What is the optimal type of physical activity to enhance health?

Determination of moderate walking intensity using step rate and VO2 reserve in healthy men

OBJECTIVE

This study investigated step rates (SR) during overground walking to estimate the relative aerobic capacity that corresponds to a moderate intensity.

METHODS

The present study utilized a repeated measure, within-subjects design incorporating a counterbalanced order. A total of twenty-three healthy men walked on a 119-meter oval track with artificial turf at self-selected pace (FP), 100, 120, and 140 steps/min for 6 min each while oxygen uptake (VO2), speed (in km/h), distance (in m), and steps (in steps/min) were measured.

RESULTS

During FP, participants walked an average cadence of 117 ± 9.3 steps/minclose to 120 steps/min, which corresponds to 4.7 metabolic equivalents (METs). The estimated VO2 reserve was 30.5% of VO2 reserve at the FP and was close to the 120 steps/min of 33.3%. At the 100 and 140 steps/min, the VO2 reserve were 24.1% and 45.2%, respectively. The regression analysis revealed that an SR of 88.2 elicited 3METs and 17.1% of VO2reserve. Additionally, an SR of 129 elicited 5.9METs and 40% of VO2 reserve.

CONCLUSIONS

This study demonstrated that a moderate walking intensity for young, healthy men corresponded to 128.9 steps per minute. A range of 120 ~ 140 steps/min for walking could be recommended as a general guideline for moderate-intensity exercise. However, concerning providing public guidelines, caution should be taken regarding determining the moderate walking intensity due to the individual's fitness level.

Physical Activity Types and Health-Related Quality of Life among Middle-Aged and Elderly Adults: The Rotterdam Study

OBJECTIVES

Physical activity (PA) is associated with health-related quality of life (HRQL). The specific PA types that provide beneficial effects in an older population remain unclear. We assessed the association of total PA, walking, cycling, domestic work, sports and gardening with HRQL in middle-aged and elderly adults.

DESIGN

Cross-sectional study.

SETTING

Rotterdam, the Netherlands.

PARTICIPANTS

5,554 participants, with a mean age of 69 years.

MEASUREMENTS

Total PA was categorized in five groups to evaluate the dose-response effect of PA and specific PA types were categorized in tertiles. HRQL was measured with the EuroQoL 5-dimension. The outcome of every HRQL domain (i.e. mobility, self-care, daily activities, pain and mood) was expressed as having any problems versus not having problems. Logistic and linear regression analyses were used, adjusting for confounders, to examine associations of total PA and PA types with HRQL domains.

RESULTS

In both middle-aged (<65 years) and elderly adults (>65 years), we found a dose-response association between total PA and better HRQL (i.e. lower odds of having problems in HRQL domains). In the middle-aged, sports was the only PA type associated with lower odds of having problems with all HRQL domains. In the elderly, all PA types were associated with less problems with HRQL domains, but cycling contributed most to the beneficial effect.

CONCLUSIONS

Total PA was associated with better HRQL. Sports and cycling were the activity types that contributed most to this association in the middle-aged and elderly, respectively. Since PA levels tend to decline with aging, cycling and sports should be promoted with the aim to improve HRQL.

Concussions and Risk Within Cultural Contexts of Play

Concussions are a type of traumatic injury caused by a jolting of the brain that disrupts normal brain function, and multiple concussions can lead to serious long-term health consequences. In this article, we examine the relationship between college students' understanding of concussions and their willingness to continue playing despite the possibility of sustaining multiple head injuries. We use a mixed-methods approach that includes participant observation, cultural domain analysis, and structured interviews. Our research finds that students hold a robust cognitive understanding of concussion yet discursively frame concussions as skeletomuscular injuries. More importantly, students affirm the importance of playing sports for themselves and others, so their decisions to risk multiple concussions must be understood within cultural and biocultural contexts of meaningful social play. We suggest that peoples' decision to risk multiple head injuries should be understood as a desire for meaningful social play rather than an uninformed health risk.

Construction workers working in musculoskeletal pain and engaging in leisure-time physical activity: Findings from a mixed-methods pilot study

BACKGROUND

While exercise has been shown to be beneficial for some musculoskeletal pain conditions, construction workers who are regularly burdened with musculoskeletal pain may engage less in leisure-time physical activity (LTPA) due to pain. In a small pilot study, we investigate how musculoskeletal pain may influence participation in LTPA among construction workers.

METHODS

A sequential explanatory mixed-methods design was employed using a jobsite-based survey (n = 43) among workers at two commercial construction sites and one focus group (n = 5).

RESULTS

Over 93% of these construction workers reported engaging in LTPA and 70% reported musculoskeletal pain. Fifty-seven percent of workers who met either moderate or vigorous LTPA guidelines reported lower extremity pain (i.e., ankle, knee) compared with 21% of those who did not engage in either LTPA (P = 0.04). Focus group analyses indicate that workers felt they already get significant physical activity out of their job because they are "moving all the time and not sitting behind a desk." Workers also felt they "have no choice but to work through pain and discomfort [as the worker] needs to do anything to get the job done."

CONCLUSION

Pilot study findings suggest that construction workers not only engage in either moderate or vigorous LTPA despite musculoskeletal pain but workers in pain engage in more LTPA than construction workers without pain.

Effects of an exercise programme for chronically ill and mobility-restricted elderly with structured support by the general practitioner's practice (HOMEfit) - study protocol of a randomised controlled trial

BACKGROUND

Exercise programmes can be administered successfully as therapeutic agents to patients with a number of chronic diseases and help to improve physical functioning in older adults. Usually, such programmes target either healthy and mobile community-dwelling seniors or elderly individuals living in nursing institutions or special residences. Chronically ill or mobility-restricted individuals, however, are difficult to reach when they live in their own homes.A pilot study has shown good feasibility of a home-based exercise programme that is delivered to this target group through cooperation between general practitioners and exercise therapists. A logical next step involves evaluation of the effects of the programme.

METHODS/DESIGN

The study is designed as a randomised controlled trial. We plan to recruit 210 patients (≥ 70 years) in about 15 general practices.The experimental intervention (duration 12 weeks)-a multidimensional home-based exercise programme-is delivered to the participant by an exercise therapist in counselling sessions at the general practitioner's practice and on the telephone. It is based on methods and strategies for facilitating behaviour change according to the Health Action Process Approach (HAPA). The control intervention-baseline physical activities-differs from the experimental intervention with regard to content of the counselling sessions as well as to content and frequency of the promoted activities.Primary outcome is functional lower body strength measured by the "chair-rise" test. Secondary outcomes are: physical function (battery of motor tests), physical activity (step count), health-related quality of life (SF-8), fall-related self-efficacy (FES-I), and exercise self-efficacy (SSA-Scale).The hypothesis that there will be differences between the two groups (experimental/control) with respect to post-interventional chair-rise time will be tested using an ANCOVA with chair-rise time at baseline, treatment group, and study centre effects as explanatory variables. Analysis of the data will be undertaken using the principle of intention-to-treat.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN17727272.

Energy Management of People in Organizations: A Review and Research Agenda

Although energy is a concept that is implied in many motivational theories, is hardly ever explicitly mentioned or researched. The current article first relates theories and research findings that were thus far not explicitly related to energy. We describe theories such as flow, subjective well-being, engagement and burn-out, and make the link with energy more explicit. Also, we make a first link between personality characteristics and energy, and describe the role of leadership in unleashing followers' energy. Following, we identify how the topic of energy management can be profitably incorporated in research from a scientific as well as a practitioner viewpoint. Finally, we describe several interventions to enhance energy in individuals and organizations.

Cornering the Market: Restriction of Retail Supermarket Locations

A major source of healthy foods, North American supermarkets have become larger in recent years, with new stores opening and older stores closing. Upon closure, there is evidence of some supermarket sites being placed under restrictive covenants, a practice that restricts future use of the site. The purpose is usually to limit food sales at the location, thus minimizing competition for a chain's nearby stores. In Edmonton, Alberta eighteen covenants have been documented on former supermarket sites. At six of these sites, termed food desolated, there is no operating supermarket within walking distance (800 m) of the former stores. The covenants disproportionately affect senior citizens as neighbourhoods with covenants have a significantly higher percentage of seniors than those neighbourhoods without covenants. Results of a group interview with community leaders from a neighbourhood that lost a supermarket and historical case study also point to the restrictive covenants resulting in difficulties for seniors accessing healthy food.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18

BACKGROUND

The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease.

OBJECTIVES

The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH STRATEGY

The search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to rate each study's methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured.

MAIN RESULTS

13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects.

AUTHORS' CONCLUSIONS

Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time.

Physical activity level and health-related quality of life in the general adult population: a systematic review

OBJECTIVE

Little is known regarding health-related quality of life and its relation with physical activity level in the general population. Our primary objective was to systematically review data examining this relationship.

METHODS

We systematically searched MEDLINE, EMBASE, CINAHL, and PsycINFO for health-related quality of life and physical activity related keywords in titles, abstracts, or indexing fields.

RESULTS

From 1426 retrieved references, 55 citations were judged to require further evaluation. Fourteen studies were retained for data extraction and analysis; seven were cross-sectional studies, two were cohort studies, four were randomized controlled trials and one used a combined cross sectional and longitudinal design. Thirteen different methods of physical activity assessment were used. Most health-related quality of life instruments related to the Medical Outcome Study SF-36 questionnaire. Cross-sectional studies showed a consistently positive association between self-reported physical activity and health-related quality of life. The largest cross-sectional study reported an adjusted odds ratio of "having 14 or more unhealthy days" during the previous month to be 0.40 (95% Confidence Interval 0.36-0.45) for those meeting recommended levels of physical activity compared to inactive subjects. Cohort studies and randomized controlled trials tended to show a positive effect of physical activity on health-related quality of life, but similar to the cross-sectional studies, had methodological limitations.

CONCLUSION

Cross-sectional data showed a consistently positive association between physical activity level and health-related quality of life. Limited evidence from randomized controlled trials and cohort studies precludes a definitive statement about the nature of this association.

Validation of the intensity of walking for pleasure in obese adults

BACKGROUND

Despite evidence that 'walking for pleasure' represents the most common leisure-time physical activity, the exercise intensity associated with 'walking for pleasure' in the obese has not been established.

METHODS

Heart rate (HR), perceived exertion (RPE) and walking speed were assessed for 30 obese and 20 non-obese adults as they completed two 2 km-walk tests on alternate days and were compared with a third 2 km walk with subjects walking 'as fast as possible'.

RESULTS

Despite both obese (O) and non-obese (NO) groups rating the intensity of 'walking for pleasure' as 'light', HR and RPE data for only the NO group complied with definitions of 'light' intensity effort. 'Walking for pleasure' was characterised by a higher absolute (15 bpm, P < 0.05) and relative (70% of predicted maximum, P < 0.01) HR in the O group, which was representative of the transition between 'moderate' and 'hard' intensity exercise. The findings in the third, maximal trial were comparable across groups for all variables.

CONCLUSION

Adiposity exerts a relative elevation-of-intensity effect on the cardiovascular system at walking speeds consistent with 'walking for pleasure'. 'Walking for pleasure' is sufficient to improve cardiovascular fitness in obese, but not normal-weight, individuals.

Physical activity of moderate intensity in leisure time and the risk of all cause mortality

BACKGROUND

There are conflicting data about the health benefits of moderately intense physical activity.

OBJECTIVES

To examine the effect of such activity on all cause mortality in a German sample of men and women.

METHODS

Physical activity during leisure time of 3742 men and 3445 women aged 30 to 69 was assessed in a baseline questionnaire from 1984 to 1986. The participants were observed during the follow up period until 1998 when a mortality follow up was conducted.

RESULTS

During the follow up period, 300 women and 643 men had died. The multivariate rate ratios (RR) for the volume of lifestyle activities of moderate intensity (for example, gardening, walking, cycling) compared with sedentary lifestyle showed a clearly protective dose-response relation (p for trend <0.001) in women but not in men (p for trend 0.20). Following the recommendation for health enhancing physical activity a second analysis was conducted; 2.5 hours per week taking part in physical activity of moderate intensity decreased the relative risk of overall mortality (0.65 (95% confidence interval, 0.51 to 0.82) and 0.90 (0.77 to 1.01) for women and men, respectively).

CONCLUSIONS

The volume of lifestyle activities of moderate intensity in leisure time was inversely associated with all cause mortality in women but not in men. With regard to the health enhancing physical activity recommendation as a threshold, there were favourable findings only in women.

Efeito do treinamento físico como modulador positivo nas alterações no eixo neuroimunoendócrino em indivíduos com insuficiência cardíaca crônica: possível atuação do fator de necrose tumoral-alfa

O exercício físico crônico ou o treinamento físico (TF) tem sido largamente utilizado nos últimos anos com finalidade terapêutica e preventiva em uma série de condições fisiopatológicas, incluindo doenças cardiovasculares. Além dos benefícios cardiovasculares, o TF modula a expressão elevada de citocinas pró-inflamatórias, atuando sobre o eixo neuroimunoendócrino. Atualmente, o quadro de insuficiência cardíaca crônica (ICC) tem sido reconsiderado como uma interação entre mecanismos hemodinâmicos, neurormonais, endócrinos e imunológicos. Esta resposta inflamatória anormal, incluindo a elevada expressão de citocinas pró-inflamatórias, tem sido proposta como responsável pela progressão e deterioração clínica na ICC. Neste quadro, a principal citocina envolvida no quadro fisiopatológico da ICC é o fator de necrose tumoral-alfa (TNF-alfa). Assim, o TF pode atuar no quadro de ICC de duas maneiras, melhorando o desempenho durante o exercício físico, bem como atenuando do quadro deletério de elevada concentração de citocinas pró-inflamatórias no sistema cardiovascular, podendo representar importante opção imunomodulatória e, desta forma, permitir melhora significativa no quadro clínico do paciente.

Physical activity, physical fitness, and general health perception among individuals with rheumatoid arthritis

OBJECTIVE

To describe self-reported physical activity and physical fitness and to identify correlates of physical activity and general health perception.

METHODS

Data on self-reported physical activity, physical fitness, activity performance, and disease activity were collected from a sample of 298 patients with rheumatoid arthritis (RA).

RESULTS

Forty-seven percent of our sample reported physical activity behaviors that did not comply with public health recommendations. A majority of the patients had decreased lower-limb muscle function (72%), grip force (94%), joint motion (94%), and functional balance (68%). Correlations between self-reported physical activity and other variables were r(s) = 0.25 or less. Variation in general health perception was explained (total adjusted R(2) = 0.65) by pain and activity performance.

CONCLUSION

Our findings indicate that there is a case for recommendations on and support for healthy physical activity behaviors among people with RA.

Urban form and older residents' service use, walking, driving, quality of life, and neighborhood satisfaction

PURPOSE

This study explored the relationship between pedestrian-friendly urban form as reflected in new urbanism design guidelines, and neighborhood service use, walking, driving, quality of life, and neighborhood satisfaction among older women.

DESIGN

A cross-sectional survey compared residents of census tracts similar indemographic characteristics but differing in urban form.

SETTING

The setting was urban and suburban areas of Portland, Oregon.

SUBJECTS

The sample consisted of 372 females living alone over age 70 in six census tracts; 133 (36%) completed surveys.

MEASURES

The New Urbanism Index rated the physical features of respondents' neighborhoods. The Neighborhood Resident Survey assessed travel modes and neighborhood satisfaction. The Quality of Life Index measured resident well-being. The Dartmouth COOP Functional Health Charts measured health status. Group comparisons were made with t-tests and regression analysis.

RESULTS

Although limited by the cross-sectional design, the study showed that new urbanism partially explained several differences in service use and activity: distance to a grocery store (r2 change = .11, p = .001), number of services used within 1 mile from home (r2 change = .06, p = .007), number of walking activities (r2 change = .08, p = .001), number of services accessed by walking (r2 change = .14, p = .000), and number of services accessed by driving (r2 change = .05, p = .001).

CONCLUSIONS

Traditional urban neighborhoods with mixed services and good pedestrian access were associated with increased walking among older residents.

Participation in Physical Activity by Persons Living with HIV Disease

Physical activity (PA) may offer substantial health benefits for persons with HIV disease. The purpose of this study is to describe and explore physical activity behaviors in a sample of persons living with HIV disease. This descriptive correlational study surveyed 78 persons (n = 70 men; n = 8 women) from two outpatient settings. Results showed somewhat fewer of the participants met Healthy People 2010 PA recommendations than persons in the general population. Walking was the preferred PA. Average functional social support was significantly correlated with (a) weekly frequency of performing moderate 30-minute PA (r = .38, p < .01) and (b) HIV-RNA (viral load) values (r = -.37, p < .05). Significant correlations were also found between scores on general health status self-reported CD4+ cell counts (.33, p < .05) and HIV-RNA (.39, p < .05) values. Total friend functional social support was significantly (.32, p < .01) correlated with weekly frequency of moderate or vigorous PA.

Physical Activity and Cardiovascular Health in Aging Women: A Health-Promotion Perspective

Cardiovascular disease is the leading cause of death in women. The purpose of this study was to explore the relationship between physical activity and other determinants of cardiovascular health in aging women from a health-promotion perspective. Participants (N= 206) completed a cardiovascular health-promotion profile, and various physical measures were recorded. The findings suggest that physically active aging women, especially those who exercise regularly or vigorously, have healthier cardiovascular profiles than do their less active counterparts. They were more likely to be members of a health and fitness facility, to be younger, and have higher socioeconomic status. Their diets were healthier, and their perception of their health status was more positive. Physical measures of cardiovascular health also decreased with increased levels of activity (p< .05). These findings validate physical activity promotion as an effective strategy to ameliorate the cardiovascular health profile of aging women. The study also lends support for population-based cardiovascular health-promotion strategies.

Effectiveness of a home-based exercise intervention for HIV-infected adults: a randomized trial

The authors conducted a randomized controlled trial to assess the impact of a 15-week (20 minutes three times per week) home-based aerobic exercise intervention versus usual care on the physical endurance, immune status, and self-reported health status of 99 HIV-infected adults. In the exercise group, there was no improvement in physical endurance or health-related quality of life (HRQOL), except in the Medical Outcomes Study-HIV Health Survey Overall Health subscale (difference = 12.1, 95% confidence interval = 2.0-22.2, p = .02). Although physical endurance levels were maintained at baseline levels in the intervention group and declined in the control group, differences between the groups were small and not significant. There were also no significant changes in CD4+ T-lymphocyte counts. Exercise appears to be safe in HIV-infected patients. Improvements in physical endurance and HRQOL might result if the exercise protocol is longer or progressive. Further research is needed to establish guidelines for exercise in patients on highly active antiretroviral therapy.

A worksite intervention module encouraging the use of stairs: results and evaluation issues

OBJECTIVES

Recent recommendations suggest that health benefits can also be derived from regular daily activities of moderate intensity which accelerate breathing, such as climbing stairs. The purpose of this study was to examine the effect of an intervention programme on behaviour change in stair use in a working environment.

METHODS

Intervention field workers were instructed to offer attractive or pull actions. 338 employees of four offices of the Swiss federal government were involved in the evaluation. Two methods were used to assess stair and lift use both before and after the four month intervention period: a non-covered personal observation and an automatic measurement.

RESULTS

Taking all four offices together, a significant increase in stair use, from 61.8% to 67.1% (p = 0.028), was found between the baseline and the follow-up observation. The automatic measurement during observation time reveals a change in stair use from 68.8% to 71.4% (p = 0.268). The pattern of stair use examined for 24 hours by automatic means, however, was not so consistent. Due to the proportion of stair use in each office it is assumed that environmental factors influences the behaviour. The highest percentage of stair use at baseline (86.2%) was identified in an office with a bright stairwell and a small number of steps between floors. The lowest proportion (31.4%) was observed in an office with a dark stairwell, a large number of steps between floors and a stairwell accessible only with a key.

CONCLUSIONS

However, our findings indicate that intervention with "rewarding" elements encourage individuals to use stairs.

Job characteristics and leisure physical activity

OBJECTIVES

This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically.

METHODS

Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one's job.

RESULTS

Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise.

DISCUSSION

The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.

A controlled trial of the health benefits of regular walking on a golf course

PURPOSE

To study the effects of regular walking during a golf game on various health and fitness indicators in middle-aged men.

METHODS

Study subjects were 55 healthy male golfers aged 48 to 64 years who had been sedentary during the 7 months before the study, and 55 age-matched, similarly sedentary controls. During the 20-week study, those in the intervention group were encouraged to play golf two to three times a week; the controls were not. Measurements of body composition, cardiorespiratory performance, motor and musculoskeletal fitness, blood pressure, and serum lipid, glucose, and insulin levels were obtained at baseline and after the 20-week study.

RESULTS

Walking during a golf game was a practical and safe form of physical activity with high adherence. It significantly increased aerobic performance and trunk muscle endurance, with a net difference (pretraining to posttraining change between the golfers and controls) of 36 seconds (95% confidence interval [CI]: 19 to 53 seconds, P < 0.001) for treadmill walking time and 13 seconds (95% CI: 2 to 24 seconds, P = 0.02) for static back extension. In addition, regular walking favorably affected body composition, including reductions in weight of 1.4 kg (95% CI: 0.6 to 2.1 kg, P < 0.001), in waist circumference of 2.2 cm (95% CI: 1.0 to 3.3 cm, P < 0.001), and in abdominal skin fold thickness of 2.2 cm (95% CI: 0.9 to 3.4 cm, P = 0.001). Golfers also had significantly greater increases in serum high-density lipoprotein (HDL) cholesterol levels and in the ratio of HDL cholesterol to total cholesterol.

CONCLUSIONS

Regular walking had many positive effects on the health and fitness of sedentary middle-aged men. Walking during a golf game is characterized by high adherence and low risk of injury and is therefore a good form of health-enhancing physical activity.