Overestimation of physical activity level is associated with lower BMI: a cross-sectional analysis

The Physiological Effects of Weight-Cycling: A Review of Current Evidence

PURPOSE OF REVIEW

There is a common perception among the public that yo-yo dieting, defined as repeated cycles of weight loss followed by weight regain, results in accumulation of fat in the body and lower metabolic rate, thus hindering subsequent attempts to lose weight. We evaluated the effects of weight-cycling on body weight and body mass index (BMI), body composition including fat mass (FM) and lean body mass (LBM), and resting metabolic rate (RMR), by systematically reviewing existing scientific literature.

RECENT FINDINGS

Twenty-three cross-sectional and cohort studies (including subjects with a history of weight-cycling compared to those without such history) and interventional studies (evaluating physiological effects during one or more cycles of weight loss and regain) were identified, conducted in generally healthy adults across various age groups, races, and both genders, who had normal weight, overweight, or obesity. Eighteen studies investigated the association between weight-cycling and body weight or BMI, and thirteen of them found no significant association. Fifteen out of twenty studies also found no increase in FM, and none of eighteen studies found a decrease in LBM. Twelve out of fourteen studies reported no adverse changes in RMR either. The overwhelming majority of evidence suggests that weight-cycling (yo-yo effect) is not associated with any adverse effects in body weight, body composition, and metabolic rate. Accordingly, healthy individuals who struggle with overweight or obesity should not be discouraged from repeated attempts to lose the excess weight.

Uterine Fibroid Prevalence in a Predominantly Black, Chicago-Based Cohort

(1) Objectives: To investigate the effect of individual-level, neighborhood, and environmental variables on uterine fibroid (UF) prevalence in a Chicago-based cohort. (2) Methods: Data from the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) were analyzed. Individual-level variables were obtained from questionnaires, neighborhood variables from the Chicago Health Atlas, and environmental variables from NASA satellite ambient air exposure levels. The Shapiro-Wilk test, logistic regression models, and Spearman's correlations were used to evaluate the association of variables to UF diagnosis. (3) Results: We analyzed 602 participants (mean age: 50.3 ± 12.3) who responded to a question about UF diagnosis. More Black than White participants had a UF diagnosis (OR, 1.32; 95% CI, 0.62-2.79). We observed non-significant trends between individual-level and neighborhood variables and UF diagnosis. Ambient air pollutants, PM2.5, and DSLPM were protective against UF diagnosis (OR 0.20, CI: 0.04-0.97: OR 0.33, CI: 0.13-0.87). (4) Conclusions: Associations observed within a sample in a specific geographic area may not be generalizable and must be interpreted cautiously.

Trends in obesity, leisure-time physical activity, and sedentary behavior in Korean adults: Korea national health and nutritional examinations survey from 2014 to 2021

OBJECTIVES

This study aimed to investigate trends in obesity by dividing it based on body mass index (BMI) and waist circumference indicators, sedentary behavior, and leisure-time physical activity (LTPA) in Korean adults from 2014 to 2021. This study also aimed to determine the adherence rate of people with obesity to physical activity.

METHODS

Data from the Korea National Health and Nutritional Examination Survey (KNHANES) from 2014 to 2021 were used. A total of 42,676 participants 19 years or older were included in the final analysis. Sociodemographic characteristics, anthropometric measurements, and physical activity levels were recorded. Physical activity levels were assessed using the Global Physical Activity Questionnaire, a self-reported questionnaire. Multivariable logistic regression analysis adjusted for covariates was used to investigate the prevalence of obesity and sitting time or adherence to meeting the physical activity guidelines for each survey year.

RESULTS

This study included 42,676 adults. The weighted prevalence of obesity in all ages significantly increased from 30.8% (29.1%-32.5%) in 2014 to 34.5% (32.9%-36.2%) in 2017 and 37.3% (35.5%-39.1%) in 2021 (p for trend < 0.004). The weighted adherence rate to LTPA ranged from 25.5% (95% confidence interval [CI], 23.7%-27.2%) in 2014 to 20.5% (95% CI, 18.7%-22.2%) in 2021(p for trend < 0.001). The weighted prevalence of sitting time for 8 h/day or more significantly increased from 46.7% (44.4%-49.0%) in 2014 to 56.2% (54.4%-58.0%) in 2017 and 63% (60.7%-65.3%) in 2021 (p for trend < 0.001). According to this study, the LTPA level among women with obesity was significantly low.

CONCLUSION

From 2014 to 2021, obesity and sedentary behavior significantly increased and adherence to LTPA decreased among Korean adults. Given these concerning trends, comprehensive interventions are needed at the national level to encourage healthy lifestyle behaviors.

Understanding Health Beliefs and Health Behaviors in Older Adults at Risk for Alzheimer's Disease

Background

There are significant public health benefits to delaying the onset of Alzheimer's disease (AD) in individuals at risk. However, adherence to brain healthy behaviors is low. The Health Belief Model proposes that specific beliefs are mediators of behavior change.

Objective

To characterize health belief measures from the Science of Behavior Change Research Network (SBCRN) in an older adult population and associations between health beliefs, AD risk, and current health behaviors.

Methods

A total of 172 individuals from the Rhode Island AD Prevention Registry participated. SBCRN health belief measures included assessments of future time perspective, self-efficacy, deferment of gratification, and consideration of future consequences. Outcome measures included individual AD risk index score, dementia risk awareness, and lifestyle behaviors including physical, cognitive, and social activity.

Results

Participants who were older had higher scores for AD risk, lower future time perspective, and lower generalized self-efficacy (all at p < 0.001). Higher generalized self-efficacy was related to increased physical activity (p < 0.010). Higher future time perspective (p < 0.001) and generalized self-efficacy (p = 0.48) were associated with lower AD risk score. Subjective cognitive decline (SCD) was associated with lower self-efficacy, ability to delay gratification, and a less expansive future time perspective.

Conclusions

Greater self-efficacy and perceived future time remaining were associated with lower AD risk and greater engagement in physical activity. SCD was associated with health beliefs that may negatively affect engagement in positive brain health behaviors. Assessment of and psychoeducation about these intrapersonal health belief constructs may be important targets for behavioral interventions to reduce AD risk.

Physical Activity Behavior and Measurement in Arab American Women: An Integrative Review

Physical activity (PA) is associated with cardiovascular health; however, in the U.S., only 20% of women are physically active, compared to 28% of men. Arab American women (AAW) experience unique barriers to engaging in the recommended PA. This review examines quantitative PA studies conducted with AAW with a specific focus on how PA outcomes were assessed. Studies were analyzed to explore: (a) types of PA behavior, (b) components of PA interventions/interest (if conducted), (c) PA measurement, and (d) translation of PA tools. After screening titles, abstracts, and a full-text review of articles from five different databases, 12 studies met the inclusion criteria. Leisure-time PA was the most readily used PA measure. Only two out of the 12 studies included women-only participants. There was a total of 10 cross-sectional studies and two quasi-experimental studies. All the studies used a self-report PA questionnaire; one study used a pedometer to measure PA. Six PA questionnaires were translated into Arabic. Future studies must explore the use of reliable and valid translated instruments, objective PA measures, and randomized controlled trial designs.

Health behaviours associated with healthy body composition among Aboriginal adolescents in Australia in the 'Next Generation: Youth Well-being study'

This study described the distribution of healthy body composition among Aboriginal adolescents in Australia aged 10-24 years and examined associations with health behaviours and self-rated health. Data were cross-sectional from the 'Next Generation: Youth Well-being study' baseline (N = 1294). We used robust Poisson regression to quantify associations of self-reported health behaviours (physical activity, screen time, sleep, consumption of vegetables, fruit, soft drinks and fast food, and tobacco smoking and alcohol) and self-rated health to healthy body mass index (BMI) and waist/height ratio (WHtR). Overall, 48% of participants had healthy BMI and 64% healthy WHtR, with healthy body composition more common among younger adolescents. Higher physical activity was associated with healthy body composition (5-7 days last week vs none; adjusted prevalence ratio (aPR) healthy BMI 1.31 [95% CI 1.05-1.64], and healthy WHtR 1.30 [1.10-1.54]), as was recommended sleep duration (vs not; aPR healthy BMI 1.56 [1.19-2.05], and healthy WHtR 1.37 [1.13-1.67]). There was a trend for higher proportion of healthy body composition with more frequent fast food consumption. Healthy body composition was also associated with higher self-rated health ('very good/excellent' vs 'poor/fair'; aPR healthy BMI 1.87 [1.45-2.42], and healthy WHtR 1.71 [1.40-2.10]). Culturally appropriate community health interventions with a focus on physical activity and sleep may hold promise for improving body composition among Aboriginal adolescents.

Validation Study of Physical Activity and Sedentary Behavior in African-American Men and Women

BACKGROUND

Self-reported data of physical activity are practical and inexpensive ways to collect data, although, subject to significant measurement errors. Most physical activity questionnaires used in the USA have been predominately validated among non-Hispanic White American populations with limited attention paid to the validity of the measures among racial/ethnic minorities. Additionally, there are limited studies that have evaluated factors related to over- and under-reporting errors linked to self-reported physical activity data, particularly among African Americans. The primary objectives of this study were to validate self-reported levels of physical activity and sedentary behavior among African-American men and women against objective measurements and to identify the factors related to under- and over-reporting.

METHODS

This study was a 7-day, cross-sectional study conducted on African-American men and women (n = 56) who were between 21-70 years of age. Participants were required to attend two study visits for the collection of self-reported and objective measurements of physical activity and sedentary behavior (VO2max, DEXA scan, anthropometrics, ActivPal accelerometer, resting metabolic rate (RMR) and International Physical Activity Questionnaire (IPAQ) questionnaire.

RESULTS

Overall, energy expenditure measured by ActivPal was 24.1 MET/hr/week whereas self-reported (IPAQ) energy expenditure was 52.66 MET/hr/week. Self-reported sedentary time was 40.37 h/week, whereas sedentary time measured by ActivPal was 63.03 h/week. Obese participants tended to over-report their physical activity levels more so than non-obese participants (Obese, Activpal-23.89 MET/hr/week vs IPAQ-58.98 MET/hr/week; Non-obese, Activpal - 24.48 MET/hr/week vs IPAQ - 42.55 MET/hr/week). Both obese and non-obese participants underestimated their sedentary time (Obese, Activpal - 66.89 h/week vs IPAQ-43.92 h/week; Non-obese, Activpal -56.07 h/week vs IPAQ - 33.98 h/week).

CONCLUSIONS

The results of this study found that the ActivPal validated physical activity and sedentary behavior among African-Americans. Self-reported data were found to be highly variable, whereas the objective assessments of physical activity and sedentary behavior had limited variability. It was also found that obese individuals over-estimated their self-reported physical activity levels and under-estimated sedentary behavior in comparison to the ActivPal. These findings strongly support the need to measure physical activity and sedentary behaviors objectively, particularly among African-Americans.

Gender Differences in the Association between Physical Activity and Mortality in Chronic Kidney Disease: Results from the National Health and Nutrition Examination Survey (2011-2018)

BACKGROUND

Physical activity is indispensable in the management of chronic kidney disease (CKD). The aim of this study was to investigate gender difference in the association of physical activity with mortality among the CKD population.

METHODS

In total, 3701 participants with CKD from the 2011 to 2018 NHANES with linked mortality data were classified into different groups based on the intensity of self-reported physical activity. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between physical activity and mortality.

RESULTS

During the median follow-up of 53.7 months, 694 all-cause deaths and 226 cardiovascular deaths were recorded. Patients were categorized into extremely highly active (>1500 MET-min/week), highly active (>600, ≤1500 MET-min/week), low-active (>0, ≤600 MET-min/week), or inactive (0 MET-min/week) groups. Among males, the multivariable Cox regression showed that the low-active group (HR, 0.67; 95% CI, 0.48-0.93) and highly active group (HR, 0.60; 95% CI, 0.41-0.88) were independently associated with lower risks for all-cause mortality, compared to the inactive group. The risks of all-cause mortality did not further decrease once physical activity surpassed 1500 MET-min/week, indicating a U-shaped association in males. In females, only the extremely highly active group (>1500 MET-min/week) was significantly associated with a mortality risk compared to inactivity (HR, 0.59; 95% CI, 0.39-0.89).

CONCLUSIONS

Any amount of physical activity is associated with reduced all-cause mortality in male CKD participants, while in female patients, only the extremely highly active group shows the significant association.

Physical Activity in Malaysia: Are We Doing Enough? Findings from the REDISCOVER Study

Physical activity (PA) in the form of structured or unstructured exercise is beneficial for health. This paper aims to study PA levels across four domains according to the International Physical Activity Questionnaire (IPAQ) and its associated factors. A total of 7479 Malaysian adult participants between 18 to 90 years old from the REDISCOVER study who completed the IPAQ were analyzed. PA was calculated as MET-min per week and were categorized according to insufficiently active, sufficiently active and very active. Multinomial regression was used to determine the association between sociodemographic, clinical factors and the level of PA. The mean age of the participants was 51.68 (±9.5 SD). The total reported physical activity in median (IQR) was 1584.0 (0-5637.3) MET-min per week. The highest total for PA was in the domestic domain which is 490 (0-2400) MET-min per week. Factors associated with sufficiently active or very active PA include Malay ethnicity, no formal education, elementary occupation, current smokers and high HDL. Whereas low income, male and normal BMI are less likely to participate in sufficiently active or very active PA. Intervention to encourage higher PA levels in all domains is important to achieve recommended PA targets.

Interaction of leisure-time physical activity with body mass index on the risk of obesity-related cancers: a pooled study

Physical activity (PA) has been associated with a lower risk of some obesity-related cancers, but the combined association and interaction of PA and body weight on obesity-related cancer risk is less clear. We examined the association of leisure-time PA (high/low) and its combination with body mass index (BMI, <25 [low]/≥25 [high] kg/m² ) on obesity-related cancer risk in 570 021 individuals, aged 43 years on average at baseline, in five Scandinavian cohorts. We used Cox regression to calculate hazard ratios of obesity-related cancers (n = 19 074) and assessed multiplicative and additive interactions between PA and BMI on risk. High leisure-time PA, recorded in 19% of the individuals, was associated with a 7% (95% confidence interval [CI] 4-10%) lower risk of any obesity-related cancer compared to low PA, with similar associations amongst individuals with a low and a high BMI (6% [1-11%] and 7% [2-11%]). High PA was also associated with decreased risks of renal cell (11% [9-31%]) and colon cancer (9% [2-16%]). When high PA and low BMI were combined, the relative risk reduction for all obesity-related cancers was 24% (95% CI 20-28%); endometrial cancer, 47% (35-57%); renal cell cancer, 39% (27-51%); colon cancer, 27% (19-35%); multiple myeloma, 23% (2-40%); and pancreatic cancer, 21% (4-35%), compared to low PA-high BMI. There were no additive or multiplicative interactions between PA and BMI on risk. The result of this study suggests a reduced risk of obesity-related cancer by leisure-time PA in both normal weight and overweight individuals, which further decreased for PA and normal weight combined.

Relations Among Locus of Control, Religiosity, and Resiliency in Collegiate Football Players

Resiliency in athletes is related to effective coping strategies. Expectedly, during the COVID-19 pandemic, this attribute was highlighted in collegiate football players. To date, the relations among locus of control (LOC), strength of religious beliefs (i.e., religiosity), and resiliency in collegiate football players have not been explored in the literature. Exploring the relation of LOC and religious beliefs to resiliency may shed light on avenues to foster resiliency in football players, which in turn can determine players' behaviors, performance, and actions during adverse times. The purpose of this study was to gain a more in-depth understanding of the relations among LOC, religiosity, and resiliency in NCAA Division II football players at a public university located in the southwestern United States. A structured online survey containing the Rotter's Locus of Control Scale (Rotter in Psychological Monographs: General and Applied, 80(1), 1-28, 1966), the Santa Clara Strength of Religious Faith Questionnaire (Plante & Boccaccini in Pastoral Psychology, 45(6), 429-437, 1997), and the Conner Davidson Resilience Scale (Connor & Davidson in Depression and Anxiety, 18(2), 76-82, 2003) was completed by 91 Division II football players. Statistically significant correlations were found between LOC and resiliency (r = -.42) as well as religiosity and resiliency (r = .26). Regression analysis indicated, on average, that football players with greater internal LOC and higher strength of religious beliefs had a higher level of resiliency than players with higher external LOC and lower strength of religious beliefs.

Responses to the Physical Activity Guidelines and Dissemination Strategies for Behavior Change in a Representative Sample of US Adults

BACKGROUND

Dissemination of the Physical Activity Guidelines for Americans (Guidelines) is needed, but how individuals respond to the Guidelines is not well understood. This surveillance study describes US adults' reported responses to and information sources for hearing about the Guidelines and explores relationships between how respondents heard about the Guidelines and their reported response(s).

METHODS

Data were analyzed from the population-based 2019 Health Information National Trends Survey 5 Cycle 3. Population-weighted proportions of response were calculated. Among those who had heard about the Guidelines, binary logistic regressions examined associations between the reported response(s) and the information source and number of sources reported.

RESULTS

The analytical sample included 5047 adults. Nearly 65% of US adults reported hearing about the Guidelines, and 29% reported a behavioral response (eg, increased physical activity). Hearing about the Guidelines through health professionals (adjusted odds ratio = 2.30, 95% confidence interval, 1.45-3.65) or social media (adjusted odds ratio = 1.89, 95% confidence interval, 1.20-2.96) (vs other sources) was associated with reporting increasing physical activity. Hearing from multiple sources (vs one source) was associated with reporting increasing physical activity (adjusted odds ratio = 1.97, 95% confidence interval, 1.18-3.31).

CONCLUSION

Findings suggest dissemination of the Guidelines across multiple channels may promote greater changes in physical activity.

What matters to you? An investigation of patients' perspectives on and acceptability of prehabilitation in major cancer surgery

OBJECTIVE

To understand perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery (cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy).

METHODS

Seventy-nine patients admitted to a Danish colorectal or ovarian cancer centre participated in qualitative semi-structured interviews and/or registered their prehabilitation activities based on preoperative recommendations presented in a leaflet. Malterud's principles of systematic text condensation were used to analyse the interview data, and descriptive statistics were used to describe the activity registrations.

RESULTS

Five domains clarify central aspects of the patients' perspectives on and acceptability of prehabilitation: the preoperative period, attitudes towards prehabilitation, the actual prehabilitation performed, motivation to take action and the need for support.

CONCLUSION

Patients undergoing major abdominal cancer surgery are interested in and positive towards prehabilitation, but it has to be on their terms. The patients need support and supervision, but it has to be provided in a setting and in a way that are in line with the patient's preferences, resources and values. Thus, patient involvement is necessary to create prehabilitation programmes that are feasible and fit into patients' everyday lives.

Sex Difference in the Association between Physical Activity and All-Cause Mortality in Ambulatory Patients with Chronic Kidney Disease

(1) Background: The purpose of this article was to investigate the association between self-reported physical activity (PA) and all-cause mortality in ambulatory patients with chronic kidney disease (CKD), stage 4–5 including maintenance dialysis. (2) Methods: Ambulatory patients with CKD (eGFR < 30 mL/min/1.73 m²) with conservative treatment or chronic dialysis were included. PA was assessed using the Saltin–Grimby Physical Activity Level Scale. A Cox proportional hazards regression model––adjusted for age, sex, plasma–albumin, body mass index, socioeconomic status, and treatment––was applied. (3) Results: Participants (n = 374) were followed 39 ± 15 months from entry to death or censoring. Throughout the study period of 39 months, 156 deaths (42%) were registered. Regarding physical activity, 128 (34%) of the participants were inactive, 212 (57%) were moderately active, and 34 (9%) were highly or vigorously active. Moderate PA was associated with a decreased mortality risk in women (n = 150) compared to inactivity (HR 0.27 (0.15; 0.51), p < 0.001), whereas a high/vigorous level of PA was not significantly associated with mortality risk compared to inactivity. In men (n = 224), the associations between PA levels and mortality risk were not significant. (4) Conclusions: Moderate PA was associated with reduced all-cause mortality in ambulatory women with stage 4–5 CKD with or without maintenance dialysis treatment. Physical activity was not significantly associated with mortality in men.

The relationship of self-reported and device-based measures of physical activity and health-related quality of life in adolescents

BACKGROUND

Physical activity (PA) has beneficial effects on health and health-related quality of life (HRQoL), which is a protective factor of illness and mortality. The purpose of this examination was to investigate if self-reported and device-based measures of PA were related to HRQoL in adolescents.

METHODS

Participants (N = 1565; 54.3% female; Mage = 14.37 years, SDage = 1.99) were recruited from 167 sample points across Germany. Adolescents self-reported their PA, supplemented by a 1-week examination of device-based PA using accelerometry. Additionally, they completed the multidimensional KIDSCREEN-27 to assess HRQoL.

RESULTS

Results showed that self-reported PA was correlated with overall HRQoL, Physical Well-Being, Psychological Well-Being, Social Support & Peers, and School Environment, whereas device-based PA was only correlated with Physical as well as Psychological Well-Being. Further, self-reported PA significantly predicted all facets of HRQoL except for Autonomy and Parent Relations, whereas device-based PA solely heightened the amount of explained variance in the Physical Well-Being subscale.

CONCLUSIONS

Findings demonstrate the importance of self-reported PA as it is related to almost all facets of HRQoL. Both measures of PA are not congruent in their relationship with HRQoL and thus implications have to be carefully considered. Future studies should investigate the direct effect of PA on HRQoL and health in a longitudinal approach to account for the causality of effects.

Health-Related Fitness in Adults From Eight European Countries-An Analysis Based on Data From the European Fitness Badge

BACKGROUND

There are conflicting reports about the fitness status of European adults, partly due to the lack of a standardized fitness test battery used across Europe. The European Fitness Badge (EFB) was developed in 2017 as an online-based tool to assess the health-related fitness of persons aged ≥ 18 years residing in European countries. We examined the demographic characteristics and fitness status of persons who completed the EFB between June 2017 and May 2019.

METHODS

We conducted a multinational study in eight European countries. Participants completed the EFB which includes 11 validated motor tests to measure endurance, strength, coordination, and flexibility performance, under the supervision of an EFB instructor in different settings (e.g., sports club sessions, public events). Two different test batteries [test profiles (TPs)] are available to distinguish between less active (TP1) and active individuals (TP2). We calculated descriptive statistics and conducted analyses of variance to examine sample characteristics and a potential impact of sex, age, body mass index (BMI), physical activity, and posture on fitness as assessed by the EFB.

RESULTS

The sample included 6,019 adults (68.7% females; mean age 52.7 years; age range 18-89 years). Participants who completed TP1 were older (TP1: 61.4 years; TP2: 44.2 years; p = 0.00), reported a lower level of physical activity (TP1: 3.8; TP2: 4.0; p = 0.00), had a higher BMI (TP1: 25.7; TP2: 24.3; p = 0.00) and a higher frequency of postural abnormalities (TP1: 43%; TP2: 33%; p = 0.00) than TP2 participants. Among 3,034 participants who completed TP2, males had higher performance in endurance, strength, and overall fitness, whereas females performed better in coordination and flexibility tests. In addition, younger age, lower BMI, and higher level of physical activity engagement were associated with better EFB test performance.

CONCLUSION

The EFB can be used to assess the health-related fitness status of individuals aged ≥ 18 years. Our results show that TP1 and TP2 were completed by persons from the respective target groups (i.e., less active vs. active), and also confirm findings from previous studies on potential determinants of fitness such as sex or age.

Interoception and alexithymia are related to differences between the self-reported and the objectively measured physical activity in patients with chronic musculoskeletal pain

OBJECTIVE

Patients with chronic musculoskeletal pain (CMP) have difficulty estimating their level of physical activity (PA). Factors associated with this difficulty have yet to be identified; however, identification could allow for increased accuracy in large-scale PA surveys, and enhanced self-management. The purpose of this study was to determine the relationship of interoception and alexithymia with differences between self-reported and objectively measured PA, and investigate factors as they relate to accurately self-reporting PA.

METHODS

A cross-sectional survey of 33 patients with CMP and 32 healthy individuals was conducted from July 2018 to June 2019. We measured differences in Moderate to Vigorous Physical Activity (D-MVPA) using an accelerometer and self-report. A heartbeat tracking task (HTT) was used to measure interoception, and alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20).

RESULTS

The CMP group (median 43.5 min/day, IQR 20.6-77.6) showed significantly higher D-MVPA values than the control group (median 22.5 min/day, IQR 6.7-34.9) (p < .001). In patients with CMP, D-MVPA positively correlated with TAS-20 (rho = 0.470, p = .006) and correlated negatively with HTT (rho = -0.390, p = .025).

CONCLUSION

Inaccurate self-reported measurements of PA in patients with CMP are associated with alexithymia and interoception. This finding suggests that behavioral interventions targeting alexithymia and interoception in CMP patients could lead to improved self-monitoring.

Health-related quality of life in pilots of a Chinese commercial airline

Health-related quality of life (HRQOL) is currently an important issue in the medical industry. However, data on HRQOL in commercial airline pilots are lacking. This study aimed to investigate HRQOL and its related factors in a sample of commercial pilots. A purposive sample of 373 participants was recruited from a Chinese Commercial Airline. The median (IQR) score for physical health, psychological health and social relationship were 64.3 (75-53.6), 62.5 (70.8-54.2) and 75 (75-58.3), respectively. The mean (SD) score for Environment was 62.2 (16). After controlling for demographics, the multiple linear regression analyses showed that physical activity, fruit intake and vegetable intake were positively correlated with HRQOL score (p < .05), while time-zone flights, smoking, alcohol drinking and being dyslipidemic showed a negative correlation with HRQOL score (p < .05). Healthcare providers should consider time-zone flights, behavioral factors and dyslipidemia when planning related health promotion and disease prevention programs for commercial pilots in the future.

Personality traits and physical functioning: a cross-sectional multimethod facet-level analysis

BACKGROUND

This study aimed to investigate whether personality traits and their facets are associated with a multi-methods assessment of physical activity and walking performance and whether they explain the discrepancy between self-reported and accelerometer-assessed physical activity.

METHODS

The participants were community-dwelling, 70-85-year-old men and women from Finland (n = 239) who were part of a clinical trial. Personality traits and their facets were measured using the 240-item NEO Personality Inventory-3. Physical activity was assessed using questions about frequency, intensity and duration of exercise (self-reported metabolic equivalent minutes (MET)) and by tri-axial accelerometers (light and moderate-to-vigorous physical activity and total MET-minutes). Walking performance was measured by 6-min walking distance and 10-m walking speed. Linear regression analyses were controlled for age, sex, education, body mass index, disease burden, and intervention group.

RESULTS

The activity facet of extraversion was positively associated with self-reported MET-minutes, accelerometer-assessed light physical activity and walking performance. The positive emotions facet of extraversion was positively associated with self-reported MET-minutes and walking performance. Openness and its facets and the excitement seeking facet of extraversion were positively associated with walking performance. Conscientiousness and most of its facets were associated with both physical activity and walking performance, but these associations were not statistically significant after accounting for all control variables. The impulsiveness facet of neuroticism was negatively associated with accelerometer-assessed light physical activity and walking performance, but the associations with walking performance attenuated after accounting for all control variables. Accelerometer-assessed moderate-to-vigorous physical activity was not associated with personality traits or facets. Discrepancy analyses suggest that openness and the excitement-seeking facet of extraversion were associated with higher self-reported than accelerometer-assessed physical activity.

CONCLUSIONS

Consistently across methods, older adults who scored higher on facets of extraversion and conscientiousness tended to be more active and outperformed peers on walking performance. Older adults who scored higher in the facets of openness and the excitement-seeking facet of extraversion had better walking performance but also overestimated their self-reported physical activity compared to the accelerometers.

Prehabilitation in cancer care: patients' ability to prepare for major abdominal surgery

BACKGROUND

Patients' perspectives on standardised, multimodal prehabilitation programmes showed barriers to adherence. Further investigation of patients' ability to prepare is needed.

AIM

To investigate what patients with cancer who were due to undergo major abdominal surgery actually were able to do when provided with preoperative, home-based, multimodal recommendations presented in a leaflet.

METHODS

Patients from the colorectal- or ovarian cancer centre, who were scheduled for major abdominal surgery, received a leaflet with preoperative recommendations. On a daily basis, the patients filled in what they had completed in relation to these recommendations, so that adherence could be investigated. Additionally, face-to-face interviews were conducted to evaluate patients' experiences of using the leaflet. Malterud's principles of systematic text condensation were used to analyse the interviews. A convergent design was used to merge the quantitative and qualitative data into a combined interpretation presented in the discussion.

RESULTS

A total of 53 patients returned a completed leaflet, and five patients were interviewed. In the combined interpretation, patients' ability to prepare was presented through four major domains. The domains were adherence and the importance of support, manageable actions leading to change, preparation in a broader perspective and impediments to preparation and to symptom relief.

CONCLUSIONS

Patients prepared themselves in various ways, which were not limited to recommendations inspired by multimodal prehabilitation. Patients from the ovarian cancer centre increased their weekly exercise during the preoperative period, which indicates that the leaflet not only functioned as a data collection tool, but also motivated and supported the patients in prehabilitation-related actions. Patients' perspectives on prehabilitation need to be taken into account, when aiming to enhance patient-centredness and adherence.

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.

Validity and bias on the online active Australia survey: activity level and participant factors associated with self-report bias

Background

This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life.

Methods

The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman’s rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv accelerometer. A Bland-Altman plot illustrated self-report bias (the difference between methods). Linear mixed effects modelling was used to examine whether participant factors predicted self-report bias.

Results

The association between moderate-to-vigorous physical activity reported on the online Active Australia Survey and accelerometer was significant (r_s = .27, p < .001). Participants reported 4 fewer minutes per day on the Active Australia Survey than was recorded by accelerometry (95% limits of agreement −104 – 96 min) but the difference was not significant (t(343) = −1.40, p = .16). Self-report bias was negatively associated with minutes of accelerometer-recorded moderate-to-vigorous physical activity and positively associated with mental health-related quality of life.

Conclusions

The online Active Australia Survey showed limited criterion validity against accelerometry. Self-report bias was related to activity level and mental health-related quality of life. Caution is recommended when interpreting studies using the online Active Australia Survey.

The risk, perceived and actual, of developing type 2 diabetes mellitus for mothers of preschool children in urban China

BACKGROUND

The perceived risk of developing type 2 diabetes mellitus (T2DM) can motivate individuals to adopt preventive health behaviors. Compared with fathers, mothers of young children often experience unique risk factors for developing T2DM: pregnancy-related weight gain, lifestyle changes related to child care, and the increased incidence of gestational diabetes mellitus. Understanding how actual risk factors affect the perceived risk of developing T2DM can foster effective diabetes prevention interventions for this population. The aims of this study were to describe the risk, perceived and actual, of developing T2DM and to explore the influencing factors of perceived risk for Chinese mothers of preschool children in China.

METHODS

A multisite, cross-sectional survey was conducted and included 176 mothers (mean age of 31.19 years old) of preschool children (aged 3-7 years old) from four preschools in Changsha, the capital city of Hunan Province, China. The overall perceived risk of developing T2DM was measured by one item "Your own personal health risk is at almost no risk, slight risk, moderate risk or high risk from diabetes" from the Risk Perception Survey for Developing Diabetes (RPS-DD). PRS-DD and the Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CHINARISK) were used to assess perceived risk related worry, personal control, optimistic bias, and diabetes risk knowledge and actual risk of T2DM. Mothers also reported their height, weight, and waist circumference followed by the NIH protocol. Pearson correlation and stepwise multivariate linear regression were used to explore how the actual risk factors affected the perceived risk of developing diabetes (RPS-DD)).

RESULTS

Nearly 90% of mothers perceived almost no/slight risk for developing diabetes. Nearly half of the mothers had parents or siblings with diabetes. Roughly 70% of the mothers did not eat five servings of fruits and vegetables per day, and more than 50% did not exercise at least 30 minutes a day. In the five stepwise multivariate linear regression models, young mothers (95% CI .400-1.311) and those with a family history of diabetes (95% CI -0.74- .000) were founded a higher overall perceived risk. Mothers who reported more sedentary time (95% CI -0.029- -0.008) and less physical activity had less personal control (95% CI -0.354- -0.046). Mothers with more sedentary time had more worries about developing T2DM(95% CI 0.008-0.035) . Mothers who were older (95% CI -0.440-0.055) or had more physical activities (95% CI 0.003-0.048) had more optimistic bias of not developing T2DM. Mothers who had a higher education level (95% CI .354-1.422) and a family history of diabetes (95% CI .029-2.231) had more diabetes risk knowledge of developing T2DM.

CONCLUSION

This study found that Chinese mothers of preschool children in urban areas reported low perceived risk of developing T2DM, although they have actual risk factors. These women did not associate anthropometric, health history, or health behavior factors with the risk of developing T2DM. Anthropometrics and risk factors associated with behavioral risk factors may be the focus of diabetes prevention programs.

Impact of the HealthMatters Train-the-Trainer Program on the Health and Health Behaviors of Staff Supporting Adults With Intellectual and Developmental Disabilities

The health status and health behaviors among support staff providing daily support for people with intellectual and developmental disabilities (IDD-SS) in community-based organizations (CBOs) have not been systematically studied. This study examined the health impact of IDD-SS workers who participated in a HealthMatters Program: Train-the-Trainer Certified Instructor Workshop followed by implementing a 12-week HealthMatters Program for people with intellectual and developmental disabilities (IDD) that they care for as part of their employment. A total of 48 IDD-SS were enrolled into either an intervention (n = 28) or control group (n = 20). IDD-SS in the intervention group received an 8-hour HealthMatters Program: Train-the-Trainer Workshop immediately prior to teaching a 12-week HealthMatters Program for people with IDD. Assessments were conducted with IDD-SS before and after completing the 12-week HealthMatters Program to evaluate whether IDD-SS experienced any benefit of the training and teaching the program on their own health and health behaviors. Relative to the control group, the IDD-SS in the intervention group showed significant improvements in social/environmental supports for nutrition (F = 4.92, p = .032), exercise outcome expectations (F = 6.58, p = .014), nutrition outcome expectations (F = 8.87, p = .005), fruit and vegetable intake (F = 13.62, p = .001), knowledge of fruit and vegetable intake recommendations (F = 11.25, p = .002), and stages of change for eating fruits and vegetables (F = 6.86, p = .012). Results demonstrated that IDD-SS benefited from the health education programming. Findings support the need to develop programs and organizational policies for health promotion activities for direct care staff.

(Cost-)effectiveness of an internet-based physical activity support program (with and without physiotherapy counselling) on physical activity levels of breast and prostate cancer survivors: design of the PABLO trial

BACKGROUND

Higher levels of physical activity (PA) after treatment are associated with beneficial effects on physical and psychosocial functioning of cancer survivors. However, survivors often do not meet the recommended levels of PA. In order to promote PA, we developed a closed internet-based program. The aim of the study is to evaluate the (cost-)effectiveness of an internet-based PA-promotion program, alone or combined with physiotherapy counselling, compared to usual care, on PA-levels of breast or prostate cancer survivors. In this multicenter randomised controlled trial (RCT), breast or prostate cancer survivors who completed their primary treatment 3-12 months earlier, will be randomised to either 6-months access to a fully-automated internet-based intervention alone, an internet-based intervention plus remote support by a physiotherapist, or a control group. The intervention is based on the Transtheoretical Model and includes personalized feedback, information, video's and assignments. Additionally, in a second arm, physiotherapy counselling is provided through monthly scheduled and on-demand telephone calls. The control group will receive usual care and a leaflet with PA guidelines.

METHODS

At baseline, 6 and 12 months, the primary outcome (PA) will be measured during 7 consecutive days by accelerometers. Secondary outcomes are self-reported PA, fatigue, mood, health-related quality of life, and costs. The group differences for primary and secondary outcomes will be analyzed using linear mixed models.

DISCUSSION

If proven to be (cost)effective, this internet-based intervention, either alone or in combination with telephone support, will be a welcome addition to previous RCT's.

TRIAL REGISTRATION

Netherlands trial register (NTR6911), Date of trial registration: December 21, 2017.

Understanding the Positive Associations of Sleep, Physical Activity, Fruit and Vegetable Intake as Predictors of Quality of Life and Subjective Health Across Age Groups: A Theory Based, Cross-Sectional Web-Based Study

Background: Due to the increase in unhealthy lifestyles and associated health risks, the promotion of healthy lifestyles to improve the prevention of non-communicable diseases is imperative. Thus, research aiming to identify strategies to modify health behaviors has been encouraged. Little is known about addressing multiple health behaviors across age groups (i.e., young, middle-aged, and older adults) and the underlying mechanisms. The theoretical framework of this study is Compensatory Carry-Over Action Model which postulates that different health behaviors (i.e., physical activity and fruit and vegetable intake) are interrelated, and they are driven by underlying mechanisms (more details in the main text). Additionally, restful sleep as one of the main indicators of good sleep quality has been suggested as a mechanism that relates to other health behaviors and well-being, and should therefore also be investigated within this study. The present study aims to identify the interrelations of restful sleep, physical activity, fruit and vegetable intake, and their associations with sleep quality as well as overall quality of life and subjective health in different age groups.

Methods: A web-based cross-sectional study was conducted in Germany and the Netherlands. 790 participants aged 20–85 years filled in the web-based baseline questionnaire about their restful sleep, physical activity, fruit and vegetable intake, sleep quality, quality of life, and subjective health. Descriptive analysis, multivariate analysis of covariance, path analysis, and multi-group analysis were conducted.

Results: Restful sleep, physical activity, and fruit and vegetable intake were associated with increased sleep quality, which in turn was associated with increased overall quality of life and subjective health. The path analysis model fitted the data well, and there were age-group differences regarding multiple health behaviors and sleep quality, quality of life, and subjective health. Compared to young and older adults, middle-aged adults showed poorest sleep quality and overall quality of life and subjective health, which were associated with less engagement in multiple health behaviors.

Conclusion: A better understanding of age-group differences in clustering of health behaviors may set the stage for designing effective customized age-specific interventions to improve health and well-being in general and clinical settings.

Trial Registration: A clinical trial registration was conducted with ClinicalTrials.gov (NCT01909349) https://clinicaltrials.gov/ct2/show/NCT01909349.

[Physical activity in older persons with eye diseases : Applicability of wrist-worn accelerometer]

BACKGROUND AND OBJECTIVES

Physical activity (PA) impacts age-related diseases but its measurement is difficult. The acceptance of wrist-worn accelerometers (ACC) in older patients with eye diseases was evaluated and the results were compared with a validated activity questionnaire.

MATERIALS AND METHODS

In this study 50 patients underwent a clinical examination and were interviewed with the International Physical Activity Questionnaire (IPAQ). They then wore an ACC for 7 days and then for 30 days. After descriptive analysis of the data, influencing factors on the PA were assessed using multiple, linear models.

RESULTS

A total of 94% of participants wore the ACC for 7 days and 74% for 30 days. For 36 patients complete data were available. In comparison, IPAQ (e. g. moderate PA: 1183.4 ± 864.3 min/week) vs. ACC across 7 and 30 days (248.5 ± 266.0 min/week and 248.8 ± 190.6 min/week, respectively) showed substantially higher results (p < 0.05 for both intervals). The ACC data across 7 and 30 days were comparable (e. g. high PA: 25.4 ± 33.7 min/week and 22.5 ± 29.0 min/week). In multiple, linear models body mass index (BMI) was associated with 7 days moderate activity (β = -0.22 [95% confidence intervals CI: -21.7; -1.9]; p = 0.021) and vigorous activity (β = -0.35 [95% CI: -4.3; -0.5]; p = 0.033) as well as 30 days vigorous activity (β = -0.45 [95% CI: -5.9; -0.1]; p = 0.044). Other factors such as better visual acuity, age and gender were not associated.

CONCLUSION

The use of ACCs are acceptable to the majority of older patients with eye diseases. The results of ACC are more precise with lower variation, and much lower PA than those of a comparable activity questionnaire. Measurement over 7 days is sufficient for capturing the average PA in older patients and can be easily applied in clinical trials.

Simple Physical Activity Index Predicts Prognosis in Older Adults: Beijing Longitudinal Study of Aging

OBJECTIVE

Frailty, which involves low physical activity (PA), is as a well-established factor of increased risk of hospitalization, disability, and mortality. To date, there are no specific tools to assess PA among Chinese elderly. As part of the Beijing Longitudinal Study of Aging (BLSA), we aimed to develop the BLSA Leisure-Time Physical Activity Questionnaire (BLSA-PAQ) and assess its prediction of mortality.

DESIGN

Longitudinal study.

SETTING

Community.

PARTICIPANTS

1810 Chinese older adults completed the BLSA-PAQ questionnaire.

MEASUREMENTS

BLSA-PAQ questionnaire containing four items: walking, outdoor chores, low-intensity exercise, and moderate-intensity exercise. Physical function was assessed through the balance test, chair-stand test, and the activities of daily living (ADL), and instrumental activities of daily living (IADL). Frailty was evaluated using a modified frailty phenotype and frailty index.

RESULTS

The following equation was obtained based on the 8-year mortality for the four BLSA-PAQ components: BLSA-PAQ index (BLSA-PAQ total score) = Walking score + Outdoor chores score + 2 × (low-intensity exercise score) + 3 × (moderate-intensity exercise score). The BLSA-PAQ index decreased with age, and was negatively related to modified frailty phenotype score and frailty index. Low PA and pre-low PA statuses were associated with poorer results in the balance and chair-stand tests, ADL dependency, IADL dependency, and frailty. After adjusting for age and gender, the 8-year mortality HRs were 1.453 (95% CI, 1.166-1.811) and 2.358 (95% CI, 1.856-2.995) for low PA and pre-low PA, respectively. Low PA defined by the BLSA-PAQ index was associated with frailty, disability, worse physical function, and higher mortality.

CONCLUSION

The BLSA-PAQ seems to be a reliable tool to measure PA in Chinese older adults. Further studies are needed to confirm these findings and validate the use of the BLSA-PAQ for frailty assessments of older adults.

Physical activity derived from questionnaires and wrist-worn accelerometers: comparability and the role of demographic, lifestyle, and health factors among a population-based sample of older adults

Background

Agreement between questionnaires and accelerometers to measure physical activity (PA) differs between studies and might be related to demographic, lifestyle, and health characteristics, including disability and depressive symptoms.

Methods

We included 1,410 individuals aged 51–94 years from the population-based Rotterdam Study. Participants completed the LASA Physical Activity Questionnaire and wore a wrist-worn accelerometer on the nondominant wrist for 1 week thereafter. We compared the Spearman correlation and disagreement (level and direction) for total PA across levels of demographic, lifestyle, and health variables. The level of disagreement was defined as the absolute difference between questionnaire- and accelerometer-derived PA, whereas the direction of disagreement was defined as questionnaire PA minus accelerometer PA. We used linear regression analyses with the level and direction of disagreement as outcome, including all demographic, lifestyle, and health variables in the model.

Results

We observed a Spearman correlation of 0.30 between questionnaire- and accelerometer-derived PA in the total population. The level of disagreement (ie, absolute difference) was 941.9 (standard deviation [SD] 747.0) minutes/week, and the PA reported by questionnaire was on average 529.4 (SD 1,079.5) minutes/week lower than PA obtained by the accelerometer. The level of disagreement decreased with higher educational levels. Additionally, participants with obesity, higher disability scores, and more depressive symptoms underestimated their self-reported PA more than their healthier counterparts.

Conclusion

We observed large differences in PA time derived from the LASA Physical Activity Questionnaire and the wrist-worn accelerometer. Differences between the methods were related to body-mass index, level of disability, and presence of depressive symptoms. Future studies using questionnaires and/or accelerometers should account for these differences.

Effectiveness of a theory-based multicomponent intervention (Movement Coaching) on the promotion of total and domain-specific physical activity: a randomised controlled trial in low back pain patients

Background

The promotion of physical activity is a major field in rehabilitation and health promotion but evidence is lacking on what method or strategy works best. Ensuing from this research gap, the present study compared the effectiveness of a comprehensive theory based multicomponent intervention (Movement Coaching) to a low intensity intervention in low back pain patients.

Methods

A monocenter randomized controlled trial with three measuring points (T0 = baseline, T1 = six month follow-up, T2 = twelve month follow-up) was conducted. N = 412 chronic low back pain patients participated. The Movement Coaching group (n = 201) received a comprehensive multicomponent intervention with small-group intervention, phone- and web 2.0-intervention. The low intensity control (n = 211) received two oral presentations that were available for download afterwards. Main outcome was total physical activity measured by Global Physical Activity Questionnaire at 12 month follow-up. Additionally, workplace, leisure time and transportation activities were compared. A split-plot anova was conducted for evaluating repeated measure effects and between group effects.

Results

At six and twelve month follow-up there were no statistically significant between group differences in total (T1: p = 0.79; T2: p = 0.30) as well as domain-specific physical activity (workplace (T1: p = 0.16; T2: p = 0.65), leisure time (T1: p = 0.54; T2: p = 0.89), transportation (T1: p = 0.29; T2: p = 0.77) between Movement Coaching and the control group. In both groups, workplace physical activity showed the highest proportion of total physical activity. From baseline to twelve month follow-up the results showed a decline in total physical activity (Movement Coaching: p = 0.04; control group: p = 0.50).

Conclusions

The comprehensive Movement Coaching intervention was not found to be more effective than a low intensity intervention in promoting total and domain-specific physical activity in chronic low back pain patients.

Trial registration

This study is registered at German Clinical Trials Register (DRKS)-ID: DRKS00004878.

Effect of Primary Preventive Examination with Cardiorespiratory Fitness Test

OBJECTIVE

The aim of this study was to explore the potential of free comprehensive primary preventive examination (CPPE) combined with cardiorespiratory fitness (CRF) test in terms of its attractiveness for general population and moreover to evaluate the induced behavioural changes. The main focus was on physical activity behaviour (PA).

METHODS

In 2009-2013, 250 people (100 men, 150 women) aged 18-65 years were examined. CPPE included assessment of health status and lifestyle, CRF test and individualized counselling. Expectations, reasons and motivations for participating were recorded. The sample was evaluated in terms of age, gender, lifestyle, body mass index, body fat percentage, CRF, and health characteristics. Evaluation according to subjective benefits, perceived effects on health and lifestyle was performed after six months using electronic feedback questionnaires (FQ). Comparison was made within groups formed according to the reported increase in PA.

RESULTS

People aged 18-39 years accounted for 72.8% of the sample; mean age 34.4±11.0 years; 40.0% were men. Behavioural and health risks were lower in comparison with the general Czech population, but at least 1 of 5 assessed risk factors was present in 88.8% (low fruit and vegetable consumption 74.8%, low physical activity level (PAL) 45.6%, smoking 19.6%, risky alcohol use 18.8%, and stress load 10.4%). The most represented category of CRF was "endurance-trained" (both genders). CPPE was perceived as a source of information concerning health, CRF and lifestyle. 40.0% of men and 30.7% of women were focused on improvement in CRF. The response rate of FQ was 75.6%. Individuals with low PAL and low CRF provided feedback less often (p<0.05). In terms of perceived effect, 84.1% of the respondents implemented some kind of behavioural change; 60.9% reported increase in PA, but only 38.1% reported maintaining improvement in PA after 6 months. A higher proportion of reported lasting changes in PA occurred in subjects who were overweight/obese and in those with low CRF. Participants with low PAL and higher number of lifestyle risks more likely increased their PA only temporarily. Improvement in PA was associated with reported changes in diet (p<0.001). In the group of respondents there was an increase in self-perceived PA (SPA) compared to the baseline (p=0.001). Moreover, individuals who reported increase in PA showed improvement in subjectively perceived health.

CONCLUSION

The testing of CRF appears to be a promising motivating factor for going through the intervention, especially for younger people and men. CPPE is effective at the individual level in terms of providing information and initiating behavioural changes in PA. However, this type of intervention is less attractive and less effective for individuals with a higher behavioural risk profile.

Optimistic and pessimistic self-assessment of own diets is associated with age, self-rated health and weight status in Danish adults

The aim of this study was to analyse concordance between Danish adults' recorded diet quality and their own assessment of the healthiness and to examine socio-demographic, health and behavioural characteristics associated with an optimistic or pessimistic self-assessment. Data were derived from The Danish National Survey of Diet and Physical Activity 2011-2013 and included a random sample of 3014 adults (18-75 y). Diet quality was evaluated on the basis of seven-day pre-coded food diaries and categorised 'unhealthy', 'somewhat healthy' and 'healthy'. Self-assessment of the healthiness of own diets was registered via personal interviews and categorised healthy enough 'to a high degree', 'to some degree' or 'not at all/only partly'. Highly and somewhat optimistic self-assessment, respectively, were defined as assessing own diets as healthy enough to a high degree or to some degree while having unhealthy diets. Highly and somewhat pessimistic self-assessment, respectively, were defined as assessing own diets as not healthy enough or healthy enough to some degree while having healthy diets. Multiple logistic regression models were used to examine characteristics associated with optimistic and pessimistic self-assessments, respectively. Among individuals with unhealthy diets, 13% were highly optimistic and 42% somewhat optimistic about the healthiness of their diets. Among individuals with healthy diets, 14% were highly pessimistic and 51% somewhat pessimistic about the healthiness of their diets. Highly optimistic self-assessment was associated with increasing age, excellent self-rated health, normal weight and a moderate activity level. Highly pessimistic self-assessment was associated with decreasing age, good self-rated health and being obese. The findings indicate that people seem to use personal health characteristics as important references when assessing the healthiness of their diets.

A cross-sectional study of physical activity and sedentary behaviours in a Caribbean population: combining objective and questionnaire data to guide future interventions

Background

Current understanding of population physical activity (PA) levels and sedentary behaviour in developing countries is limited, and based primarily on self-report. We described PA levels using objective and self-report methods in a developing country population.

Methods

PA was assessed in a cross-sectional, representative sample of the population of Barbados (25–54 years), using a validated questionnaire (RPAQ) and individually calibrated combined heart rate and movement sensing monitors. The RPAQ collects information on recalled activity in 4 domains: home, work, transport, and leisure. Physical inactivity was defined according to World Health Organization (WHO) guidelines; sedentary lifestyle was defined as being sedentary for 8 h or more daily; PA overestimation was defined as perceiving activity to be sufficient, when classified as ‘inactive’ by objective measurement.

Results

According to objective estimates, 90.5 % (95 % CI: 83.3,94.7) of women and 58.9 % (48.4,68.7) of men did not accumulate sufficient activity to meet WHO minimum recommendations. Overall, 50.7 % (43.3,58.1) of the population was sedentary for 8 h or more each day, and 60.1 % (52.8,66.9) overestimated their activity levels. The prevalence of inactivity was underestimated by self-report in both genders by 28 percentage points (95 % CI: 18,38), but the accuracy of reporting differed by age group, education level, occupational grade, and overweight/obesity status. Low PA was greater in more socially privileged groups: higher educational level and higher occupational grade were both associated with less objectively measured PA and more sedentary time. Variation in domain-specific self-reported physical activity energy expenditure (PAEE) by educational attainment was observed: higher education level was associated with more leisure activity and less occupational activity. Occupational PA was the main driver of PAEE for women and men according to self-report, contributing 57 % (95 % CI: 52,61). The most popular leisure activities for both genders were walking and gardening.

Conclusions

The use of both objective and self-report methods to assess PA and sedentary behaviour provides important complementary information to guide public health programmes. Our results emphasize the urgent need to increase PA and reduce sedentary time in this developing country population. Women and those with higher social economic position are particularly at risk from low levels of physical activity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3689-2) contains supplementary material, which is available to authorized users.

Physical activity of workers with and without chronic diseases

OBJECTIVE

To contribute to the development of measures that increase physical activity (PA) levels in workers with and without chronic diseases, insight into workers' PA level is needed. Therefore, this study examined the association between the number of chronic diseases and PA in a Dutch working population.

METHODS

Data of 131,032 workers from the Dutch Public Health Monitor 2012 were used in this cross-sectional study conducted in 2015 in the Netherlands. PA was operationalized as adherence (yes/no) to three PA guidelines. One of these was the American College of Sports Medicine (ACSM) guideline (≥ 3 days/week, ≥ 20 min/day of vigorous-intensity activities). Also, the amount of moderate- and vigorous-intensity PA in min/week for those who were physically active for > 0 min/week was calculated. Associations between chronic diseases (0, 1, ≥ 2 chronic diseases) and PA were examined using logistic regression and Generalized Estimating Equations stratified for age (19-54 years/55-64 years).

RESULTS

Workers aged 19-54 years with one (OR = 0.90 (99% CI = 0.84-0.95)) and multiple chronic diseases (OR = 0.76 (99% CI = 0.69-0.83)) had lower odds of adhering to the ACSM-guideline than workers without chronic diseases. Similar patterns were found for older workers. Younger workers with one (B = 24.44 (99% CI = 8.59-40.30)) and multiple chronic diseases (B = 49.11 (99% CI = 26.61-71.61)) had a higher amount of moderate PA than workers without chronic diseases.

CONCLUSION

Workers with chronic diseases adhered less often to the ACSM-guideline, but among workers aged 19-54 years who were physically active for > 0 min/week, those with chronic diseases spent more time in moderate-intensity PA than those without chronic diseases.

Reasons for non-participation in a primary care-based physical activity trial: a qualitative study

OBJECTIVES

To explore reasons for non-participation in a primary care-based physical activity trial and understand how these may contribute to recruitment of non-representative research samples. We also aimed to elicit non-participants' own recommendations for enhancing trial uptake in primary care.

DESIGN

Semistructured telephone interviews with non-participants to a randomised controlled trial of a very brief intervention for promoting physical activity conducted in primary care (the Very Brief Interventions trial), with thematic analysis of interview transcripts.

SETTING

5 general practice (GP) surgeries in the East of England, UK.

PARTICIPANTS

Interviews were completed with 10 female and 6 male non-participants of white ethnicity and aged between 40 and 71 years. 13 of the 16 interviewees were either active or moderately active according to the GP Physical Activity Questionnaire (GPPAQ).

RESULTS

Interviewees discussed a range of reasons for non-participation. These included beliefs surrounding the personal relevance of the trial based on preconceptions of intervention content. Many interviewees considered themselves either sufficiently active or too functionally limited to increase activity levels further, so rendering participation pointless in their view. Other identified barriers included a lack of free time, for trial participation and for increasing physical activity, and dissatisfaction with appointment scheduling systems in place at GP surgeries. Interviewees questioned the appropriateness of primary care as a context for delivering interventions to promote physical activity. In general, interviewees were positively disposed towards the idea of trial participation, especially if personal benefits are made salient, but suggested that interventions could be delivered in a different setting such as the internet.

CONCLUSIONS

To increase participation in physical activity promotion trials conducted in primary care, the content of invitation materials and procedures for contacting potential participants require reconsideration. Specific recommendations include streamlining intervention materials and enhancing their relevance to the health concerns of invitees.

TRIAL REGISTRATION NUMBER

ISRCTN72691150; Pre-results.

Influencing Factors on the Overestimation of Self-Reported Physical Activity: A Cross-Sectional Analysis of Low Back Pain Patients and Healthy Controls

Introduction. The aim of the present study was to determine the closeness of agreement between a self-reported and an objective measure of physical activity in low back pain patients and healthy controls. Beyond, influencing factors on overestimation were identified. Methods. 27 low back pain patients and 53 healthy controls wore an accelerometer (objective measure) for seven consecutive days and answered a questionnaire on physical activity (self-report) over the same period of time. Differences between self-reported and objective data were tested by Wilcoxon test. Bland-Altman analysis was conducted for describing the closeness of agreement. Linear regression models were calculated to identify the influence of age, sex, and body mass index on the overestimation by self-report. Results. Participants overestimated self-reported moderate activity in average by 42 min/day (p = 0.003) and vigorous activity by 39 min/day (p < 0.001). Self-reported sedentary time was underestimated by 122 min/day (p < 0.001). No individual-related variables influenced the overestimation of physical activity. Low back pain patients were more likely to underestimate sedentary time compared to healthy controls. Discussion. In rehabilitation and health promotion, the application-oriented measurement of physical activity remains a challenge. The present results contradict other studies that had identified an influence of age, sex, and body mass index on the overestimation of physical activity.

Decline in physical activity during adolescence is not associated with changes in mental health

Background

The majority of studies investigating associations between physical activity and mental health in adolescents have been cross-sectional in design. Potential associations between physical activity and mental health may be better examined longitudinally as physical activity levels tend to decrease in adolescence. Few studies have investigated these associations longitudinally in adolescents and none by measuring physical activity objectively.

Methods

A total of 158 Dutch adolescents (mean age 13.6 years, 38.6 % boys, grades 7 and 9 at baseline) participated in this longitudinal study. Physical activity, depressive symptoms and self-esteem were measured at baseline and at the 1-year follow-up. Physical activity was objectively measured with an ActivPAL3™ accelerometer during one full week. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) and self-esteem was assessed with the Rosenberg Self-Esteem Scale (RSE). Results were analysed using structural equation modelling.

Results

Physical activity levels decreased 15.3 % over a 1-year period (p < .001), with significantly (p = .001) greater decreases during grade 7 (-20.7 %) than during grade 9 (-5.0 %). Overall, depressive symptoms decreased (-12.1 %, p < .001) over a 1-year period, while self-esteem did not change significantly (+2.9 %, p = .066). Higher levels of depressive symptoms at baseline predicted a greater decline in depressive symptoms (β = -.51, p < .001) and higher levels of self-esteem at baseline predicted a smaller increase in self-esteem (β = -.48, p < .001). The decline in physical activity did not appear to predict any change in depressive symptoms and self-esteem.

Conclusion

The decline in physical activity over a 1-year period during adolescence is not associated with a change in mental health. Further studies in adolescents aiming to investigate whether a change in physical activity is associated with a change in mental health should control for baseline levels of mental health and academic year differences.

Randomised controlled trial of a home-based physical activity intervention in breast cancer survivors

BACKGROUND

To improve adherence to physical activity (PA), behavioural support in the form of behavioural change counselling may be necessary. However, limited evidence of the effectiveness of home-based PA combined with counselling in breast cancer patients exists. The aim of this current randomised controlled trial with a parallel group design was to evaluate the effectiveness of a home-based PA intervention on PA levels, anthropometric measures, health-related quality of life (HRQoL), and blood biomarkers in breast cancer survivors.

METHODS

Eighty post-adjuvant therapy invasive breast cancer patients (age = 53.6 ± 9.4 years; height = 161.2 ± 6.8 cm; mass = 68.7 ± 10.5 kg) were randomly allocated to a 6-month home-based PA intervention or usual care. The intervention group received face-to-face and telephone PA counselling aimed at encouraging the achievement of current recommended PA guidelines. All patients were evaluated for our primary outcome, PA (International PA Questionnaire) and secondary outcomes, mass, BMI, body fat %, HRQoL (Functional assessment of Cancer Therapy-Breast), insulin resistance, triglycerides (TG) and total (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol were assessed at baseline and at 6-months.

RESULTS

On the basis of linear mixed-model analyses adjusted for baseline values performed on 40 patients in each group, total, leisure and vigorous PA significantly increased from baseline to post-intervention in the intervention compared to usual care (between-group differences, 578.5 MET-min∙wk(-1), p = .024, 382.2 MET-min∙wk(-1), p = .010, and 264.1 MET-min∙wk(-1), p = .007, respectively). Both body mass and BMI decreased significantly in the intervention compared to usual care (between-group differences, -1.6 kg, p = .040, and -.6 kg/m(2), p = .020, respectively). Of the HRQoL variables, FACT-Breast, Trial Outcome Index, functional wellbeing, and breast cancer subscale improved significantly in the PA group compared to the usual care group (between-group differences, 5.1, p = .024; 5.6, p = .001; 1.9 p = .025; and 2.8, p = .007, respectively). Finally, TC and LDL-C was significantly reduced in the PA group compared to the usual care group (between-group differences, -.38 mmol∙L(-1), p = .001; and -.3 mmol∙L(-1), p = .023, respectively).

CONCLUSIONS

We found that home-based PA resulted in significant albeit small to moderate improvements in self-reported PA, mass, BMI, breast cancer specific HRQoL, and TC and LDL-C compared with usual care. CLINICALTRIALS.

GOV IDENTIFIER

NCT02408107 (March 25, 2015).

Messages to promote physical activity: Are descriptors of required duration and intensity related to intentions to be more active?

INTRODUCTION

Mass-media campaigns such as, "Change4Life' in the UK and "get active America" in the US, promote physical activity (PA) recommendations of at least 150 min/week of moderate-to-vigorous PA (MVPA). We investigated whether different messages used in MVPA campaigns were associated with intention to engage in more MVPA.

MATERIALS AND METHODS

Theory of planned behavior (TPB) constructs; subjective norms, affective attitudes, instrumental attitudes and perceived behavioral control (PBC) were applied to explain the associations between campaign messages and intentions to engage in more MVPA.

RESULTS

A total of 1412 UK adults completed an online survey on MVPA and TPB. The sample was 70% female and 93% white with 23% reporting meeting PA guidelines. Participants received one of three messages: A walking message either with or without the 150 min/week threshold (WalkT; WalkNT); a physiological description of MVPA with the 150 min/week threshold (PhysT). ANCOVA examined group differences in intention. Path analysis evaluated mediation by TPB variables. ANCOVA identified lower intentions to increase MVPA in group PhysT relative to WalkT and WalkNT (P < 0.001). PBC mediated this relationship in WalkT (β = 0.014, 95% confidence interval [CI] = 0.004-0.028) whereas affective attitudes mediated this relationship in WalkNT (β = 0.059, 95% CI = 0.006-0.113).

CONCLUSIONS

Campaigns promoting MVPA guidelines need to choose their messages carefully. Messages which exemplified MVPA through walking were associated with higher intentions to increase MVPA than messages using a physiological description. Further, PBC was enhanced when the 150 min/week threshold was promoted alongside the walking exemplar. Future exemplars should be investigated to inform adults how to meet MVPA guidelines.

Validity of the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire

This study provides evidence of construct validity for the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), a 1-item instrument used among 236 participants referred for cardiopulmonary exercise testing. The Baecke Habitual Physical Activity Questionnaire (Baecke-HPA) was used to evaluate convergent and divergent validity. The self-reported measure of walking (QCAF) evaluated the convergent validity. Cardiorespiratory fitness assessed convergent validity by the Veterans Specific Activity Questionnaire (VSAQ), peak measured (VO2peak) and maximum predicted (VO2pred) oxygen uptake. Partial adjusted correlation coefficients between the GSLTPAQ, Baecke-HPA, QCAF, VO2pred and VSAQ provided evidence for convergent validity; while divergent validity was supported by the absence of correlations between the GSLTPAQ and the Occupational Physical Activity domain (Baecke-HPA). The GSLTPAQ presents level 3 of evidence of construct validity and may be useful to assess leisure-time physical activity among patients with cardiovascular disease and healthy individuals.

Deviation between self-reported and measured occupational physical activity levels in office employees: effects of age and body composition

OBJECTIVES

Whether occupational physical activity (PA) will be assessed via questionnaires or accelerometry depends on available resources. Although self-reported data collection seems feasible and inexpensive, obtained information could be biased by demographic determinants. Thus, we aimed at comparing self-reported and objectively measured occupational sitting, standing, and walking times adjusted for socio-demographic variables.

METHODS

Thirty-eight office employees (eight males, 30 females, age 40.8 ± 11.4 years, BMI 23.9 ± 4.2 kg/m(2)) supplied with height-adjustable working desks were asked to report sitting, standing, and walking times using the Occupational Sitting and Physical Activity Questionnaire during one working week. The ActiGraph wGT3X-BT was used to objectively measure occupational PA during the same week. Subjectively and objectively measured data were compared computing the intra-class correlation coefficients, paired t tests and Bland-Altman plots. Furthermore, repeated-measurement ANOVAs for measurement (subjective vs. objective) and socio-demographic variables were calculated.

RESULTS

Self-reported data yielded a significant underestimation of standing time (13.3 vs. 17.9%) and an overestimation of walking time (12.7 vs. 5.0%). Significant interaction effects of age and measurement of standing time (F = 6.0, p = .02, ηp(2) = .14) and BMI group and measurement of walking time were found (F = 3.7, p = .04, ηp(2) = .17). Older employees (>39 years) underestimated their standing time, while underweight workers (BMI < 20 kg/m(2)) overestimated their walking time.

CONCLUSIONS

Self-reported PA data differ from objective data. Demographic variables (age, BMI) affect the amount of self-reported misjudging of PA. In order to improve the validity of self-reported data, a correction formula for the economic assessment of PA by subjective measures is needed, considering age and BMI.

Effects of a Web-Based Personalized Intervention on Physical Activity in European Adults: A Randomized Controlled Trial

BACKGROUND

The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity (PA). There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults.

OBJECTIVE

It is hypothesized that providing personalized advice based on PA measured objectively alongside diet, phenotype, or genotype information would lead to larger and more sustained changes in PA, compared with nonpersonalized advice.

METHODS

A total of 1607 adults in seven European countries were randomized to either a control group (nonpersonalized advice, Level 0, L0) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet (Level 1, L1), PA plus diet and phenotype (Level 2, L2), or PA plus diet, phenotype, and genotype (Level 3, L3). PA was measured for 6 months using triaxial accelerometers, and self-reported using the Baecke questionnaire. Outcomes were objective and self-reported PA after 3 and 6 months.

RESULTS

While 1270 participants (85.81% of 1480 actual starters) completed the 6-month trial, 1233 (83.31%) self-reported PA at both baseline and month 6, but only 730 (49.32%) had sufficient objective PA data at both time points. For the total cohort after 6 months, a greater improvement in self-reported total PA (P=.02) and PA during leisure (nonsport) (P=.03) was observed in personalized groups compared with the control group. For individuals advised to increase PA, we also observed greater improvements in those two self-reported indices (P=.006 and P=.008, respectively) with increased personalization of the advice (L2 and L3 vs L1). However, there were no significant differences in accelerometer results between personalized and control groups, and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6. After 6 months, there were small but significant improvements in the objectively measured physical activity level (P<.05), moderate PA (P<.01), and sedentary time (P<.001) for individuals advised to increase PA, but these changes were similar across all groups.

CONCLUSIONS

Different levels of personalization produced similar small changes in objective PA. We found no evidence that personalized advice is more effective than conventional "one size fits all" guidelines to promote changes in PA in our Web-based intervention when PA was measured objectively. Based on self-reports, PA increased to a greater extent with more personalized advice. Thus, it is crucial to measure PA objectively in any PA intervention study.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01530139; http://clinicaltrials.gov/show/NCT01530139 (Archived by WebCite at: http://www.webcitation.org/6XII1QwHz).

Knowledge of physical activity recommendations in adults employed in England: associations with individual and workplace-related predictors

Background

Physical activity guidelines state that adults should engage in at least 150 min of moderate to vigorous physical activity (MVPA) per week to benefit health. A high proportion of adults in England fail to reach this target. Accurate knowledge of MVPA guidelines could influence the amount and quality of MVPA engaged in by adults. This study aimed to determine knowledge of the MVPA guideline within a large sample of working adults in England and identify individual and workplace-related predictors of knowledge.

Methods

10,992 adults completed an online survey which included questions on demographics, knowledge of the MVPA guideline and workplace predictors for physical activity. Multinomial logistic regression identified predictors of underestimating, overestimating or not knowing the MVPA guideline relative to accurately reporting the guideline for males and females separately.

Results

Respondents were 37 % male, 95 % White, 63 % with a degree or higher, and had a mean age of 38.9 ± 11 years. The MVPA guideline was accurately reported by 15 % of adults while 13.8 % overestimated, 8.9 % underestimated and 62.3 % failed to provide any estimate of the guideline. Low education predicted underestimation (females: OR = 0.36, 95 % CI 0.17, 0.80) and not knowing (males: OR = 0.37, 95 % CI 0.14, 0.96; females: OR = 0.36, 95 % CI 0.19, 0.69). Ethnicity was a significant predictor for females only (OR 3.55, 95 % CI 1.46, 8.63; OR 4.03, 95 % CI 1.58, 10.27; OR 3.73, 95 % CI 1.67, 8.33). Employer support for physical activity was a significant predictor of accurate knowledge of the MVPA guideline for both males (underestimation: OR = 0.63, 95 % CI 0.40, 1.00; ‘don’t know’: OR = 0.71, 95 % CI 0.51, 1.00) and females (overestimation: OR = 0.72, 95 % CI 0.53, 0.97; underestimation: OR = 0.66, 95 % CI 0.47, 0.92; ‘don’t know’: OR = 0.60, 95 % CI 0.47, 0.76).

Conclusions

Knowledge of the MVPA guideline within working adults in England is low. Employers should play a role in using targeted strategies to increase knowledge as employer support-related factors may influence knowledge of the MVPA guideline. Employers who assert strategies to promote physical activity and encourage employees who have responsibility for promoting health to educate their colleagues may help improve the MVPA knowledge of their employees.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0231-3) contains supplementary material, which is available to authorized users.

Physical activity in non-frail and frail older adults

Introduction

Physical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA.

Aim

This study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels.

Methods

Data were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA).

Results

Older adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home.

Conclusions

Objective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.

Awareness of moderate-to-vigorous physical activity: can information on guidelines prevent overestimation?

Background

Mass-media campaigns such as Change4Life use messaging to promote physical activity guidelines. Raising knowledge of MVPA guidelines within UK adults is a main goal of current mass media campaigns aimed at increasing engagement in MVPA. As this may help to inform accurate perceptions of adults’ own MVPA level it is an important area of investigation. Subjective norms, health status and normal walking intensity may also influence adult’s awareness of their own MVPA behaviour. The aim of this study was to examine the hypothesis that greater knowledge of MVPA guidelines, supportive subjective norms, lower self-reported health status and intensity of typical walking pace are associated with accurate awareness of MVPA engagement within a sample of UK adults.

Methods

A cross-sectional study of UK adults was conducted. UK adults who subscribed to the National Academic Mailing List Service (JISCMail) were sent an invitation to complete an online survey. 1,724 UK adults completed the online survey which included items on minutes spent in MVPA, awareness of MVPA using constructs highlighted by the precaution adoption process model, subjective norms, knowledge of guidelines, health status and demographics.

Results

The sample was 70% female, 57% aged under 45, 93% White and 69% in full-time employment. 62% reported their health to be above average, while 62% demonstrated accurate awareness of their own physical activity level, only 18% correctly reported the MVPA guidelines and 51% reported high subjective norms towards MVPA. Logistic regression analyses identified high subjective norms (OR = 1.84, CI: 1.29, 2.63, p = .001), average or below average health status (OR = .71, CI: .53 .97, p = .001), and a self-reported regular walking pace of moderate-to-vigorous (OR = 1.31, CI: 1.05, 1.63, p = .02) to be associated with accurate MVPA awareness. Knowledge of MVPA guidelines was not associated with MVPA awareness.

Conclusions

Mass media campaigns, such as Change4Life, inform the general public of MVPA guidelines. Campaign messages may be more influential targeting subjective norms instead of knowledge of guidelines, thereby raising awareness of personal MVPA behaviour amongst inactive adults and increasing motivation to engage in more MVPA.

Comparison of self-reported measure of sitting time (IPAQ) with objective measurement (activPAL)

This study compared sitting time measured by a questionnaire (International Physical Activity Questionnaire; IPAQ) with concurrently measured objective sitting time from an accelerometer-based measure of thigh inclination (activPAL).Adults (n = 69), wore an activPAL for a week, and then completed the long-form 7 d recall IPAQ questionnaire. IPAQ reported sitting time (including and excluding transportation sitting) for the week, weekdays and weekend days were compared to activPAL (criterion measure) sitting time using intraclass correlation coefficients and Bland Altman plots.Confidence intervals between the IPAQ and the activPAL were wide, while correlations between the two measures were low and non-significant (0.112-0.275). Compared to a direct measure of postural sitting (activPAL), the IPAQ underestimated sitting time across the group for the whole week, both when including (mean 2.2 h d(-1)) and excluding (mean 3.4 h d(-1)) transportation sitting. Sitting was less accurately reported on weekend days than weekdays, and at lower levels of sitting on weekdays.Agreement between the IPAQ and the activPAL, a direct measure of sitting, in this study was poor. The direction of group agreement was different to comparisons using a measure of low accelerometer counts (Actigraph) as the criterion measure in previous research. Future studies should use a direct measure of sitting as a criterion measure to validate subjective measurement tools.

Do lifestyle, health and social participation mediate educational inequalities in frailty worsening?

BACKGROUND

Lower educated older persons are at increased risk of becoming frail as compared with higher educated older persons. To reduce educational inequalities in the development of frailty, we investigated whether lifestyle, health and social participation mediate this relationship.

METHODS

Longitudinal data of 14 082 European community-dwelling persons aged 55 years and older participating in the Survey on Health, Ageing, and Retirement in Europe (SHARE) in 2004 and 2006, were used. Associations of lifestyle (smoking behaviour and alcohol consumption), health (depression, memory function, chronic diseases) and social participation, with educational level and frailty worsening were investigated using regression models. In multinomial logistic regression analysis, mediators were added to models in which educational level was associated with worsening in frailty over 2 years follow-up.

RESULTS

In all countries, frailty worsening was more prevalent among lower as compared with higher educated persons, although odds ratios were only statistically significant in five of the 11 countries included [ORs varying from 1.40 (95% CI: 1.06-1.84) to 1.61 (95% CI: 1.21-2.14)]. Except for smoking behaviour and memory function, the factors under study all showed associations with educational level and frailty worsening that met the conditions for mediation. After inclusion of the four relevant mediators, attenuation of odds ratios varied between 4.9 and 31.5%.

CONCLUSION

While lifestyle, health and social participation were associated with frailty worsening over 2 years among European community-dwelling older persons, only small to moderate parts of educational inequalities in frailty worsening were explained by these factors.

Physical activity and awareness in breast screening attendees in Black Country, UK

This study aimed to determine the physical activity levels and awareness of the influence of physical activity and overweight/obesity on breast cancer risk among NHS breast screening programme (NHSBSP) attendees. One hundred and eighty-eight (white British = 95%; post-menopausal = 80%) attendees completed a demographic and anthropometric data questionnaire, International Physical Activity Questionnaire (IPAQ) and awareness of breast cancer risk factors questionnaire. IPAQ data were reported as continuous measures (MET-min · week(-1)) and as categorical variables (low, moderate and high activities). The highest median physical activity levels were reported in the domestic physical activity domain (756 MET-min · week(-1)). Most participants were categorized as 'moderately active' (45%), while 30% were classified in the 'high activity' and 25% as 'low activity' categories. Almost a third of participants (30%) reported no leisure-time physical activity and 83% reported no vigorous physical activity. There was high awareness of the effects of physical activity (75%) and obesity (80%) on breast cancer risk. No significant differences were found between physical activity categories and awareness that physical activity can reduce breast cancer risk (p > 0.05). However, compared with moderate and high activity categories, participants in the 'low activity' category were significantly more likely to respond that they thought they achieved recommended physical activity levels (p < 0.05). Participants who are unaware of their inadequate physical activity levels may have a less positive intention to increase physical activity levels. Practical strategies aimed to increase knowledge of the recommended physical activity guidelines and facilitate the achievement of these guidelines may be required for NHSBSP attendees.

Individual characteristics associated with mismatches between self-reported and accelerometer-measured physical activity

Background

Accurate assessment tools are required for the surveillance of physical activity (PA) levels and the assessment of the effect of interventions. In addition, increasing awareness of PA is often used as the first step in pragmatic behavioural interventions, as discrepancies between the amount of activity an individual perceives they do and the amount actually undertaken may act as a barrier to change. Previous research has demonstrated differences in the amount of activity individuals report doing, compared to their level of physical activity when measured with an accelerometer. Understanding the characteristics of those whose PA level is ranked differently when measured with either self-report or accelerometry is important as it may inform the choice of instrument for future research. The aim of this project was to determine which individual characteristics are associated with differences between self-reported and accelerometer measured physical activity.

Methods

Participant data from the 2009 wave of the Commuting and Health in Cambridge study were used. Quartiles of self-reported and accelerometer-measured PA were derived by ranking each measure from lowest to highest. These quartiles were compared to determine whether individuals’ physical activity was ranked higher by either method. Multinomial logistic regression models were used to investigate the individual characteristics associated with different categories of mismatch.

Results

Data from 486 participants (70% female) were included in the analysis. In adjusted analyses, the physical activity of overweight or obese individuals was significantly more likely to be ranked higher by self-report than by accelerometer than that of normal-weight individuals (OR = 2.07, 95%CI = 1.28–3.34), particularly among women (OR = 3.97, 95%CI = 2.11–7.47).

Conclusions

There was a greater likelihood of mismatch between self-reported and accelerometer measured physical activity levels in overweight or obese adults. Future studies in overweight or obese adults should consider employing both methods of measurement.

Comparison of physical activity using questionnaires (leisure time physical activity instrument and physical activity at home and work instrument) and accelerometry in fibromyalgia patients: the Al-Ándalus project

OBJECTIVE

To compare the levels of physical activity (PA) assessed with questionnaires (Leisure Time Physical Activity Instrument [LTPAI], Physical Activity at Home and Work Instrument [PAHWI]) and accelerometry in patients with fibromyalgia; and to analyze the test-retest reliability of these questionnaires.

DESIGN

Cross-sectional study.

SETTING

Local fibromyalgia association.

PARTICIPANTS

Participants (N=99; 5 men) with fibromyalgia with a mean age of 50.2±9.5 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants carried an accelerometer for 1 week and completed the LTPAI and PAHWI twice (separated by a 1-wk interval). The LTPAI and PAHWI were summed to obtain overall values of PA.

RESULTS

Time spent in total, moderate, and moderate-vigorous PA was higher (P<.01) when assessed by the LTPAI and PAHWI compared with accelerometry. The Bland-Altman method showed an absence of agreement between the LTPAI and PAHWI and the accelerometer for moderate, moderate-vigorous, and total PA. The test-retest reliability for the workplace subscale and total score of the PAHWI showed high and moderate intraclass correlation coefficients (ICCs), respectively, but also manifested high SE of measurements (up to 179min/d). The LTPAI showed low to moderate ICCs and high SE of measurements (up to 79min/d). For the LTPAI and PAHWI, the ICCs for total activity across the population were low to moderate, and the Bland-Altman method confirmed this lack of agreement.

CONCLUSIONS

The LTPAI and PAHWI and the accelerometer differ greatly when assessing PA. Furthermore, the LTPAI and PAHWI did not show good levels of test-retest reliability. Therefore, the self-administered LTPAI and PAHWI show questionable usefulness to assess PA in populations with fibromyalgia.