Associations of Various Physical Activities with Mortality and Life Expectancy are Mediated by Telomere Length

OBJECTIVES

Physical activity (PA) and telomeres both contribute to healthy aging and longevity. To investigate the optimal dosage of various PA for longevity and the role of telomere length in PA and mortality.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

A total of 333,865 adults (mean age of 56 years) from the UK Biobank were analyzed.

METHODS

Walking, moderate PA (MPA), and vigorous PA (VPA) were self-reported via questionnaire, and leukocyte telomere length (LTL) was measured. Cox proportional hazards regression was used to predict all-cause mortality risk. A flexible parametric Royston-Parmar survival model was used to estimate life expectancy.

RESULTS

During a median follow-up of 13.8 years, 19,789 deaths were recorded. Compared with the no-walking group, 90 to 720 minutes/week of walking was similarly associated with 27% to 31% of lower mortality and about 6 years of additional life expectancy. We observed nearly major benefits for mortality and life expectancy among those meeting the PA guidelines [151-300 minutes/wk for MPA: hazard ratio (HR) 0.80, 95% CI 0.75-0.85, 3.40-3.42 additional life years; 76-150 minutes/wk for VPA: HR 0.78, 95% CI 0.75-0.82, 2.61 years (2.33-2.89)] vs the no-PA group. Similar benefits were also observed at 76-150 and 301-375 minutes/wk of MPA (18%-19% lower mortality, 3.20-3.42 gained years) or 151-300 minutes/wk of VPA (20%-26% lower mortality, 2.41-2.61 gained years). The associations between MPA, VPA, and mortality risk were slightly mediated by LTL (≈1% mediation proportion, both P < .001).

CONCLUSIONS AND IMPLICATIONS

Our study suggests a more flexible range of PA than the current PA guidelines, which could gain similar benefits and is easier to achieve: 90 to 720 minutes/wk of walking, 75 to 375 minutes/wk of MPA, and 75 to 300 minutes/wk of VPA. Telomeres might be a potential mechanism by which PA promotes longevity.

Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review

INTRODUCTION

The evidence supporting the cardiovascular health benefits of physical activity and/or exercise training is well-established. While the role of physical activity in primary prevention is unequivocal, its significance in secondary prevention (among those with preexisting cardiovascular disease) is less definitive. Though guidelines universally recommend physical activity as part of the secondary preventive strategy, the empirical evidence underpinning these recommendations is not as robust as that for primary prevention.

AREAS COVERED

This review distills the body of available observational and interventional evidence on the relationship between physical activity, exercise, and adverse cardiovascular outcomes among those with preexisting cardiovascular disease. The postulated biologic mechanisms underlying the relationships, areas of prevailing uncertainty, and potential public health implications are also discussed.

EXPERT OPINION

A physical activity level of 500 MET-min/week (equivalent to 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity or an equivalent combination) may be a minimum requirement for patients with preexisting CVD. However, to reap the maximum benefits of physical activity and also minimize adverse effects, physical activity and/or exercise regimens should be tailored to unique factors such as individual's baseline physical activity habits, cardiovascular health status and the specific nature of their cardiovascular disease.

Associations between neighborhood walkability and walking following residential relocation: Findings from Alberta's Tomorrow Project

Introduction

Cross-sectional studies consistently find that the neighborhood built environment (e.g., walkability) is associated with walking. However, findings from the few existing longitudinal residential relocation studies that have estimated associations between changes in neighborhood built characteristics and walking are equivocal. The study objective was to estimate whether changes in neighborhood walkability resulting from residential relocation were associated with leisure, transportation, and total walking levels among adults.

Methods

This study included longitudinal data from the "Alberta's Tomorrow Project"-a province-wide cohort study (Alberta, Canada). The analysis included data collected at two time points (i.e., baseline and follow-up) from 5,977 urban adults. The International Physical Activity Questionnaire (IPAQ) captured self-reported walking. We estimated neighborhood walkability, an index capturing intersection, destination, and population counts for the 400 m Euclidean buffer around participants' homes. Using household postal codes reported at baseline and follow-up, we categorized participants into three groups reflecting residential relocation ("non-movers:" n = 5,679; "movers to less walkability:" n = 164, and; "movers to more walkability:" n = 134). We used Inverse-Probability-Weighted Regression Adjustment to estimate differences [i.e., average treatment effects in the treated (ATET)] in weekly minutes of leisure, transportation, and total walking at follow-up between residential relocation groups, adjusting for baseline walking, sociodemographic characteristics, and walkability. The median time between baseline and follow-up was 2-years.

Results

The three residential relocation groups mainly included women (61.6-67.2%) and had a mean age of between 52.2 and 55.7 years. Compared to "non-movers" (reference group), weekly minutes of transportation walking at follow-up was significantly lower among adults who moved to less walkable neighborhoods (ATET: -41.34, 95 CI: -68.30, -14.39; p < 0.01). We found no other statistically significant differences in walking between the groups.

Discussion

Our findings suggest that relocating to less walkable neighborhoods could have detrimental effects on transportation walking to the extent of adversely affecting health. Public health strategies that counteract the negative impacts of low walkable neighborhoods and leverage the supportiveness of high walkable neighborhoods might promote more walking.

Physical Activity Tracker Application in Promoting Physical Activity Behavior among Older Adults: A 24-month Follow-Up Study

Objectives

To investigate whether and how PA tracker application use supports PA behavior among older adults during the first 24 months of use. Methods: The changes in PA levels (i.e., time spent in different PA intensities) and between PA categories (i.e., low, moderate, or high based on total PA) were examined between three different time points: before taking the application into use (t0), after 12 months of use (t1), and after 24 months of use (t2). The data was collected by using the International Physical Activity Questionnaire modified for the elderly (IPAQ-E). Results: A statistically significant increase was observed in walking (χ2 (2) = 29.741, p < .001), moderate PA (χ2 (2) = 6.327, p = .042), and total PA levels (χ2 (2) = 11.489, p = .003). The increase was observed between t0 and t1 as well as between t0 and t2. The overall changes between PA categories were statistically significant between t0 and t1 (χ2 (3) = 15.789, p = .001) as well as between t0 and t2 (χ2 (3) = 14.745, p = .002). There were more increasingly active (moved to a higher PA category) than decreasingly active (moved to a lower PA category) participants. Discussion: Overall, the results indicate that PA tracker application use can promote PA behavior among older adults. Stakeholders that work with PA programs and PA promotion, as well as individual users, can utilize digital wellness technologies in supporting PA promotion, especially in exceptional times, like the COVID-19 pandemic, when health care restrictions prevent general gatherings.

Salivary concentrations of IL-8 and IL-1ra after HIIT and MICT in young, healthy adults: A randomized exercise study

The purpose of this study was to determine whether six weeks of high intensity interval training (HIIT) would lead to greater changes in resting concentrations of salivary IL-8 and IL-1ra than moderate intensity continuous training (MICT) in young, healthy adults, and to determine whether changes in IL-8 and IL-1ra after six weeks of either HIIT or MICT were associated with changes in maximal exercise capacity (VO₂max). Participants were randomly assigned to 6 weeks of HIIT (n = 12) or MICT (n = 11), matched for workload. Saliva samples were collected at the beginning (T1) and end (T2) of the intervention, and analyzed for IL-8 and IL-1ra. Participants in both groups had significant improvements in VO₂max; there were no group differences in improvements. A greater reduction in IL-8 was observed in the MICT group when compared to the HIIT group (HIIT median: -9.5; MICT median: -82.3 pg/µg of protein; U = 11.5, p < 0.001). When combining the HIIT and MICT group, there were significant reductions in IL-8 from T1 to T2. There was no correlation between changes in IL-8 (r < 0.00) or IL-1ra (r = -0.013) with changes in VO₂max. In conclusion, 6 weeks of exercise training leads to a reduction in IL-8; MICT may lead to greater reductions when compared to HIIT. Future research examining longer intervention periods is needed to further elucidate the effects of HIIT and MICT on different pro and anti-inflammatory cytokines.

THE EFFECTIVENESS OF AN 8-WEEK PHYSICAL ACTIVITY INTERVENTION INVOLVING WEARABLE ACTIVITY TRACKERS AND AN eHEATLH APPLICATION: A MIXED METHODS STUDY

BACKGROUND

Health promotion interventions incorporating wearable technology or eHealth applications can encourage participants to self-monitor and modify their physical activity and sedentary behavior. In 2020, a Calgary (Canada) recreational facility developed and implemented a health promotion intervention (Vivo Play Scientist program) that provided commercially-available wearable activity tracker (WT) and a customized eHealth dashboard to participants, free-of-cost.

OBJECTIVE

To independently evaluate the effectiveness of the Vivo Play Scientist program for modifying physical activity and sedentary behavior during the initial 8-weeks of the piloted intervention.

METHODS

Our concurrent mixed-methods study included a single-arm repeated-measures quasi-experiment and semi-structured interviews. Among the 318 eligible participants (≥18 years of age) registered for the program, 87 completed three self-administered online surveys (baseline, T0; 4-weeks, T1; and 8-weeks, T2). The survey captured physical activity, sedentary behavior, use of wearable technology and eHealth applications, and sociodemographic characteristics. Twenty-three participants were recruited using maximal variation sampling, and completed telephone-administered semi-structured interviews regarding their program experiences. Self-reported physical activity and sedentary behavior outcomes were statistically compared between the three time points using Friedman's tests. Thematic analysis was used to analyze the interview data.

RESULTS

The mean age of participants was 39.8 (SD 7.4) years and 74.7% were female. Approximately half of all participants had previously used wearable technology (46.0%) or an eHealth application (49.4%) prior to the intervention. On average, participants reported wearing the WT (Garmin Vivofit4) on 6.4 (SD 1.7) days in the past week at T1 and on 6.0 (SD 2.2) days in the past week at T2. On average participants reported using the dashboard on 1.6 (SD 2.1) days in the past week at T1 and 1.0 (SD 1.8) days in the past week at T2. The mean time spent walking at 8-weeks was significantly higher compared with baseline (T0 180.34 vs. T2 253.79 min/week, P=.005), with no significant differences for other physical activity outcomes. Compared to baseline, the mean time spent sitting was significantly lower at 4-weeks (T0 334.26 vs. T1 260.46 min/day, P<.001) and 8-weeks (T0 334.26 vs. T2 267.13 min/day, P<.001). Significant differences in physical activity and sitting between time points were found among subgroups based on the household composition, history of wearable technology use, and history of eHealth applications use. Participants described how wearing the Vivofit4 was beneficial in helping them to modify physical activity and sedentary behavior. The social support as a result of multiple members of the same household participating in the program, motivated changes in physical activity. Participants experienced improvements in their mental, physical, and social health.

CONCLUSIONS

Providing individuals with free-of-cost commercially-available wearable technology and an eHealth application has the potential to support increases in physical activity and reduce sedentary behavior in the short-term, even under COVID-19 public health restrictions.

CLINICALTRIAL

How junior doctors perceive personalised yoga and group exercise in the management of occupational and traumatic stressors

OBJECTIVES

Junior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors.

METHODS

Twenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme.

RESULTS

Many participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: 'It was really eye opening how much I felt my body just needed to detox … I wouldn't have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20).'

CONCLUSION

Junior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection.