Physical activity patterns and socioeconomic position: the German National Health Interview and Examination Survey 1998 (GNHIES98)

Evaluating the diet in Germany with two indices focusing on healthy eating and planetary healthy eating using nationwide cross-sectional food intake data from DEGS1 (2008-2011)

PURPOSE

To improve sustainability, adjustments to current diets are necessary. Therefore, limited planetary resources are considered within the healthy reference diet proposed by the EAT-Lancet Commission. The agreement with nationwide food intake was evaluated with two indices which reflect this reference and German food intake recommendations.

METHODS

A healthy eating index (HEI-MON) reflecting the dietary guidelines of the German nutrition society and a planetary healthy eating index (PHEI-MON) reflecting the healthy reference diet were developed, with scores from 0 to 100. Both indices were applied to data from a nationally representative sample of the German population aged 18-79 years for which data from a 53-item food frequency questionnaire are available.

RESULTS

Mean scores for the indices were 53 for HEI-MON and 39 for PHEI-MON. A better adherence to either guideline could be found among women, persons of older age as well as persons with higher education level. The sub-scores for HEI-MON showed high agreement with the recommendations for side dishes, fruit/nuts, (processed) meat and cereals, but low agreement with the recommendations for free sugar and vegetables/legumes. PHEI-MON sub-scores were highest for poultry, fruits and potatoes, and lowest for nuts, red meat and legumes. High scores in one index do not necessarily correspond to high scores in the other index. Individuals with more plantbased diets had higher scores in both indices, while high sugar and meat consumption led to lower scores.

CONCLUSIONS

More plant-based diets are crucial for individual and planetary health. Both indices reflect such diets which consider already health and sustainability aspects. At an individual level, the scores for both indices may differ considerably, but overall there is a huge potential in the population to adapt to a diet more in line with both guidelines.

Lifetime occupational and recreational physical activity and risk of lymphoma subtypes. Results from the European Epilymph case-control study

Physical activity is known to convey protection against several cancers. However, results on the risk of lymphoma overall and its subtypes have been inconsistent. The aim of this study was to investigate occupational and recreational physical activity in relation to risk of lymphoma subtypes adjusting for established occupational risk factors. We applied standardized tools to assess energy expenditure at work and in recreational physical activities to the questionnaire information on lifetime work and exercise history in 1117 lymphoma cases, including Hodgkin lymphoma, and B-cell (including chronic lymphocytic leukemia, and multiple myeloma) and T-cell non-Hodgkin's lymphoma (NHL) subtypes, and 1207 controls who took part in the multicentre European EpiLymph case-control study. We calculated the risk of lymphoma (all subtypes), B-cell NHL and its most represented subtypes, and Hodgkin's lymphoma (all subtypes) associated with weekly average Metabolic Equivalent of Task (MET-hours/week) and cumulative MET-hours of lifetime recreational, occupational, and total physical activity, with unconditional logistic regression and polytomous regression analysis adjusting by age, centre, sex, education, body mass index, history of farm work and solvent use. We observed an inverse association of occupational, and total physical activity with risk of lymphoma (all subtypes), and B-cell non-Hodgkin's lymphoma among women, and an upward trend in risk of Hodgkin's lymphoma with recreational and total physical activity among men, for which we cannot exclude chance or bias. Our results suggest no effect of overall physical activity on risk of lymphoma and its subtypes.

A cohort study of factors influencing the physical fitness of preschool children: a decision tree analysis

Objective

Based on the decision tree model, to explore the key influencing factors of children's physical fitness, rank the key influencing factors, and explain the complex interaction between the influencing factors.

Methods

A cohort study design was adopted. 1,276 children (ages 3-6) from 23 kindergartens in Nanchang, China, were chosen for the study to measure the children's physical fitness at baseline and a year later and to compare the physical fitness scores at the two stages. The study was conducted following the Chinese National Physical Fitness Testing Standard (Children Part); To identify the primary influencing factors of changes in physical fitness, a decision tree model was developed, and a questionnaire survey on birth information, feeding patterns, SB, PA, dietary nutrition, sleep, parental factors, and other relevant information was conducted.

Results

The levels of physical fitness indicators among preschool children showed a significant increase after 1 year. The accuracy of the CHAID model is 84.17%. It showed that 7 variables were strongly correlated with the physical changes of children's fitness, the order of importance of each variable was weekend PA, weekend MVPA, mother's BMI, mother's sports frequency, father's education, mother's education, and school day PA. Three factors are related to PA. Four factors are related to parental circumstances. In addition to the seven important variables mentioned, variables such as breakfast frequency on school day, puffed food, frequency of outing, school day MVPA, parental feeling of sports, father's occupation, and weekend breakfast frequency are all statistically significant leaf node variables.

Conclusion

PA, especially weekend PA, is the most critical factor in children's physical fitness improvement and the weekend MVPA should be increased to more than 30 min/d based on the improvement of weekend PA. In addition, parental factors and school day PA are also important in making decisions about changes in fitness for children. The mother's efforts to maintain a healthy BMI and engage in regular physical activity are crucial for enhancing the physical fitness of children. Additionally, other parental factors, such as the parents' educational levels and the father's occupation, can indirectly impact the level of physical fitness in children.

Factors affecting decreased physical activity during the COVID-19 pandemic: an age-, gender-, and body mass index-matched study

Purpose

This study aims to investigate the association between factors affecting decreased physical activity (PA) during the COVID-19 pandemic by matching groups based on age, gender, and BMI variables using public Community Health Survey (CHS) data.

Methods

Data from the CHS was selected and used to investigate health-related factors related to PA, including demographic, psychological, behavioral characteristics, sociocultural, and chronic disease. Exact group matching was conducted based on age, gender, and BMI variables. Frequency analysis, Chi-square test (χ2 test), and multinominal logistic regression analysis were performed to analyze the data, and odds ratio (OR) and 95% confidence interval (95% CI) were presented. The study also examined the impact of COVID-19 on PA, the fear of PA infection.

Results

The logistic regression analysis by gender showed that PA decreased in all age groups, males, and females during the COVID-19 pandemic. The decrease in PA was lower in age groups other than those aged 60 or older. Stress experience, residence area, housing type, drinking, smoking, education level, and fear of infection were found to affect decreased PA due to COVID-19. Specifically, experiencing stress (Odds Ratio [OR] = 1.178; 95% Confidence Interval [CI] = 1.054 ~ 1.317) and increased smoking (OR = 1.332; 95% CI = 1.073 ~ 1.653) had a slightly higher impact on decreased PA. Conversely, living in a suburban area (OR = 0.653; CI = 0.585 ~ 0.728), having public housing (OR = 0.836; CI = 0.754 ~ 0.928), having less than a high school education (OR = 0.813; CI = 0.729 ~ 0.907), staying the same with alcohol (OR = 0.567; CI = 0.507 ~ 0.633) and smoking (OR = 0.836; CI = 0.728 ~ 0.959), and having low fear of infection (OR = 0.817; CI = 0.737 ~ 0.905) had a slightly lower impact on decreased PA.

Conclusion

PA should be maintained or increased, particularly in the context of social distancing measures during the pandemic. To ensure that PA can be sustained, a program should be developed that considers the individual's geographical location, economic status, lifestyle, and environment.

Associations between socioeconomic status and physical activity: A cross-sectional analysis of Chinese children and adolescents

Objectives

Although socioeconomic status (SES) has been shown to be an important determinant of physical activity (PA) in adults, the association in children and adolescents remains less consistent based on evidence from western developed countries. The purpose of this study, therefore, is to investigate associations between SES and PA among Chinese children and adolescents.

Methods

A cross-sectional study was conducted with a self-reported questionnaire in China. The multi-stage stratified cluster sampling method was used, and 2,955 children and adolescents (8–17 years old, 53.4% girls) were enrolled in this study. SES was assessed by measuring parental education levels, perceived family wealth, and Family Affluence Scale II (FAS II). PA was assessed by reliable and valid items from the Health Behavior School-aged Children Surveillance questionnaires. Descriptive statistics were used to report sample characteristics, including demographic characteristics, levels of PA, and SES. The Chi-square test was applied to analyze the differences of PA in gender and school period. Binary logistic regression was used to analyze the association between SES and PA among children and adolescents.

Results

Overall, 10.4% of children and adolescents accumulated moderate-to-vigorous physical activity (MVPA) at least 60 min per day. Boys were more physically active than girls (14.1% vs. 7.2%, p < 0.001). Higher socioeconomic status was positively associated with higher physical activity levels among children and adolescents, especially using FAS and mother education level as SES measures. The association between SES and PA varied by gender and grade group, and the effects of SES are also different on weekdays and weekends.

Conclusion

This study found socioeconomic disparities in PA among Chinese children and adolescents, and showed the importance of targeting children and adolescents with low SES intervention priority. Based on these research findings, it is suggested that SES, especially for FAS and mother education level, should be considered when designing and implementing the promotion of regular PA in children and adolescents. Health policymakers may use this information to develop interventions to reduce health inequalities among children and adolescents in the future.

Exploring the Role of Physical Activity in Mediating the Association between Educational Level and Health-Related Quality of Life in an Adult Lifespan Sample from Madeira Island

Background: People more socioeconomically vulnerable tend to have a poorer health-related quality of life (HRQoL). Studies are trying to analyse the factors that may condition this relationship, including physical activity (PA), which may influence the relationship between socioeconomic status (SES) and HRQoL. This study aimed to analyse the relationship between SES and HRQoL through specific domains of PA. Methods: A total of 381 adults (≥18 years) from the Autonomous Region of Madeira completed the measurements. Mediation analyses using bootstrapping methods adjusted for confounding variables were performed to relate SES and HRQoL; the latter was evaluated using the physical component score (PCS) of the SF-12, the mental component score (MCS) of the SF-12, and the total score in the SF-12 questionnaire (SF-12 score), through physical activity. Results: Educational level was positively related to PCS and SF-12 score. Leisure-time PA (not including sports PA) and PA at work, as single mediating variables, did not mediate the relationship between SES and HRQoL. The total PA suppressed the socioeconomic gradient of HRQoL by 8–10%, 39–46%, and 15–16%, respectively, for the PCS, MCS, and the SF-12 score; sports PA mediated the relationship by 13–16%, 50%, and 15–21%, respectively. Conclusions: The results suggest that sports PA contributes to reducing the socioeconomic gradient of HRQoL.

Physical Inactivity among Ghanaians in Ghana and Ghanaian Migrants in Europe

PURPOSE

There is a paucity of data on physical activity (PA) among migrants from sub-Saharan Africa, yet physical inactivity is a key risk factor for noncommunicable diseases. We examined the levels of physical inactivity and its determinants among Ghanaians in different geographical locations.

METHODS

We used the Research on Obesity and Diabetes among African Migrants data of Ghanaian adults (n = 4760) age 25-70 yr in rural and urban Ghana and three European cities (Amsterdam, London, and Berlin). Using total physical activity metabolic equivalent of task, physical inactivity was defined as total physical activity metabolic equivalent of task minutes per week less than 600. Logistic regression was used to examine the differences in the levels and the determinants of physical inactivity across sites.

RESULTS

Physical inactivity was higher among Ghanaian migrants (14.6% in Amsterdam, 24.1% in Berlin, and 36.6% in London) and urban Ghanaians (29.0%) compared with rural Ghanaians (11.2%). After adjustment for covariates (age, sex, education, health status, smoking status, body mass index, and social network) using rural Ghanaians as the comparator group, the odds ratios for physical inactivity in men ranged from 3.67 (95% confidence interval, 2.19-6.16) in urban Ghanaians to 10.37 (5.96-18.02) in London Ghanaians, and from 3.27 (2.46-4.35) in urban Ghanaians to 4.41 (3.12-6.22) in London Ghanaians in women. Migrants in London and Berlin had higher odds of physical inactivity compared with Amsterdam. Increased age, university education, and overweight/obesity were positively associated with physical inactivity, whereas social support was inversely associated with physical inactivity with variability across sites.

CONCLUSIONS

Findings indicate high prevalence of physical inactivity among Ghanaians in all sites, particularly among Ghanaians in Europe. Hence, there is the need to take local context into account to improve PA.

Occupation-related effects on motor cortex thickness among older, cognitive healthy individuals

Both, decline of sensorimotor functions and cortical thickness are known processes in healthy aging. Physical activity has been suggested to enhance the execution of daily routine activities and to extend the time of functional independence in advanced age. We hypothesized that cortical thickness of motor areas in retired individuals could be related to physical demands of the profession carried out during working life. Depending on their former occupations, 69 cognitively healthy individuals (range 70–85 years) were divided into higher and lower physically complex occupations (HPCO n = 27 and LPCO n = 42) according to the international standard classification of occupations (ISCO-08). Participants underwent a high-resolution 3T T1-weighted MRI scan. Surface-based analysis revealed higher cortical thickness in the left precentral (P = 0.001) and postcentral gyrus (P < 0.001) and right postcentral gyrus (P = 0.001) for the HPCO relative to the LPCO group (corrected for multiple comparisons, sex, age and leisure activities in the past 20 years). Physical leisure activities associated with exertion were positively correlated with cortical thickness in the left pre- and postcentral gyrus (P = 0.037) of the LPCO group. Time since retirement was negatively associated with cortical thickness in the left postcentral gyrus (P = 0.004) of the HPCO group. Executing a higher physically complex occupation before retirement was related to relative higher cortical thickness in the primary motor and somatosensory cortex in later life, supporting the hypothesis that physical activity contributes to neural reserve in these regions. However, these benefits appear to vanish when physical activity is reduced due to retirement.

Socioeconomic status and change in sports activity among middle-aged and older men and women: evidence from the German Ageing Survey

BACKGROUND

Sports activity (SA) behavior is unequally distributed across socioeconomic status (SES) groups. However, little is known about the impact of SES on change in SA over time.

METHODS

Based on data from the German Ageing Survey, we examined the role of objective (education, occupational prestige, household equivalent income, composite SES-index) and subjective (self-rated standard of living) SES indicators on negative and positive changes in SA during a follow-up of 6 years among adults aged 40+ years using logistic regression analysis.

RESULTS

Among active individuals at baseline, 32.1% of males and 24.8% of females experienced a negative change in SA. Among inactive individuals, 25.8 and 29.9% experienced a positive change. In the multivariate analysis, males and females with low SES were about twice as likely to experience a negative change and half as likely to experience a positive change. These patterns were observed regardless which SES indicator was examined.

CONCLUSIONS

This study provides comprehensive evidence for socioeconomic inequalities in negative and positive changes in SA behavior among middle-aged and older adults in Germany. To reduce socioeconomic inequalities, future SA interventions should address the mechanisms leading to differential probabilities of change in SA behavior by SES.

Domain-specific physical activity patterns and cardiorespiratory fitness among the working population: Findings from the cross-sectional German Health Interview and Examination Survey

OBJECTIVES

This study aimed to investigate associations between occupational physical activity patterns (physical work demands linked to job title) and leisure time physical activity (assessed by questionnaire) with cardiorespiratory fitness (assessed by exercise test) among men and women in the German working population.

DESIGN

Population-based cross-sectional study.

SETTING

Two-stage cluster-randomised general population sample selected from population registries of 180 nationally distributed sample points. Information was collected from 2008 to 2011.

PARTICIPANTS

1296 women and 1199 men aged 18-64 from the resident working population.

OUTCOME MEASURE

Estimated low maximal oxygen consumption ([Formula: see text]), defined as first and second sex-specific quintile, assessed by a standardised, submaximal cycle ergometer test.

RESULTS

Low estimated [Formula: see text] was strongly linked to low leisure time physical activity, but not occupational physical activity. The association of domain-specific physical activity patterns with low [Formula: see text] varied by sex: women doing no leisure time physical activity with high occupational physical activity levels were more likely to have low [Formula: see text] (OR 6.54; 95% CI 2.98 to 14.3) compared with women with ≥2 hours of leisure time physical activity and high occupational physical activity. Men with no leisure time physical activity and low occupational physical activity had the highest odds of low [Formula: see text] (OR 4.37; 95% CI 2.02 to 9.47).

CONCLUSION

There was a strong association between patterns of leisure time and occupational physical activity and cardiorespiratory fitness within the adult working population in Germany. Women doing no leisure time physical activity were likely to have poor cardiorespiratory fitness, especially if they worked in physically demanding jobs. However, further investigation is needed to understand the relationships between activity and fitness in different domains. Current guidelines do not distinguish between activity during work and leisure time, so specifying leisure time recommendations by occupational physical activity level should be considered.

Educational differentials in key domains of physical activity by ethnicity, age and sex: a cross-sectional study of over 40 000 participants in the UK household longitudinal study (2013-2015)

OBJECTIVES

To assess whether educational differentials in three key physical activity (PA) domains vary by age, sex and ethnicity.

DESIGN

National cross-sectional survey.

SETTING

UK.

PARTICIPANTS

Altogether 40 270 participants, aged 20 years and over, from the UK Household Longitudinal Study with information on education, PA and demographics collected in 2013-2015.

OUTCOME MEASURES

Participation in active travel (AT), occupational activity (OA) and leisure time physical activity (LTPA) at the time of assessment.

RESULTS

Lower educational attainment was associated with higher AT and OA, but lower weekly LTPA activity; these associations were modified by sex, ethnicity and age. Education-related differences in AT were larger for women-the difference in predicted probability of activity between the highest and the lowest education groups was -10% in women (95% CI: -11.9% to 7.9%) and -3% in men (-4.8% to -0.4%). Education-related differences in OA were larger among men -35% (-36.9% to -32.4%) than women -17% (-19.4% to -15.0%). Finally, education-related differences in moderate-to-vigorous LTPA varied by ethnicity; for example, differences were 17% (16.2% to 18.7%) for white individuals compared with 6% (0.6% to 11.6%) for black individuals.

CONCLUSIONS

Educational differences in PA vary by domain and are modified by age, sex and ethnicity. A better understanding of physically inactive subgroups may aid development of interventions to both increase activity levels and reduce health inequalities.

Individual and interpersonal correlates of cardiorespiratory fitness in adults - Findings from the German Health Interview and Examination Survey

Cardiorespiratory fitness (CRF) is an established predictor of adverse health outcomes. The aim of this study is to investigate potential behavioral, interpersonal and socioeconomic correlates of CRF among men and women living in Germany using data from a population-based nationwide cross-sectional study. 1,439 men and 1,486 women aged 18-64 participated in the German Health Interview and Examination Survey (2008-2011) and completed a standardized sub-maximal cycle ergometer test. Maximal oxygen consumption ([Formula: see text]) in ml·min-1·kg-1 was estimated. Mean values of VO2max for various anthropometric, behavioral, interpersonal, and sociodemographic variables were estimated. Linear regression analyses using multiple imputations technique for missing values was performed to analyze the influence of potential correlates on CRF. Women with high alcohol consumption had higher [Formula: see text], (β = 2.20; 95% CI 0.98 to 3.42) than women with low alcohol consumption and women with high occupational status had higher [Formula: see text] (β = 1.83; 95% CI 0.21 to 3.44) in comparison to women with low occupational status. Among men, high fruit intake (β = 1.52; 95% CI 0.63 to 2.40), compared to low or medium fruit intake and performing at least 2.5 hours of total PA per week (β = 2.19; 95% CI 1.11 to 3.28), compared to less than 2.5 hours was associated with higher [Formula: see text]. Among both men and women, lower body mass index, lower waist circumference and higher levels of physical exercise were considerably associated with higher [Formula: see text]. Among women, those in higher age groups showed a considerably lower level of [Formula: see text] compared with those aged 18-24. Furthermore, mean estimated [Formula: see text] was higher among men (36.5; 95% CI 36.0 to 37.0) than among women (30.3; 95% CI 29.8 to 30.7). Despite the cross-sectional nature of the current study, we conclude that several behavioral, anthropometric, and sociodemographic factors are associated with CRF in the general adult population in Germany. These results can provide evidence to tailor prevention measures according to the needs of specific subgroups.

Educational differences in the prevalence of behavioural risk factors in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2

This article examines educational differences in the prevalence of behavioural risk factors among adults and compares the results for Germany with the average from the European Union (EU). Data were derived from the second wave of the European Health Interview Survey, which took place between 2013 and 2015 (EHIS 2). Analyses were conducted using a regression-based calculation of relative and absolute educational differences in the prevalence of behavioural risk factors, based on self-reported data from women and men aged between 25 and 69 (n=217,215). Current smoking, obesity, physical activity lasting less than 150 minutes per week, heavy episodic drinking and non-daily fruit or vegetable intake are more prevalent among people with a low education level than those with a high education level. This applies to Germany as well as the EU average. Overall, the relative educational differences identified for these risk factors place Germany in the mid-range compared to the EU average. However, relative educational differences in current smoking and heavy episodic drinking are more manifest among women in Germany than the EU average, with the same applying to low physical activity among men. In contrast, relative educational differences in non-daily fruit or vegetable intake are less pronounced among women and men in Germany than the average across the EU. Increased efforts are needed in various policy fields to improve the structural conditions underlying health behaviour, particularly for socially disadvantaged groups, and increase health equity.

Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional 'German Health Update 2014/15 - EHIS' in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

Identifying female pelvic cancer survivors with low levels of physical activity after radiotherapy: women with fecal and urinary leakage need additional support

Objective

To investigate the frequency of physical activity among female pelvic cancer survivors (i.e., gynecological, rectal, and anal cancer survivors) and to investigate if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and fecal leakage, clinical and sociodemographic characteristics, quality of life (QoL), and depressed and anxious mood.

Methods

Female pelvic cancer survivors (n = 578, mean age 64 years) answered a questionnaire 6–48 months after radiotherapy. A multivariable regression model analyzed factors covarying with frequency of physical activity. We compared QoL and depressed and anxious mood between women practicing physical activity at least or less than once a week.

Results

Of 568 women delivering data, 186 (33%) practiced physical activity less than once a week while 382 (67%) practiced physical activity at least weekly. Women who leaked a large or all volume of stools (p = 0.01), had just elementary school level of education (p < 0.001), smokers (p = 0.049), or had lymphedema without receiving lymphedema treatment (p = 0.030) were more likely to practice physical activity less than weekly (50%, 45%, 45%, and 37%, respectively) compared with other women. Women practicing physical activity at least weekly reported better QoL (p < 0.001) and lower frequency of depressed mood (p = 0.044) compared with the others.

Conclusions

Female cancer survivors experiencing fecal leakage were less likely to practice weekly physical activity than survivors without leakage. The survivors practicing weekly physical activity experienced better QoL and experienced depressed mood less frequently than the others.

Analysis of physical exercise in cardiac patients following cardiovascular rehabilitation

Background: Cardiovascular rehabilitation and retraining seek to increase cardiorespiratory fitness and to manage certain risk factors such as smoking, hypercholesterolaemia and sedentary lifestyle. Such lifestyle changes can be influenced by a combination of health determinants. Aim: The purpose of this study is to analyse the profile (health determinants) of patients who continue to practice a physical activity and who are following guidelines for physical activity, at one year after rehabilitation. Methods: One hundred patients (23 women and 77 men) with an average age of 59.9 years (±10.42) were monitored. The level of physical activity of these patients was measured with weekly journals and with the International Physical Activity Questionnaire (IPAQ). Results: We found that 46.4% of patients did not follow the recommendations for physical exercise. In addition, patients from higher social strata and those with higher levels of education were more inclined to continue to practice physical activity. Conclusions: Our results suggest that professional practices and patient education would benefit from a greater understanding of social and cultural determinants, and that this would also promote patient compliance with instructions regarding physical activity.

Light intensity physical activity increases and sedentary behavior decreases following total knee arthroplasty in patients with osteoarthritis

PURPOSE

To describe objectively measured changes in the volume and pattern of physical activity and sedentary behavior in patients undergoing total knee arthroplasty for osteoarthritis.

METHODS

Physical activity and sedentary behavior were measured in patients (13 males, 76 females) with a mean age of 64 years (range 55-80) and end-stage osteoarthritis of the knee, using an accelerometer (ActiGraph GT3X+) for seven consecutive days (24 h/day) prior to, 6 weeks and 6 months after total knee arthroplasty. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) Activity index and range of motion (ROM) were also assessed.

RESULTS

Proportion of time spent in sedentary behavior decreased from baseline to 6 months (mean 70.1 vs. 64.0%; p = 0.009) and the interruptions to sedentary behavior improved between baseline and 6 months after total knee arthroplasty (mean 85.0-93.0 breaks/day, p = 0.014). Proportion of time spent in light physical activity increased from baseline to 6 months after total knee arthroplasty (29.0 vs. 34.8%; p = 0.008). There was no change in time spent in moderate to vigorous physical activity after total knee arthroplasty. WOMAC (median 71.0 vs. 4.0, p < 0.001), UCLA (median 2.0 vs. 5.0, p < 0.001) as well as ROM [median (0.0°-90.0°) vs. (0.0°-110°), p < 0.05] scores improved between baseline and 6 months after total knee arthroplasty.

CONCLUSION

Clinically, functional improvements in patients following total knee arthroplasty may be assessed by objectively measuring changes in low intensity activity behaviors. The use of accelerometers in this study gives new insights into activity accumulation patterns in a clinical population and highlights their use in determining a behavioral response to an intervention.

LEVEL OF EVIDENCE

II.

The association between income and leisure-time physical activity is moderated by utilitarian lifestyles: A nationally representative US population (NHANES 1999-2014)

The objective of this study was to determine whether the relationship between income and leisure-time physical activity (LTPA) persists after accounting for a person's utilitarian PA (all non-LTPA), sociodemographic characteristics and transportation PA. Data were from eight cycles (1999-2014) of the nationally representative samples of the US adult population from the National Health and Nutrition Examination Survey (n = 35,239). Whether the poverty income ratio (0-1.3, 1.3-1.86, 1.86+ [reference]) was associated with minutes of LTPA (moderate, vigorous) after stratifying for utilitarian PA (sedentary, light, moderate, and vigorous) was assessed in multiple linear regressions adjusted for age, sex, race, education, marital status, weight status, hours worked, and minutes of transportation-related PA in the past week. Likelihood of meeting national physical activity recommendations was also assessed in multiple logistic regressions adjusting for the covariates described. For both sedentary and light utilitarian PA levels, compared to the reference, persons living in households of the lowest poverty income ratio were consistently associated with approximately 17-30 less minutes of moderate LTPA minutes per week, and 20-25 less minutes of vigorous LTPA across all survey cycles. Compared to the reference, the likelihood of meeting national PA recommendations was approximately 31-55% less for these households. The known association between lower income and lower LTPA persist, but is the most persistent and consistent for those with less active utilitarian (such as sedentary) lifestyles. Interventions aimed at increasing LTPA among people with low income and sedentary utilitarian lifestyles whether or not they are in the workforce are particularly needed.

Descriptive Epidemiology of Uruguayan Adults' Leisure Time Physical Activity

Policymakers rely on information for describing and monitoring levels of physical activity among the population. However, in Uruguay there is no research presenting physical activity practices nationwide. The present study aims to describe the leisure time physical activity levels and their unequal distribution among Uruguayan adults. Data from the 2014 Uruguayan National Health Survey (n = 3543 adults aged > 15 years) were analysed. Physical activity was measured by questionnaire, with participants reporting the number of days and time spent doing physical activity during leisure time in a typical week. Only 25.1% of the participants met the international recommendations for physical activity. Males were twice as active as females in early adulthood in terms of time. The absolute socioeconomic gap between the poorest and wealthiest income quintiles was around 20 percentage points, and participants with the highest physical activity levels were within the wealthiest and highest-educational levels. A low proportion of the population met the proxy of the international recommendations for physical activity. Important socioeconomic inequalities have been found in physical activity practices and must be considered in public health interventions.

Socioeconomic Correlates and Determinants of Cardiorespiratory Fitness in the General Adult Population: a Systematic Review and Meta-Analysis

BACKGROUND

This review aims to (1) consolidate evidence regarding the association between socioeconomic status (SES) and cardiorespiratory fitness (CRF), (2) conduct a meta-analysis of the association between SES and CRF using methodologically comparable data, stratified by sex, and (3) test whether the association varies after adjustment for physical activity (PA).

METHODS

A systematic review of studies from MEDLINE, EMBASE, Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (ScIELO), and Cochrane Library without time or language restrictions, which investigated associations between SES and CRF. Risk of bias within studies was assessed using a customized quality assessment tool. Results were summarized in table format and methodologically similar studies were synthesized using meta-analysis of Hedges' g effect sizes. Synthesized results were appraised for cross-study bias. Results were tested for the impact of PA adjustment using meta-regression.

RESULTS

Compared to individuals with low education, both men and women showed higher CRF among individuals with high education (men 0.12 [0.04-0.20], women 0.19 [0.02-0.36]), while participants with medium education showed no significant difference in CRF (men 0.03 [- 0.04-0.11], women 0.09 [- 0.03-0.21]). Adjustment for PA did not significantly impact the association between education and CRF.

CONCLUSIONS

There is fair evidence for an association between high levels of education and increased CRF. This could have implications for monitoring, of health target compliance and of chronic disease risk among higher risk populations, to detect and prevent non-communicable diseases (NCDs) and to diminish social health inequalities.

TRIAL REGISTRATION

PROSPERO, CRD42017055456.

Predictors of physical activity among older adults in Germany: a nationwide cohort study

OBJECTIVES

To investigate individual, interpersonal and environmental baseline factors predicting regular aerobic physical activity (PA) participation among older adults in Germany at follow-up 12 years later.

DESIGN

Population-based cohort study.

SETTING

Cluster-randomised general population sample selected based on population registry address information from 130 nationally distributed sample points collected from 1997 to 1999 and re-evaluated 12 years later from 2008 to 2011.

PARTICIPANTS

1184 adults, aged 65 years or older at follow-up with complete data at baseline and follow-up, were included in the final study sample.

OUTCOME MEASURE

Regular 'aerobic PA ≥1 day/week' assessed based on self-reported information.

RESULTS

At follow-up, 53.2% of the participants engaged in aerobic PA ≥1 day/week. Participants aged 50 to 60 years at baseline were more likely to engage in aerobic PA ≥1 day/week than participants aged 61 to 78 years; OR 1.88, 95% CI 1.46 to 2.40. Participants with middle and high socioeconomic status (SES) were more likely to engage in aerobic PA ≥1 day/week than participants with low SES; OR middle SES 2.08, 1.33 to 3.25; high SES 3.44, 2.11 to 5.60. Participants with high social support were more likely to engage in aerobic PA ≥1 day/week at follow-up than participants with low social support; OR 1.98, 1.26 to 3.12. Furthermore, participants who engaged in leisure time PA at least once per week at baseline were more likely to engage in aerobic PA ≥1 day/week at follow-up than those who engaged less than once per week; OR 1.95, 1.46 to 2.60.

CONCLUSIONS

Several influencing factors assessed at baseline predicted regular aerobic PA participation 12 years later. These factors should be considered when planning interventions to prevent physical inactivity in older adults. There is great potential to increase aerobic PA participation in older adults in Germany, in particular among those with low SES and low social support.

Correlates of sedentary behaviour in adults: a systematic review

OBJECTIVE

The objective of this study was to systematically review evidence to identify intrapersonal, social environmental, physical environmental and policy correlates of sedentary behaviour (SB) among adults.

METHODS

Six databases were searched to identify studies that reported on intrapersonal, social, physical environmental and/or policy correlates of SB across domains (i.e. occupational, leisure and transportation) in adults (mean ≥ 18 years old). Subgroup differences (sex, age, disease status, publication status and date, weekdays vs. weekend) were examined. Risk of bias was assessed, and a qualitative synthesis completed.

PROSPERO

CRD42014009814 RESULTS: Searching identified 22,779 articles; 257 were used in the analysis. Most studies used self-reported SB and were cross-sectional. The most studied domain of SB and correlate was leisure and intrapersonal, respectively. Consistent evidence found positive relationships between full-time employment and higher transportation and lower leisure SB; higher income/socioeconomic status and greater transportation and occupation SB; living in more urban areas and greater sitting time and total SB; ownership of televisions and greater leisure SB; and, active workstations and lower occupational SB.

CONCLUSIONS

The review identifies the need for longitudinal studies, as well as further research on factors in the physical, social and policy environments. The review also recognizes the need to standardize methodology for collecting, defining and reporting SB and correlates.

Changing educational inequalities in sporting inactivity among adults in Germany: a trend study from 2003 to 2012

BACKGROUND

Social inequalities in health can be explained in part by the social patterning of leisure-time physical activity, such as non-participation in sports. This study is the first to explore whether absolute and relative educational inequalities in sporting inactivity among adults have changed in Germany since the early 2000s.

METHODS

Data from four cross-sectional national health surveys conducted in 2003 (n = 6890), 2009 (n = 16,418), 2010 (n = 17,145) and 2012 (n = 13,744) were analysed. The study population was aged 25-69 years in each survey. Sporting inactivity was defined as no sports participation during the preceding 3 months. The regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in sporting inactivity, respectively.

RESULTS

Sporting inactivity was consistently more prevalent in less-educated groups. The overall prevalence of sporting inactivity declined significantly over time. However, the decline was observed only in the high and medium education groups, while no change was observed in the low education group. Both absolute and relative educational inequalities in sporting inactivity were found to have widened significantly between 2003 (SII = 0.30, 95% CI = 0.25-0.35; RII = 2.08, 95% CI = 1.83-2.38) and 2012 (SII = 0.41, 95% CI = 0.37-0.45; RII = 3.44, 95% CI = 3.03-3.91). Interaction analysis showed that these increases in inequalities were larger in the younger population under the age of 50 than among the elderly.

CONCLUSIONS

The findings suggest that the gap in sports participation between adults with high and low educational attainment has widened in both absolute and relative terms because of an increase in sports participation among the better educated. Health-enhancing physical activity interventions specifically targeted to less-educated younger adults are needed to prevent future increases in social inequalities in health.

[Social inequality and health: Status and prospects of socio-epidemiological research in Germany]

Social differences in morbidity and mortality have always been a central topic in public health research. In recent years, there has been a growing research interest that has clearly resonated with the general public and the political arena as well. This article describes the development and establishment of social epidemiology in Germany and presents the current status of research. In addition, it describes different models for explaining health inequalities. On this basis, selected challenges and prospects of socio-epidemiological research are demonstrated. The reason why the analysis of social differences in morbidity and mortality will continue to be a key task of public health research in the national and international context in the future is also explained.

[Socioeconomic differences in physical activity in the middle-aged working population: The role of education, occupation, and income]

BACKGROUND

Regular physical activity has positive effects on health at all ages. This study aims to investigate how far physical activity and regular sports engagement, as a more specific type of physical activity, are associated with socioeconomic factors in the middle-aged working population.

METHODS

Data were obtained from 21,699 working men and women aged between 30 and 64 years who participated in the 2009 and 2010 population-based national German Health Update (GEDA) surveys conducted by the Robert Koch Institute. Besides a multi-dimensional index of socioeconomic status (SES), three single dimensions of SES (education, occupation, and income) were used to analyse socioeconomic differences in total physical activity and regular sports engagement.

RESULTS

While the prevalence of total physical activity increased with lower SES, the proportion of people with regular sports engagement decreased with lower SES. These associations remained after adjusting for age in men and women. After mutual adjustment of the three single socioeconomic dimensions, physical activity was independently associated with lower education and lower occupational status. Regular sports engagement was observed to be independently associated with higher education, higher occupational status, as well as higher income after mutual adjustment.

CONCLUSIONS

This study demonstrates significant socioeconomic differences in physical and sports activity in the middle-aged working population. Education, occupation, and income show varying independent associations with physical activity behaviour. Such differences need to be considered when identifying target groups for health-enhancing physical activity interventions.

Secular trends and correlates of physical activity: The Tromsø Study 1979-2008

Background

The aim was to describe secular trends in leisure time physical activity (LTPA) and work related physical activity (WPA) from 1979 to 2008. Additionally, we explored potential cross-sectional and longitudinal correlates of LTPA and WPA.

Methods

Data are collected from 34,898 individuals (49.7% men) aged >20 years who participated in at least one Tromsø Study survey between 1979 and 2008. In each survey, the participants completed a self-administered questionnaire and underwent physical examinations. LTPA and WPA were assessed by the validated “Saltin-Grimby” 4-scale questions. Potential correlates of LTPA and WPA (sex, age, body mass index (BMI), education, smoking, self-reported cardiovascular disease, self-perceived health, and employment status) were tested using ordinal logistic regression.

Results

The age-adjusted prevalence of participants being inactive in leisure time remained relatively stable around 20% from 1979 to 2008 (range 19.9–23.6%). The age-adjusted prevalence of moderate-vigorous LTPA decreased from 23.2% in 1979–80 to 16.0% in 2001, thereafter the prevalence increased to 24.3% in 2007–08 (P <0.05). The age-adjusted prevalence of being mostly sedentary at work increased gradually from 35.5% in 1979–80 to 53.4% in 2007–08 (P <0.05). Sex, age, education, and smoking were identified as cross-sectional correlates of LTPA and WPA (P <0.05). Men had higher odds of engaging in LTPA than women (adjusted OR 1.52 [95% CI 1.39–1.67] in 2007–08), whereas the association between sex and WPA shifted over time. High education level, not being a smoker, and high WPA were associated with high LTPA, whereas low education level, being a smoker, and high levels of LTPA were associated with high WPA (P <0.05). In general, odds of engaging in LTPA and WPA decreased with age (P <0.05). Individuals with healthy BMI had higher odds of being in a higher LTPA level than those who were underweight and obese (P <0.05). Longitudinal analyses identified sex, age, education, smoking, WPA, and LTPA measured in 1979–80 as determinants of LTPA in 2007–08.

Conclusions

In Norwegian adults, the proportion of sedentary WPA increased from 1979 to 2008, whereas the proportion of inactive LTPA remained stable. Being female, older, smoker, obese or underweight, and low education level were associated with low LTPA levels.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3886-z) contains supplementary material, which is available to authorized users.

Determinants of organised sports participation patterns during the transition from childhood to adolescence in Germany: results of a nationwide cohort study

BACKGROUND

Organised sports (OS) participation is an important health behaviour but it seems to decline from childhood to adolescence. The aim of this study was to investigate OS participation patterns from childhood to adolescence and potential determinants for those patterns.

METHODS

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) cohort study with a 6 year follow-up period were used (KiGGS0: 2003-06, KiGGS1: 2009-12). Participants aged 6-10 years at KiGGS0, who were aged 12-16 at KiGGS1, were included (n = 3790). The outcome variable was 'OS participation' between KiGGS0 and KiGGS1 with the categories 'maintenance' (reference), 'dropout', 'commencement' and 'nonparticipation'. Relative risk ratios (RRRs) were calculated using multinomial logistic regression to identify potential predictors for OS patterns. Socio-demographic, family-related, health-related, behavioural and environmental factors were considered as independent variables.

RESULTS

48.5 % maintained OS, 20.5 % dropped out, 12.3 % commenced OS between KiGGS0 and KiGGS1 and 18.7 % did not participate at both times. The RRRs for dropout rather than maintenance were 0.6 (95 % Cl 0.5-0.7) for boys versus girls, 1.5 (1.3-1.9) for the age group 8-10 versus 6-7 years, 0.7 (0.5-0.9) for high versus intermediate parental education, 1.4 (1.1-1.8) for low versus middle household income, 1.4 (1.0-1.8) for below-average versus average motor fitness. The RRRs for commencement rather than maintenance were 0.6 (0.5-0.8) for boys versus girls, 0.6 (0.5-0.8) for the age group 8-10 versus 6-7 years, 1.5 (1.1-2.1) for low versus intermediate parental education, 1.5 (1.1-2.0) for low versus middle household income, 0.7 (0.5-1.0) for no single-parent versus single parent family, 1.8 (1.3-2.5) for below-average and 0.6 (0.4-0.8) for above-average versus average motor fitness, and 1.4 (1.1-1.9) for high versus middle screen-based media use. The RRRs for abstinence rather than maintenance were 0.6 (0.4-0.7) for boys versus girls, 1.5 (1.1-2.0) for low versus intermediate parental education, 2.2 (1.7-2.8) for low and 0.6 (0.5-0.8) for high versus middle household income, 1.6 (1.2-2.1) for psychopathological problems versus no problems, 1.7 (1.3-2.2) for below-average and 0.4 (0.3-0.6) for above-average versus average motor fitness, and 1.6 (1.0-2.6) for rural versus metropolitan residential area.

CONCLUSIONS

OS participation rates among all children living in Germany need to be improved. More tailored offerings are needed which consider the preferences and interests of adolescents as well as a cooperation between public health actors to reduce barriers to OS.

New insights into potential risk factors and associations in genital lichen sclerosus: Data from a multicentre Italian study on 729 consecutive cases

BACKGROUND

Limited data are available on risk factors associated with lichen sclerosus and no data are available on gender differences in genital lichen sclerosus (GLS).

OBJECTIVE

This multicentre study aimed at identifying potential risk factors for GLS, through data collection from a large, mixed-sex sample of patients comparing gender-related differences in relation to data from the general population.

METHODS

This was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was collected: demographic data, anthropometric measures, comorbidities, family history of LS, clinical features and symptoms related to GLS.

RESULTS

Overweight and obesity, blood hypertension, hypothyroidism and an educational attainment equal or above upper secondary school level were more frequent among the study patients than among the general Italian population. Moreover, a family history of GLS was reported more frequently than expected among GLS patients. These factors were similar in males and females. The disease tended to occur later in females than in males.

CONCLUSIONS

Our findings suggest that metabolic factors, and possibly a sedentary lifestyle, may play a role in GLS pathogenesis in genetically predisposed patients, and that risk profile is similar in males and females despite some difference in the onset of symptoms.

Association between education and future leisure-time physical inactivity: a study of Finnish twins over a 35-year follow-up

Background

Education is associated with health related lifestyle choices including leisure-time physical inactivity. However, the longitudinal associations between education and inactivity merit further studies. We investigated the association between education and leisure-time physical inactivity over a 35-year follow-up with four time points controlling for multiple covariates including familial confounding.

Methods

This study of the population-based Finnish Twin Cohort consisted of 5254 twin individuals born in 1945–1957 (59 % women), of which 1604 were complete same-sexed twin pairs. Data on leisure-time physical activity and multiple covariates was available from four surveys conducted in 1975, 1981, 1990 and 2011 (response rates 72 to 89 %). The association between years of education and leisure-time physical inactivity (<1.5 metabolic equivalent hours/day) was first analysed for each survey. Then, the role of education was investigated for 15-year and 35-year inactivity periods in the longitudinal analyses. The co-twin control design was used to analyse the potential familial confounding of the effects. All analyses were conducted with and without multiple covariates. Odds Ratios (OR) with 95 % Confidence Intervals (CI) were calculated using logistic and conditional (fixed-effects) regression models.

Results

Each additional year of education was associated with less inactivity (OR 0.94 to 0.95, 95 % CI 0.92, 0.99) in the cross-sectional age- and sex-adjusted analyses. The associations of education with inactivity in the 15- and 35-year follow-ups showed a similar trend: OR 0.97 (95 % CI 0.93, 1.00) and OR 0.94 (95 % CI 0.91, 0.98), respectively. In all co-twin control analyses, each year of higher education was associated with a reduced likelihood of inactivity suggesting direct effect (i.e. independent from familial confounding) of education on inactivity. However, the point estimates were lower than in the individual-level analyses. Adjustment for multiple covariates did not change these associations.

Conclusions

Higher education is associated with lower odds of leisure-time physical inactivity during the three-decade follow-up. The association was found after adjusting for several confounders, including familial factors. Hence, the results point to the conclusion that education has an independent role in the development of long-term physical inactivity and tailored efforts to promote physical activity among lower educated people would be needed throughout adulthood.

Social identity, perceived urban neighborhood quality, and physical inactivity: A comparison study of China, Taiwan, and South Korea

Asian countries are currently witnessing unprecedented increase in physical inactivity and subsequent negative health outcomes; however, few cross-country studies documenting this trend exist. This paper presents the findings of a nationally representative sample, based on the East Asian Social Survey in 2011. The study sought to examine the association of social identity factors, such as objective socio-economic position, perceived social status and neighborhood quality with physical inactivity, while controlling for psychosocial and physical health. A sample of 5222 adults living in urban areas across China, Taiwan, and South Korea were surveyed.

METHODS

Multivariate nested logistic regressions were constructed.

RESULTS

Perceived social status was positively associated with physical activity. Gender difference in physical activity was significant, and this difference widened as educational levels increased. Class division in physical activity was also found. Perceived physical and social features of neighborhood such as suitability for walking and jogging, air quality, and help from neighbors were to different degrees associated with physical inactivity.

CONCLUSION

Gender, marital status, education and perceived social status were common factors associated with physical inactivity in East Asian countries. Perceived urban neighborhood quality is particularly important for Chinese people to stay physically active. Cultural-behavioral norms for physical activity associated with gender and social status call for more studies on cultural perspective for health behaviors in cross-cultural contexts.

FATORES ASSOCIADOS À PRÁTICA DE ATIVIDADE FÍSICA EM HOMENS DE MEIA-IDADE

Introdução: O aumento dos níveis de atividade física (AF) tem sido importante para uma vida saudável, e identificar os fatores que se associam a essa prática pode incentivar a adoção de um estilo de vida ativo. Objetivo: Analisar os fatores associados à prática de AF atual em homens de meia-idade. Métodos: Estudo transversal com amostra probabilística de 416 homens de meia-idade (40 a 59 anos) em duas cidades no sul do Brasil. Para a coleta de dados utilizou-se um questionário dividido em seis partes: características da amostra; medidas antropométricas; estrato econômico - IBGE; AF - IPAQ-versão curta; percepção de saúde - BRFSS; e sintomas do envelhecimento masculino - escala dos sintomas do envelhecimento masculino (AMS). A amostra foi dividida em dois grupos etários: 40 a 49 e 50 a 59 anos. A análise estatística foi descritiva e inferencial. Resultados: Aproximadamente 60,2% dos homens foram considerados suficientemente ativos (ativos + muito ativos), entretanto, não foram observadas diferenças significativas entre as faixas etárias (p = 0,152). A caminhada foi a AF mais prevalente e a atividade vigorosa, a menos prevalente. As intensidades da AF (caminhada moderada e vigorosa) se relacionaram com a escolaridade, classe econômica, percepção de saúde e sintomas do envelhecimento masculino. Os homens acima do peso e com sintomas apresentaram probabilidade maior (RP = 1,12; IC 95% = 1,01-1,24; RP = 1,30; IC 95% = 1,00-1,69) de ter AF insuficiente. Conclusão: O presente estudo identificou a relação de determinadas características pessoais dos participantes com a intensidade da AF praticada. Além disso, foi possível identificar associação entre sintomas do envelhecimento masculino e condições de peso e o nível de AF dos homens de meia-idade. Assim, estes resultados podem atuar como insumo à promoção da AF para homens nessa faixa etária, como forma a melhorar o estilo de vida e os cuidados com a saúde.

Predictors of adherence to a 12-week exercise program among men treated for prostate cancer: ENGAGE study

Understanding the factors that influence adherence to exercise programs is necessary to develop effective interventions for people with cancer. We examined the predictors of adherence to a supervised exercise program for participants in the ENGAGE study – a cluster randomized controlled trial that assessed the efficacy of a clinician‐referred 12‐week exercise program among men treated for prostate cancer. Demographic, clinical, behavioral, and psychosocial data from 52 participants in the intervention group were collected at baseline through self‐report and medical records. Adherence to the supervised exercise program was assessed through objective attendance records. Adherence to the supervised exercise program was 80.3%. In the univariate analyses, cancer‐specific quality of life subscales (role functioning r = 0.37, P = 0.01; sexual activity r = 0.26, P = 0.06; fatigue r = −0.26, P = 0.06, and hormonal symptoms r = −0.31, P = 0.03) and education (d = −0.60, P = 0.011) were associated with adherence. In the subsequent multivariate analysis, role functioning (B = 0.309, P = 0.019) and hormonal symptoms (B = −0.483, P = 0.054) independently predicted adherence. Men who experienced more severe hormonal symptoms had lower levels of adherence to the exercise program. Those who experienced more positive perceptions of their ability to perform daily tasks and leisure activities had higher levels of adherence to the exercise program. Hormonal symptoms and role functioning need to be considered when conducting exercise programs for men who have been treated for prostate cancer.

Human development, occupational structure and physical inactivity among 47 low and middle income countries

This study aimed to (a) assess the relationship between a person's occupational category and their physical inactivity, and (b) analyze the association among country-level variables and physical inactivity. The World Health Survey (WHS) was administered in 2002–2003 among 47 low- and middle-income countries (n = 196,742). The International Physical Activity Questionnaire (IPAQ) was used to collect verbal reports of physical activity and convert responses into measures of physical inactivity. Economic development (GDP/c), degree of urbanization, and the Human Development Index (HDI) were used to measure country-level variables and physical inactivity. Multilevel logistic regression analysis was used to examine the association among country-level factors, individual occupational status, and physical inactivity. Overall, the worldwide prevalence of physical inactivity in 2002–2003 was 23.7%. Individuals working in the white-collar industry compared to agriculture were 84% more likely to be physically inactive (OR: 1.84, CI: 1.73–1.95). Among low- and middle-income countries increased HDI values were associated with decreased levels of physical inactivity (OR: 0.98, CI: 0.97–0.99). This study is one of the first to adjust for within-country differences, specifically occupation while analyzing physical inactivity. As countries experience economic development, changes are also seen in their occupational structure, which result in increased countrywide physical inactivity levels.

•

We analyzed the relationship between occupation and physical inactivity.

•

The IPAQ was used to measure the level of physical inactivity.

•

All occupations other than agriculture were more likely to be physically inactive.

•

Gender, income and urban/rural are positively associated with physical inactivity.

•

The HDI was inversely associated with physical inactivity.

Development of the European Health Interview Survey - Physical Activity Questionnaire (EHIS-PAQ) to monitor physical activity in the European Union

Background

A domain-specific physical activity questionnaire (EHIS-PAQ) was developed in the framework of the second wave of the European Health Interview Survey (EHIS). This article presents the EHIS-PAQ and describes its development and evaluation processes.

Methods

Research institutes from Belgium, Estonia and Germany participated in the Improvement of the EHIS (ImpEHIS) Grant project issued by Eurostat. The instrument development process comprised a non-systematic literature review and a systematic HIS/HES database search for physical activity survey questions. The developed EHIS-PAQ proposal was reviewed by survey experts. Cognitive testing of the EHIS-PAQ was conducted in Estonia and Germany. The EHIS-PAQ was further tested in a pilot survey in Belgium, Estonia and Germany in different modes of data collection, face-to-face paper and pencil interview (PAPI) and computer assisted telephone interview (CATI).

Results

The EHIS-PAQ is a rather pragmatic tool aiming to evaluate how far the population is physically active in specific public health relevant settings. It assesses work-related, transport-related and leisure-time physical activity in a typical week. Cognitive testing revealed that the EHIS-PAQ worked as intended. The pilot testing showed the feasibility of using the EHIS-PAQ in an international health interview survey setting in Europe. It will be implemented in all 28 European Union Member States via European Union implementing regulation in the period between 2013 and 2015. This will be a first opportunity to get comparable data on domain-specific physical activity in all 28 EU MS and to publish indicators at the EU level.

Conclusions

The EHIS-PAQ is a short, domain-specific PA questionnaire based on PA questions which have been used in large-scale health interview surveys before. It was designed by considering the respondents’ perspective in answering PA questions.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-015-0110-z) contains supplementary material, which is available to authorized users.

How well do physical activity questions perform? A European cognitive testing study

BACKGROUND

Only few studies have focused on the cognitive processes of the respondents that are involved when answering physical activity questionnaires (PAQs). This study aimed at examining whether two PAQs work as intended with different segments of the survey population in different cultural settings in Europe.

METHODS

The International Physical Activity Questionnaire - Short Form (IPAQ-SF) and the US National Health Interview Survey - Adult Core Physical Activity Questionnaire (NHIS-PAQ) were tested in Belgium, Estonia, Germany and the UK using a standardized cognitive interviewing procedure. IPAQ-SF measures total vigorous physical activity (PA), moderate PA, walking and sitting. NHIS-PAQ measures leisure-time vigorous PA, light and moderate PA and muscle-strengthening PA. In total 62 persons completed cognitive interviews, at least 15 interviews were conducted in each country.

RESULTS

Both PAQs performed as intended with young and high-skilled persons and those having a regular exercise schedule. For the others, however, the testing revealed that problems occurred with both PAQs relating to understanding the concepts of '(light and) moderate' and 'vigorous' PA, classifying activities into the provided answer options of different PA intensities, recalling instances of 'normal' activities such as walking and sitting, and calculating the total duration of more than one activity or instance of an activity. The revealed problems with the questionnaires were quite similar in different countries; profound cultural differences were not observed.

CONCLUSIONS

Both questionnaires were difficult to answer for many respondents and rather user-unfriendly. They are designed to measure an exactness of PA quantity (frequency and duration) and intensity which would be desirable to obtain from a scientific point of view; however, respondents can hardly provide this information for cognitive reasons. Studies investigating the respondents' perspective are useful for improving physical activity information based on self-reports.

Socioeconomic Status and Physical Activity in Chinese Adults: A Report from a Community-Based Survey in Jiaxing, China

OBJECTIVES

This study examines the associations of socioeconomic status (SES) with intensity of different types of physical activity (PA) in Chinese adults, aimed at outlining and projecting socioeconomic disparities in PA among the population undergoing a rapid nutrition transition.

METHODS

A community-based survey was conducted among 3,567 residents aged 30-65 years old in Jiaxing, China, in 2010. SES and PA were assessed by a structured questionnaire. SES was assessed as socioeconomic index (SEI) score based on self-reported educational attainment, household income and occupation. Metabolic equivalents (METs) were calculated for each subject to quantify the total amount of PA from occupation, exercise, transportation and housework.

RESULTS

Intensity of overall PA in this population was 165 MET-hours/week, in which energy expenditure in occupational PA accounted for 82%. Both types and intensity of PA were significantly different by SES: middle SES groups had higher intensity of occupational activities; lower SES subjects engaged in more household work; whereas higher SES subjects were more likely to exercise, more active during commuting and had longer sedentary time. All the three components of SES, education attainment, income and occupation, contributed to socioeconomic disparities in PA in this population.

CONCLUSIONS

Our results suggest an overall insufficiency and socioeconomic inequalities in PA among Chinese adults in Jiaxing, a typical city experiencing a rapid urbanization in China. There is an urgent need to promote leisure-time activities in this population.

Patterns of physical activity and sedentary behaviour in the general population in France: cluster analysis with personal and socioeconomic correlates

BACKGROUND

Few studies have focused on relating physical activity (PA) and sedentary behaviour (SB) to identify homogeneous groups. This study aimed to identify patterns of PA and SB in France general population and their correlates.

METHODS

A sample of 3294 (mean age 44 ± 17 years) from the general population in France was included. PA and SB were assessed by the World Health Organization Global Physical Activity Questionnaire. Cluster analysis was used to identify PA and SB patterns, with polytomous logistic regression to identify their correlates.

RESULTS

Five clusters were identified: (i) 'low total PA, active-transportation and low SB' (41%), (ii) 'low total PA and moderate SB' (22%), (iii) 'low total PA, leisure-time PA and high SB' (15%), (iv) 'high total PA, moderate occupational PA and moderate SB' (17%) and (v) 'high total PA, vigorous occupational PA and low SB' (5%). Occupational PA substantially contributed to total PA which depended on socioeconomic status (SES): low total PA and high SB in higher SES and high total PA and low SB in lower SES.

CONCLUSIONS

Based on PA and SB, French adults were clustered into groups with socioeconomic differences emphasizing that adapted interventions may be more beneficial for health.

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany.

Methods

The German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) included 17,641 individuals aged 0–17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11–17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators.

Results

After full adjustment, higher parental education level was associated with lower energy-dense food intake – with an OR of 1.3 (95 % CI 1.0–1.7) for boys with secondary educated parents and 1.8 (1.4–2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9–1.5) and 1.6 (1.2–2.2). Higher parental education was associated with higher fruit intake – with an OR of 1.3 (1.0–1.7) for boys with secondary educated parents and 2.0 (1.5–2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8–1.4) and 1.5 (1.0–2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0–1.7, CI girls: 1.0–1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2–2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1–1.9).

Conclusions

A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1830-2) contains supplementary material, which is available to authorized users.

Individual and school level correlates of moderate to vigorous physical activity among school-children in Germany--a multi-level analysis

Background

Young people spend half of their days in school, but evidence concerning the influence of school environment on the physical activity (PA) of pupils is still inconsistent. A better understanding of potential correlates of PA on the school-level and their possible interaction with individual aspects is needed to improve the development of more effective interventions.

Methods

We used data from the 2009/10 German Health Behaviour in School-aged Children study (HBSC)-sample (n=5,005 students aged 11–15 years) including self-reported moderate to vigorous intensity PA as well as a variety of biological, demographic and behavioral correlates and matched them with school-level data from the national school principals’ HBSC questionnaire. We analyzed the associations of individual- and school-level correlates with MVPA by gender-specific multi-level regression.

Results

Only a small share of the overall variation in student’s PA was attributable to the school-level. Consequently, the associations of individual-level correlates with PA were stronger than those of the school-level. Our analysis revealed significant associations of individual-level (i.e. age, consumption of softdrinks, overweight) as well as school-level correlates (i.e. the availability of a football ground and a swimming pool) with MVPA. We also observed some gender-specific findings especially for the school level correlates. Cross-level interactions between individual- and school-level were not apparent.

Conclusions

Our findings indicate the usefulness of applying an ecological framework to understand and explain complex health behaviors like PA. As we found gender-specific association it might be important to acknowledge that boys and girls have specific needs to be more physically active. Further research should also take other features/elements of the school environment and neighborhood as well as socio-cognitive correlates into account to advance the field.

Mode differences in a mixed-mode health interview survey among adults

Background

Health interview surveys are important data sources for empirical research in public health. However, the diversity of methods applied, such as in the mode of data collection, make it difficult to compare results across surveys, time, or countries. The aim of this study was to explore whether the prevalence rates of health-related indicators amongst adults differ when self-administered paper mail questionnaires (SAQ-Paper), self-administered web surveys (SAQ-Web), and computer-assisted telephone interviews (CATI) are used for data collection in a health survey.

Methods

Data were obtained from a population-based mixed-mode health interview survey of adults in Germany carried out within the ‘German Health Update’ (GEDA) study. Data were collected either by SAQ-Paper (n = 746), SAQ-Web (n = 414), or CATI (n = 411). Predictive margins from logistic regression models were used to estimate the prevalence rates of chronic conditions, subjective health, mental health, psychosocial factors, and health behaviours, adjusted for the socio-demographic characteristics of each mode group.

Results

Socio-demographic characteristics were found to differ significantly between study participants who responded by SAQ-Paper, SAQ-Web, and CATI. Crude prevalence rates for health-related indicators also showed significant variation across all three survey modes. After adjusting for socio-demographic factors though, significant differences in prevalence rates between the two self-administered modes (SAQ-Paper and SAQ-Web) were found in only 2 out of the 19 health-related indicators studied. The differences between CATI and the two self-administered modes remained significant however, especially for indicators of mental and psychosocial health and self-reported sporting activity.

Conclusions

The findings of this study indicate that prevalence rates obtained from health interview surveys can vary with the mode of data collection, primarily between interviewer and self-administered modes. Hence, the type of survey mode used should be considered when comparing results from different health surveys. Mixing self-administered modes, such as paper-based questionnaires and web surveys, may be a combination to minimize mode differences in mixed-mode health interview surveys.

Electronic supplementary material

The online version of this article (doi:10.1186/2049-3258-72-46) contains supplementary material, which is available to authorized users.

Patterns and correlates of physical activity among middle-aged employees: a population-based, cross-sectional study

OBJECTIVES

The purpose of this study was to determine the level, pattern and correlates (socio-demographic, lifestyle and work-related) of physical activity among middle-aged employees in Croatia.

MATERIAL AND METHODS

In this cross-sectional study the data were collected using a household interview on a random sample of 766 middle-aged employees (52% female) living in Croatia. The International Physical Activity Questionnaire (IPAQ-long) was used to assess physical activity. An additional questionnaire was used to collect data on socio-demographic, lifestyle and work-related correlates.

RESULTS

The median (95% CI) total physical activity for the whole sample was 78.7 (69.1-88.3) MET-hours/week. Most physical activity was accumulated in the domain of work (26.4 (20.3-32.5) MET-hours/week) or in domestic activities (19.2(17.8-20.7) MET-hours/week), whilst a significantly lower physical activity was found in the transport (3.3 (2.9-3.7) MET-hours/week) and leisure-time domains (6.5 (5.7-7.3) MET-hours/week). The multiple regression analysis showed an inverse relationship between educational level and the size of settlements with the domestic-related and total physical activity (β range: -0.11 to -0.22; p < 0.01). Among lifestyle correlates, only alcohol consumption was positively related to the total physical activity (β = 0.12; p < 0.01), while the perceived level of stress outside work was the only one, which was inversely associated with the work-related (β = -0.09; p < 0.01) and leisure-time physical activity (β = -0.10; p < 0.01).

CONCLUSIONS

Middle-aged employees in Croatia accumulate most of their daily physical activity in the work and domestic domains. Analysis of the relationship between physical activity and potential socio-demographic, lifestyle, and work-related correlates indicated that physical activity promotional activities should be primarily focused on males, employees living in smaller settlements and those with higher educational levels. The correlates of physical activity among middle-aged employees seem to be domain-specific. Therefore, future studies in this area should consider assessing physical activity in each domain separately.

Trends in television time, non-gaming PC use and moderate-to-vigorous physical activity among German adolescents 2002-2010

Background

Studies in youth highlight that moderate-to-vigorous physical activity (MVPA) and screen-time behaviours such as television viewing and PC use are associated with a range of health outcomes. However, little is known about recent trends in these behaviours in adolescents. This paper presents time trends in German adolescents’ television time, non-gaming PC use as well as MVPA from 2002 to 2010.

Methods

Data were derived from the cross-sectional German Health Behaviour in School-aged Children (HBSC) study in 2002, 2006 and 2010. Analyses were based on 16,918 11-to 15-year olds boys (49.1%) and girls. Outcome variables were time spent in TV viewing and using a PC (weekday and weekend day) as well as the number of days achieving 60 minutes of MVPA. Changes in both screen-time behaviours and MVPA over time were analysed using sex-specific linear regression, controlling for age and family affluence.

Results

TV viewing on weekdays, but not at weekends, declined steadily over time with a difference between 2002 and 2010 of 12.4 min/day in girls and 18.3 min/day in boys (p for trend < .01). We found a strong increase in PC use for non-gaming purposes over time for girls only, with a difference between 2002 and 2010 of 54.1 min/weekday and 68.8 min/weekend day (p < .001). For MVPA we found a slight statistically significant increase in terms of meeting PA guidelines as well as days/week in MVPA for boys and girls (p < .001). In 2010 14.0% of girls and 19.9% of boys met PA guideline.

Conclusion

Although MVPA increased from 2002 to 2010 in German adolescents, the time spent in MVPA was still low. Despite the observed decrease in TV viewing, there was no overall decline in the observed screen-based behaviours, especially for girls. This is mainly due to a marked increase in use of a PC for chatting on-line, internet, emailing, homework etc. among girls during the last ten years which outweighs the corresponding decrease in TV viewing. The findings highlight a need for strategies and interventions aimed at reducing screen-time behaviours and promoting MVPA.

Physical activity, aerobic fitness and parental socio-economic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socio-economic position (PSEP) and health among adolescents may be partly explained by physical activity behaviour. We investigated the associations between physical activity, aerobic fitness and PSEP in a population based sample of German adolescents.

Methods

5,251 participants, aged 11–17 years, in the German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) underwent a sub-maximal cycle ergometer test and completed a questionnaire obtaining information on physical activity and media use. The associations between physical activity, media use, aerobic fitness and PSEP were analysed with multivariate logistic regression models for boys and girls separately. Odds ratios (ORs) of PSEP (education, occupation and income) on the outcomes were calculated adjusted for age, region, and other influencing factors.

Results

Parental education was more strongly associated with the outcome variables than parental occupation and income. After adjusting for age and region, a higher parental education level was associated with better aerobic fitness – with an OR of 1.5 (95% CI 1.2-1.9) for girls whose parents had secondary education and 1.9 (1.4-2.5) for girls whose parents had tertiary education compared to girls whose parents had primary education. The corresponding ORs for boys were 1.3 (1.0-1.6) and 1.6 (1.2-2.1), respectively. Higher parental education level was associated with lower media use: an OR of 2.1 (1.5-3.0) for girls whose parents had secondary education and 2.7 (1.8-4.1) for girls whose parents had primary education compared to girls whose parents had tertiary education. The corresponding ORs for boys were 1.5 (1.2-1.9) and 1.9 (1.5-2.5), respectively. Higher parental education level was associated with a higher physical activity level only among girls: an OR of 1.3 (1.0-1.6) for girls whose parents had secondary education and 1.2 (0.9-1.5) for girls whose parents had tertiary education compared to girls whose parents had primary education. The corresponding ORs for boys were 0.9 (0.8-1.2) and 0.8 (0.6-1.0), respectively.

Conclusions

Adolescents of parents with low SEP showed a lower level of aerobic fitness and higher levels of media use than adolescents of parents with higher SEP. Health-promotion interventions need to reach adolescents of parents with low PSEP and stimulate physical activity.

Dietary behaviour and socioeconomic position: the role of physical activity patterns

BACKGROUND

The positive association between education level and health outcomes can be partly explained by dietary behaviour. We investigated the associations between education and several indices of food intake and potential influencing factors, placing special emphasis on physical-activity patterns, using a representative sample of the German adult population.

METHODS

The German National Health Interview and Examination Survey 1998 (GNHIES98) involved 7,124 participants aged between 18 and 79. Complete information on the exposure (education) and outcome (nutrition) variables was available for 6,767 persons. The associations between 'education' and indices of 'sugar-rich food', 'fat-rich food', 'fruit-and-vegetable' and 'alcohol' intake were analysed separately for men and women using multivariate logistic regression analysis. Odds ratios (OR) of education level on nutrition outcomes were calculated and adjusted for age, region (former East/West Germany), occupation, income and other influencing factors such as physical activity indicators.

RESULTS

Men and women with only a primary education had a more frequent intake of sugar-rich and fat-rich foods and a less frequent intake of fruit and vegetables and alcohol than people with a tertiary education. 'Physical work activity' partly explained the associations between education and sugar-rich food intake. The interference with physical work activity was stronger among men than women. No significant associations between education and energy-dense food intake were observed in the retirement-age group of persons aged 65+ and among persons with low energy expenditure.

CONCLUSIONS

In Germany, adults with a low level of education report that they consume energy-dense foods more frequently - and fruit and vegetables and alcohol less frequently - than adults with a high education level. High levels of physical work activity among adults with a low education level may partly explain why they consume more energy-dense foods.