Estimating physical activity level: the role of domestic activities

Predictors of CRC Stage at Diagnosis among Male and Female Adults Participating in a Prospective Cohort Study: Findings from Alberta's Tomorrow Project

Colorectal cancer (CRC) is a leading cause of morbidity and mortality in Canada. CRC screening and other factors associated with early-stage disease can improve CRC treatment efficacy and survival. This study examined factors associated with CRC stage at diagnosis among male and female adults using data from a large prospective cohort study in Alberta, Canada. Baseline data were obtained from healthy adults aged 35–69 years participating in Alberta’s Tomorrow Project. Factors associated with CRC stage at diagnosis were evaluated using Partial Proportional Odds models. Analyses were stratified to examine sex-specific associations. A total of 267 participants (128 males and 139 females) developed CRC over the study period. Among participants, 43.0% of males and 43.2% of females were diagnosed with late-stage CRC. Social support, having children, and caffeine intake were predictors of CRC stage at diagnosis among males, while family history of CRC, pregnancy, hysterectomy, menopausal hormone therapy, lifetime number of Pap tests, and household physical activity were predictive of CRC stage at diagnosis among females. These findings highlight the importance of sex differences in susceptibility to advanced CRC diagnosis and can help inform targets for cancer prevention programs to effectively reduce advanced CRC and thus improve survival.

Household physical activity and cancer risk: a systematic review and dose-response meta-analysis of epidemiological studies

Controversial results of the association between household physical activity and cancer risk were reported among previous epidemiological studies. We conducted a meta-analysis to investigate the relationship of household physical activity and cancer risk quantitatively, especially in dose-response manner. PubMed, Embase, Web of science and the Cochrane Library were searched for cohort or case-control studies that examined the association between household physical activity and cancer risks. Random–effect models were conducted to estimate the summary relative risks (RRs), nonlinear or linear dose–response meta-analyses were performed to estimate the trend from the correlated log RR estimates across levels of household physical activity quantitatively. Totally, 30 studies including 41 comparisons met the inclusion criteria. Total cancer risks were reduced 16% among the people with highest household physical activity compared to those with lowest household physical activity (RR = 0.84, 95% CI = 0.76–0.93). The dose-response analyses indicated an inverse linear association between household physical activity and cancer risk. The relative risk was 0.98 (95% CI = 0.97–1.00) for per additional 10 MET-hours/week and it was 0.99 (95% CI = 0.98–0.99) for per 1 hour/week increase. These findings provide quantitative data supporting household physical activity is associated with decreased cancer risk in dose-response effect.

Does doing housework keep you healthy? The contribution of domestic physical activity to meeting current recommendations for health

Background

Recent lifestyle approaches to physical activity have included the promotion of domestic physical activities such as do-it-yourself or home maintenance, gardening and housework. Although it is acknowledged that any activity is better than none, there is a danger that those undertaking domestic ‘chores’ may assume that this activity is moderate intensity and therefore counts towards this 150 minute per week target The purpose of this paper was to report the contribution domestic physical activity makes to total weekly physical activity and the relationship between domestic physical activity and leanness in the Northern Ireland population.

Methods

4563 adults participated in this cross-sectional survey of physical activity behaviour. Data were collected through face-to-face interviews using computer assisted personal interviewing. Gender and age group differences in domestic MVPA activity and the ratio of domestic to total MVPA were explored using non-parametric Kruskal-Wallis tests. Self-reported volume and intensity of physical activity (in bouts of 10 minutes or more) in the home and self-reported height and weight were used to determine the association between domestic physical activity and leanness using an ANCOVA having controlled for age, gender, socio-economic and smoking status.

Results

42.7% of the population report levels of physical activity which meet or exceed the current United Kingdom recommendations. Domestic physical activity accounts for 35.6% of the reported moderate to vigorous physical activity (MVPA). For women, if domestic physical activity was excluded from total MVPA, only 20.4% would be deemed to meet current recommendations. Time spent in domestic physical activity at moderate or vigorous intensity was found to be negatively associated with leanness (P = 0.024), [R Squared = .132 (Adjusted R Squared = .125)].

Conclusions

Domestic physical activity accounts for a significant proportion of self-reported daily MVPA particularly among females and older adults however such activity is negatively associated with leanness suggesting that this activity may not be sufficient to provide all of the benefits normally associated with meeting the physical activity guidelines.

Physical activity in older people: a systematic review

BACKGROUND

Physical activity (PA) in older people is critically important in the prevention of disease, maintenance of independence and improvement of quality of life. Little is known about the physical activity of the older adults or their compliance with current physical activity guidelines.

METHODS

A systematic literature search of the published literature was conducted. Included were published reports of original research that independently reported: the PA level of non-institutional older adults (aged 60 years and over); and the proportion of older adults in the different samples who met PA recommendations or guidelines. The review was restricted to studies published since 2000 to provide a current picture of older adults' PA levels.

RESULTS

Fifty three papers were included in the review. The percentage of older adults meeting recommended physical activity ranged from 2.4 - 83.0% across the studies. Definitions of "recommended" physical activity in older adults varied across the studies as did approaches to measurement which posed methodological challenges to data analysis. Older age groups were less likely than the reference group to be regularly active, and women were less likely than men to achieve regular physical activity, especially leisure time physical activity, when measured by both subjective and objective criteria.

CONCLUSION

The review highlights the need for studies which recruit representative random samples of community based older people and employ validated measurement methods consistently to enable comparison of PA levels over time and between countries.

Prevalence of physical activity among adults in a metropolitan Nigerian city: a cross-sectional study

BACKGROUND

Baseline information on physical activity is relevant to controlling the epidemic of chronic noncommunicable diseases occurring in many African countries. However, standardized data on physical activity are lacking in Nigeria. We assessed the prevalence of physical activity and its relationships with sociodemographic characteristics in a subnational sample of Nigerian adults.

METHODS

A cross-sectional survey was conducted among a representative sample of 934 adults (age, 20-82 years) living in metropolitan Maiduguri, Nigeria. Physical activity was measured using the validated Nigerian version of the International Physical Activity Questionnaire (Hausa IPAQ-SF). Using the World Health Organization (WHO) guideline, participants were classified as sufficiently active or insufficiently active. Sociodemographic correlates of sufficient physical activity were identified using multinomial logistic regression.

RESULTS

Overall, 68.6% of Nigerian adults were sufficiently active. There was no significant difference (P > 0.05) in prevalence of physical activity between men (68.0%) and women (69.3%), but physical activity tended to decrease with increasing age category, especially among men. Physical activity prevalence was positively associated with being married (OR = 1.52, CI = 1.04-4.37) and blue collar work (OR = 2.19, CI = 1.16-4.12) and negatively associated with car ownership (OR = 0.38, CI = 0.17-0.86) and higher income (OR = 0.54, CI = 0.10-0.95).

CONCLUSIONS

The prevalence of physical activity varied between sociodemographic subgroups of Nigerian adults; thus, public health policies and interventions based on ecologic models of health behaviors may be warranted in promoting physical activity in Nigeria.

The experience of physical activity and the transition to retirement: a systematic review and integrative synthesis of qualitative and quantitative evidence

BACKGROUND

The transition to retirement has been recognised as a critical turning point for physical activity (PA). In an earlier systematic review of quantitative studies, retirement was found to be associated with an increase in recreational PA but with a decrease in PA among retirees from lower occupational groups. To gain a deeper understanding of the quantitative review findings, qualitative evidence on experiences of and views on PA around the transition to retirement was systematically reviewed and integrated with the quantitative review findings.

METHOD

19 electronic databases were searched and reference lists were checked, citations tracked and journals hand-searched to identify qualitative studies on PA around the transition to retirement, published between January 1980 and August 2010 in any country or language. Independent quality appraisal, data extraction and evidence synthesis were carried out by two reviewers using a stepwise thematic approach. The qualitative findings were integrated with those of the existing quantitative systematic review using a parallel synthesis approach.

RESULTS

Five qualitative studies met the inclusion criteria. Three overarching themes emerged from the synthesis of these studies: these related to retirees' broad concepts of PA, the motives for and the challenges to PA in retirement. Integrative synthesis of the qualitative findings with the quantitative evidence offered several potential explanations for why adults might engage in more recreational PA after the transition to retirement. These included expected health benefits, lifelong PA patterns, opportunities for socialising and personal challenges, and the desire for a new routine. A decrease in PA among retirees from lower occupational groups might be explained by a lack of time and a perceived low personal value of recreational PA.

CONCLUSIONS

To encourage adoption and maintenance of PA after retirement, interventions should promote health-related and broader benefits of PA. Interventions for retirees from lower occupational groups should take account of busy post-retirement lifestyles and the low personal value that might be attributed to recreational PA. Future research should address predictors of maintenance of recreational PA after the transition to retirement, the broader benefits of PA, and barriers to PA among retirees from lower occupational groups.

Prospective Associations Between Household-, Work-, and Leisure-Based Physical Activity and All-Cause Mortality Among Older Taiwanese Adults

Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

Relationships of leisure-time and non-leisure-time physical activity with depressive symptoms: a population-based study of Taiwanese older adults

Background

Limited research has explored the relationship between non-leisure-time physical activity (NLTPA), including domestic and work-related physical activities, with depressive symptoms. This study was designed to elucidate independent associations between leisure-time physical activity (LTPA), NLTPA, and specific parameters of physical activity (frequency, duration and intensity) with depressive symptoms in older adults.

Methods

A total of 2,727 persons aged ≥ 65 years participating in the 2005 Taiwan National Health Interview Survey were studied. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale. Information regarding energy parameters for each type of LTPA and NLTPA during the past 2-week period was analyzed. After adjusting for socio-demographic variables, lifestyle behaviors and health status, multivariate logistic regression models were used to compute adjusted odds ratios (AOR) for LTPA and NLTPA for predicting depressive symptoms.

Results

LTPA but not NLTPA was significantly associated with depressive symptoms. Compared with participants expending 2000+ kcal/week through LTPA, the risk of experiencing depressive symptoms was significantly higher for those expending 1-999 kcal/week (AOR = 2.06, 95% CI: 1.25-3.39), and those who expending 0 kcal/week (AOR = 3.72, 95%CI: 2.28-6.06). Among the three parameters of LTPA (intensity, duration and frequency) examined, only intensity was independently associated with depressive symptoms.

Conclusions

These findings imply that exercise recommendations for older adults should emphasize the importance of higher intensity activity, rather than frequency or duration, for improved mental well-being. However, well-designed prospective cohort studies or intervention trials are needed to confirm these findings.

Non-leisure time physical activity is an independent predictor of longevity for a Taiwanese elderly population: an eight-year follow-up study

Background

The aim of this study is to determine the relationship between leisure time physical activity (LTPA) and non-leisure time physical activity (NLTPA) on mortality among the elderly in Taiwan.

Methods

This is a prospective observational cohort study. We analyzed the mortality data from a cohort of 876 non-institutionalized community-dwelling men and women aged 65 years or over, who were recruited by stratified clustering random sampling from Tainan city and participated in the 1996 Elderly Medication Survey. Information about activities and other variables were collected by structured interviews at baseline in the participants' home. The Cox proportional hazards model and crude death rate were applied to estimate mortality risk.

Results

Among the 876 participants, 312 died during the follow-up period (1996-2004). In the unadjusted Cox regression model, subjects aged over 75, having difficulty in carrying out activities of daily living (ADLs), a BMI less than 18.5, a history of diabetes mellitus or stroke, without LTPA or being inactive in NLTPA, were found to have a higher risk of eight-year mortality. With the adjustment for age, gender, education level, habitual smoking and drinking, living status, BMI and medical history, the mortality was found to be higher among the sedentary subjects, either defined by lack of LTPA or NLTPA, with the hazard ratio of 1.27 (95% confidence interval [CI] = 0.97-1.66) and 1.45 (95% CI = 1.07-1.97), respectively. Furthermore, when both LTPA and NLTPA were put into the model simultaneously, NLTPA (HR = 1.40; 95% CI = 1.03-1.91) but not LTPA (HR = 1.21, 95% CI = 0.92-1.59) significantly predicted mortality during eight-year follow-up. In addition, subjects who were actively engaged in NLTPA had a lower mortality risk especially in subjects without performing LTPA.

Conclusions

NLTPA is an independent predictor of longevity among older people in Taiwan. A physically active lifestyle, especially engaged in NLTPA, is associated with lower mortality risk in the elderly population. We thus suggest that encouraging older people to keep on engaging in customary NLTPA is good for their health.

Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women

Hip fracture risk is known to increase with physical inactivity and decrease with obesity, but there is little information on their combined effects. We report on the separate and combined effects of body mass index (BMI) and physical activity on hospital admissions for hip fracture among postmenopausal women in a large prospective UK study. Baseline information on body size, physical activity, and other relevant factors was collected in 1996-2001, and participants were followed for incident hip fractures by record linkage to National Health Service (NHS) hospital admission data. Cox regression was used to calculate adjusted relative risks of hip fracture. Among 925,345 postmenopausal women followed for an average of 6.2 years, 2582 were admitted to hospital with an incident hip fracture. Hip fracture risk increased with decreasing BMI: Compared with obese women (BMI of 30+ kg/m(2) ), relative risks were 1.71 [95% confidence interval (CI) 1.47-1.97)] for BMI of 25.0 to 29.9 kg/m(2) and 2.55 (95% CI 2.22-2.94) for BMI of 20.0 to 24.9 kg/m(2). The increase in fracture risk per unit decrease in BMI was significantly greater among lean women than among overweight women (p < .001). For women in every category of BMI, physical inactivity was associated with an increased risk of hip fracture. There was no significant interaction between the relative effects of BMI and physical activity. For women who reported that they took any exercise versus no exercise, the adjusted relative risk of hip fracture was 0.68 (95% CI 0.62-0.75), with similar results for strenuous exercise. In this large cohort of postmenopausal women, BMI and physical activity had independent effects on hip fracture risk.

Changes in stepping response to lateral perturbations immediately following a single bout of physical activity

BACKGROUND AND PURPOSE

Fatiguing exercise can adversely alter postural stability and therefore may contribute to falling. However, older adults rarely perform exercise to fatigue. This study aimed to determine whether undertaking a single bout of moderate-intensity physical activity, similar to that experienced during daily activity or rehabilitation, altered the ability to recover balance with an outward step response to a lateral perturbation.

METHODS

Thirty-four healthy older adults (mean: 76±5 years) and 31 healthy young adults (29±6 years) underwent a 14-minute, self-paced, moderate-intensity physical activity protocol. Before and immediately after the protocol, their responses to lateral waist-pull perturbations were recorded. For participants who used a single outward step response before and after the perturbation, the changes to the timing of the step phases and the hip abductor muscle activity onsets were compared.

RESULTS

Young adults responded with an outward step in 55% of trials before and 70% after activity, whereas this frequency was 35% before and 36% after among older adults. When performed, the timing of steps and muscle activity onsets were not adversely altered following the physical activity in either group, apart from a slightly later stance limb gluteus medius onset after activity, found in both groups.

CONCLUSIONS

Before and after activity, older adults responded with a single outward step to arrest a fall less frequently than young adults. This may place older adults at risk of overbalancing. However, when responding with this strategy, both young and older adults demonstrated few changes immediately following moderate-intensity physical activity compared with before. They appear to be not adversely affected by moderate physical activity.

Conference on "Multidisciplinary approaches to nutritional problems". Symposium on "Performance, exercise and health". Exercise in improving health v. performance

Regular and goal-appropriate exercise is critical to improving and maintaining both health and performance. However, the frequency, intensity, duration and type of activities needed to optimise health or achieve successful sports performance will differ considerably depending on an individual's goals and capabilities. Although sport is one of many forms of exercise that can be counted towards daily physical activity, participation in sport is not necessary to meet current physical activity recommendations. The current consensus is that the minimum amount of physical activity needed to improve and maintain good health is 30 min moderate-intensity activity/d on > or = 5 d/week. The evidence supporting this consensus is based on predominantly observational evidence that performing regular aerobic (endurance)-type physical activity is associated with reduced morbidity and premature mortality from CVD, CHD, stroke and colo-rectal cancer. The exact dose needed to improve health and the slope of the dose-response gradient between physical activity and mortality for various diseases are not known, and one major limitation of the existing evidence is the lack of objective measurement of physical activity. Limited evidence indicates that a much higher dose of activity (45-90 min each day on > or = 5 d/week) may be needed to prevent overweight and obesity and to avoid weight regain in previously overweight and obese individuals. The role of resistance training and heavy domestic work in reducing morbidity and premature mortality for various diseases is unclear. As most adults do not meet current recommendations there is a critical need for innovative approaches to increase physical activity across large-scale populations.

The prevalence and correlates of physical inactivity among adults in Ho Chi Minh City

Background

Socioeconomic changes have led to profound changes in individuals' lifestyles, including the adoption of unhealthy food consumption patterns, prevalent tobacco use, alcohol abuse and physical inactivity, especially in large cities like Ho Chi Minh City (HCMC). The Stepwise Approach to Surveillance of Non-communicable Disease Risk Factors survey was conducted to identify physical activity patterns and factors associated with 'insufficient' levels of physical activity for health in adults in HCMC.

Methods

A cross-sectional survey was conducted in 2005 among 1906 adults aged 25–64 years using a probability proportional to size cluster sampling method to estimate the prevalence of non-communicable disease risk factors including physical inactivity. Data on socioeconomic status, health behaviours, and time spent in physical activity during work, commuting and leisure time were collected. Physical activity was measured using the validated Global Physical Activity Questionnaire (GPAQ). Responders were classified as 'sufficiently active' or 'insufficiently active' using the GPAQ protocol. Correlates of insufficient physical activity were identified using multivariable logistic regression.

Results

A high proportion of adults were physically inactive, with only 56.2% (95% CI = 52.1–60.4) aged 25–64 years in HCMC achieving the minimum recommendation of 'doing 30 minutes moderate-intensity physical activity for at least 5 days per week'. The main contributors to total physical activity among adults were from working and active commuting. Leisure-time physical activity represented a very small proportion (9.4%) of individuals' total activity level. Some differences in the pattern of physical activity between men and women were noted, with insufficient activity levels decreasing with age among women, but not among men. Physical inactivity was positively associated with high income (OR = 1.77, 95% CI = 1.05–2.97) and high household wealth index (OR = 1.86, 95% CI = 1.29–2.66) amongst men.

Conclusion

Public health policies and programs to preserve active commuting in HCMC and to promote time spent in recreational physical activity in both genders and across all age groups, but especially among young adults, will be critical in any comprehensive national plan to tackle inactivity. Clear and consistent national recommendations about how much physical activity Vietnamese people need for preventing and managing non-communicable diseases should also be part of this population-wide promotional effort.

Temporal trends in physical activity in England: the Health Survey for England 1991 to 2004

OBJECTIVES

Physical activity is an established risk factor for chronic disease but very little is known about its temporal trends in England. Such information is crucial for planning public health interventions.

METHODS

We explored temporal trends in occupational activity, walking, domestic activity, and sports using Health Survey for England data in 95,342 adults aged 16 and over. Data were collected annually in 1991-4, 1997-9, and 2003-04. Multivariate logistic regression and multiple linear regression models assessed trends in physical activity for dichotomous and continuous outcomes, respectively. Analyses were adjusted for age and social class.

RESULTS

Physical activity levels at work declined over time but there was a consistent and significant upward trend in regular sports participation among all age groups. Changes in questions in 1997 and 1999 confounded trends in walking and heavy domestic activity and total physical activity. Between 1999 and 2004 (when physical activity questions remained unchanged), there were significant increases in average time spent in all activity types and the percentage of adults meeting the current physical activity recommendations. These short-term increases were more marked among adults aged 35 to 64.

CONCLUSION

The common perception that overall physical activity levels are declining may be over-simplistic as despite the decreases in occupational physical activity, there is a clear upward trend in sports participation. Changes in the measuring methodology over time preclude the presentation of a clear picture of the total temporal trends in physical activity in England.

Longitudinal relationships between occupational and domestic physical activity patterns and body weight in China

OBJECTIVES

To examine the longitudinal relationship between occupational and domestic sources of physical activity and body weight in a sample of Chinese adults.

METHODS

Population-based longitudinal observational study of Chinese adults (4697 women and 4708 men) aged 18-55 from the 1991, 1993, 1997, and 2000 waves of the China Health and Nutrition Survey. Measured height and weight and detailed self-reported energy expenditure from multiple occupational and domestic sources were assessed over a 9-year period. Longitudinal relationships were modeled using linear random effects models.

RESULTS

Increased occupational physical activity resulted in overall lower body weight for both men and women (beta-coefficients (95% confidence interval (CI)) for high levels: -0.46 (-0.76, -0.15) for men, -0.36 (-0.62, -0.10) for women, and increased domestic physical activity resulted in overall lower body weight in men (beta-coefficient (95% CI): -0.40 (-0.62, -0.18)).

CONCLUSIONS

Physical activity that occurs in the occupational and domestic sectors is often overlooked; yet our research suggests they have important effects on body weight in Chinese adults. As China continues to urbanize, energy expenditure from these sources is decreasing, and our results point out the need to explore these types of physical activity more broadly across the world as potential sources of weight gain.