Poisson models to examine the independent and joint associations between PA and DST changes with BMI and WC and incident obesity, respectively. Development of a BMI ≥ 30 kg/m² was defined as incident obesity.

RESULTS

Among 30,735 participants, 1,628 (5.3%) developed incident obesity over a mean follow-up of 6.9 (2.2) years. In the independent association analyses, improving PA (Incident Rate Ratio (IRR) 0.46 (0.38-0.56)) was associated with a lower risk of incident obesity than maintaining PA, maintaining DST, or improving DST. Compared to the referent group (both PA and DST worsened), all other combinations of PA and DST changes were associated with lower incident obesity risk in the joint association analyses. We observed substantial beneficial associations in the improved PA groups, regardless of DST change [e.g., DST worsened (IRR 0.31 (0.21-0.44)), maintained (IRR 0.34 (0.25-0.46)), or improved (IRR 0.35 (0.22-0.56)]. The most pronounced decline in BMI and WC was observed when PA was maintained or improved and DST was maintained.

CONCLUSION

We found that improved PA had the most pronounced beneficial associations with incident obesity, irrespective of DST changes. Improvements in PA or DST mutually attenuated the deleterious effects of the other behaviour's deterioration.

Relationship Between Accelerometer-Based Physical Activity, Sedentary Behavior, and Mental Health in Young Finnish Men

Healthy lifestyle behaviors including physical activity (PA) have been recognized to contribute positively to mental health. Most of the evidence on relationship between PA and mental health relies on self-reported PA results. Device-based measures on PA or sedentary behavior (SB) are less frequently used in mental health research. The present study aimed at examining the relationship between mental health and PA/SB measured by accelerometers in young Finnish men. The sample consisted of 409 men (mean age 28 ± 7 years), who participated in the military refresher training in Finland. Self-rated mental health was measured with Mental Health Inventory (MHI-5) and short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) measuring mental health both from the perspective of mental health problems and mental well-being. PA was measured with accelerometer from the perspective of light, moderate, vigorous, and total activity, as well as SB. Linear regression models and compositional analysis were applied. Age, education, marital status, employment status, BMI, alcohol use and smoking were used as covariates. Evidence on relationship between total PA (standardized regression coefficient 0.340; 95% CI 0.022–0.657, p = 0.036) and SB (standardized regression coefficient −0.340; 95% CI −0.657 to −0.022, p = 0.036) with symptoms of mental health problems was found after adjusting for age, education, marital and employment status. The relationship was marginally significant (p = 0.056) after adjusting also for BMI, alcohol use and smoking. No evidence on relationship between PA or SB and mental well-being was found, neither in standard linear regression analysis nor in compositional approach. In our sample of young adult men, PA seemed to have a stronger relationship with symptoms of mental health problems rather than with mental well-being. The findings lead to a conclusion that all PA per se may not be independently associated with mental well-being in young adult males and raise the question whether the domain of PA and its context play a critical role in these relationships.

Implantable device measured objective daily physical activity as a predictor of long-term all-cause mortality and cardiac death in patients with age > 75 years and high risk of sudden cardiac death: a cohort study : Physical activity and patients over 75 years old

BACKGROUND

To study the relationship between objective daily physical activity (PA), as measured by implantable cardioverter defibrillators (ICDs)/cardiac resynchronization therapy defibrillators (CRTDs), and long-term prognoses in patients with age > 75 years at high risk of sudden cardiac death (SCD).

METHODS

In total, 133 patients with age > 75 years old (age 79.52 ± 3.68 years) in the SUMMIT study were retrospectively analysed. The major endpoint was all-cause mortality, and the minor endpoint was cardiac death.

RESULTS

The mean follow-up time was 57.1 ± 24.2 months (range: from 4 to 96 months). In total, 46 all-cause mortality and 23 cardiac death events occurred. The receiver operating characteristic curve indicated a baseline PA cut-off value of 6.47% (93 min/day) can predict all-cause mortality in patients with age > 75 years, with an area under the curve of 0.670 (95% confidence interval (CI): 0.573-0.767, P = 0.001). The sensitivity was 67.4%, and the specificity was 66.7%. Patients with baseline PA ≤ 6.47% had higher rates of all-cause mortality (51.7% vs 20.5%, P < 0.001) and cardiac death (25.0% vs 11.0%, P = 0.040). The estimated Kaplan-Meier survival curves showed that patients with PA ≤ 6.47% had an increased cumulative incidence of all-cause mortality (Log-rank P < 0.0001) and cardiac death (Log-rank P = 0.0067). Multivariate Cox regression analysis showed that PA ≤ 6.47% was an independent predictor of all-cause mortality (hazard ratio (HR) 3.137, 95% CI: 1.667-5.904, P < 0.001) and cardiac death (HR value 3.345, 95% CI: 1.394-8.028, P = 0.007).

CONCLUSIONS

Daily PA of about 1.5 h was associated with lower all-cause mortality and cardiac death risk in patients with age > 75 years and high risk of SCD with ICDs/CRTDs. PA monitoring may aid in long-term management of older patients at high risk of SCD.

Daily Level Association of Physical Activity and Performance on Ecological Momentary Cognitive Tests in Free-living Environments: A Mobile Health Observational Study

BACKGROUND

Research suggests that physical activity (PA) has both acute and chronic beneficial effects on cognitive function in laboratory settings and under supervised conditions. Mobile health technologies make it possible to reliably measure PA and cognition in free-living environments, thus increasing generalizability and reach. Research is needed to determine whether the benefits of PA on cognitive function extend from the laboratory to real-world contexts.

OBJECTIVE

This observational study aims to examine the association between daily fluctuations in PA and cognitive performance using mobile health technologies in free-living environments.

METHODS

A total of 90 adults (mean age 59, SD 6.3 years; 65/90, 72% men) with various comorbidities (eg, cardiovascular risk and HIV) and different levels of baseline cognition (ranging from cognitively normal to impaired) completed ecological momentary cognitive tests (EMCTs) on a smartphone twice daily while wearing an accelerometer to capture PA levels for 14 days. Linear mixed-effects models examined the daily associations of PA with executive function and verbal learning EMCTs. Moderation analyses investigated whether the relationship between daily PA and daily performance on EMCTs changed as a function of baseline cognition, cardiovascular risk, and functional status (independent vs dependent).

RESULTS

Days with greater PA were associated with better (faster) performance on an executive function EMCT after covariate adjustment (estimate -0.013; β=-.16; P=.04). Moderation analyses (estimate 0.048; β=.58; P=.001) indicated that days with greater PA were associated with better (faster) executive function performance in individuals who were functionally dependent (effect size -0.53; P<.001) and not in functionally independent adults (effect size -0.01; P=.91).

CONCLUSIONS

EMCTs may be a sensitive tool for capturing daily-level PA-related fluctuations in cognitive performance in real-world contexts and could be a promising candidate for tracking cognitive performance in digital health interventions aimed at increasing PA. Further research is needed to determine individual characteristics that may moderate the association between daily PA and EMCT performance in free-living environments.

Do Fitter Children Better Assess Their Physical Activity with Questionnaire Than Less Fit Children?

Most physical activity (PA) questionnaires assess moderate to vigorous PA (MVPA) describing the physical exertion of individuals that might be influenced by their physical fitness. Therefore, the aim of this study was to determine whether fitter children could better assess their PA with the questionnaire than less fit children. The cross-sectional validation study was conducted with 108 children (60 girls) aged 11 to 14 years, who were divided into three fitness groups based on the results of the 600 m running test. To answer the research question, the agreement between their assessment of PA using the SHAPES questionnaire and the UKK RM42 accelerometer data was analysed. One quarter of the participants achieved at least 60 min of MVPA each day, measured by accelerometer. The average MVPA obtained was 97.8 ± 35.6 min per day, with the high fitness group having a significantly higher value compared with the other groups. Moderate to high validity coefficients were found in the high fitness group (Spearman’s ρ range 0.34–0.70). In contrast, the lower fitness groups had poor to moderate validity for all variables (Spearman’s ρ range 0.03–0.42). These results suggest that the fittest children self-assess their PA with the questionnaire better than less fit children, which may advance new directions for the development and evaluation of PA questionnaires and their usability.

Levels and correlates of physical activity and capacity among HIV-infected compared to HIV-uninfected individuals

INTRODUCTION

In the HIV-infected individuals, physical activity improves physical strength, quality of life and reduces the risk of developing non-communicable diseases. In Sub-Saharan Africa, HIV-infected patients report being less active compared to HIV-uninfected individuals. We assessed the levels and correlates of objectively measured physical activity and capacity among HIV-infected antiretroviral therapy (ART)-naive individuals compared to HIV-uninfected individuals in Mwanza, Tanzania.

METHOD

We conducted a cross-sectional study among newly diagnosed HIV-infected ART-naive individuals and HIV-uninfected individuals frequency-matched for age and sex. Socio-demographic data, anthropometrics, CD4 counts, haemoglobin level, and C-reactive protein (CRP) were collected. Physical activity energy expenditure (PAEE) was assessed as measure of physical activity whereas sleeping heart rate (SHR) and grip strength were assessed as measures of physical capacity. Multivariable linear regression was used to assess the correlates associated with physical activity and capacity.

RESULTS

A total of 272 HIV-infected and 119 HIV-uninfected individuals, mean age 39 years and 60% women participated in the study. Compared to HIV-uninfected individuals, HIV-infected had poorer physical activity and capacity: lower PAEE (-7.3 kj/kg/day, 95% CI: -11.2, -3.3), elevated SHR (7.7 beats/min, 95%CI: 10.1, 5.3) and reduced grip strength (-4.7 kg, 95%CI: -6.8, -2.8). In HIV-infected individuals, low body mass index, moderate-severe anaemia, low CD4 counts and high CRP were associated with lower physical activity and capacity. In HIV-uninfected individuals, abdominal obesity and moderate anaemia were associated with lower physical activity and capacity.

CONCLUSION

HIV-infected participants had lower levels of physical activity and capacity than HIV-uninfected participants. Correlates of physical activity and capacity differed by HIV status. Management of HIV and related conditions needs to be provided effectively in health care facilities. Interventions promoting physical activity in these populations will be of importance to improve their health and reduce the risk of non-communicable diseases.

Measurement of physical activity and sedentary behavior in national health surveys, South America

Objectives.

To characterize how physical activity and sedentary behavior have been measured in national health surveys in South American countries.

Methods.

An extensive search was made for national health surveys from all 12 South American countries through health websites, national statistical offices, and contact with researchers and policy-makers. The following eligibility criteria were used to select surveys: conducted in a South American country; used a nationally representative sample ≥ 18 years; coordinated by the public, private or mixed private–public sector; and assessed physical activity and/or sedentary behavior. Data were extracted on general information about the surveys, specific details about the physical activity and sedentary behavior assessment, and additional questions related to activity behavior.

Results.

In total, 36 surveys were included, two of which were multicountry surveys; all surveys assessed physical activity and 27 assessed sedentary behavior. Most surveys (23/36; 64%) were based on previously validated international questionnaires, but 13 (57%) of these deviated from the reference tools, introducing changes and adaptations. Sedentary behavior was assessed mostly through questions on screen time and/or daily sitting time in the same physical activity questionnaires. No survey used device-based measures to generate data on these behaviors.

Conclusions.

Differences between instruments used and modifications limit the comparability of data across countries. This highlights the importance of standardizing assessment within South America for physical activity and sedentary behavior sections in national surveys, with the broader aim of contributing to establishing a standardized strategy for the surveillance of physical activity and sedentary behavior in South America.