Validity of actigraphs uniaxial and triaxial accelerometers for assessment of physical activity in adults in laboratory conditions

Influence of unilateral versus bilateral patellofemoral pain on physical activity, pain self-efficacy, and disability

BACKGROUND

Patellofemoral pain (PFP) affects physical and psychosocial health; however, it is unclear if unilateral and bilateral PFP induce similar levels of impairments.

OBJECTIVES

We aimed to compare physical activity (PA), pain self-efficacy, and disability between individuals with unilateral and bilateral PFP, and to compare these groups against pain-free controls.

DESIGN

Cross-sectional case-control.

METHOD

Sixty-two individuals with PFP (25 unilateral and 37 bilateral) and 20 pain-free controls completed the PA assessment using an accelerometer by daily steps, light PA, and moderate-to-vigorous PA (MVPA). We also calculated variability in each PA variable. Pain self-efficacy and disability were measured using the Pain Self-Efficacy Questionnaire and Anterior Knee Pain Scale, respectively.

RESULTS

Individuals with bilateral PFP took fewer daily steps compared to pain-free controls (9568.1 ± 3827.0 vs. 12,285.8 ± 2821.2 steps/day; P = 0.018, Cohen d = 0.79), whereas individuals with unilateral PFP did not (11,099.2 ± 3547.1 steps/day; P = 0.503, Cohen d = 0.37). Individuals with bilateral PFP showed greater variability in MVPA compared to individuals with unilateral PFP (42.9 ± 23.1 vs. 29.0 ± 15.9; P = 0.011, Cohen d = 0.91) and pain-free controls (42.9 ± 23.1 vs. 17.6 ± 6.1; P < 0.001, Cohen d = 1.21). Individuals with unilateral and bilateral PFP similarly exhibited less time spent in MVPA, greater variability in daily steps, lower pain self-efficacy, and greater disability compared to pain-free controls (P < 0.001, Cohen d = 1.14-3.89).

CONCLUSIONS

Versus pain-free controls, individuals with bilateral PFP displayed greater variability in MVPA than individuals with unilateral PFP. However, it is important to note that unilateral PFP influenced time spent in MVPA, variability in daily steps, pain self-efficacy, and disability at similar levels to bilateral PFP.

Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review

BACKGROUND

Monitoring free-living physical activity (PA) through wearable devices enables the real-time assessment of activity features associated with health outcomes and provision of treatment recommendations and adjustments. The conclusions of studies on PA and health depend crucially on reliable statistical analyses of digital data. Data analytics, however, are challenging due to the various metrics adopted for measuring PA, different aims of studies, and complex temporal variations within variables. The application, interpretation, and appropriateness of these analytical tools have yet to be summarized.

OBJECTIVE

This research aimed to review studies that used analytical methods for analyzing PA monitored by accelerometers. Specifically, this review addressed three questions: (1) What metrics are used to describe an individual's free-living daily PA? (2) What are the current analytical tools for analyzing PA data, particularly under the aims of classification, association with health outcomes, and prediction of health events? and (3) What challenges exist in the analyses, and what recommendations for future research are suggested regarding the use of statistical methods in various research tasks?

METHODS

This scoping review was conducted following an existing framework to map research studies by exploring the information about PA. Three databases, PubMed, IEEE Xplore, and the ACM Digital Library, were searched in February 2024 to identify related publications. Eligible articles were classification, association, or prediction studies involving human PA monitored through wearable accelerometers.

RESULTS

After screening 1312 articles, 428 (32.62%) eligible studies were identified and categorized into at least 1 of the following 3 thematic categories: classification (75/428, 17.5%), association (342/428, 79.9%), and prediction (32/428, 7.5%). Most articles (414/428, 96.7%) derived PA variables from 3D acceleration, rather than 1D acceleration. All eligible articles (428/428, 100%) considered PA metrics represented in the time domain, while a small fraction (16/428, 3.7%) also considered PA metrics in the frequency domain. The number of studies evaluating the influence of PA on health conditions has increased greatly. Among the studies in our review, regression-type models were the most prevalent (373/428, 87.1%). The machine learning approach for classification research is also gaining popularity (32/75, 43%). In addition to summary statistics of PA, several recent studies used tools to incorporate PA trajectories and account for temporal patterns, including longitudinal data analysis with repeated PA measurements and functional data analysis with PA as a continuum for time-varying association (68/428, 15.9%).

CONCLUSIONS

Summary metrics can quickly provide descriptions of the strength, frequency, and duration of individuals' overall PA. When the distribution and profile of PA need to be evaluated or detected, considering PA metrics as longitudinal or functional data can provide detailed information and improve the understanding of the role PA plays in health. Depending on the research goal, appropriate analytical tools can ensure the reliability of the scientific findings.

Algorithm Validation for Quantifying ActiGraph™ Physical Activity Metrics in Individuals with Chronic Low Back Pain and Healthy Controls

Assessing physical activity is important in the treatment of chronic conditions, including chronic low back pain (cLBP). ActiGraph™, a widely used physical activity monitor, collects raw acceleration data, and processes these data through proprietary algorithms to produce physical activity measures. The purpose of this study was to replicate ActiGraph™ algorithms in MATLAB and test the validity of this method with both healthy controls and participants with cLBP. MATLAB code was developed to replicate ActiGraph™'s activity counts and step counts algorithms, to sum the activity counts into counts per minute (CPM), and categorize each minute into activity intensity cut points. A free-living validation was performed where 24 individuals, 12 cLBP and 12 healthy, wore an ActiGraph™ GT9X on their non-dominant hip for up to seven days. The raw acceleration data were processed in both ActiLife™ (v6), ActiGraph™'s data analysis software platform, and through MATLAB (2022a). Percent errors between methods for all 24 participants, as well as separated by cLBP and healthy, were all less than 2%. ActiGraph™ algorithms were replicated and validated for both populations, based on minimal error differences between ActiLife™ and MATLAB, allowing researchers to analyze data from any accelerometer in a manner comparable to ActiLife™.

The acute hypoalgesic effects of active head-mounted display virtual reality games

The purpose of this study was to determine: (1) whether physically active virtual reality (VR) games exert an acute hypoaglesic effect on the thigh and bicep compared to a non-active VR game and an exercise only condition matched for exercise intensity in healthy individuals, and (2) whether movement variables during gameplay are associated with the hypoalgesic effect of the games. Twenty young adults completed five separate study sessions, with each session devoted to playing one head-mounted display VR game or stationary cycling for 15 minutes. The games included Holopoint at level 2 and level 3, Hot Squat, and Relax Walk. Pressure pain thresholds at the thigh and bicep were measured pre and post VR gameplay and cycling. Participants wore a heart rate monitor and accelerometers on the wrist and thigh during play to measure the intensity and quantity of movement. Repeated measures ANOVAs revealed that pressure pain thresholds on the bicep increased from pre to posttest for each condition. The results also revealed that pressure pain thresholds on the thigh increased only for the conditions eliciting the greatest cardiovascular response, which included Holopoint at level 3, Hot Squat, and cycling. Bivariate correlations indicated that moderate to vigorous physical activity of the thigh was associated with pain reduction at the thigh during Holopoint. These results revealed that active VR games and exercise exerted a more widespread hypoalgesic effect compared to the non-active VR game, which was likely driven in part by the intensity and quantity of movement during gameplay.

Long-Term Follow-Up of a Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion

OBJECTIVE

Long-term follow-ups of prehabilitation programs for lumbar spine surgery are lacking, and more comprehensive evaluations are needed. In the current study, we evaluated the long-term effects of a prehabilitation program compared with conventional care in relation to lumbar fusion surgery in patients with degenerative disc disease.

METHODS

Patients (n = 118) receiving lumbar fusion surgery were included in a multicenter randomized controlled trial, involving 1 university hospital and 2 spine clinics. The intervention was a person-centered prehabilitation program based on cognitive-behavioral physical therapy that targeted psychological presurgical risk factors, physical activity, and overall health. The control group received conventional preoperative care. Patient-reported outcome measures (PROMs) included assessments at 8 time-points: low back disability (primary outcome), back pain intensity, leg pain intensity, pain catastrophizing, fear of movement, anxiety and depressive mood, health-related quality of life, and patient-specific functioning. Physical activity and physical capacity were assessed at 5 time points. Linear mixed models were used to analyze the effects of the intervention.

RESULTS

There were no significant differences between groups at the 12- and 24-month follow-ups for any outcome, except for the One Leg Stand test 1 year following surgery, in favor of the control group. There were significant improvements for both groups, from baseline to the 12- and 24-month follow-ups for all physical capacity test and patient-reported outcome measures, except for leg pain and self-efficacy for exercise.

CONCLUSION

No long-term effects were found for the prehabilitation program compared to conventional care. Physical activity did not improve over time, despite significantly improved self-reported functioning and physical capacity measurements.

IMPACT

These findings have implications for the current understanding of the long-term effects of prehabilitation and suggest that future research should focus on programs promoting physical activity both before and after lumbar spine surgery to decrease the risk of long-term adverse health outcomes.

Ecological momentary assessment of physical activity and sedentary behaviour in shift workers and non-shift workers: Validation study

This study examined the criterion validity of an ecological momentary assessment (EMA)-reported physical activity and sedentary time compared with accelerometry in shift workers and non-shift workers. Australian workers (n = 102) received prompts through a mobile EMA app and wore the Actigraph accelerometer on the right hip for 7-10 days. Participants received five EMA prompts per day at 3-hour intervals on their mobile phones. EMA prompts sent to shift workers (SW-T) were tailored according to their work schedule. Non-shift workers (NSW-S) received prompts at standardised times. To assess criterion validity, the association of EMA-reported activities and the Actigraph accelerometer activity counts and number of steps were used. Participants were 36 ± 11 years and 58% were female. On occasions where participants reported physical activity, acceleration counts per minute (CPM) and steps were significantly higher (β = 1184 CPM, CI 95%: 1034, 1334; β = 20.9 steps, CI 95%: 18.2, 23.6) than each of the other EMA activities. Acceleration counts and steps were lower when sitting was reported than when no sitting was reported by EMA. Our study showed that EMA-reported physical activity and sedentary time was significantly associated with accelerometer-derived data. Therefore, EMA can be considered to assess shift workers' movement-related behaviours with accelerometers to provide rich contextual data.

Nicotinamide riboside for peripheral artery disease: the NICE randomized clinical trial

People with lower extremity peripheral artery disease (PAD) have increased oxidative stress, impaired mitochondrial activity, and poor walking performance. NAD+ reduces oxidative stress and is an essential cofactor for mitochondrial respiration. Oral nicotinamide riboside (NR) increases bioavailability of NAD+ in humans. Among 90 people with PAD, this randomized double-blind clinical trial assessed whether 6-months of NR, with and without resveratrol, improves 6-min walk distance, compared to placebo, at 6-month follow-up. At 6-month follow-up, compared to placebo, NR significantly improved 6-min walk (+7.0 vs. -10.6 meters, between group difference: +17.6 (90% CI: + 1.8,+∞). Among participants who took at least 75% of study pills, compared to placebo, NR improved 6-min walk by 31.0 meters and NR + resveratrol improved 6-min walk by 26.9 meters. In this work, NR meaningfully improved 6-min walk, and resveratrol did not add benefit to NR alone in PAD. A larger clinical trial to confirm these findings is needed.

Digital measurement of mobility in pulmonary arterial hypertension: A structured review of an emerging area

This review examined literature that has examined mobility in pulmonary arterial hypertension (PAH) using digital technology. Specifically, the review focussed on: (a) digital mobility measurement in PAH; (b) commonly reported mobility outcomes in PAH; (c) PAH specific impact on mobility outcomes; and (d) recommendations concerning protocols for mobility measurement in PAH. PubMed, Scopus, and Medline databases were searched. Two independent reviewers screened articles that described objective measurement of mobility in PAH using digital technology. Twenty-one articles were screened, and 16 articles met the inclusion/exclusion criteria and were reviewed. Current methodologies for mobility measurement in PAH with digital technologies are discussed. In brief, the reviewed evidence demonstrated that there is a lack of standardisation across studies for instrumentation, outcomes, and interpretation in PAH. The validity and reliability of digital approaches were insufficiently reported in all studies. Future research is required to standardise digital mobility measurement and characterise mobility impairments in PAH across clinical and real-world settings. The reviewed evidence suggests that digital mobility outcomes may be useful clinical measures and may be impaired in PAH, but further research is required to accurately and robustly establish findings. Recommendations are provided for future studies that encompass comprehensive reporting, validation, and measurement.

Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study

BACKGROUND

Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments.

OBJECTIVE

The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up.

METHODS

Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models.

RESULTS

On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; β=-112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; β=-101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; β=-.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; β=-1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; β=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; β=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; β=-4.78; P=.02).

CONCLUSIONS

This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors.

Validity of Actigraph for Measuring Energy Expenditure in Healthy Adults: A Systematic Review and Meta-Analysis

PURPOSE

The objective of this systematic review and meta-analysis was to assess the validity of the Actigraph triaxial accelerometer device in measuring physical activity energy expenditure (PAEE) in healthy adults, with indirect calorimetry (IC) serving as the validity criterion.

METHODS

A comprehensive search was conducted using the PubMed, Web of Science, and sportdiscuss databases, in addition to manual searches for supplementary sources. Search strategies were employed that involved conducting single keyword searches using the terms "gt3x" and "Actigraph gt3x". The literature search encompassed the timeframe spanning from 1 January 2010 to 1 March 2023. The methodological quality of the studies included in the analysis was evaluated using both the Downs and Black checklist and the Consensus-Based Criteria for Selection of Measurement Instruments (COSMIN) checklist. The meta-analysis was conducted using the Review Manager 5.4 software. The standardized mean difference (SMD) was calculated and expressed as a 95% confidence interval (CI). The significance level was set at α = 0.05. A systematic assessment of the Actigraph's performance was conducted through the descriptive analysis of computed effect sizes.

RESULTS

A total of 4738 articles were retrieved from the initial search. After eliminating duplicate articles and excluding those deemed irrelevant, a comprehensive analysis was conducted on a total of 20 studies, encompassing a combined sample size of 1247 participants. The scores on the Downs and Black checklist ranged from 10 to 14, with a mean score of 11.35. The scores on the COSMIN checklist varied from 50% to 100%, with an average score of 65.83%. The meta-analysis findings revealed a small effect size (SMD = 0.01, 95% CI = 0.50-0.52, p = 0.97), indicating no statistically significant difference (p > 0.05).

CONCLUSIONS

The meta-analysis revealed a small effect size when comparing the Actigraph and IC, suggesting that the Actigraph can be utilized for assessing total PAEE. Descriptive analyses have indicated that the Actigraph device has limited validity in accurately measuring energy expenditure during specific physical activities, such as high-intensity and low-intensity activities. Therefore, caution should be exercised when utilizing this device for such purposes. Furthermore, there was a significant correlation between the activity counts measured by the Actigraph and the PAEE, indicating that activity counts can be utilized as a predictive variable for PAEE.

Global Accelerometer-derived Physical Activity Levels from Preschoolers to Adolescents: A Multilevel Meta-analysis and Meta-regression

BACKGROUND

Global level physical activity surveillance studies were primarily based on self-report data that could generate inaccurate results.

PURPOSE

To investigate global accelerometer-measured daily moderate to vigorous physical activity (MVPA) changes from preschool age to adolescence as well as gender differences in MVPA while adjusting for the geographic regions and major MVPA cut points.

METHODS

A comprehensive search was conducted through August 2020 that includes 30 databases such as Academic Search Ultimate, Child Development & Adolescent Studies, Education Full Text, ERIC, General Science, PsycINFO, ScienceDirect, and SPORTDiscuss. We included both cross-sectional and longitudinal MVPA tracking studies with daily MVPA being measured by waist-worn accelerometers and determined by either Freedson 3 METs, 4 METs, or Evenson cut points for preschoolers, children, and adolescents.

RESULTS

Researchers analyzed 84 studies reporting on 124 effect sizes with a total of 57,587 participants. The combined data showed significant MVPA differences among various continents of participants (p < .001) or cut points (p < .05-.001) for both preschoolers, children, and adolescents. Globally, when continents and cut points were controlled, individuals' daily MVPA time decreased every year by an average of 7.88, 10.37, and 6.68 min from preschool age to adolescence, preschool age to children, and children to adolescence, respectively. When cut points and continents were controlled, boys had significantly higher daily MVPA than girls for all three age groups (p < .001).

CONCLUSIONS

Globally, individuals' daily MVPA starts to decline dramatically as early as the beginning of preschool age. Early intervention is needed to counteract the high decline rate in MVPA.

Pilot Lifestyle Intervention Effect on Lifestyle Behaviors, Psychosocial Factors, and Affect

Background

This paper presents results of a pilot intervention effect on lifestyle behaviors, psychosocial factors, and affect among overweight or obese pregnant women.

Methods

70 participants were randomized to the intervention or usual care group. During the 20-week intervention, participants completed a weekly online intervention module and joined individual online health coaching. Data were collected at baseline (<17 weeks gestation), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Lifestyle behaviors included dietary intake (caloric, fat, added sugar, fruit, and vegetable) and physical activity (PA). Psychosocial factors were autonomous motivation, self-efficacy, executive functions, and consideration of future consequences (CFC). Affect comprised stress and emotional control. Two-sample t-tests and Cohen's d effect sizes were used to compare between group mean differences in the change from baseline to T2 and T3.

Results

At T2, intervention positively influenced fruit intake (d = 0.47), autonomous motivation for healthy eating (d = 0.36), self-efficacy for healthy eating (d = 0.25) and PA (d = 0.24), executive functions (behavior regulation, d = -0.21; metacognition, d = -0.69), and emotional control (d = 0.79). At T3, the intervention improved PA (d = 0.19), autonomous motivation for healthy eating (d = 0.33), self-efficacy for healthy eating (d = 0.50) and stress management (d = 0.62), executive functions (metacognition, d = -0.46), CFC (d = 0.25), stress (d = -0.45), and emotional control (d = 0.72).

Conclusion

The pilot intervention has positive effects on most psychosocial variables and affect in both the short and long terms.

A cross-sectional follow-up study of physical activity in adults with moderate and severe haemophilia

AIM

To conduct a cross-sectional follow-up assessment of physical activity (PA) in people with moderate and severe haemophilia (PwMSH) from the Irish Personalised Approach to the Treatment of Haemophilia (iPATH) study.

METHODS

Between June-December 2021, participants' PA was measured over one week using accelerometery, and was compared with their previously measured data from the original iPATH assessment. Self-awareness of PA and the impact of the Covid-19 pandemic on PA, pain, mobility and function were retrospectively examined using a survey.

RESULTS

Of 30 participants who returned surveys [n = 19, severe (FVIII, <.01 IU/mL); n = 4, moderate (FVIII, .01-.05 IU/mL); n = 7, severe (FIX, <.01 IU/mL); age: 47 (36, 55) years], 28 completed accelerometery (follow-up time: 3 years). There were no significant differences in accelerometer PA (all p > .05), but achievement of World Health Organisation guidelines increased (67.9%-75.0%; p = .646). Increased self-awareness of PA was reported by 76.7%, and 66.7% reported desires to become more physically active. Compared to normal, most reported either no differences or lower levels of PA during lockdown restrictions. Self-reported PA increased for most when restrictions eased from April 2021 onwards. Beyond the pandemic, concerns included pain and access to exercise resources.

CONCLUSION

Self-reported PA throughout the pandemic was variable, whilst there were no significant differences in objectively measured PA between assessment periods, despite reports of increased self-awareness and desires to be physically active at follow-up. Further qualitative research is needed to design personalised PA and health interventions, capturing perspectives of patients, their families, and multi-disciplinary haemophilia healthcare providers.

Associations of Mutually Exclusive Categories of Physical Activity and Sedentary Behavior with Body Composition and Fall Risk in Older Women: A Cross-Sectional Study

The individual effects of physical activity (PA) and sedentary behavior (SB) on health are well-recognized. However, little is known about the extent to which different combinations of these behaviors are associated with body composition and fall risk in older adults. This cross-sectional study examined the associations of mutually exclusive categories of PA and SB with body composition and fall risk in older women. Accelerometer-measured PA, body composition and fall risk (static and dynamic balance) parameters were assessed among 94 community-dwelling older women. The participants were categorized into four groups: active-low sedentary, active-high sedentary, inactive-low sedentary and inactive-high sedentary (active: ≥150 min/week moderate-to-vigorous PA (MVPA); low sedentary: lowest tertile of SB and light PA ratio). Compared to the inactive-high sedentary group, more favorable body composition and dynamic balance results were found in the active-low sedentary (body fat mass index (BFMI): β = -4.37, p = 0.002; skeletal muscle mass index (SMI): β = 1.23, p = 0.017; appendicular lean mass index (ALMI): β = 1.89, p = 0.003; appendicular fat mass index (AFMI): β = -2.19, p = 0.003; sit-to-stand: β = 4.52, p = 0.014) and inactive-low sedentary (BFMI: β = -3.14, p = 0.007; SMI: β = 1.05, p = 0.014; AFMI: β = -1.74, p = 0.005, sit-to-stand: β = 3.28, p = 0.034) groups. Our results suggest that PA programs focusing on concurrently achieving sufficient MVPA and reduced SB might promote a healthy body composition and reduced fall risk among older adults.

Relationship of sleep regularity with device-based sedentary behavior time and physical activity time in working adults

OBJECTIVES

This study aimed to investigate the association of sleep regularity with time spent in sedentary behavior (SB) and physical activity (PA) in adults with full-time jobs.

METHODS

This was a cross-sectional study. Adults aged 21-64 years with full-time jobs were recruited between August 2019 and December 2020 in Taiwan. The time spent in SB/PA was assessed using triaxial accelerometers (Actigraph wGT3x-BT), and PA was further classified into light-intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA). Each participant recorded their daily sleep patterns and work hours in a log, which was further used to measure sleep variability and social jet lag. Linear regression was applied to examine the associations of indicators of sleep regularity with SB time and PA time.

RESULTS

A total of 192 adults (men = 28.13%; mean age = 38.56 ± 8.89 years) were included in this study. After adjusting for potential covariates, greater social jet lag was related to more SB time (unstandardized coefficient [B] = 14.39, P = .005) and less LPA time (B = -0.02, P = .010). No evidence of an association between other indicators of sleep regularity with SB/PA time was found.

CONCLUSIONS

These results provide evidence for a relationship between sleep regularity and SB/PA time in working adults. Maintaining regular sleep, especially a small social jet lag, was suggested to promote physical activity and avoid a sedentary lifestyle. Future research is recommended to examine work-related influences on the associations and bidirectional relationship between sleep regularity and SB/PA.

Cigarette smoking and mitochondrial dysfunction in peripheral artery disease

BACKGROUND

This study evaluated the association of smoking with mitochondrial function in gastrocnemius muscle of people with peripheral artery disease (PAD).

METHODS

Participants were enrolled from Chicago, Illinois and consented to gastrocnemius biopsy. Mitochondrial oxidative capacity was measured in muscle with respirometry. Abundance of voltage-dependent anion channel (VDAC) (mitochondrial membrane abundance), peroxisome proliferator-activated receptor-γ coactivator (PGC-1α) (mitochondrial biogenesis), and electron transport chain complexes I-V were measured with Western blot.

RESULTS

Fourteen of 31 people with PAD (age 72.1 years, ABI 0.64) smoked cigarettes currently. Overall, there were no significant differences in mitochondrial oxidative capacity between PAD participants who currently smoked and those not currently smoking (complex I+II-mediated oxidative phosphorylation: 86.6 vs 78.3 pmolO₂/s/mg, respectively [p = 0.39]). Among participants with PAD, those who currently smoked had a higher abundance of PGC-1α (p < 0.01), VDAC (p = 0.022), complex I (p = 0.021), and complex III (p = 0.021) proteins compared to those not currently smoking. People with PAD who currently smoked had lower oxidative capacity per VDAC unit (complex I+II-mediated oxidative phosphorylation [137.4 vs 231.8 arbitrary units, p = 0.030]) compared to people with PAD not currently smoking. Among people without PAD, there were no significant differences in any mitochondrial measures between currently smoking (n = 5) and those not currently smoking (n = 63).

CONCLUSIONS

Among people with PAD, cigarette smoking may stimulate mitochondrial biogenesis to compensate for reduced oxidative capacity per unit of mitochondrial membrane, resulting in no difference in overall mitochondrial oxidative capacity according to current smoking status among people with PAD. However, these results were cross-sectional and a longitudinal study is needed.

Physical activity, physical fitness and cardiometabolic risk amongst adults with moderate and severe haemophilia

AIM

This study aimed to examine physical activity (PA), physical fitness and cardiometabolic risk amongst people with moderate and severe haemophilia (PwMSH).

METHODS

The following domains were examined: PA (accelerometry); functional aerobic capacity (6-Minute Walk Test); grip strength (dynamometry); balance (One Leg Stand Test); body composition (anthropometry and bioimpedance analysis); blood pressure; arterial stiffness; and cardiometabolic disorders.

RESULTS

A total of 53 PwMSH (44 years) and 33 controls (43 years; p = .679) were recruited. Compared to controls, PwMSH were significantly less active in moderate and vigorous PA parameters (all p < .05), and less physically fit indicated by 6-Minute Walk distance (p < .0005), grip strength (p = .040) and balance (p < .0005). PwMSH had higher rates of abdominal adiposity compared to controls measured by waist circumference indices (all p < .05). Resting blood pressure and arterial stiffness were not significantly different (p = .797 and .818, respectively). With respect to overall PA, World Health Organisation recommended targets for adults were achieved by the majority of both groups (haemophilia: 72.9% vs. controls: 90.0%; p = .069). Importantly, the number of PwMSH who achieved guideline recommended PA via longer, sustained bouts of moderate-vigorous PA was significantly lower compared to controls (18.8% vs. 56.7%; p = .001). Lastly, clinically diagnosed hypertension, insulin resistance and hyperlipidaemia were more prevalent amongst PwMSH compared to controls.

CONCLUSION

Low levels of PA and physical fitness, and significant rates of abdominal adiposity and hypertension may collectively influence the risk and severity of various cardiometabolic and/or musculoskeletal health issues amongst ageing PwMSH. Personalised multi-disciplinary health interventions involving PA, dietary and health psychology input for PwMSH warrant future investigation.

A virtual reality physical activity pattern assessment: Mixed crossover experiments and cluster analysis

Objective

The subjects' physical activity levels and enjoyment of exercise after 15 min of virtual reality (VR) physical activity of different intensities were compared.

Methods

Thirty-two subjects were selected for a mixed crossover experiment. They were randomly assigned to exercise in three VR games with different exercise intensities. Acceleration data of the subjects were collected and subjects' exercise enjoyment and exercise levels were compared. The subjects' emotional efficacy and arousal during exercise were measured and evaluated using the Feeling Scale (FS) and the Felt Arousal Scale (FAS), and the acceleration data were evaluated by clustering using the fuzzy c-mean (FCM) clustering algorithm.

Results

A one-way ANOVA was performed on FS and FAS before and after VR physical activity, P overall p = .003 in FS, before and after low-intensity (LI), medium-intensity (MI), and high-intensity (HI) VR physical activity, the p-values were.087, p = .027, and p = .021, respectively. p < .001 in FAS, before and after LI, MI, and HI VR physical activity, the p-values were .029, < .001, < .001. According to the FCM clustering of acceleration activity counts by LI, MI, and HI, the clustering centers of the right arm acceleration counts were 2016.77, 6118.31, and 9923.45; the clustering centers of the right thigh acceleration counts were 248.30, 1895.22, and 3485.60; and the clustering centers of the combined upper and lower limb acceleration counts were 1443.83, 4415.47, and 7149.13.

Conclusion

VR physical activity enhances subjects' sense of enjoyment of exercise and emotional arousal, with moderate intensity VR physical activity having the best effect. VR physical activity is skewed toward high upper-extremity activity and low lower-extremity activity. The combined intensity of VR physical activity matches that of traditional exercise, and it can achieve the workout effect of the traditional workout modality.

The physical activity at work (PAW) study: a cluster randomised trial of a multicomponent short-break intervention to reduce sitting time and increase physical activity among office workers in Thailand

Background

Sedentary behaviour increases the risks of non-communicable diseases. The objective of this trial was to evaluate the effect of the Physical Activity at Work multicomponent intervention to reduce sedentary behaviour in Thai office workers.

Methods

Offices under the Ministry of Public Health Thailand, were randomly allocated to the intervention and control group in a 1:1 ratio, stratified by office size. The intervention included individual (pedometer and lottery-based financial incentives), social (group movement breaks), environmental (posters), and organisational (leader encouragement) components. At baseline and 6-month follow-up, participants wore ActiGraphTM on the waist for ten days. The primary outcome was the between-group difference in sedentary time at 6-month, analysed using a linear mixed-effects model. Other outcomes were physical activity, biomarkers, productivity, and musculoskeletal health. Trial registration: The PAW study was registered at the Thai Clinical Trials Registry (ID TCTR20200604007) on 02 June 2020.

Findings

282 office workers were recruited and randomly allocated to the control group (142 participants, nine offices) and the intervention group (140 participants, nine offices). The mean age was 38.6 years (SD = 10.4), and 81% were women. There was no evidence of intervention effects on sedentary time during waking hours (-26.8; 95% CI = -69.2 to 15.7 min), physical activity levels, or biomarkers between groups at 6-month. In the adjusted analysis, increases in time spent in moderate-to-vigorous physical activity (5.45; 95% CI = -0.15 to 11.1 min) and step count (718; 95% CI = -45 to 1481 steps) during waking hours were observed, although there was no evidence of a difference between groups.

Interpretation

The intervention did not significantly reduce sedentary time in Thai office workers. Suboptimal intervention uptake due to Covid-19 pandemic restrictions and loss of statistical power associated with recruitment constraints may explain this result. Further investigations are needed to evaluate the processes of the trial.

Funding

The Thai Health Promotion Foundation and the International Decision Support Initiative (iDSI).

A Sensor Network Utilizing Consumer Wearables for Telerehabilitation of Post-Acute COVID-19 Patients

A considerable number of patients with COVID-19 suffer from respiratory problems in the post-acute phase of the disease (the second-third month after disease onset). Individual telerehabilitation and telecoaching are viable, effective options for treating these patients. To treat patients individually, medical staff must have detailed knowledge of their physical activity and condition. A sensor network that utilizes medical-grade devices can be created to collect these data, but the price and availability of these devices might limit such a network's scalability to larger groups of patients. Hence, the use of low-cost commercial fitness wearables is an option worth exploring. This article presents the concept and technical infrastructure of such a telerehabilitation program that started in April 2021 in the Czech Republic. A pilot controlled study with 14 patients with COVID-19 indicated the program's potential to improve patients' physical activity, (85.7% of patients in telerehabilitation versus 41.9% educational group) and exercise tolerance (71.4% of patients in telerehabilitation versus 42.8% of the educational group). Regarding the accuracy of collected data, the used commercial wristband was compared with the medical-grade device in a separate test. Evaluating [Formula: see text]-scores of the intensity of participants' physical activity in this test, the difference in data is not statistically significant at level [Formula: see text]. Hence, the used infrastructure can be considered sufficiently accurate for the telerehabilitation program examined in this study. The technical and medical aspects of the problem are discussed, as well as the technical details of the solution and the lessons learned, regarding using this approach to treat COVID-19 patients in the post-acute phase.

The Feel4Diabetes intervention: effectiveness on 24-hour physical behaviour composition in families at risk for diabetes development

The Feel4Diabetes project conducted a 2-year intervention aiming to encourage healthy behaviours in families in six European countries. Within this paper, the intervention effect was evaluated after the first intervention year on 24-hour physical behaviour composition in Belgian families at risk for type 2 diabetes. Parents’ and children’s levels of physical activity (PA) and sedentary behaviour (SB) were objectively measured and sleep duration was self-reported. Valid data were obtained in 82 children (mean age: 8.2 ± 0.84; 50.0% boys) and 72 parents (mean age: 40.1 ± 5.5; 27.8% fathers). Data were analysed using a compositional data approach, and mixed models were used to take clustering into account. Results showed that for children, the mean baseline composition of the 24-hour day in sleep, SB, light and moderate-to-vigorous PA for the intervention group was (11 hours 18 minutes; 6 hours 33 minutes; 5 hours 02 minutes, 1 hour 08 minutes) and for the control group (11 hours 18 minutes; 6 hours 35 minutes; 5 hours 04 minutes; 1 hour 06 minutes), respectively. For parents, the mean baseline composition was for the intervention group (8 hours 12 minutes; 9 hours 36 minutes; 5 hours 43 minutes; 27 minutes) and for the control group (8 hours 00 minute; 9 hours 00 minute; 6 hours 27 minutes; 33 minutes). No significant intervention effects were found on 24-hour physical behaviour composition of either parents or children (p = 0.19 and p = 0.21, respectively). A relatively small study population and a poor attendance rate among parents could maybe explain the lack of effectiveness. More effective strategies are needed to retain vulnerable families in interventions. Furthermore, future approaches to improve the 24-hour physical behaviour composition should maybe focus more specifically on PA, SB and sleep, and involve teachers, children and parents in the design of the intervention. Trial registration: NCT02393872 in ClinicalTrials.gov.

Reliability of the accelerometer to control the effects of physical activity in older adults

Background

Reliable physical activity measurements in community-dwelling older adults are important to determine effects of targeted health promotion interventions. Many exercise interventions aim to improve time spent sedentary (SED), in light-intensity-physical-activity (LPA) and moderate-to-vigorous-intensity-physical-activity (MVPA), since these parameters have independently proposed associations with health and longevity. However, many previous studies rely on self-reports which have lower validity compared to accelerometer measured physical activity patterns. In addition, separating intervention-effects from reactivity measurements requires sufficient test-retest reliability for accelerometer assessments, which is lacking in older adults.

Objectives

The study objective was to investigate the reliability of sensor-based PA-patterns in community-dwelling older adults. Furthermore, to investigate change over time of physical activity patterns and examine any compensatory-effect from the eight-week supervised exercise-intervention.

Methods

An exercise-group (n = 78, age-range:65-91yrs) performed two 1h-exercise sessions/week during eight-weeks. PA-pattern was assessed (using hip-worn accelerometers), twice before and once during the last-week of the intervention. A control-group (n = 43, age-range:65-88yrs) performed one pre-test and the end-test with no exercise-intervention. A dependent-t-test, mean-difference (95%-CI), limits-of-agreement and intraclass-correlation-coefficient-ICC were used between the two pre-tests. Repeated-measures-ANOVA were used to analyze any intervention-effects.

Results

The exercise-groups´ two pre-tests showed generally no systematic change in any PA- or SED-parameter (ICC ranged 0.75–0.90). Compared to the control group, the exercise intervention significantly (time x group-interaction, p<0.05) increased total-PA-cpm (exercise-group/control-group +17%/+7%) and MVPA-min/week (+41/-2min) and decreased %-of-wear-time for SED-total (-4.7%/-2.7%) and SED-bouts (-5.7%/-1.8%), and SED-bouts min/d (-46/-16min). At baseline level, no significant differences were found between the two groups for any parameter.

Conclusions

The current study presents a good test-retest-reliability of sensor-based-one-week-assessed-PA-pattern in older-adults. Participating in an 8-week supervised exercise intervention improved some physical activity and sedentary parameters compared to the control group. No compensatory-effect was noted in the intervention-group i.e., no decrease in any PA-parameter or increase in SED at End-test (in %-of-wear-time, min/day or total-PA).

Fitbit Use and Activity Levels From Intervention to 2 Years After: Secondary Analysis of a Randomized Controlled Trial

Background

There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions.

Objective

This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time.

Methods

Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models.

Results

Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001).

Conclusions

While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity.

Trial Registration

ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876

Validity of trunk acceleration measurement with a chest-worn monitor for assessment of physical activity intensity

Background

Recent advancements in wearable technology have enabled easy measurement of daily activities, potentially applicable in rehabilitation practice for various purposes such as maintaining and increasing patients’ activity levels. In this study, we aimed to examine the validity of trunk acceleration measurement using a chest monitor embedded in a smart clothing system (‘hitoe’ system), an emerging wearable system, in assessing the physical activity in an experimental setting with healthy subjects (Study 1) and in a clinical setting with post-stroke patients (Study 2).

Methods

Study 1 involved the participation of 14 healthy individuals. The trunk acceleration, heart rate (HR), and oxygen consumption were simultaneously measured during treadmill testing with a Bruce protocol. Trunk acceleration and HR were measured using the "hitoe" system, a smart clothing system with embedded chest sensors. Expiratory gas analysis was performed to measure oxygen consumption. Three parameters, moving average (MA), moving standard deviation (MSD), and moving root mean square (RMS), were calculated from the norm of the trunk acceleration. The relationships between these accelerometer-based parameters and oxygen consumption-based physical activity intensity measured with the percent VO2 reserve (%VO₂R) were examined. In Study 2, 48 h of simultaneous measurement of trunk acceleration and heart rate-based physical activity intensity in terms of percent heart rate reserve (%HRR) was conducted with the "hitoe" system in 136 post-stroke patients.

Results

The values of MA, MSD, RMS, and %VO₂R were significantly different between levels 1, 2, 3, and 4 in the Bruce protocol (P < 0.01). The average coefficients of determination for individual regression for %VO₂R versus MA, %VO₂R versus MSD, and %VO₂R versus RMS were 0.89 ± 0.05, 0.96 ± 0.03, and 0.91 ± 0.05, respectively. Among the parameters examined, MSD showed the best correlation with %VO₂R, indicating high validity of the parameter for assessing physical activity intensity. The 48-h measurement of MSD and %HRR in post-stroke patients showed significant within-individual correlation (P < 0.05) in 131 out of 136 patients (correlation coefficient: 0.60 ± 0.16).

Conclusions

The results support the validity of the MSD calculated from the trunk acceleration measured with a smart clothing system in assessing the physical activity intensity.

Trial registration: UMIN000034967. Registered 21 November 2018 (retrospectively registered).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00492-4.

Pain and functional disability amongst adults with moderate and severe haemophilia from the Irish personalised approach to the treatment of haemophilia (iPATH) study

Objectives

To establish the prevalence of pain and functional disability in Irish adults with moderate and severe haemophilia, and to examine demographic and lifestyle influences.

Methods

Males ≥18 years with moderate or severe haemophilia participated. Pain and function were examined using the PROBE questionnaire.

Results

Of 49 participants [median age 44 (IQR 32, 52) years], most had severe haemophilia (Factor VIII = 30; Factor IX = 13) and were on regular prophylaxis (88%). Those with moderate haemophilia (Factor VIII = 5; Factor IX = 1) treated on demand (12%). Acute (72%) and chronic pain (71%), functional difficulties (58%), and analgesic requirements (92%) were prevalent. Age was significantly associated with more advanced haemophilic arthropathy (p = .002), chronic pain (p = .029) and functional difficulties (p = .036). Adults who reported chronic pain commenced prophylaxis significantly later in life [32 (20, 51) vs. 8 (1, 23) years; p = .004]. Physical activity was significantly lower in those with functional difficulties (p < .05). A disparity between self‐perceived ‘target joints’ and clinically defined target joints was also identified (76% vs. 23%).

Conclusion

Haemophilic arthropathy, pain and functional disability were prevalent amongst Irish adults with moderate and severe haemophilia. Age‐dependent lifestyle, analgesic and treatment influences on pain and function warrant further investigation.

Accelerometer derived physical activity patterns in 27.890 middle-aged adults: The SCAPIS cohort study

The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50-64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an "at-risk" behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.

Accelerometer-based estimation of oxygen uptake in adults with Down syndrome: vector magnitude vs. vertical axis

BACKGROUND

Triaxial accelerometer output [vector magnitude (VM) counts] may better estimate physical activity intensity as reflected in the rate of oxygen uptake (V̇O₂ ) than the traditional vertical axis (VA) counts in adults with Down syndrome (DS). This study examined the accuracy of VM vs. VA counts in estimating V̇O₂ in adults with and without DS across different physical activities and sedentary behaviours.

METHODS

Sixteen adults with DS (10 men and 6 women; 31 ± 15 years) and 19 adults without DS (10 men and 9 women; 24 ± 5 years) performed 12 tasks. V̇O₂ was measured by portable spirometer (K4b² , Cosmed) and VM and VA with an accelerometer (wGT3X-BT, Actigraph).

RESULTS

Vector magnitude and VA were significant predictors of V̇O₂ in adults with DS (P < 0.001; R²  = 0.74 and 0.65, respectively) and adults without DS (P < 0.001; P < 0.001; R²  = 0.75 and 0.61, respectively). Absolute error of prediction was significantly smaller for VM than VA for sitting, playing app, drawing, sweeping, standing and basketball (P ≤ 0.005), but smaller for VA than VM for walking at 0.8 m·s^-1 (P = 0.005). Bland-Altman plots for adults with and without DS indicated narrower limits of agreement for VM than VA (-5.57 to 5.57 and -6.44 to 6.44 mL·kg^-1 ·min^-1 ; -6.21 to 6.17 and -7.75 to 7.74 mL·kg^-1 ·min^-1 , respectively).

CONCLUSIONS

Vector magnitude and VA are significant predictors of V̇O₂ in adults with and without DS, yet VM more accurately estimated V̇O₂ than VA for most tasks. Development of accelerometer-based prediction of physical activity levels in adults with and without DS may improve by utilising VM counts.

Exploring Families' Acceptance of Wearable Activity Trackers: A Mixed-Methods Study

Background: The family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children’s PA; however, few studies have explored families’ acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Methods: Twenty-four families, with children aged 5–9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Results: Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Conclusions: Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.

Dietary and physical activity changes and adherence to WCRF/AICR cancer prevention recommendations following a remotely delivered weight loss intervention for female breast cancer survivors: The Living Well after Breast Cancer randomized controlled trial

BACKGROUND

Diet, exercise, and weight management are key in improving outcomes for breast cancer survivors, with international recommendations for cancer survivors relating to these behaviors. However, few behavioral interventions have reported outcomes aligned specifically with these recommendations.

OBJECTIVE

To evaluate a remotely delivered weight loss intervention versus usual care for female breast cancer survivors, on changes in multiple diet and physical activity behaviors.

DESIGN

A randomized controlled trial with assessments at study baseline, 6-, 12- and 18 months (i.e., mid-intervention, post-intervention, and non-contact follow-up).

PARTICIPANTS/SETTING

Participants were recruited between October 2012 and December 2014 through hospitals in Brisbane (Australia) and the state-based cancer registry. Eligible participants (female, 18-75 years, BMI 25-45 kg/m², diagnosed with stage I-III breast cancer in previous two years) were randomly allocated to intervention (n=79) or usual care (n=80).

INTERVENTION

Participants randomized to the intervention group received 22 counseling telephone calls targeting diet and physical activity aimed at achieving 5-10% weight loss, and optional text messages, over 12 months. Usual care participants received their standard medical care and brief feedback following each assessment, which was similar to that provided to intervention participants with the exception that usual care participants' results were not compared to national and study recommendations.

MAIN OUTCOME MEASURES

Dietary intake (24-hour recalls); physical activity (hip-worn Actigraph); sitting time (thigh-worn activPAL3); and, adherence to World Cancer Research Fund/American Cancer Research Institute (WCRF/AICR) recommendations for cancer survivors (0-7 score) were measured at each assessment, with data collected between November 2012 and October 2016.

STATISTICAL ANALYSES PERFORMED

Intervention effects were assessed by linear mixed models, accounting for repeated measures and baseline values. Significance was set at P<0.05.

RESULTS

At baseline, participants were (mean±SD) aged 55±9 years, with a BMI of 31.4±5.0 kg/m², 10.7±5.0 months post-diagnosis, and primarily non-minority. At baseline, only 8% (n=12) of participants met ≥5/7 WCRF/AICR recommendations (mean±SD WCRF/AICR adherence score: 3.8±1.0). At 12 months, significant intervention effects were observed in walking/running ( +21 mins/week; 95%CI: 4, 38) and WCRF/AICR adherence scores (+0.3 points; 95%CI: 0.0, 0.6) only. At 18 months, significant intervention effects were observed for energy intake (-229 kcal/day energy; 95%CI: -373, -84), total fat (-10 g/day; 95%CI: -18, -2), and saturated fat (-5 g/day; 95%CI: -9, -1), and were sustained for WCRF/AICR adherence scores (+0.5 points; 95%CI: 0.2, 0.8).

CONCLUSIONS

This remotely delivered weight loss intervention led to sustained improvements in WCRF/AICR adherence scores, and some improvements in diet and physical activity. These findings provide support for the health benefit of programs targeting lifestyle behaviors in line with cancer survivor recommendations, and the potential for dissemination of such programs following treatment for early-stage female breast cancer.

Perspective: Opportunities and Challenges of Technology Tools in Dietary and Activity Assessment: Bridging Stakeholder Viewpoints

The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.

Detailed analysis and comparison of different activity metrics

Actigraphic measurements are an important part of research in different disciplines, yet the procedure of determining activity values is unexpectedly not standardized in the literature. Although the measured raw acceleration signal can be diversely processed, and then the activity values can be calculated by different activity calculation methods, the documentations of them are generally incomplete or vary by manufacturer. These numerous activity metrics may require different types of preprocessing of the acceleration signal. For example, digital filtering of the acceleration signals can have various parameters; moreover, both the filter and the activity metrics can also be applied per axis or on the magnitudes of the acceleration vector. Level crossing-based activity metrics also depend on threshold level values, yet the determination of their exact values is unclear as well. Due to the serious inconsistency of determining activity values, we created a detailed and comprehensive comparison of the different available activity calculation procedures because, up to the present, it was lacking in the literature. We assessed the different methods by analysing the triaxial acceleration signals measured during a 10-day movement of 42 subjects. We calculated 148 different activity signals for each subject’s movement using the combinations of various types of preprocessing and 7 different activity metrics applied on both axial and magnitude data. We determined the strength of the linear relationship between the metrics by correlation analysis, while we also examined the effects of the preprocessing steps. Moreover, we established that the standard deviation of the data series can be used as an appropriate, adaptive and generalized threshold level for the level intersection-based metrics. On the basis of these results, our work also serves as a general guide on how to proceed if one wants to determine activity from the raw acceleration data. All of the analysed raw acceleration signals are also publicly available.

Accelerometry-based physical activity, disability and quality of life before and after lumbar decompression surgery from a physiotherapeutic perspective: An observational cohort study

BACKGROUND

The effect of lumbar decompression on physical activity (PA) measures (measured as number of steps/day and as moderate to vigorous PA (MVPA)) is poorly understood. The aim of the current study was to compare PA in patients before and after lumbar decompression and to determine the association between change in steps/day and MVPA with change in disability, health-related quality of life (HRQOL) and pain.

METHODS

Patients undergoing lumbar decompression surgery were recruited. Steps/day and MVPA MVPA were recorded with an accelerometer. Oswestry Disability Index (ODI), HRQOL (Short Form 36 questionnaire (SF-36)) and pain levels (visual analogue scale (VAS)) were collected prior to surgery and six and twelve weeks postoperatively. Steps/day were compared to the lower bound of steps/day in healthy persons (7,000 steps per day), and the relationship between changes in steps/day, MVPA, ODI, SF-36, and VAS were calculated.

RESULTS

Twenty-six patients aged 37 to 75 years met inclusion criteria and were included in the study. Lumbar decompressions were performed for stenosis and/or disc herniation. Preoperatively, patients took an average 5,073±2,621 (mean±standard deviation) steps/day. At 6 weeks postoperatively, patients took 6,131±2,343 steps/day. At 12 weeks postoperatively, patients took 5,683±2,128 steps/day. Postoperative MVPA minutes per week increased compared to preoperative MVPA (preoperative: 94.6±122.9; 6 weeks: 173.9±181.9; 12 weeks: 145.7±132.8). From preoperative to 12 weeks postoperative, change in steps correlated with MVPA (R=0.775; P<0.001), but not with ODI (R=0.069; P=0.739), SF-36 (R=0.138; P=0.371), VAS in the back (R=0.230; P=0.259) or VAS in the leg (R=-0.123; P=0.550).

CONCLUSIONS

During the first 12 postoperative weeks, daily steps did not reach the lower bound of normal step activity of 7,000 steps/day, however postoperative steps/day were higher than before surgery. Steps/day and MVPA appear to be independent of ODI and SF-36 and represent additional outcome parameters in patients undergoing lumbar decompression surgery and should be considered e.g., by physiotherapists especially from 6 to 12 weeks postoperatively.

LEVEL OF EVIDENCE

2, prospective cohort study.

Randomized trial examining the effect of exercise and wellness interventions on preventing postpartum depression and perceived stress

BACKGROUND

Approximately 13-19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk.

METHODS

Participants (n = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care.

RESULTS

Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = - 1.00, SE = 0.46, p = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = - 2.00, SE = .98, p = .04) and exercise vs. wellness participants (b = - 2.20, SE = 1.11, p = .04).

CONCLUSIONS

The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care.

TRIAL REGISTRATION

Clinical Trials Number: NCT01883479 (06/21/2013).

Physical Activity Intensity, Perceived Exertion, and Enjoyment During Head-Mounted Display Virtual Reality Games

Objectives: The purpose of this study was to determine the following: (1) the level of physical activity (PA) achieved during commercial active virtual reality (VR) games, and (2) which active VR games elicit higher enjoyment levels in young, healthy adults. Materials and Methods: Thirty-six participants completed four study sessions, each devoted to playing one of the following head-mounted display VR games for 15 minutes: Beat Saber (BS), Holopoint (HP), Hot Squat (HS), and Relax Walk VR. PA intensity measures included percentage of heart rate reserve (%HRR), ratings of perceived exertion (RPE), and accelerometry. Enjoyment was measured with the Physical Activity Enjoyment Scale (PACES) following each gaming session. Mixed-model analysis of variances were used to analyze the outcome measures. Results: The analyses showed that HS elicited significantly higher %HRR and RPE than BS, HP, and Relax Walk. HS was the only game to reach moderate intensity via %HRR. Accelerometer data showed that time in whole-body moderate-to-vigorous physical activity (MVPA) for HS was significantly greater than HP, which was greater than BS and Relax Walk. Also, males exhibited significantly more whole-body and upper limb MVPA compared with females during gameplay. BS and HP were rated significantly more enjoyable than HS and Relax Walk. Conclusions: Results from this study suggest that active VR games can elicit varying degrees of PA intensity levels in young healthy adults, with HS eliciting moderate intensity activity. The games rated highest in enjoyment required mostly arm movement and a perceived light exertion. ClinicalTrials: NCT04221139.

Comparative assessment of ActiGraph data processing techniques for measuring sedentary behavior in adults with COPD

Objective.The ActiGraph is commonly used for measuring sedentary behavior (SB), but the best data processing technique is not established for sedentary adults with chronic illness. The purpose of this study was to process ActiGraph vertical axis and vector magnitude data with multiple combinations of filters, non-wear algorithm lengths, and cut-points and to compare ActiGraph estimates to activPAL-measured sedentary time in sedentary adults with chronic obstructive pulmonary disease (COPD).Approach.This study was a secondary analysis of adults ≥50 years (N = 59; mean age: 69.4 years;N = 31 males) with COPD. Participants woreActiGraph GT9XandactivPAL3for 7 d. ActiGraph vertical axis and vector magnitude data were processed using combinations of filters (normal, low frequency extension (LFE)), non-wear algorithm lengths (60, 90, 120 min), and cut-points for SB previously validated in older adults (two for vertical axis and three for vector magnitude data). The Bland-Altman method was used to assess concordance between sedentary time measured with 30 ActiGraph techniques and activPAL-measured sedentary time.Main results. Agreement between the two devices was moderate to strong for all techniques; concordance correlations ranged from 0.614 to 0.838. Limits of agreement were wide. The best overall technique was vector magnitude data with LFE filter, 120 min non-wear algorithm, and <40 counts/15 s SB cut-point (concordance correlation 0.838; mean difference -11.7 min d^-1).Significance. This analysis supports the use of ActiGraph vector magnitude data and LFE filter in adults with COPD, but also demonstrates that other techniques may be acceptable with appropriate cut-points. These results can guide ActiGraph data processing decisions.

Assessing Physical Activity After ACL Injury: Moving Beyond Return to Sport

CONTEXT

Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation.

EVIDENCE ACQUISITION

Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population.

CONCLUSION

Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.

Relationships between College Students' Sedentary Behavior, Sleep Quality, and Body Mass Index

PURPOSE

Sedentary behavior (SB), sleep efficiency (SE), sleep duration (SD), and body mass index (BMI) are crucial determinants of an individual's health. However, empirical evidence regarding associations between these factors in young adults living in China remains unknown. Therefore, the purpose of this study was to examine the relationships between accelerometer-measured SB, SE, SD, and BMI in Chinese college students.

METHODS

Two-hundred and twenty college students (115 females, Meanage = 20.29 years, SD = 2.37) were recruited from a south-central Chinese university. Participants' SB (daily % time spent in SB), SE (number of minutes of sleep duration/number of minutes in bed), and SD were assessed via wrist-worn ActiGraph GT9X Link accelerometers for one week. Body weight was measured using a digital weight scale, height was measured using a stadiometer, and BMI was calculated as weight (kg)/height (m2).

RESULTS

Participants' average time spent in SB was 76.52% (SD = 10.03), SE was 84.12% (SD = 4.79), and BMI was 20.67 kg/m2 (SD = 3.12), respectively. Regression analyses indicated that SB (β = -0.17, p = 0.01) and BMI (β = -0.20, p < 0.01) negatively predicted SE. In addition, BMI negatively predicted SD (β = -0.22, p < 0.01).

CONCLUSION

Prolonged SB (e.g., screen viewing, smartphone use, and computer playing) and higher BMI may link to shorter sleep duration and lower sleep efficiency in Chinese young adults. Future randomized controlled trials are needed to further confirm these findings. Given that increased BMI status and SB may relate to adverse health outcomes, more population-based intervention strategies seeking to lower BMI and reduce SB (e.g., nutrition education and physical activity promotion) are needed in this population.

Sustained physical activity in peripheral artery disease: Associations with disease severity, functional performance, health-related quality of life, and subsequent serious adverse events in the LITE randomized clinical trial

This study investigated cross-sectional associations of peripheral artery disease (PAD) severity (defined by the ankle-brachial index (ABI)) and amounts of daily sustained physical activity (PA) (defined as > 100 activity counts per minute lasting 5 consecutive minutes or more). This study also investigated associations of amounts of daily sustained PA with 6-minute walk (6MW) distance and the Short Form-36 physical functioning domain (SF-36 PF) score in cross-sectional analyses and with serious adverse events (SAEs) in longitudinal analyses of people with PAD. PA was measured continuously for 10 days using a tri-axial accelerometer at baseline in 277 participants with PAD randomized to the LITE clinical trial. In regression analyses, each 0.15 lower ABI value was associated with a 5.67% decrease in the number of daily bouts of sustained PA (95% CI: 3.85-6.54; p < 0.001). Every additional bout of sustained PA per day was associated with a 4.56-meter greater 6MW distance (95% CI: 2.67-6.46; p < 0.0001), and a 0.81-point improvement in SF-36 PF score (95% CI: 0.34-1.28; p < 0.001). Participants with values of daily bouts of sustained PA below the median had higher rates of SAEs during follow-up, compared to participants above the median (41% vs 24%; p = 0.002). In conclusion, among participants with PAD, lower ABI values were associated with fewer bouts of daily sustained PA. A greater number of bouts of daily sustained PA were associated with better 6MW performance and SF-36 PF score, and, in longitudinal analyses, lower rates of SAEs. Clinicaltrials.gov ID: NCT02538900.

Comparison of uniaxial and triaxial accelerometer outputs among individuals with and without Down syndrome

BACKGROUND

Using uniaxial accelerometry approach in measuring physical activity levels of individuals with Down syndrome (DS) might underestimate their energy expenditure due to the unique mediolateral walking pattern. Therefore, the purpose of this study was to examine and compare the relationship between two types of accelerometer outputs, uniaxial and triaxial, and energy expenditure in individuals with and without DS.

METHODS

Eighteen participants with DS and 19 participants without DS wore a GT3X+ accelerometer and a portable metabolic system in three different walking conditions.

RESULTS

Correlations between V̇O2 and each of the two accelerometer outputs (uniaxial: r = 0.75, triaxial: r = 0.75) were not significantly different among individuals without DS (z = 0.14, P = 0.89); however, significant differences in the relationship between V̇O2 and accelerometer outputs (uniaxial: r = 0.53, triaxial: r = 0.64) were observed among individuals with DS (z = -1.72, P < 0.046).

CONCLUSIONS

The findings suggest that when using accelerometers to measure physical activity levels for individuals with DS, triaxial outputs may better predict physical activity levels.

Self-Regulatory Processes, Motivation to Conserve Resources and Activity Levels in People With Chronic Pain: A Series of Digital N-of-1 Observational Studies

Objectives

Motivational and self-regulatory processes during goal pursuit may account for activity patterns in people with chronic pain. This article describes a series of N-of-1 observational studies designed to investigate the influence of goal-related factors on fluctuations in motivation to conserve resources and objectively measured activity levels.

Methods

Four participants with chronic pain who attended a formal pain management program (PMP; 41–59 years old; three female) were recruited and completed digital daily diaries for 11–12 weeks. The daily dairies, delivered via text message, measured self-regulatory fatigue, goal self-efficacy, goal striving, perceived demands, pain, and motivation to conserve resources. Continuously worn accelerometers measured physical activity and sedentary time. Analyses were conducted individually for each participant. The effects of self-regulatory fatigue, goal self-efficacy, goal striving, perceived demands, and pain on motivation to conserve resources, physical activity and sedentary time were assessed with dynamic regression modeling.

Results

Different patterns of associations between the predictors and outcomes were observed across participants. Most associations occurred concurrently (e.g., on the same day). Perceived demand was the only variable to predict motivation to conserve resources, physical activity, and sedentary time. Motivation to conserve resources and sedentary time were most frequently predicted by goal striving and perceived demand. Self-regulatory fatigue and pain intensity both predicted motivation to conserve resources in two participants and sedentary time in one participant. Motivation to conserve resources predicted sedentary time in two participants.

Conclusion

This study was the first to examine the impact of fluctuations in self-regulatory processes on motivation to conserve resources and objective activity levels within individuals with chronic pain. The results generally supported recent affective-motivational views of goal pursuit in chronic pain. This study demonstrated that N-of-1 observational studies can be conducted with patients during a PMP using digital technologies. The use of these approaches may facilitate the application of personalized medicine.

Active Gaming: It Is Not Just for Young People

Whether active gaming is an appropriate method to facilitate moderate-intensity physical activity in older adults remains unclear. The purpose of this study was to evaluate the intensity of physical activity and enjoyment while playing three active video games in older adults compared with younger adults. Ten younger and 10 older adults played three active games on separate days. Participants played two 15-min periods per game: one period at a self-selected intensity and one period with structured instructions to maximize the movement. Physical activity intensity and enjoyment were measured during gameplay. The results indicated that older adults played games at significantly higher intensities (5.3 + 1.8 vs. 3.6 + 1.8 metabolic equivalents), spent less time in whole-body sedentary activity, and rated games more enjoyable compared with younger adults. With physical activity intensity being consistent with moderate-to-vigorous intensity for older adults during gameplay, the results suggest that active video games could be used as a cardiovascular tool for older adults.

Pragmatic evaluation of a coproduced physical activity referral scheme: a UK quasi-experimental study

OBJECTIVES

UK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness.

DESIGN

A three-arm quasi-experimental trial.

SETTING

Two leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control.

PARTICIPANTS

68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment.

INTERVENTION

16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access.

OUTCOME MEASURES

Cardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects.

RESULTS

Significant improvements in cardiorespiratory fitness (p=0.002) and vascular health (p=0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant.

CONCLUSION

A coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months.

TRIAL REGISTRATION NUMBER

NCT03490747.

Parents and children active together: a randomized trial protocol examining motivational, regulatory, and habitual intervention approaches

BACKGROUND

Regular physical activity (PA) is associated with many health benefits during childhood, and tracks into desirable PA patterns and health profiles in adulthood. Interventions designed to support these behaviours among young children are critical. Family-based interventions focusing on parent-child activities together (i.e., co-activity) among preschool-aged children are warranted. Targeting parental support practices can increase the frequency of co-activity, however interventions must move beyond merely building intention and planning skills for successful maintenance. Interventions designed to increase co-activity habit strength may facilitate the sustainability and thus impact child PA. The purpose of this study is to compare the effects of three intervention conditions designed to increase child PA through co-activity: a standard education condition (information about benefits), a planning (action planning, coping planning) + education condition and a habit (context-dependent repetition from prompts and cues) + planning +education condition.

METHODS/DESIGN

A longitudinal three-arm parallel design randomized trial will compare three conditions over six months. Families are eligible if they have at least one child between 3y and 5y that is not meeting 60mins/day of moderate to vigorous physical activity (MVPA). The primary outcome (child MVPA) is assessed via accelerometry at baseline, six weeks, three months and six months (primary endpoint). Intervention materials targeting co-activity are delivered post baseline assessment, with booster sessions at six weeks and three months. Parental co-activity habit, parent-child co-activity and other behavioural constructs are also assessed via questionnaire at all measurement occasions. As tertiary outcomes, parental PA is measured via accelerometry and co-activity is measured via a Bluetooth-enabled proximity feature. A total of 106 families have been recruited thus far from the Greater Victoria region. The study is ongoing with a minimum target of 150 families and an anticipated recruitment completion date of August 2022.

DISCUSSION

This protocol describes the implementation of a randomized trial evaluating the effectiveness of a habit formation group compared with a planning group and an education only group to increase child PA through targeting parent-child co-activity. This information could prove useful in informing public health initiatives to promote PA among families with preschool-aged children.

TRIAL REGISTRATION

This trial was prospectively registered on clinicaltrials.gov in February 2016, identifier NCT03055871 .

Positive Lifestyle Behavior Changes Among Canadian Men: Findings From the HAT TRICK Program

PURPOSE

To estimate program effectiveness regarding physical activity (PA), diet, and social connectedness as part of a feasibility study.

DESIGN

Pre-post quasi-experimental.

SETTING

HAT TRICK was delivered in collaboration with a Canadian semi-professional ice hockey team and offered at the arena where they trained and played games.

PARTICIPANTS

Participants (N = 62) at baseline were overweight (BMI >25kg/m²) and inactive (<150 minutes of MVPA/week) men age 35+ years.

INTERVENTION

Gender-sensitized 12-week intervention for men targeting PA, healthy eating and social connectedness.

METHOD

Baseline, post-intervention (12 weeks) and 9-month follow-up self-report and accelerometer data were collected. Multi-level modeling assessed growth trajectories of outcome measures across time.

RESULTS

Accelerometer measured weekly/min. of moderate PA showed significant linear trends (95%CI: 42.9 - 175.3) from baseline (147.0 ± 104.6), 12-week (237.7 ± 135.5) and 9-month follow-up (204.89 ± 137.7) qualified with a quadratic trend. Self-reported weekly/min of moderate and vigorous PA showed significant linear trends (95%CI: 94.1, 264.1; 95%CI: 35.1, 109.6) from baseline (52.6 ± 83.8, 22.42 ± 44.9), 12 week (160.1 ± 157.4, 66.6 ± 74.4) and 9-month follow-up (118.6 ± 104.6, 52.2 ± 59.2) qualified with quadratic trends. DINE measured fat score rating showed linear trends over time (95%CI -14.24, -6.8), qualified with a quadratic trend. DINE fibre score and social connectedness showed no trends.

CONCLUSION

Findings yield valuable information about the implementation of gender-sensitized lifestyle interventions for men and demonstrate the importance of male-specific strategies for reaching and engaging overweight, physically inactive men.

Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain

BACKGROUND

Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures.

PURPOSE

To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement.

METHODS

Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based 6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function.

RESULTS

Performance-based and objective physical function were significantly interrelated (r=0.48, p<0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p<0.001), adaptive coping (β=-0.65, p<0.001) and social-emotional dysfunction (β=0.65, p<0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps>0.1).

CONCLUSION

Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03412916.

Reactivity to accelerometer measurement of youth with moderate and severe intellectual disabilities

BACKGROUND

Reactivity occurs when research participants alter their behaviours due to the awareness of being monitored, which is a concern with using wearable devices to measure physical activity. The purpose of this study was to examine reactivity to accelerometer measurement among youth with moderate and severe intellectual disabilities (ID).

METHODS

A sample of 175 youth with ID (108 with moderate and 67 with severe ID) was recruited from residential centres in China. Demographic data were measured using a parent-reported questionnaire, and light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were measured using the ActiGraph GT3X accelerometers. Data were analysed using an analysis of covariances where Day 1 LPA/MVPA, Day 2-6 LPA/MVPA, and Day 7 LPA/MVPA were repeated measures.

RESULTS

Youth with moderate ID had significantly higher LPA (8.01%) and MVPA (10.30%) on Day 1 than Day 2-6. Similarly, youth with severe ID had significantly higher LPA (21.69%) and MVPA (19.48%) on Day 1 than Day 2-6. An inverse reactivity was also found on Day 7 among youth with severe ID for LPA (-10.65%) and MVPA (-14.82%).

CONCLUSIONS

Reactivity to accelerometer measurement was found for youth with moderate and severe ID. Findings support the utilisation of a 1-day familiarisation period, as well as discounting the final day of measurement, when examining physical activity behaviours among youth with moderate and severe ID.

Effectiveness of a family-, school- and community-based intervention on physical activity and its correlates in Belgian families with an increased risk for type 2 diabetes mellitus: the Feel4Diabetes-study

Background

The study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium.

Methods

The Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4 years; 72.0% women) and 444 children (mean age 8.0 years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year.

Results

In parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p = 0.05; η_p² = 0.008) and steps (p = 0.03; η_p² = 0.006%) on weekdays, with physical activity decreasing (more) in the intervention group.

Conclusions

The F4D-intervention lacks effectiveness on high-risk families’ physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group).

Trial registration

The Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015.

Utilizing RE-AIM to examine the translational potential of Project MOVE, a novel intervention for increasing physical activity levels in breast cancer survivors

Translating effective research into community practice is critical for improving breast cancer (BC) survivor health. The purpose of this study is to utilize the RE-AIM framework to evaluate the translational potential of Project MOVE, an innovative intervention focused on increasing physical activity (PA) in BC survivors. A mixed-methods design, including a self-report questionnaire, accelerometry, focus groups, and interviews, was used to inform each RE-AIM dimension. Reach was evaluated by the representativeness of participants. Effectiveness was reflected by change in PA levels and perceptions of satisfaction and acceptability. Adoption was examined using participants' perceived barriers/facilitators to program uptake. Implementation was examined by participants' perceived barriers/facilitators to implementing the program. Maintenance was assessed by participant retention. Assessments occurred at baseline and 6-months. Mixed analysis of variance and content analysis were used to analyze the data. A total of 87 participants participated in Project MOVE and were demographically comparable to similar studies (Reach). Participants indicated high levels of program satisfaction (88%) and previously inactive survivors' significantly increased PA levels from baseline to 6-month follow-up (Effectiveness). Participants reported that a program focused on PA rather than disease helped them overcome barriers to PA (Adoption) and having leaders with BC and exercise expertise was essential to accommodate population specific barriers (Implementation). At 6-months, participant retention was 83% (Maintenance). Project MOVE is an acceptable, practical, and effective program for engaging BC survivors in PA and has the potential to be highly transferable to other populations and regions.

Levels of self-reported and objective physical activity in individuals with age-related macular degeneration

Background

Self-report in people with age-related macular degeneration (AMD) shows that they lead less active lifestyles. Physical activity is important as it has been shown to improve quality of life, reduce co-morbidity and also slow down the progression of AMD. Self-reported measures of physical activity are prone to subjective biases and therefore less accurate in quantifying physical activity. This study compared self-reported and objective (accelerometer-based) physical activity levels and patterns in older adults with AMD.

Methods

Data were collected in 11 AMD subjects with binocular vision loss (aged 76 ± 7 years), 10 AMD subjects with good binocular vision (aged 76 ± 7 years), and 11 controls (aged 70 ± 4 years). Binocular vision was established using visual acuity score. Contrast sensitivity and visual fields were also measured. Self-reported sedentary behaviour and moderate-to-vigorous physical activity (MVPA) was assessed using the Global Physical Activity Questionnaire. Objective measurements were obtained with an Actigraph GT3X accelerometer being worn for seven consecutive days on the hip. The objective physical activity measures were sedentary behaviour, light physical activity, MVPA, and step count.

Results

Objectively measured MVPA was 33–34% higher for controls compared to both AMD groups (p < 0.05). There were no group differences for any of the other objectively measured physical activity variables and self-reported physical activity variables were also not significantly different (all p > 0.05). Comparing the objective with the self-report physical activity measure showed that all groups under-reported their sedentary behaviour and MVPA, but controls under-reported their MVPA more than both AMD groups (p < 0.05). Weak to moderate correlations were observed between the severity of vision loss and objective physical activity measures (all − 0.413 ≥ r ≤ 0.443), while correlations for self-reported physical activity measures were less strong (all − 0.303 ≥ r ≤ 0.114).

Conclusions

People with AMD, irrespective of whether they were vision impaired, were better able to estimate the time spent in MVPA compared to controls. However, objectively measured MVPA, was higher in controls than AMD subjects. Although clinicians may use self-report to monitor the compliance of AMD subjects with any prescribed exercise programs, they should be aware that a valid comparison with healthy controls can only be made when MVPA is objectively measured.