U.S. Adults' Participation in Specific Activities: Behavioral Risk Factor Surveillance System--2011

Factors Associated With Leisure-Time Bicycling Among Adults in the United States: An Urban-Rural Comparison

BACKGROUND

Bicycling is a healthy form of physical activity that can be performed by most adults as part of leisure-time (LT) activity. However, little is known about LT bicycling behaviors, especially in the rural areas of the United States. This study sought to contrast the prevalence and factors associated with LT bicycling in populations living in urban settings with those living in rural settings.

METHODS

The 2019 Behavior Risk Factor Survey, which contains information regarding LT physical activity behaviors among adults (N = 396,261) in the United States, was used to determine the prevalence, demographic profile, and likelihood of meeting the physical activity guidelines of LT bicyclists. The 2013 National Center for Health Statistics Urban/Rural Classification Scheme was used to classify respondents living in rural and urban settings.

RESULTS

Among US adults, 3.8% (95% CI, 3.7-3.9) reported LT bicycling activity, the sixth most common physical activity. Adults living in urban counties compared with rural counties had a greater prevalence of LT bicycling (3.9% vs 2.3%, respectively), with adults living in rural counties having a 34% lower probability of LT bicycling. Rural bicycling prevalence rates were lower across all demographics. Urban bicyclists, compared with rural bicyclists, cycled more months of the year. Overall, 85.5% of all bicyclists met the aerobic physical guidelines, with no differences between urban and rural bicyclists.

CONCLUSIONS

Bicycling remains an important LT physical activity among adults in the United States. However, a rural-urban difference in the prevalence does exist for LT bicycling. The reasons for this disparity warrant further investigation.

Rural libraries implementing walking groups or walking groups plus civic engagement for walkability in rural communities: a comparative effectiveness trial study protocol

BACKGROUND

Rural residents generally lack adequate physical activity to benefit health and reduce disparities in chronic diseases, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between individual, social, and community factors. Community group-based walking programs and civic engagement interventions aimed at enhancing physical activity have been successful in rural communities but have not targeted all three socioecological levels. Public libraries can act as innovative public health partners in rural communities. However, challenges remain because rural libraries often lack the capacity to implement evidence-based health promotion programming. The goals of this study are (1) build the capacity for rural libraries to implement evidence-based health promotion programs, (2) compare changes in physical activity between a group-based walking program and a combined group-based walking and civic engagement program with rural residents, and (3) conduct an implementation evaluation.

METHODS

We will conduct a comparative effectiveness study of a group-based walking (standard approach) versus a group-based walking plus civic engagement program (combined approach) aimed at enhancing walkability to increase physical activity among rural adults. Key mediators between the program effects and change in outcomes will also be identified. Finally, we will evaluate program implementation, conduct a cost effectiveness evaluation, and use a positive deviance analysis to understand experiences of high and low changers on key outcomes. Twenty towns will be matched and randomized to one of the two conditions and our aim is to enroll a total of 350-400 rural residents (15-20 per town). Study outcomes will be assessed at baseline, and 6, 12, and 24 months.

DISCUSSION

This study will build the capacity of rural libraries to implement evidence-based walking programs as well as other health promotion programs in their communities. The study results will answer questions regarding the relative effectiveness and cost effectiveness of two multilevel physical activity interventions targeting rural communities. We will learn what works and how these multilevel interventions can be implemented in rural populations.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05677906.

Association Between Wearable Device Use and Levels of Physical Activity Among Older Adults in the US: Evidence From the 2019-2020 Health Information National Trends Survey

Objective To examine the relationship between electronic wearable device (WD) use and physical activity (PA) levels among older adults in the US. Methods Data were pooled from 3310 older adults from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels, resistance training, and sedentary time. Logistic regression was conducted to investigate the association between WD use and the reported outcome variables. Separate logistic models were also fitted to explore the relationship between WD use and physical activity outcomes among a subgroup of older adults with chronic conditions. Results A total of 14.4% of older adults reported WD use. Older adults who use WD were more likely to meet national guidelines for weekly levels of PA (odds ratio (OR) 1.60, 95% confidence intervals (CI) (1.10, 2.32); p = 0.015) and resistance strength training (OR 1.54, 95% CI (1.14, 2.09); p = 0.005) when compared with their counterparts not using WD. After restricting the analysis to those with chronic conditions only, WD use was only associated with a higher level of weekly strength training (OR 1.68, 95% CI 1.19, 2.38; p = 0.004). Conclusion  WD use may be associated with increased physical activity among older adults, including those with chronic health conditions. Further studies are needed to examine the factors influencing the adoption and sustained use of WD in older adults.

Culturally Relevant Physical Activity in the Behavioral Risk Factor Surveillance System in Hawai'i

INTRODUCTION

Culturally relevant physical activity is a promising field for chronic disease prevention and management. Native Hawaiians and Other Pacific Islanders have higher rates of physical inactivity than other racial or ethnic groups and increased risk of chronic disease. The study objective was to provide population-level data from Hawai'i on lifetime experiences in the Native Hawaiian Indigenous practices of hula and outrigger canoe paddling across demographic and health factors to identify opportunities for public health intervention, engagement, and surveillance.

METHODS

Questions about hula and paddling were added to the Hawai'i 2018 and 2019 Behavioral Risk Factor Surveillance System (N = 13,548). We considered level of engagement by demographic categories and health status indicators, accounting for the complex survey design.

RESULTS

Overall, 24.5% of adults engaged in hula and 19.8% in paddling in their lifetime. Prevalence of engagement was higher among Native Hawaiians (48.8% hula, 41.5% paddling) and Other Pacific Islanders (35.3% hula, 31.1% paddling) than among other racial and ethnic groups. In adjusted rate ratios, experience in these activities was strong across age groups, education, sex, and income levels, particularly among Native Hawaiians and Other Pacific Islanders.

CONCLUSION

Throughout Hawai'i, hula and outrigger canoe paddling are important and popular cultural practices with high physical activity demands. Participation was notably high for Native Hawaiians and Other Pacific Islanders. Surveillance information around culturally relevant physical activities can benefit public health programming and research from a strength-based community perspective.

Physical Activity Level and Specific Type of Exercises Among US Middle-Aged and Older Adults: Findings From the Behavioral Risk Factor Surveillance Survey

BACKGROUND

This study aimed to assess physical activity level and identify specific types of exercises by sex, race/ethnicity, and age for adults 50 years and older.

METHODS

Behavioral Risk Factor Surveillance System 2013, 2015, and 2017 data were used to study US adults 50 years and older on their specific types of exercises, stratified by sex, race/ethnicity, and age. Weighted logistic regression was used to model physical exercise level and specific types of exercises.

RESULTS

The sample included 460,780 respondents. Non-Hispanic Black and Hispanic were less likely than non-Hispanic White to meet the recommended physical activity level (Odds ratio [OR] = 0.73, P < .0001 and OR = 0.96, P = .04, respectively). Walking was the most participated type of exercise, followed by gardening, for both men and women, all racial/ethnic groups, and all age groups. Non-Hispanic Blacks were more likely to participate in walking (OR = 1.19, P = .02) and less likely to participate in gardening (OR = 0.65, P < .0001) than non-Hispanic Whites. Men were more likely to engage in strenuous exercises than women. The average number of minutes on walking was the longest among all types of specific exercises.

CONCLUSIONS

The types of exercises were mostly walking and gardening for adults aged 50 and older. Non-Hispanic Black adults had less physical activity than non-Hispanic White and were less likely to engage in gardening.

The Relationship of Neighborhood Walking Behavior to Duration of Aging in Place-A Retrospective Cohort Study

The benefits of physical activity on health are widely known. However, the impact of physical activity on aging-in-place at home for older adults is unclear. Focusing on older adults who recently moved from home to a senior-living facility, this research explored the impact of walking on the ability to age-in-place. Data were collected through a questionnaire survey completed by residents in 12 assisted-living facilities in Houston, Texas. Controlling for significant personal factors, ANOVAs were applied. Non-Hispanic White older adults (N = 124) who used canes or no aids and engaged in 30 min to 1 h of walking per occurrence were able to remain in their homes for an average of 17.84 years after age 65, 1.85 years longer than their counterparts who walked less than 30 min per occurrence. Those who walked for more than an hour per occurrence remained at home for 22.71 years on average, 6.72 years longer than their counterparts (p ≤ 0.05). Engaging in neighborhood walking may help older adults maintain more years of aging-in-place at home. The findings have a direct impact on both public health programs and community design and planning strategies promoting aging-in-place.

Motives and Barriers Affecting the Participation of Polish People in the Physical Activity of Nordic Walking

The aim of the study was to identify motives and barriers which have the greatest influence on participation in Nordic Walking (NW) of people with normal body weight and persons who are either overweight or obese (according to their BMI). In the study, the modified Physical Activity and Leisure Motivation Scale (PALMS) was used, which was designed to measure adult physical activity (PA) motivation. PALMS measures eight motives for participation in PA, on a 5-point Likert scale. The study was conducted during a NW competition and during training sessions of its participants. Two groups of respondents were taken into account: the first group with those with normal body weight and the second group with those who were overweight or obese. Respondents with normal body weight were more frequent participants of NW sessions. Enhanced body capacity, concern for one's health, improved body shape and lifespan extension were major motives of practicing NW. Polish people perceive PA as a means of improving the quality of life due to enhanced health and wellbeing. Subjects with normal body weight tended to mention lack of areas suitable for NW and lack of time due to professional work. Overweight or obese persons pointed to other types of PA, shyness and lack of time.

Criterion validity of ActiGraph monitoring devices for step counting and distance measurement in adults and older adults: a systematic review

BACKGROUND

Wearable activity monitors such as ActiGraph monitoring devices are widely used, especially in research settings. Various research studies have assessed the criterion validity of ActiGraph devices for step counting and distance estimation in adults and older adults. Although several studies have used the ActiGraph devices as a reference system for activity monitoring, there is no summarized evidence of the psychometric properties. The main objective of this systematic review was to summarize evidence related to the criterion validity of ActiGraph monitoring devices for step counting and distance estimation in adults and/or older adults.

METHODS

Literature searches were conducted in six databases (Medline (OVID), Embase, IEEExplore, CINAHL, Engineering Village and Web of Science). Two reviewers independently conducted selection, a quality analysis of articles (using COSMIN and MacDermid's grids) and data extraction.

RESULTS

This review included 21 studies involving 637 participants (age 30.3 ± 7.5 years (for adults) and 82.7 ± 3.3 years (for older adults)). Five ActiGraph devices (7164, GT1M, wGTX +, GT3X +/wGT3X + and wGT3X - BT) were used to collect data at the hip, wrist and ankle to assess various walking and running speeds (ranging from 0.2 m/s to 4.44 m/s) over durations of 2 min to 3 days (13 h 30 mins per day) for step counting and distance estimation. The ActiGraph GT3X +/wGT3X + and wGT3X - BT had better criterion validity than the ActiGraph 7164, wGTX + and GT1M according to walking and running speeds for step counting. Validity of ActiGraph wGT3X + was good for distance estimation.

CONCLUSION

The ActiGraph wGT3X - BT and GT3X +/wGT3X + have good criterion validity for step counting, under certain conditions related to walking speeds, positioning and data processing.

Traffic as a Barrier to Walking Safely in the United States: Perceived Reasons and Potential Mitigation Strategies

•

Almost a quarter of US adults perceive traffic as a barrier to safe walking.

•

Vehicle speed is the leading perceived traffic characteristic of concern.

•

Respondents perceive sidewalks as the most favorable strategy to mitigate risk.

Motor vehicle traffic is commonly cited as a barrier to walking, but national level perceptions of traffic characteristics that negatively influence walking and potential traffic mitigation strategies remain unclear. The objectives of this study were to describe perceptions of (1) traffic characteristics that make walking unsafe in the United States and (2) potential mitigation strategies to address these concerns among those who report traffic as a barrier to walking. Data were from FallStyles, a nationwide internet panel survey conducted in October 2019 (n = 3,284 adults). Respondents reported if traffic makes walking unsafe where they live; those who answered yes were then asked about traffic characteristics that make walking unsafe (number of vehicles, speed of vehicles, distracted or impaired driving, types of vehicles, and other reasons) and potential mitigation strategies (new or improved sidewalks, crosswalks, pedestrian signals, street lighting, things that slow vehicles down, separating the sidewalk from the road, fewer vehicle lanes, and other). Prevalence of responses was assessed overall and by select sociodemographic and geographic characteristics, and by walking status. Nearly 25% of US adults reported that traffic is a barrier to walking where they live. Of these, 79% selected vehicle speed as a contributing traffic characteristic, and 57% indicated new or improved sidewalks as a potential mitigation strategy. These top responses were shared across all sociodemographic, geographic, and walking behavior subgroups. Speed reduction efforts and built environment enhancements such as sidewalks may alleviate pedestrian safety concerns. Promotion campaigns may be needed to bring awareness to such changes.

Living with severe obesity: adults' physical activity preferences, self-efficacy to overcome barriers and motives

BACKGROUND

This study aimed to explore the preferences, self-efficacy to overcome barriers and motives for physical activity of individuals with severe obesity (body mass index ≥35 kg/m²).

METHODS

44 adults with severe obesity (50.5 ± 13.3 years, 80% female) consented to participate in this study. Accelerometers, the 6-minute walking test, and questionnaires were used to collect data on participants' sociodemographic and medical characteristics, physical fitness, physical activity behaviour, preferences for physical activity, self-efficacy to overcome physical activity barriers and motives for physical activity.

RESULTS

A preference for walking (89%) and engaging in supervised physical activity (61%) at moderate intensity (46%) was reported. Most participants (71%) preferred engaging in physical activity outdoors for a duration of 30 to 60 min (84%), either in the morning (64%) or in the evening (48%). Participants had the lowest self-efficacy to overcome physical activity barriers when they had poor health and pain. The two most frequently reported physical activity motives were: preventing health problems and having better health.

CONCLUSIONS

A preference-based program focusing on health motives and addressing health and pain issues may help to promote physical activity behaviour among adults with severe obesity. Nevertheless, experimental studies are needed to determine if such strategies effectively increase physical activity behaviour in this population.Implications for rehabilitationPhysical activity preferences (i.e., walking, biking and swimming performed at a moderate intensity and outdoors for a duration of 30 minutes to 1 hour with supervision) can be used to enhance motivation in people with severe obesity.Addressing the main barriers of regular physical activity (e.g., poor health, pain, depression) could ensure better adherence to physical activity in people with severe obesity.Using motives of health improvement and health problems prevention could lead to increased physical activity in people with severe obesity.

Immersive virtual reality to relieve exercise-induced pain caused by aerobic cycling

Chronic pain affects 20% of the global population and is incredibly complex to treat. The burden of chronic pain is physical, emotional and financial, and prevalence rates continue to rise. Current treatments are ineffective long-term against pain and common comorbidities, including anxiety and depression, mood and sleep disorders, and social isolation. While a large body of evidence supports regular physical exercise as an effective long-term treatment for chronic pain and its comorbidities, exercise-induced pain and kinesiophobia are significant barriers to participation and adherence. Immersive virtual reality is a powerful short-term pain reliever, that, when combined with exercise, can help overcome these barriers. This perspective argues for the use of combined exercise and virtual reality treatment techniques to mitigate chronic pain.

Comparison of Leisure Time Physical Activities by Metabolic Syndrome Status among Adolescents

Background: Metabolic syndrome (MetS) increases the risk of premature morbidity and mortality. Physical activity (PA) beneficially affects MetS; however, it is unclear if PA types differ among adolescents 12-15 years old, according to their MetS status. This study compared self-reported PA types by MetS status. Methods: Using the 2015-2016 National Health and Nutritional Examination Survey (NHANES) data, 664 adolescents self-reported PA in the past seven days. MetS status was assessed using Ford's pediatric adaptation of the ATP-III adult criteria. Pearson chi-square and t-tests were conducted to determine self-reported PA differences. Results: The adolescents' mean age was 13.47 years (95% CIs; 13.04, 14.38) and 52.69% were male (352). Twenty-seven (4.07%) adolescents were MetS positive. The prevalence of PA engagement in the past seven days was similar for MetS-positive and -negative adolescents (77.67% and 70.51%, respectively; p > 0.05). No significant differences were observed for PA type by MetS status. MetS-positive adolescents reported higher sedentary time (565.77 [438.99, 692.56] vs. 490.59 [377.86, 603.33] minutes per day, respectively; p = 0239). Conclusions: Engagement in specific PA types does not appear to differ by MetS status, but MetS-positive adolescents have significantly higher sedentary time. PA promotion should target a variety of activities to maximize the effectiveness of public health programs and interventions should target reducing sedentary time.

Connectedness to Nature Does Not Explain the Variation in Physical Activity and Body Composition in Adults and Older People

Connectedness to nature (CN) is a significant predictor of pro-environmental behaviours, human health and well-being. However, research on how this connection to the natural world might promote a more active lifestyle and improve body mass composition according to gender is lacking. This study investigated the influence of CN on physical activity (PA) and body composition in adults and older people. We recruited a sample of 219 individuals (77 men and 142 women), and a self-administered questionnaire was used to measure CN and obtain demographic data. Body composition was assessed by bioimpedance, and PA was assessed by accelerometry. Correlations and stepwise multiple regressions were used in data analysis. CN's association with other variables was more pronounced in women than in men, and we only identified significant associations with steps/day and body composition. However, this variable would not be included in the regression models that we developed. Adiposity levels and muscle status were significant predictors of PA in women. In both genders, age, percentage of fat mass and fat-free mass were selected as regressors in the models developed for visceral fat area and muscle condition (R2 Adjusted ≥ 0.908).

Amount, Type, and Timing of Domain-Specific Moderate to Vigorous Physical Activity Among US Adults

BACKGROUND

Surveillance of domain-specific physical activity in the United States is lacking. Thus, the authors describe domain-specific moderate to vigorous physical activity (MVPA) in a nationwide sample of US adults.

METHODS

Participants from the AmeriSpeak panel (n = 2649; 20-75 y; 50% female) completed the Activities Completed Over Time in 24-Hours previous-day recall. The authors estimated average MVPA duration (in hours per day) overall and in major life domains by sex, age, race/ethnicity, and education. They also described the most commonly reported MVPAs and timing of MVPA during the day.

RESULTS

Across all life domains, participants reported an average of 2.5 hours per day in MVPA. Most MVPA was accumulated during work (50% of total, 1.2 h/d) and household activities (28%, 0.7 h/d) with less MVPA reported in leisure time (15%, 0.4 h/d). Time reported in MVPA varied by sex, and race/ethnicity (P < .05). Walking at work and for exercise, childcare, and walking for transportation were the most commonly reported domain-specific MVPAs. A greater proportion of MVPA took place in the morning (∼06:00 h) and evening (∼18:00 h).

CONCLUSIONS

Work and household activities accounted for 78% of overall MVPA reported, while leisure-time MVPA accounted for only 15% of the total. Encouraging MVPA during leisure time and transportation remain important targets for promoting MVPA in US adults.

U.S. Older Adults' Participation in Balance Activities

The Physical Activity Guidelines for Americans, second edition recommends that older adults do multicomponent physical activity, which includes balance training in addition to aerobic and muscle-strengthening activities. The authors estimated the prevalence of U.S. older adults (age ≥65 years) who do balance activities and meet the aerobic and muscle-strengthening physical activity guidelines. The authors analyzed data on 1,012 respondents to the 2019 FallStyles survey, a nationwide web-based panel survey. Approximately four in 10 respondents (40.7%) reported doing balance activities on ≥1 day/week, 34.0% on ≥2 days/week, and 25.3% on ≥3 days/week. Prevalence differed by sex, education level, income level, census region, body mass index category, and meeting the aerobic and/or muscle-strengthening guidelines. The combined prevalence of participation in balance activities and meeting aerobic and muscle-strengthening guidelines ranged from 12.0% for ≥3 days/week to 15.8% for ≥1 day/week. Opportunities exist to introduce and increase participation in balance and multicomponent activities by older adults.

Physical activity motives, barriers, and preferences in people with obesity: A systematic review

Background

Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population.

Methods

Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m² (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT).

Results

From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity.

Conclusions

Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.

Effects of physical exercise combined with captopril or losartan on left ventricular hypertrophy of hypertensive rats

Background: Left ventricular hypertrophy (LVH) is an endpoint of hypertensive cardiac alterations. Renin-angiotensin-aldosterone system (RAAS) blockers are among the most effective on LVH regression. Physical exercise combined to antihypertensive drug contributes to arterial pressure (AP) control and LVH prevention. We evaluated the effects of physical exercise combined to captopril or losartan during eight weeks for spontaneously hypertensive rats (SHR) on some cardiac parameters.Methods: SHR (n=5-6 per group) were sedentary or trained 5 days a week in treadmill during 8 weeks; and they were treated with daily oral captopril (12.5, 25, or 50mg/kg), losartan (2.5, 5, or 10mg/kg), or vehicle. At the end, it was obtained systolic AP (SAP), electrocardiogram (ECG), and hearts metalloproteinase 2 (MMP-2) activity and histology.Results: Captopril 25 and 50 mg/kg, and losartan 10 mg/kg lowered SAP of sedentary and trained SHR. Losartan 5 mg/kg combined with physical exercise also lowered SAP. Combined with exercise, captopril 50 mg/kg lowered 13.6% of QT interval, 14.2% of QTc interval, and 22.8% of Tpeak-Tend compared to sedentary SHR. Losartan 5 and 10mg/kg lowered QT interval of sedentary and trained SHR. Losartan 2.5, 5 and 10mg/kg combined with physical exercise lowered respectively 25.4%, 24.8%, and 31.8% of MMP-2 activity. Losartan (10mg/kg) combined with exercise reduced cardiomyocyte diameter.Conclusion: These data support the hypothesis of physical exercise combined with RAAS blockers could improve the benefits on hypertensive LVH treatment.

Pain During a Marathon Run: Prevalence and Correlates in a Cross-Sectional Study of 1,251 Recreational Runners in 251 Marathons

This cross-sectional study aimed to obtain fundamental knowledge about pain during a marathon run. During the first seven months of 2007, announcements on websites of interest to marathon runners were used to recruit participants. A total of 1,251 runners (550 female runners) completed a 41-question online survey about the location and intensity of their primary pain during their last marathon and potentially related variables [perception of effort during the marathon, number of prior marathons run, typical pain intensity during training runs, percentage of training days with run-induced pain, highest intensity pain ever experienced]. Pain location was selected from a list of 27 specified body sites covering the entire body. Kilometer at which pain first occurred indexed pain threshold. Pain intensity at the primary location of pain was measured with a standardized, well-validated 0–10 pain intensity scale. Pearson correlations and multiple regression quantified the associations between average pain intensity and other variables. Sex-related differences in pain were tested using independent t-tests. Effort ratings (6–20) were added as a covariate in an ANCOVA to test if perceived effort accounted for possible sex-related differences in pain. Based on the available research, it was hypothesized that: (i) most runners would report moderate intensity pain, (ii) pain would be associated with both exercise intensity during the marathon and pain during training, and (iii) after adjusting for expected sex-related differences in perceived effort, females would experience pain earlier and rate the pain intensity as higher. All but two runners (99.8%) reported pain during a marathon, and most frequently in the anterior/medial thigh (17.1%), hamstring (10%), and calf (9.3%) locations. Pain threshold occurred at 25.3 ± 9.8 km (15.7 ± 6.1 miles) and the overall pain intensity of the run was 5.26 ± 2.45. No sex-related pain differences were found. Overall pain intensity during a marathon was significantly associated with: pain intensity during training runs (r = 0.39), percentage of training days with run-induced pain (r = 0.23), highest intensity pain ever experienced (r = 0.23), number of prior marathons (r = −0.18), and intensity of effort (r = 0.11) (all P < 0.001). Most runners experience moderate to very strong intensity pain during a marathon; the pain was independent of biological sex, and the pain is weakly associated with marathon race experience, pain during training, race effort, and the highest intensity of pain ever experienced.

Developing the Active Communities Tool to Implement the Community Guide's Built Environment Recommendation for Increasing Physical Activity

Physical activity is higher in communities that include supportive features for walking and bicycling. In 2016, the Community Preventive Services Task Force released a systematic review of built environment approaches to increase physical activity. The results of the review recommended approaches that combine interventions to improve pedestrian and bicycle transportation systems with land use and environmental design strategies. Because the recommendation was multifaceted, the Centers for Disease Control and Prevention determined that communities could benefit from an assessment tool to address the breadth of the Task Force recommendations. The purpose of this article is to describe the systematic approach used to develop the Active Communities Tool. First, we created and refined a logic model and community theory of change for tool development. Second, we reviewed existing community-based tools and abstracted key elements (item domains, advantages, disadvantages, updates, costs, permissions to use, and psychometrics) from 42 tools. The review indicated that no tool encompassed the breadth of the Community Guide recommendations for communities. Third, we developed a new tool and pilot tested its use with 9 diverse teams with public health and planning expertise. Final revisions followed from pilot team and expert input. The Active Communities Tool comprises 6 modules addressing all 8 interventions recommended by the Task Force. The tool is designed to help cross-sector teams create an action plan for improving community built environments that promote physical activity and may help to monitor progress toward achieving community conditions known to promote physical activity.

Associations between physical activity types and reaching the physical activity guidelines: The FinHealth 2017 Study

Physical activity (PA) guidelines for adults recommend to both aerobic and muscle-strengthening exercise. We aimed to report prevalence of adults reaching these guidelines and further study associations of types of physical activities with the PA guidelines. In a national FinHealth 2017 Study, adults (18+ years, n = 5335) reported participation in different types of physical activities in summer and winter, in duration of moderate- and vigorous-intensity aerobic PA, and frequency of muscle-strengthening PA. Logistic regression analysis was used, adjusting for age, education, and self-rated health, stratified into age-groups of 18-64 years and 65+ years by gender. PA guidelines were reached in the age-group of 18-64 years by 42% of men and 39% of women and in the age-group of 65+ years by 26% of men and 20% of women. Walking, cleaning and maintenance work, and stair climbing were the most popular PA types throughout the year. Workout and muscle-strengthening exercises were consistently associated with 3-8 times higher odds for reaching the PA guidelines across age, gender, and season. Other PA types (eg, jogging, swimming, skiing, gardening, or stair climbing) had more varied associations with the PA guidelines across gender, age, and season. Our data suggest that only certain conditioning activity types associate with reaching PA guidelines. Findings indicate that future interventions could more specifically use information on gender and age variation in the PA types, to find solutions for low physical activity in the population.

Should we target increased physical activity or less sedentary behavior in the battle against cardiovascular disease risk development?

Physical inactivity is a well-established risk factor for cardiovascular disease (CVD) incidence and mortality. In the last decade, there is also emerging evidence of the role of sedentary behaviors (sitting) as a risk factor for CVD. Therefore, there is increasing interest in understanding the independent and joint effects of physical activity and sedentary behavior on CVD risk. Higher levels of moderate-to-vigorous physical activity and less time spent in sedentary behavior are associated with a decreased risk of CVD. There is also preliminary evidence that higher levels of light-intensity physical activity are associated with lower all-cause mortality rates; however, the cardio-protective effects of light-intensity physical activity are yet to be determined. The results from several studies have demonstrated that the effects of sedentary behavior on CVD risk is more pronounced among individuals who are physically inactive, compared to those who are more active. Further, high levels (60-75 min per day) of moderate-to-vigorous physical activity appear to eliminate the increased risk of CVD associated with excessive sedentary behavior. Replacing sedentary behavior with any intensity of physical activity will produce health benefits; however, the greatest benefits occur when replacing sedentary behavior with moderate-to-vigorous intensity physical activity.

Interrater Reliability of Historical Virtual Audits Using Archived Google Street View Imagery

Impaired mobility occurs in up to half of community-dwelling older adults and is associated with poor health outcomes and high health care costs. Although the built environment impacts mobility, most studies of older adults lack information about environmental-level factors. In-person observational audits can be utilized but cannot assess the historical environment. We applied a 78-item checklist to archived Google Street View imagery to assess historical residence access and neighborhood characteristics. Interrater reliability between two raters was tested on 50 addresses using prevalence-adjusted and bias-adjusted kappa (PABAK). The mean PABAK for all items was .75, with 81% of the items having substantial (PABAK ≥ .61) or almost perfect (PABAK ≥ .81) agreement. Environmental assessment using archived virtual imagery has excellent reliability for factors related to residence access and many neighborhood characteristics. Archived imagery can assess past neighborhood characteristics, facilitating the use of historical environment data within existing cohorts.

Trends in Total Physical Activity Time, Walking, and Vigorous Physical Activity Time in Queensland Adults From 2004-2018

BACKGROUND

Health benefits of physical activity (PA) accrue with small increases in PA, with the greatest benefits for those transitioning from inactivity to any level of PA. This study examined whether self-reported PA time in Queensland adults changed between 2004 and 2018.

METHODS

The Queensland government conducts regular cross-sectional telephone surveys. Between 2004 and 2018, adults aged 18-75 years answered identical questions about their weekly minutes of walking, moderate PA, and vigorous PA. Hurdle regression estimated the average annual change in weekly minutes of PA overall and by activity type, focusing on sociodemographic differences in trends.

RESULTS

The sample size averaged 1764 (2004-2008) and 10,188 (2009-2018), totaling 107,171 participants aged 18-75 years. Unadjusted PA increased by 10 minutes per week per year (95% confidence interval [CI], 8.8-11.1) overall, with increases for most subgroups. Adjusted PA increased by 10.5 minutes per week per year (95% CI, 9.4-11.7). Trends differed by employment-employed adults and those not in the labor force increased by 14.3 (95% CI, 12.8-15.8) and 2.2 minutes per week per year (95% CI, 0.4-4.0), respectively, with no increase for unemployed adults. The increases were due to both an increased prevalence of doing any activity and an increased average duration among active adults.

CONCLUSIONS

Since 2004, PA time has increased for Queensland adults, with substantial variability by employment status.

Physical activity types among US adults with mobility disability, Behavioral Risk Factor Surveillance System, 2017

BACKGROUND

The Physical Activity Guidelines for Americans, second edition, recommend that all adults participate in moderate-intensity equivalent aerobic physical activity at least 150-300 min/week for substantial health benefits and muscle-strengthening activities involving all major muscle groups 2 or more days a week. The prevalence of the general population meeting the Guidelines and the types of physical activity in which they engage have been described elsewhere. Similar descriptions are lacking for individuals with mobility disability whose physical activity profiles may differ from the general population.

OBJECTIVE

This study examined patterns of aerobic and muscle-strengthening physical activity among US adults with mobility disability.

METHODS

We used 2017 Behavioral Risk Factor Surveillance System data from 66,635 adults with mobility disability. We estimated the percentage who engaged in any aerobic physical activity, met the aerobic and/or muscle-strengthening guidelines, and who participated in specific activities.

RESULTS

Less than half (45.2%) of US adults with mobility disability reported engaging in aerobic physical activity, and 39.5% met one or both components of the physical activity guidelines. Walking was the most commonly reported activity type (34.0%).

CONCLUSIONS

Walking is a common activity type among adults with mobility disability. Efforts to make walking or wheelchair rolling a safe, viable option are important to helping decrease barriers that may limit the ability of those with mobility disability to engage in walking or other physical activity types.

Comparative Effects of Three Kinds of Bariatric Surgery: A Randomized Case-Control Study in Obese Patients

INTRODUCTION

Laparoscopic bariatric surgery is necessary for obese patients who cannot control body weight through daily diet and exercise, or other non-surgical ways. Three kinds of laparoscopic bariatric surgery, namely Roux-en-Y gastric bypass, sleeve gastrectomy, and sleeve gastrectomy with jejunal bypass, are available for weight loss in clinical practice, but their comparative effects are unclear. In this study, these were compared to illustrate their clinical effects.

METHODS

A case-control study was conducted on 175 participants who fulfilled the inclusion criteria of laparoscopic bariatric surgery, while the controls were the same subjects before and after surgery, as well as with different surgeries specifically. Standardized weight loss measures were compared using analysis of covariance, with months from surgery as the covariant, including percentage total weight loss and excess body mass index (BMI) loss.

RESULTS

A total of 175 patients were enrolled in this study (age 38 ± 10 years; BMI 46 ± 5 kg/m2), with a mean postsurgery follow-up of 18 ± 6 months. No significant difference was included among the enlisted patients before bariatric surgery. However, after surgery according to personal health indexes of patients and professional assessment by doctors, patients specifically receiving one of Roux-en-Y gastric bypass, sleeve gastrectomy, and sleeve gastrectomy with jejunal bypass had no significant difference between weight loss and BMI, while the most important factors were dietary control and exercise after bariatric surgery.

CONCLUSION

This study suggests that bariatric surgery is only a prerequisite for weight loss, and the long-term dietary control and exercise can help patients achieve optimal weight loss.

The Effects of Varying Structured Physical Activity Duration on Young Children's and Parents' Activity Levels

Purpose: The purpose of this study was to examine whether structured physical activity (PA) in a family-based community exercise program affects PA of young children and parents. Method: Twenty-two children (mean ± SD; age, 4.9 ± 2.1 years) and their parents (age, 34.3 ± 7.6 years) participated in unstructured PA sessions followed by either short- or long-duration structured PA sessions, while wearing an ActiGraph GT9X activity monitor on their right hip to estimate PA. Independent t-tests compared children's and parents' PA during short- and long-structured PA sessions. Paired t-tests compared short- versus long-structured PA sessions. A mixed model ANOVA compared PA during unstructured versus structured sessions and between children and parents. Results: Children spent proportionately more time in moderate-to-vigorous PA (MVPA) and had higher accelerometer counts/min than parents during short-structured PA (children:60.9 ± 18.8% vs. parents:17.7 ± 6.8%, children:3870 ± 742 vs. parents:1836 ± 556 counts/min, p < .05) and long-structured PA (children:61.1 ± 20.1% vs. parents:12.6 ± 4.9%, children:3415 ± 758 vs. parents:1604 ± 633 counts/min, p < .05). No statistical differences were found between short- and long-structured PA sessions for proportion of time spent in MVPA or counts/min for children or parents (all, p > .05). Children spent proportionally more time in MVPA and had higher counts/min during unstructured PA compared to structured PA (unstructured MVPA:54.4 ± 3.9% vs. structured MVPA:38.2 ± 4.2%, unstructured counts/min:3830 ± 222 vs. structured counts/min:2768 ± 239 counts/min; p < .05). Conclusions: Children were more active than parents during both the unstructured and structured PA sessions. However, unstructured PA sessions resulted in 63-77% and 10-11% of PA recommendations for children and adults, respectively. Family-based exercise programming can provide an opportunity for children and their parents to attain MVPA during the week.

The Association of Sport and Exercise Activities With Cardiovascular Disease Risk: The Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND

This study assessed the independent associations between participation in self-reported sport and exercise activities and incident cardiovascular disease (CVD).

METHODS

Data were from 13,204 participants in the Atherosclerosis Risk in Communities Study cohort (1987-2015). Baseline sport and exercise activities were assessed via the modified Baecke questionnaire. Incident CVD included coronary heart disease, heart failure, or stroke. Multivariable-adjusted Cox proportional hazard models assessed the association of participation in specific sport and exercise activities at enrollment with risk of CVD.

RESULTS

During a median follow-up time of 25.2 years, 30% of the analytic sample (n = 3966) was diagnosed with incident CVD. In fully adjusted models, participation in racquet sports (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.61-0.93), aerobics (HR 0.75; 95% CI, 0.63-0.88), running (HR 0.68; 95% CI, 0.54-0.85), and walking (HR 0.89; 95% CI, 0.83-0.95) was significantly associated with a lower risk of CVD. There were no significant associations for bicycling, softball/baseball, gymnastics, swimming, basketball, calisthenics exercises, golfing with cart, golfing with walking, bowling, or weight training.

CONCLUSIONS

Participation in specific sport and exercises may substantially reduce the risk for CVD.

Assessing Physical Activity and Sedentary Behavior under Free-Living Conditions: Comparison of Active Style Pro HJA-350IT and ActiGraphTM GT3X

Various accelerometers have been used in research measuring physical activity (PA) and sedentary behavior (SB). This study compared two triaxial accelerometers—Active style Pro (ASP) and ActiGraph (AG)—in measuring PA and SB during work and nonwork days in free-living conditions. A total of 50 working participants simultaneously wore these two accelerometers on one work day and one nonwork day. The difference and agreement between the ASP and AG were analyzed using paired t-tests, Bland–Altman plots, and intraclass coefficients, respectively. Correction factors were provided by linear regression analysis. The agreement in intraclass coefficients was high among all PA intensities between ASP and AG. SB in the AG vertical axis was approximately 103 min greater than ASP. Regarding moderate-to-vigorous-intensity PA (MVPA), ASP had the greatest amount, followed by AG. There were significant differences in all variables among these devices across all day classifications, except for SB between ASP and AG vector magnitude. The correction factors decreased the differences of SB and MVPA. PA time differed significantly between ASP and AG. However, SB and MVPA differences between these two devices can be decreased using correction factors, which are useful methods for public health researchers.

Step It Up! Prioritization of Community Supports for Walking Among US Adults

PURPOSE

Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities (Call to Action) presents goals and supporting strategies to promote walking. We assessed the presence and prioritization of 4 community supports for walking related to the goals of the Call to Action from the perspective of US adults.

DESIGN

Cross-sectional web-based survey.

SETTING

US adults.

PARTICIPANTS

A total of 4043 respondents.

MEASURES

SummerStyles 2016 survey assessing the reported presence and prioritization of 4 community supports for walking.

ANALYSIS

Estimated prevalence of the presence of supports overall and by demographic characteristics, and prevalence and adjusted prevalence ratios of their prioritization.

RESULTS

The most commonly reported community supports for walking were access to walkable locations (46.5%) and safe streets (29.2%), followed by walking groups (12.9%) and promotional campaigns (9.6%). Access to walkable locations (60.0%) and safe streets (50.6%) were most often prioritized by respondents, followed by promotional campaigns (23.6%) and walking groups (18.8%). Many differences in prioritization by demographic characteristics remained significant after adjusting for presence and other demographic characteristics, such as increased prioritization of all supports with older age groups.

CONCLUSIONS

Presence and prioritization of community supports for walking varied widely by type of support and by demographic characteristics. Opportunities exist to improve access and public sentiment related to these supports to promote walking in the United States.

National-level environmental perceptions and walking among urban and rural residents: Informing surveillance of walkability

Built environments that provide activity-friendly routes (e.g., sidewalks) to everyday destinations (e.g., shops) can increase physical activity. Surveillance of supports and destinations is important, and identifying which are associated with walking could prioritize surveillance questions. Our purpose was to identify the significant associations between supports and destinations with walking among a nationally-representative sample of urban- and rural-dwelling adults. Participants in the 2015 National Health Interview Survey, Cancer Control Supplement (n = 29,925) reported the near-home presence of walkable supports (roads, sidewalks, paths, or trails; sidewalks on most streets), destinations (shops; transit; movies, libraries, or churches; relaxing places), and past-week walking for leisure or transportation. We used stepwise logistic regression to quantify associations between supports and destinations and walking, including by urban/rural residence. We calculated the prevalence of walking across counts of reported elements by urban/rural residence. Among all participants, roads, sidewalks, paths, or trails and relaxing destinations were associated with leisure walking. Among urban residents, sidewalks on most streets and all four destination types were associated with transportation walking; among rural residents, roads, sidewalks, paths, or trails; movies, libraries, or churches; and relaxing destinations were associated with transportation walking. Walking was more common when more environmental elements were reported. To improve efficiency, communities may match surveillance priorities to behavioral priorities (i.e., leisure versus transportation walking) and environmental context (i.e., urban/rural areas). Surveillance of environments supporting leisure walking might focus on recreation-oriented spaces. Surveillance of environments supporting transportation walking might differ for urban and rural areas, and assessing destinations may be particularly important.

Validation of the Block Walk Method for Assessing Physical Activity occurring on Sidewalks/Streets

The block walk method (BWM) is one of the more common approaches for assessing physical activity (PA) performed on sidewalks/streets; however, it is non-technical, labor-intensive, and lacks validation. This study aimed to validate the BWM and examine the potential for using a wearable video device (WVD) to assess PA occurring on sidewalks/streets. Trained observers (one wearing and one not wearing the WVD) walked together and performed the BWM according to a previously developed protocol along routes in low, medium, and high walkable areas. Two experts then reviewed the videos. A total of 1150 (traditional) and 1087 (video review) individuals were observed during 900 min of observation. When larger numbers of individuals were observed, the traditional method overestimated the overall number of people as well as those walking and sitting/standing, while underestimating the number of runners. Valid estimates of PA occurring on sidewalks/streets can be obtained by the traditional BWM in low and medium walkability areas and/or with non-common activities (cycling); however, its validity is questionable when sidewalks/streets use volume is high. The use of WVDs in PA assessment has the potential to establish new levels of accuracy, reduce resource requirements, and open up the possibility for retrospective analysis.

Associations between Walk Score and objective measures of physical activity in urban overweight and obese women

The purpose of this study was to examine associations between the Walk Score and physical activity in young, overweight/obese urban women. Project Health included 45 White or African American women (BMI 31.5±3.9 kg/m²; age 26.5±4.6 years; 62% African American) living in the Boston area. An accelerometer estimated steps/day and mins/day in light physical activity (100–2019 counts-per-minute) and moderate-to-vigorous-physical activity (≥2020 cpm). Walk Score was used to estimate the walkability of home address by analyzing proximity to nearby amenities. General linear regression models estimated associations between total Walk Score and physical activity (light physical activity, moderate-to-vigorous-physical activity, steps, total activity counts, METs), adjusting for body mass index, age, race/ethnicity, seasonality, wear time, employment and student status. For physical activity variables that had significant associations with Walk Score (steps/day and steps/min), regression models were estimated for Walk Score sub-scores (parks, grocery, errands, shopping, dining/drinking, culture/entertainment and schools). Logistic regression models estimated the odds of meeting the guidelines for steps (≥10,000/day) and moderate-to-vigorous-physical activity (≥150mins MVPA/week) based on Walk Score. Participants had a Walk Score of 63.9±26.4, took 14,143±3,934 steps/day, and spent 206.2±66.0 mins/day in light physical activity and 46.7±17.5 mins/day in moderate-to-vigorous- physical activity. Walk Score was significantly and positively associated with steps/day (β = 51.4, p = 0.01) and steps/min (β = 0.06, p = 0.009) but was not associated with mins/day of light physical activity, moderate-to-vigorous-physical activity, total activity counts or METs. Parks, grocery, errands, shopping, dining/drinking, and culture/entertainment Walk Score sub-scores were significantly associated with steps and steps/min (all p<0.05), but not significantly associated for schools. Participants who lived in higher Walk Score neighborhoods were more likely to meet the step guidelines (OR, 95% CI: 1.59, 1.04–2.99) and moderate-to-vigorous-physical activity guidelines (1.63, 1.06–3.02), respectively, per 10-unit increase in Walk Score. These results indicate that living in a more walkable neighborhood may support walking behavior in young, urban-dwelling overweight/obese women and provide further evidence for the expanded use of urban planning and transportation policies to improve the walkability of urban neighborhoods.

Urban Minority Community Safety and its Impact on Physical Activity: The Center for Promoting Health and Health Equity-Racial and Ethnic Approaches to Community Health (CPHHE-REACH) Initiative

BACKGROUND/PURPOSE

Daily physical activity is known to improve personal health and well-being and can often be influenced by one's living environment. A qualitative secondary data analysis of a focus group study, performed by the Creighton University Center for Promoting Health and Health Equity (CPHHE) - Racial and Ethnic Approaches to Community Health (REACH), assesses behavioral changes in individuals who participated in newly established physical activities in faith-based organizations, local residential towers, and the local community health center.

METHOD

Applying thematic analysis within the Health Belief Model framework, the investigators further investigated the relationships between its constructs and levels of physical activity in urban minority neighborhoods.

RESULTS

Results indicated that residents who perceived their neighborhoods as unsafe had a negative attitude toward physical activity. In contrast, building social relationships and camaraderie that enhanced social cohesion were major themes that increased participants' self-efficacy, resulting in positive changes in health behavior.

CONCLUSION

Community partnerships had a positive impact on motivating individuals to live healthier lifestyles. An interesting concept was that of community efficacy, which reflects the community's confidence in its ability to generate behavioral changes in individuals.

A Cross-sectional Study of Reported Exercise and Medium-Term Weight Loss Following Laparoscopic Bariatric Surgery

BACKGROUND

Exercise is a strong determinant of prolonged weight loss in non-surgical patients. Studies evaluating the impact of exercise beyond the first year after bariatric surgery are lacking. We analyzed the relationship between reported intentional exercise and medium-term weight loss following bariatric surgery.

METHODS

Patients who underwent bariatric surgery from 2007 thru 2013 completed a follow-up telephone survey and were separated into groups based on reported weekly exercise, i.e., < 90 min week^-1, 90-200 min week^-1, and > 200 min week^-1. Standardized weight loss measures including percent of total weight loss, percent of excess body mass index (BMI) loss, percent of excess weight loss, and change in BMI were compared using analysis of covariance, with years from surgery as the covariant.

RESULTS

A total of 872 patients were included in this study (age = 48 ± 10 years; BMI = 48 ± 7 kg/m²), with a mean post-surgery follow-up of 39 ± 14 months. Patients reporting > 200 min week^-1 of planned exercise had greater weight loss than those who did less than 90 min week^-1 (p < 0.05). No significant difference was found between those who reported less than 90 min week^-1and those reporting between 91 and 200 min week^-1.

CONCLUSIONS

This study suggests that regular exercise in excess of 200 min week^-1 is associated with greater medium-term weight loss following laparoscopic bariatric surgery. Multidisciplinary bariatric surgery teams should consider emphasizing exercise at this level to help patients achieve optimal weight loss.

Moving to an active lifestyle? A systematic review of the effects of residential relocation on walking, physical activity and travel behaviour

OBJECTIVE

To synthesise the literature on the effects of neighbourhood environmental change through residential relocation on physical activity, walking and travel behaviour.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42017077681).

DATA SOURCES

Electronic databases for peer-reviewed and grey literature were systematically searched to March 2017, followed by forward and backward citation tracking.

ELIGIBILITY CRITERIA

A study was eligible for inclusion if it (1) measured changes in neighbourhood built environment attributes as a result of residential relocation (either prospectively or retrospectively); (2) included a measure of physical activity, walking, cycling or travel modal change as an outcome; (3) was quantitative and (4) included an English abstract or summary.

RESULTS

A total of 23 studies was included in the review. Among the eight retrospective longitudinal studies, there was good evidence for the relationship between relocation and walking (consistency score (CS)>90%). For the 15 prospective longitudinal studies, the evidence for the effects of environmental change/relocation on physical activity or walking was weak to moderate (CS mostly <45%), even weaker for effects on other outcomes, including physical activity, cycling, public transport use and driving. Results from risk of bias analyses support the robustness of the findings.

CONCLUSION

The results are encouraging for the retrospective longitudinal relocation studies, but weaker evidence exists for the methodologically stronger prospective longitudinal relocation studies. The evidence base is currently limited, and continued longitudinal research should extend the plethora of cross-sectional studies to build higher-quality evidence.

Epidemiology of sports concussion in the United States

Sports and recreation-related (SRR) activities are common in the United States. Beyond the benefits to health, SRR activities can create new friendships, give people a sense of belonging, foster teamwork and other leadership skills, and develop sportsmanship and a respect for rules that govern play. Public awareness about the risk of concussion has grown as the long-term consequences of traumatic brain injury (TBI) have become better known, and likely explains the increasing concussion incidence rates. Currently, surveillance systems capture SRR concussions among high school and college athletes participating in sanctioned sports. National estimates of SRR TBI presenting to an emergency department also exist. Persons under the age of 19 sustain a majority of SRR concussions. Concussion risk is greatest for boys in contact/collision sports like football, ice hockey, and lacrosse, and is more likely to occur in competition versus practice settings. Girls have elevated concussion rates in gender-comparable sports. Despite better data, concussions are still underreported, undermanaged, and often not properly identified. This is especially true for concussions occurring outside organized sports, in nonsport recreational activities, and for concussions either not seen or evaluated in nonemergency department settings. A new surveillance system proposed by the Centers for Disease Control and Prevention aims to fill the gap.

Leisure-Time Physical Activity and Risk of Fracture: A Cohort Study of 66,940 Men and Women

Physical activity has been associated with reduced risk of fracture, but it is not known how the intensity or frequency of physical activity influences this risk reduction. We aim to compare the risk of hip fracture and fracture of any locale between men and women with different levels of leisure-time walking/bicycling and exercise. A total of 37,238 women (born 1914-1948) from the Swedish Mammography Cohort and 45,906 men (born 1918-1952) from the Cohort of Swedish Men were followed for a maximum of 17 years. Exposure and covariate information was collected through a self-administered questionnaire in 1997. Incident fractures (5153 individuals with hip fracture and 15,043 with any type of fracture) and comorbidities were gathered from national and local patient registries. Hazard ratios (HRs) were calculated using Cox proportional hazards regression. Individuals who walked/bicycled less than 20 minutes per day had a lower rate of hip fracture (multivariable adjusted HR = 0.77; 95% confidence interval [CI] 0.70 to 0.85) and any fracture (HR = 0.87; 95% CI 0.82 to 0.92) compared with those who hardly ever walked/bicycled. These reduced rates were also evident in both sexes, in different age categories, for vertebral fractures and for non-hip, non-vertebral fractures. Those who reported exercise 1 hour per week had a lower rate of hip fracture (HR = 0.87; 95% CI 0.80 to 0.96) and any fracture (HR = 0.94; 95% CI 0.89 to 0.99) compared with those who exercised less than 1 hour per week. Only minor differences in HRs were observed in individuals with moderate compared with higher levels of walking/bicycling or exercise. Walking/bicycling and exercise showed almost equal reductions in rate of fracture when compared with those in a joint category with lowest activity. In conclusion, both moderate and high self-reported frequency of physical activity is associated with reduced future risk of fracture. © 2017 American Society for Bone and Mineral Research.

Gender differences in walking (for leisure, transport and in total) across adult life: a systematic review

BACKGROUND

The aim of this systematic review was to examine gender differences in walking for leisure, transport and in total in adults living in high-income countries, and to assess whether gender differences in walking practices change across the life-course.

METHODS

A systematic literature search was conducted of publications dated 1995 to 2015. Papers providing quantitative data on participation in walking of both men and women aged at least 18 years in a high-income country were screened for the quality of the data on gender differences in walking. Data were extracted and results were synthesised using forest plots and narrative summary.

RESULTS

Thirty-six studies were included in the review: 18 reported on walking for leisure, 16 on walking for transport (in total, or for particular purposes), and 14 on total walking. Most (33) studies provided data comparing the proportion of men and women who walked (at all or for a minimum duration) over a defined period, usually one week. There was consistent evidence that more women than men walk for leisure, although effect sizes were small. However, this effect varies by age: more younger women than younger men walk for leisure, but the gender difference diminishes with age and appears to reverse in the oldest age groups. Taking all ages together, there was no consistent gender difference in walking for transport or in total walking, although the small number of studies reporting on walking to undertake errands suggested that more women than men walk for this purpose.

CONCLUSIONS

While there is little evidence that levels of total walking consistently vary by gender, our findings suggest that there are consistent gender differences in participation in walking for some purposes, including for leisure, and that there are gender differences in the impact of age on walking. We conclude that more research is needed to improve our understanding of how walking fits into the lives of women and men across the life-course, especially in relation to gender differences in the impact of aging on walking.

PROSPERO REGISTRATION

PROSPERO registration number: CRD42015025961 .

Walking and the Perception of Neighborhood Attributes Among U.S. Adults-2012

BACKGROUND

The association between walking and environmental attributes depends on walking purpose. This study, based on a large survey of U.S. adults, examined the association between perceived neighborhood safety and built environment attributes, and walking for transportation and leisure.

METHODS

Data were obtained on transportation and leisure-time walking, perceived neighborhood safety and built environment attributes, and demographic characteristics from the summer wave of the 2012 ConsumerStyles survey of 3951 U.S. adults. Associations were examined by demographic characteristics.

RESULTS

Seventy-five percent of respondents reported walking for either transportation (54%) or leisure (56%) in the past week, 59% reported no safety concern, and 36% reported absence of any built environment attribute of walkability nearby. Respondents with more education, and those who lived in metropolitan areas were more likely to report built environment attributes supportive of walking. All built environment attributes examined, as well as safety concern due to speeding vehicles, were associated with walking after adjustment for demographic characteristics.

CONCLUSION

Walking, particularly for transportation, is associated with many built environment attributes among U.S. adults. These attributes may be important to consider when designing and modifying the built environment of communities, especially those which are less walkable.

Communities on the Move: Pedestrian-Oriented Zoning as a Facilitator of Adult Active Travel to Work in the United States

BACKGROUND

Communities across the United States have been reforming their zoning codes to create pedestrian-friendly neighborhoods with increased street connectivity, mixed use and higher density, open space, transportation infrastructure, and a traditional neighborhood structure. Zoning code reforms include new urbanist zoning such as the SmartCode, form-based codes, transects, transportation and pedestrian-oriented developments, and traditional neighborhood developments.

PURPOSE

To examine the relationship of zoning code reforms and more active living--oriented zoning provisions with adult active travel to work via walking, biking, or by using public transit.

METHODS

Zoning codes effective as of 2010 were compiled for 3,914 municipal-level jurisdictions located in 471 counties and 2 consolidated cities in 48 states and the District of Columbia, and that collectively covered 72.9% of the U.S. population. Zoning codes were evaluated for the presence of code reform zoning and nine pedestrian-oriented zoning provisions (1 = yes): sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, bike-pedestrian trails/paths, mixed-use development, and other walkability/pedestrian orientation. A zoning scale reflected the number of provisions addressed (out of 10). Five continuous outcome measures were constructed using 2010-2014 American Community Survey municipal-level 5-year estimates to assess the percentage of workers: walking, biking, walking or biking, or taking public transit to work OR engaged in any active travel to work. Regression models controlled for municipal-level socioeconomic characteristics and a GIS-constructed walkability scale and were clustered on county with robust standard errors.

RESULTS

Adjusted models indicated that several pedestrian-oriented zoning provisions were statistically associated (p < 0.05 or lower) with increased rates of walking, biking, or engaging in any active travel (walking, biking, or any active travel) to work: code reform zoning, bike parking (street furniture), bike lanes, bike-pedestrian trails/paths, other walkability, mixed-use zoning, and a higher score on the zoning scale. Public transit use was associated with code reform zoning and a number of zoning measures in Southern jurisdictions but not in non-Southern jurisdictions.

CONCLUSION

As jurisdictions revisit their zoning and land use policies, they may want to evaluate the pedestrian-orientation of their zoning codes so that they can plan for pedestrian improvements that will help to encourage active travel to work.

Utilization of 2013 BRFSS Physical Activity Data for State Cancer Control Plan Objectives: Alabama Data

OBJECTIVES

All comprehensive US cancer control plans mention physical activity and implement physical activity promotion objectives as part of these cancer plans. The purpose of this investigation was to describe the physical activities reported by Alabama adults in the 2013 Behavioral Risk Factor Surveillance System (BFRSS) and to compare these activities by age group and relative exercise intensity.

METHODS

This investigation used data on 6503 respondents from the 2013 BRFSS sample of respondents from Alabama with landline and cellular telephones. Respondents were asked whether they engaged in any physical activities or aerobic exercises such as running, calisthenics, golf, gardening, or walking. Information was collected on strengthening activities such as yoga, sit-ups, push-ups, and using weight machines, free weights, and elastic bands. Relative exercise intensity was estimated for each aerobic activity by comparing the 60% maximal oxygen uptake with metabolic equivalent values.

RESULTS

Approximately two-thirds (63.7%) of respondents reported that they engaged in exercise in the past 30 days; 45.4% participated in enough aerobic activity per week to meet guidelines, and 25.9% met the muscle-strengthening guidelines. Only 10.1% of respondents 65 years old and older met both aerobic and muscle-strengthening guidelines, compared with 15.2% of those 18 to 64 years old (P < 0.05). The most common activity reported for ages 18 to 64 years was walking (53.3%), followed by running (12.7%), and gardening (4.7%). Among adults aged 65 and older, the top three activities were walking (63.2%), gardening (13.3%), and use of a bicycle machine (2.9%). The activity intensity was significantly greater for walking, gardening, and household activities among older adults compared with those younger than age 65.

CONCLUSIONS

Because the recommended levels of physical activity are not met by a majority of Alabama residents, it is important to incorporate this information into state cancer objectives. Older adults may have higher relative energy costs compared with younger adults. Future studies should discern whether activities previously classified as low intensity have adequate health benefits, especially for cancer survivors and older adults with comorbidities.

Walking for Transportation and Leisure Among U.S. Adults--National Health Interview Survey 2010

BACKGROUND

Walking, the most commonly reported physical activity among U.S. adults, is undertaken in various domains, including transportation and leisure.

METHODS

This study examined prevalence, bout length, and mean amount of walking in the last week for transportation and leisure, by selected characteristics. Self-reported data from the 2010 National Health Interview Survey (N = 24,017) were analyzed.

RESULTS

Prevalence of transportation walking was 29.4% (95% CI: 28.6%-30.3%) and of leisure walking was 50.0% (95% CI: 49.1%-51.0%). Prevalence of transportation walking was higher among men; prevalence of leisure walking was higher among women. Most (52.4%) transportation walking bouts were 10 to 15 minutes; leisure walking bouts were distributed more evenly (28.0%, 10-15 minutes; 17.1%, 41-60 minutes). Mean time spent in transportation walking was higher among men, decreased with increasing BMI, and varied by race/ethnicity and region of residence. Mean time spent leisure walking increased with increasing age and with decreasing BMI.

CONCLUSION

Demographic correlates and patterns of walking differ by domain. Interventions focusing on either leisure or transportation walking should consider correlates for the specific walking domain. Assessing prevalence, bout length, and mean time of walking for transportation and leisure separately allows for more comprehensive surveillance of walking.

Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship

IMPORTANCE

The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear.

OBJECTIVE

To quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity.

DESIGN, SETTING, AND PARTICIPANTS

We pooled data from 6 studies in the National Cancer Institute Cohort Consortium (baseline 1992-2003). Population-based prospective cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014. A total of 661,137 men and women (median age, 62 years; range, 21-98 years) and 116,686 deaths were included. We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Median follow-up time was 14.2 years.

EXPOSURES

Leisure time moderate- to vigorous-intensity physical activity.

MAIN OUTCOMES AND MEASURES

The upper limit of mortality benefit from high levels of leisure time physical activity.

RESULTS

Compared with individuals reporting no leisure time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week (HR, 0.80 [95% CI, 0.78-0.82]), a 31% lower risk at 1 to 2 times the recommended minimum (HR, 0.69 [95% CI, 0.67-0.70]), and a 37% lower risk at 2 to 3 times the minimum (HR, 0.63 [95% CI, 0.62-0.65]). An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation (HR, 0.61 [95% CI, 0.59-0.62]); however, compared with the recommended minimum, the additional benefit was modest (31% vs 39%). There was no evidence of harm at 10 or more times the recommended minimum (HR, 0.69 [95% CI, 0.59-0.78]). A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer.

CONCLUSIONS AND RELEVANCE

Meeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum. In regard to mortality, health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels.