Accelerometry and physical activity questionnaires - a systematic review

High-level physical activity provides protection against all-cause mortality among U.S. adults with depression

BACKGROUND

Regular physical activity (PA) offers numerous benefits, decreasing all-cause mortality (ACM) among the general population. However, its impact on individuals with depression remains unknown. The present study aimed to investigate the correlation between various PA levels and ACM among adult patients with depression in the United States.

METHODS

Data from the National Health and Nutrition Examination Survey from 2007 to 2018, as well as relevant mortality data up to December 31, 2018 were extracted. 4850 adults with depression were incorporated into this cohort study. PA level was quantified based on weekly metabolic equivalent of task (MET-min/week) and categorized into four groups according to the Physical Activity Guidelines for Americans. Weighted Cox proportional-hazards models were leveraged to assess the association of different PA levels with ACM among adults with depression, and adjustments were made for various sociodemographic and health factors.

RESULTS

Among the 4850 patients with depression, 503 deaths were noted over a median follow-up of 6.6 years. The weighted Cox regression analysis showed that participants with high-level PA (>1200 MET-min/week) had a markedly lower risk of ACM (HR = 0.48, 95 % CI 0.33 to 0.68) compared to those with no PA (0 MET-min/week). The benefit conferred by the high-level PA group (HR = 0.65, 95CI 0.45 to 0.94) remained significant (p < 0.05) after adjustment for other confounders.

LIMITATIONS

PA and some covariates were assessed through self-reported questionnaires.

CONCLUSION

High-level PA has the most pronounced effect on reducing ACM among adult patients with depression, which should be recognized in clinical and public health guidelines.

Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial

PURPOSE

This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA).

METHODS

A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours.

RESULTS

A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046).

CONCLUSION

This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.

Parous women perform less moderate to vigorous physical activity than their nulliparous peers: a population-based study in Denmark

OBJECTIVES

The World Health Organization (WHO) highlights parous women as a key population for monitoring trends of physical activity (PA). We aimed to estimate the proportion of Danish women non-adhering to WHO PA guidelines in parous women compared with nulliparous women and to describe leisure-time PA intensity in each of these groups.

STUDY DESIGN

Cross-sectional study.

METHODS

This population-based study builds on a sample of 27,668 women aged 16-40 years from the Danish National Health Survey 2021. These data were linked with childbirth data from the Danish National Birth Registry. The primary outcome was self-reported weekly hours of moderate to vigorous leisure-time PA (MVPA) dichotomized into: (i) adhering to WHO guidelines for MVPA or (ii) not adhering to WHO guidelines for MVPA. Binomial regression analysis was used to calculate prevalence proportions (PP) and prevalence proportion ratios (PPR).

RESULTS

Of the 27,668 women, a total of 20,022 were included; 9338 (46.6%) parous women and 10,684 (53.4%) nulliparous women. The PP of women non-adhering to WHO PA guidelines was 63.8% (95% CI 62.9-64.8) for parous and 51.3% (95% CI 50.4-52.3) for nulliparous women, corresponding to a PPR of 1.24 (95% CI 1.21; 1.27).

CONCLUSIONS

The proportion of parous women who did not adhere to WHO PA guidelines for MVPA was 24% higher than that of nulliparous women. This highlights parous women as a subgroup of the adult population at increased risk of non-adherence to WHO PA guidelines. These findings call for future research to inform new strategies aiming to promote PA in parous women.

Daily Pain Severity but Not Vertebral Fractures Is Associated With Lower Physical Activity in Postmenopausal Women With Back Pain

Back pain lifetime incidence is 60%-70%, while 12%-20% of older women have vertebral fractures (VFs), often with back pain. We aimed to provide objective evidence, currently lacking, regarding whether back pain and VFs affect physical activity (PA). We recruited 69 women with recent back pain (age 74.5 ± 5.4 years). Low- (0.5 < g < 1.0), medium- (1.0 ≤ g < 1.5), and high-impact (g ≥ 1.5) PA and walking time were measured (100 Hz for 7 days, hip-worn accelerometer). Linear mixed-effects models assessed associations between self-reported pain and PA, and group differences (VFs from spine radiographs/no-VF) in PA. Higher daily pain was associated with reduced low (β = -0.12, 95% confidence interval, [-0.22, -0.03], p = .013) and medium-impact PA (β = -0.11, 95% confidence interval, [-0.21, -0.01], p = .041), but not high-impact PA or walking time (p > .11). VFs were not associated with PA (all p > .2). Higher daily pain levels but not VFs were associated with reduced low- and medium-impact PA, which could increase sarcopenia and falls risk in older women with back pain.

Accelerometer-Measured Physical Activity, Fitness and Indicators of Cardiometabolic Risk among Rural Adolescents: A Cross-Sectional Study at 15-Year Follow-up of the MINIMat Cohort

BACKGROUND

Little is known about the relationship of physical activity (PA) and fitness with cardiometabolic risk among rural adolescents in low- and middle-income countries. Thus, we examined the associations of PA and fitness with selected cardiometabolic indicators along with potential gender-based differences in a birth cohort of rural adolescents from southeast Bangladesh.

METHODS

We utilized data from the 15-year follow-up of Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort (n = 2253). Wrist-worn ActiGraph wGT3x-BT accelerometers were used to estimate sedentary time (ST) and PA. Fitness was assessed using: handgrip strength, standing long jump, and Chester Step Test. Anthropometric parameters, systolic blood pressure (SBP), and fasting lipid, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Linear regression and isotemporal substitution models were fitted.

RESULTS

The adolescents spent 64 min/day (inter-quartile range: 50-81) in moderate-to-vigorous physical activity (MVPA). A 10-minute-per-day higher vigorous PA (VPA) was associated with: 4.9% (95% confidence interval (CI): 2.9-6.8%) lower waist circumference (WC), 3.2 mmHg (95% CI: 1.5-4.8) lower SBP, 10.4% (95% CI: 2.9-17.3%) lower TG, and 24.4% (95% CI: 11.3-34.9%) lower HOMA-IR. MVPA showed similar associations of notably smaller magnitude. Except for WC, the associations were more pronounced among the boys. Substituting ST with VPA of equal duration was associated with lower WC, SBP, triglyceride and HOMA-IR. Grip strength was favorably associated with all indicators, displaying considerably large effect sizes.

CONCLUSION

Our findings indicated beneficial roles of PA- particularly VPA- and muscular fitness in shaping cardiometabolic profile in mid-adolescence. VPA and grip strength may represent potential targets for preventive strategies tailored to adolescents in resource-limited settings.

Higher levels of physical activity are associated with less evasive coping, better physical function and quality of life in patients with axial spondyloarthritis

OBJECTIVE

To evaluate daily physical activity (PA) in relation to psychosocial factors, such as anxiety, depression and different types of coping strategies, as well as patient- and disease-related factors in patients with axial spondyloarthritis (axSpA).

METHODS

Consecutive outpatients from the Groningen Leeuwarden AxSpA (GLAS) cohort completed the modified Short Questionnaire to assess health-enhancing PA (mSQUASH), Hospital Anxiety and Depression Scale (HADS) and Coping with Rheumatic Stressors (CORS) questionnaires, as well as standardized patient- and disease-related assessments. Univariable and multivariable linear regression analyses and comparison of lowest and highest PA tertiles were performed to explore associations between the HADS, CORS, patient- and disease-related factors and PA.

RESULTS

In total, 84 axSpA patients were included; 60% male, mean age 49 (SD ±14) years, median symptom duration 20 (25th-75th percentiles: 12-31) years, mean ASDAS 2.1 (±1.0). Higher PA levels were significantly associated with better scores on patient-reported disease activity (BASDAI), physical function (BASFI) and quality of life (ASQoL). Furthermore, higher levels of PA were associated with less impact of axSpA on wellbeing and lower HADS depression scores. In the multivariable linear regression model, less use of the coping strategy 'decreasing activities' (β: -376.4; p 0.003) and lower BMI (β:-235.5; p: 0.030) were independently associated with higher level of PA. Comparison of patients from the lowest and highest PA tertiles showed results similar to those found in the regression analyses.

CONCLUSION

In this cohort of axSpA patients, higher levels of daily PA were associated with better patient-reported outcomes and lower depression scores. Additionally, the passive coping strategy "decreasing activities" and lifestyle factor BMI were independently associated with PA. Besides anti-inflammatory treatment, coping strategies and lifestyle should be taken into account in the management of individual axSpA patients. Incorporating these aspects into patient education could increase patient awareness and self-efficacy. In the future, longitudinal studies are needed to better understand the complex relationship between patient-, disease- and psychosocial factors associated with daily PA.

Large-scale assessment of physical activity in a population using high-resolution hip-worn accelerometry: the German National Cohort (NAKO)

Large population-based cohort studies utilizing device-based measures of physical activity are crucial to close important research gaps regarding the potential protective effects of physical activity on chronic diseases. The present study details the quality control processes and the derivation of physical activity metrics from 100 Hz accelerometer data collected in the German National Cohort (NAKO). During the 2014 to 2019 baseline assessment, a subsample of NAKO participants wore a triaxial ActiGraph accelerometer on their right hip for seven consecutive days. Auto-calibration, signal feature calculations including Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD), identification of non-wear time, and imputation, were conducted using the R package GGIR version 2.10-3. A total of 73,334 participants contributed data for accelerometry analysis, of whom 63,236 provided valid data. The average ENMO was 11.7 ± 3.7 mg (milli gravitational acceleration) and the average MAD was 19.9 ± 6.1 mg. Notably, acceleration summary metrics were higher in men than women and diminished with increasing age. Work generated in the present study will facilitate harmonized analysis, reproducibility, and utilization of NAKO accelerometry data. The NAKO accelerometry dataset represents a valuable asset for physical activity research and will be accessible through a specified application process.

Tiredness after work associates with less leisure-time physical activity

Physical activities and sedentary behaviors take place in different contexts. This study aimed to determine if the context, total score, and leisure-time MET-index assessed by the Baecke questionnaire associate with each other or with sedentary behavior and physical activity outcomes from a 4-week accelerometer measurement in physically inactive adults with overweight. The item "After working I am tired" correlated negatively with items related to leisure-time physical activity and sports participation. The total Baecke Score showed weak but significant correlations with accelerometer-measured sedentary behavior, physical activity, daily steps, and mean activity intensity of the day (r = - 0.33, 0.41, 0.35, and 0.41, respectively). The associations strengthened when the Sport Index was omitted from the Score. The leisure-time MET-Index did not correlate with accelerometer-measured sedentary behavior or physical activity. Tiredness after working associated with less self-reported physical activity during leisure time. This suggests that better recovery from work-related stress could increase leisure-time physical activity, or increasing leisure-time physical activity could reduce tiredness after working. Moreover, among self-reportedly inactive adults with overweight, focusing the questionnaire on work and non-sport leisure time instead of total time might give more accurate estimates of sedentary behavior and physical activity when compared to accelerometry.The study is registered at ClinicalTrials.gov (NCT03101228, 05/04/2017).

Lifestyle and health changes in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application

PURPOSE

The aim of this study was to determine changes in physical activity, nutrition, sleep behaviour and body composition in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application (app).

METHODS

A 12-week pre-post intervention study was performed, starting with a 1-week control period. Physical activity and sleep behaviour were continuously measured with a Fitbit charge 3. Self-reported nutritional intake, body mass and waist circumference were collected. Pre-post outcomes were compared with a paired-sample t-test or Wilcoxon signed-rank test. Fitbit data were analysed with a mixed model or a panel linear model. Effect sizes were determined and significance was accepted at p < .05.

RESULTS

Thirty participants completed the study. No significant changes in physical activity (+1.5 √steps) and sleep quality (-9.7 sleep minutes; -1.2% sleep efficiency) were found. Significant reduction in energy (-1022 kJ, d = 0.71), protein (-8.3 g, d = 0.61) and fat (-13.1 g, d = 0.87) intake, body mass (-2.2 kg, d = 0.61) and waist circumference (-3.3 cm, d = 0.80) were found.

CONCLUSION

Positive changes were found in nutritional behaviour and body composition, but not in physical activity and sleep quality. The WHEELS app seems to partly support healthy lifestyle behaviour.Implications for RehabilitationHealthy lifestyle promotion is crucial, especially for wheelchair users as they tend to show poorer lifestyle behaviour despite an increased risk of obesity and comorbidity.The WHEELS lifestyle app seems to be a valuable tool to support healthy nutrition choices and weight loss and to improve body satisfaction, mental health and vitality.

Comparison of Physical Activity Measured by Self-Reported Physical Activity and Wearable Device Xiaomi MI2 Band in Preadolescent School Children - A Pilot Cross-Sectional Study

The purpose of this study is to compare physical activity measured by the wearable device Xiaomi Mi2 Band and self-reported physical activity by YPAQ in preadolescent school children. A pilot cross-sectional study was performed on a subsample (5%=n=60) of preadolescent children within a parallel-group feasibility intervention trial (n=1000). All children aged 9-11 years enrolled in the schools were included in the study and children with any physical disability were excluded. Self-reported physical activity was recorded through the modified version of the Youth Physical Activity Questionnaire (YPAQ) and automatic physical activity was measured by the Xiaomi Mi2 band over 7 days. Data from the Xiaomi Mi2 band was synchronized with its mobile application from where data was transferred to an excel sheet. Data on 7-day total physical activity in minutes and 7-day total step count were recorded by the Xiaomi Mi2 band. Student's t-tests were used to determine whether significant differences were present between self-reported physical activity and by Xiaomi Mi2 band. A Bland-Altman method was also used to assess the degree of agreement between the two methods of measuring physical activity. Mean ± SD age of the children was 9.6 (± 1.0) years and 31 (51.7 %) were boys. The mean ± SD time spent in physical activity reported by YPAQ was 457.5 (± 136) minutes and by the Xiaomi Mi2 band was 594.7 (± 183) minutes. The Bland-Altman plot identified a mean bias between the methods (YPAQ and Xiaomi Mi2 band) of -157.6 (95% CI: 296.3, -611.0) minutes of 7-day physical activity. Physical activity measured by a wearable device, the Xiaomi Mi2 band can give overestimated values of physical activity compared to self-reported physical activity in preadolescent school children. However, when PA is measured through step counts by the Xiaomi Mi2 band converted to minutes, it is comparable to PA measured by YPAQ.

Study protocol and rationale of "the UP project": evaluating the effectiveness of active breaks on health indicators in desk-based workers

Background

Excessive sedentary time has been negatively associated with several health outcomes, and physical activity alone does not seem to fully counteract these consequences. This panorama emphasizes the essential of sedentary time interruption programs. "The Up Project" seeks to assess the effectiveness of two interventions, one incorporating active breaks led by a professional and the other utilizing a computer application (self-led), of both equivalent duration and intensity. These interventions will be compared with a control group to evaluate their impact on physical activity levels, sedentary time, stress perception, occupational pain, and cardiometabolic risk factors among office workers.

Methods

This quasi-experimental study includes 60 desk-based workers from universities and educational institutes in Valparaiso, Chile, assigned to three groups: (a) booster breaks led by professionals, (b) computer prompts that are unled, and (c) a control group. The intervention protocol for both experimental groups will last 12 weeks (only weekdays). The following measurements will be performed at baseline and post-intervention: cardiometabolic risk based on body composition (fat mass, fat-free mass, and bone mass evaluated by DXA), waist circumference, blood pressure, resting heart rate, and handgrip strength. Physical activity and sedentary time will be self-reported and device-based assessed using accelerometry. Questionnaires will be used to determine the perception of stress and occupational pain.

Discussion

Governments worldwide are addressing health issues associated with sedentary behavior, particularly concerning individuals highly exposed to it, such as desk-based workers. Despite implementing certain strategies, there remains a noticeable gap in comprehensive research comparing diverse protocols. For instance, studies that contrast the outcomes of interventions led by professionals with those prompted by computers are scarce. This ongoing project is expected to contribute to evidence-based interventions targeting reduced perceived stress levels and enhancing desk-based employees' mental and physical well-being. The implications of these findings could have the capacity to lay the groundwork for future public health initiatives and government-funded programs.

Reliability and validity of self-report questions for assessing levels of physical activity and sedentary time in adult childhood cancer survivors

BACKGROUND

Regular physical activity and limited sedentary time are recommended for adult childhood cancer survivors. The Swedish National Board of Health and Welfare designed a questionnaire to assess levels of physical activity (BHW-Q), including two questions: one on vigorous physical activity (BHW-Q VPA) and one on moderate physical activity (BHW-Q MPA). Furthermore, a single-item question was developed to measure sedentary time (SED-GIH-Q). These questions are recommended for clinical practice and have been found valid for the general population but have so far not been tested in adult childhood cancer survivors. The aim of the study was to assess test-retest reliability, agreement and criterion-related validity of the BHW-Q and the SED-GIH-Q in adult childhood cancer survivors.

METHOD

A non-experimental methodological study. In total 60 participants (50% women), median age 28 (min-max 18-54) years were included at the Long-Term Follow-Up Clinic at Sahlgrenska University Hospital. Participants were instructed to wear an accelerometer for seven days, and to answer the BHW-Q and the SED-GIH-Q before and after the seven days. Test-retest reliability and criterion-related validity comparing the BHW-Q and SED GIH-Q with accelerometer data were calculated with weighted Kappa (k) (agreement) and by using Spearman´s rho (r) (correlation).

RESULTS

Test-retest reliability regarding the SED-GIH-Q showed a high agreement (k = 0.88) and very strong correlation (r = 0.93), while the BHW-Q showed a moderate agreement and moderately strong correlation, BHW-Q VPA (k = 0.50, r = 0.64), BHW-Q MPA (k = 0.47, r = 0.58). Both the agreement and the correlation of the criterion-related validity were interpreted as fair for the BHW-Q VPA (k = 0.29, r = 0.45), while the agreement for BHW-Q MPA was interpreted as low (k = 0.07), but the correlation as fair (r = 0.37). The agreement of the SED-GIH-Q (k = 0.13) was interpreted as low and the correlation as poor (r = 0.26).

CONCLUSION

These simple questions assessing physical activity and sedentary time can be used as screening tools in clinical practice to identify adult childhood cancer survivors in need of support to increase physical activity level. Further development is needed on the design of a sufficiently valid question measuring sedentary time.

TRIAL REGISTRATION

This research project was registered in the Swedish National Database of Research and Development; identifier 275251, November 25, 2020. https://www.researchweb.org/is/vgr/project/275251 .

Agreement between self-reported and objectively assessed physical activity among out-of-hospital cardiac arrest survivors

BACKGROUND

Low level of physical activity is a risk factor for new cardiac events in out-of-hospital cardiac arrest (OHCA) survivors. Physical activity can be assessed by self-reporting or objectively by accelerometery.

AIM

To investigate the agreement between self-reported and objectively assessed physical activity among OHCA survivors HYPOTHESIS: Self-reported levels of physical activity will show moderate agreement with objectively assessed levels of physical activity.

METHOD

Cross-sectional study including OHCA survivors in Sweden, Denmark, and the United Kingdom. Two questions about moderate and vigorous intensity physical activity during the last week were used as self-reports. Moderate and vigorous intensity physical activity were objectively assessed with accelerometers (ActiGraph GT3X-BT) worn upon the right hip for 7 consecutive days.

RESULTS

Forty-nine of 106 OHCA survivors answered the two questions for self-reporting and had 7 valid days of accelerometer assessment. More physically active days were registered by self-report compared with accelerometery for both moderate intensity (median 5 [3:7] vs. 3 [0:5] days; p < 0.001) and vigorous intensity (1 [0:3] vs. 0 [0:0] days; p < 0.001). Correlations between self-reported and accelerometer assessed physical activity were sufficient (moderate intensity: rs  = 0.336, p = 0.018; vigorous intensity: rs  = 0.375, p = 0.008), and agreements were fair and none to slight (moderate intensity: k = 0.269, p = 0.001; vigorous intensity: k = 0.148, p = 0.015). The categorization of self-reported versus objectively assessed physical activity showed that 26% versus 65% had a low level of physical activity.

CONCLUSION

OHCA survivors reported more physically active days compared with the results of the accelerometer assessment and correlated sufficiently and agreed fairly and none to slightly.

Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults: A Randomized Clinical Trial

Importance

Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active.

Objective

To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA.

Design, Setting, and Participants

This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022.

Interventions

Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention.

Main Outcomes and Measures

The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months.

Results

Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant.

Conclusions and Relevance

In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered.

Trial Registration

ClinicalTrials.gov Identifier: NCT03326141.

Four-year longitudinal associations of physical activity, waist circumference, and blood pressure in UK adolescents

BACKGROUND

This study assessed the specific influence of physical activity (PA) and waist circumference (WC) on the 4-year growth trajectory of blood pressure in UK high-school students.

METHODS

Four-year longitudinal monitoring of 1501 adolescents was conducted as part of the EoEHHS. Measurements were taken in Grades (G)7, 9, and 11.

RESULTS

Systolic (SBP) and diastolic blood pressure (DBP) increased over the 4-year period (SBP G7 114.6 ± 8.9 mmHg, G9 118.1 ± 9.7 mmHg, G11 122.8 ± 7.8 mmHg; DBP G7 66.7 ± 6.6 mmHg, G9 68.0 ± 6.4 mmHg, G11 70.0 ± 5.2 mmHg). Baseline WC predicted baseline and growth in SBP, but the strongest contribution to SBP came from changes in WC (β = 0.084, p = 0.002). Baseline PAQ-A score (β = -0.822, p = 0.020) and changes in PAQ-A score (β = -0.650, p = 0.019) were associated with smaller increases in DBP over the 4-year measurement period.

CONCLUSIONS

Baseline and change in WC predicted the growth trajectory of SBP, while baseline and change in PA predicted the growth trajectory of DBP. PA and WC have a prognostic value in predicting changes in blood pressure in adolescents. Increasing PA during adolescence could slow the rise in DBP over time. This is meaningful for future hypertension and CVD risk reduction into adulthood.

IMPACT

Hypertension in adolescents is a growing health problem that is often overlooked. Baseline and changes in waist circumference over a 4-year period predicted development of systolic blood pressure, while baseline and changes in physical activity predicted development of diastolic blood pressure. Physical activity and waist circumference have a prognostic value in predicting changes in blood pressure in adolescents and could be valuable in planning programmes to prevent hypertension in similar communities and reduce the risk of future adult hypertension.

Effects of the SmartDrive on mobility, activity, and shoulder pain among manual wheelchair users with spinal cord injury - a prospective long-term cohort pilot study

PURPOSE

to investigate long-term effects of SmartDrive on mobility, everyday activity, and shoulder pain among spinal cord injured manual wheelchairs users.

MATERIAL AND METHODS

A prospective pilot intervention study was conducted at Spinalis/Aleris Rehab Station, Sweden. Participants were consecutively invited when evaluated for SmartDrive prescription. Assessments were done at baseline, intervention (use of SmartDrive), and after six months. A smartwatch registered wheelchair utilization including push intensity and pushes/day. Wheelchair Outcome Measure, pain rating instruments including Wheelchair User's Shoulder Pain Index, a wheelchair test, and semi-structured interviews were used. Descriptive statistics and content analysis approach were used.

RESULTS

Twenty-five persons were screened, six of 14 included completed the study. Drop-out reasons were not related to SmartDrive for five of the eight persons. After intervention, there was a tendency of decreased pain (median (IQR) 5/10 (2.6-6.6) vs 2.5 (2-3.2). All participants reported increased satisfaction of performance when "taking a walk", from median (IQR) 45/100 (27-70) at baseline to 95 (80-100) at 6 months. Two persons who could not ascend a slope at baseline could manage using the SmartDrive. Interviews revealed that the in general positive response persisted at six months. Also, with the SmartDrive the participants could go out despite pain, providing a sense of freedom and independence. Three incidents were reported.

CONCLUSION

This long-term pilot study indicates that a SmartDrive might be a valuable assistive device to promote mobility despite of shoulder pain. All participants considered it easy to use and experienced increased independence, however skills training and follow-ups are necessary. IMPLICATIONS FOR REHABILITATIONA Rear Drive Power Assist Device (RD-PAD) could increase satisfaction with self-selected activities.A RD-PAD could increase functional mobility by facilitating propelling longer distances and steeper slopes.A RD-PAD could improve perseverance of daily activities in spite of shoulder pain.A RD-PAD could be a valuable assistive aid for persons with paraplegia with different level of wheelchair skills but with good self-awareness regarding their abilities.Thorough assessment of initial wheelchair skills, training, and follow-up are important to enhance safety and maximize performance when using the RD-PAD.

Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review

Introduction

The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies.

Methods

We performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review.

Results

Of 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (total n=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA.

Conclusions

PA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions.

PROSPERO registration number

CRD42021226089.

Effects of physical activity levels on characteristic pain in temporomandibular dysfunctions: a cross-sectional study

BACKGROUND

Physical activity is known to influence the symptoms of a variety of pain disorders including fibromyalgia and osteoarthritis although the underlying mechanism is not fully understood. In spite of the high prevalence of temporomandibular disorders (TMD), no previous study has objectively evaluated the relationship between TMD and general physical activity. This study aims to investigate the influence of physical activity on pain and disability from TMD, considering various confounders including sleep, systemic inflammation, psychosocial disturbances, and widespread pain.

METHODS

This observational cross-sectional study is based on consecutive samples of 100 TMD patients (22 with high pain disability and 78 with low pain disability level). Physical activity levels were assessed with actigraph. Level of pain and disability were evaluated using the Graded Chronic Pain Scale. Hematologic examinations including inflammatory biomarkers were assessed and comorbidities were investigated with validated questionnaires. Differences were analyzed according to disability level.

RESULTS

Patients with high disability level spent significantly more time doing both moderate (p = 0.033) and vigorous (p = 0.039) level physical activity. Light physical activity, on the other hand, was associated with low disability but the difference did not reach statistical significance. Time spent in light physical activity was significantly associated with high levels of pain and disability (p = 0.026, β = -0.001) and time spent in vigorous physical activity had significant predictive power (cutoff value 2.5 min per week, AUC 0.643, p = 0.041). Scores of the Jaw Function Limitation Score-20 (p = 0.001), present McGill Pain Score (p = 0.010), and number of people potentially diagnosed with fibromyalgia (p = 0.033) were significantly higher in the high disability group.

CONCLUSIONS

Moderate or vigorous physical activity is associated with worse TMD symptoms while light physical activity may be beneficial. Further research related to the amount and frequency of physical activity is necessary to establish clinical guidelines for TMD.

TRIAL REGISTRATION

clinical trial registration of the Clinical Research Information Service of Republic of Korea (number KCT0007107).

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention in adolescent and young adult (AYA) cancer survivors: results from the SURVAYA study

PURPOSE

For adolescent and young adult (AYA) cancer survivors with a good prognosis, having a healthy lifestyle prevents morbidity and mortality after treatment. The aim of this study was to investigate the prevalence of (un)healthy lifestyle behaviors and related determinants in AYA cancer survivors.

METHODS

A population-based, cross-sectional study was performed among long-term (5-20 years) AYA cancer survivors (18-39 years old at diagnosis) registered within the Netherlands Cancer Registry. Self-reported questionnaires data about health behaviors were used to calculate the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) adherence score. Associations between the score and clinical/sociodemographic determinants of (un)healthy behaviors were investigated using logistic regression models.

RESULTS

The mean WCRF/AICR score was low to moderate, 3.8 ± 1.2 (0.5-7.0) (n = 3668). Sixty-one percent adhered to "limit the consumption of sugar sweetened drinks," 28% to "be a healthy weight," 25% to "fruit and vegetable consumption," and 31% to "limit alcohol consumption." Moderate and high adherence were associated with being a woman (ORmoderate = 1.46, 95% CI = 1.14-1.85, and ORhigh = 1.87, 95% CI = 1.46-2.4) and highly educated (ORmoderate = 1.54, 95% CI = 1.30-1.83, and ORhigh = 1.87, 95% CI = 1.46-2.4). Low adherence was associated with smoking (ORmoderate = 0.68, 95% CI = 0.50-0.92, and ORhigh = 0.30, 95% CI = 0.21-0.44) and diagnosis of germ cell tumor (ORmoderate = 0.58, 95% CI = 0.39-0.86, and ORhigh = 0.45, 95% CI = 0.30-0.69).

CONCLUSIONS

Adherence to the 2018 WCRF/AICR lifestyle recommendations was low to moderate, especially regarding body weight, fruit, vegetables, and alcohol consumption. Men, current smokers, lower-educated participants, and/or those diagnosed with germ cell tumors were less likely to have a healthy lifestyle.

IMPLICATIONS FOR CANCER SURVIVORS

Health-promotion programs (e.g., age-specific tools) are needed, focusing on high-risk groups.

Accelerometer-based and self-reported physical activity of children and adolescents from a seasonal perspective

Background

Many children and adolescents in Europe are insufficiently physically active, which makes the advancement of children's physical activity a critical health promotion target. However, there are some environmental factors, such as the amount of daylight, weather conditions, temperature, and precipitation levels, which might influence physical activity behavior. The purpose of this study was to assess accelerometer-based and self-reported daily physical activity of children and adolescents in Luxembourg, during autumn/winter as well as during spring/summer, and to examine if there is a seasonal influence on the physical activity behavior.

Methods

At two measurements, one in autumn/winter and one in spring/summer, physical activity of N = 137 (59.12% females; M = 12.37 years) participating children and adolescents aged 10-18 years was objectively undertaken via an accelerometer (ActiGraph) and subjectively assessed using, among others, one item of the MoMo physical activity questionnaire.

Results

A repeated measures ANOVA revealed a significant seasonal effect on moderate to vigorous physical activity per day [F(1.000, 135.000) = 7.69, p < 0.05, partial η² = 0.054]. More minutes of moderate to vigorous physical activity per day were accrued in spring/summer than in autumn/winter. The mean difference scores between the accelerometer-based and the self-reported physical activity at the two time periods, T1 and T2, correlated significantly (r = 0.31, p < 0.001).

Conclusions

According to these results, children and adolescents are less physically active in autumn/winter than in spring/summer. However, the discrepancy between the accelerometer-based and the self-reported physical activity remains stable over the two measurements. Therefore, schools, sports clubs, and communities should offer special physical activity programs for the colder season.

The longitudinal association between physical activity, strength and fitness, and lung function: A UK Biobank cohort study

BACKGROUND

While physical activity is hypothesized to slow lung-function decline, the evidence is limited at a population level. This study investigated the longitudinal association between physical activity and related measures (grip strength, cardiovascular fitness) and lung function decline.

METHODS

20,111 UK Biobank cohort participants with lung function measures at baseline (2006-2010) and follow-up (2012-2014) were included. Physical activity (International Physical Activity Questionnaire: low, moderate, high categories), grip strength (dynamometer) and cardiovascular fitness (subsample, submaximal stationary bicycle) data were collected. Linear regression was utilized to assess the effect on follow-up FEV1, FVC, FEV1/FVC ratio (as decline in ml/yr and as z-scores) adjusting for baseline lung function and confounders.

RESULTS

After 6.3 years mean follow-up, the decline in mean FEV1 and FVC was 30 ml/year and 38 ml/year respectively (n = 20,111). Consistent low physical activity (across baseline and follow-up) was associated with accelerated decline in FEV1 z-score (-0.119, 95 % Confidence Interval (CI) -0.168, -0.071, n = 16,900) and FVC z-score (-0.133, 95%CI -0.178, -0.088, n = 16,832). Accelerated decline in FEV1 z-scores was observed with decreasing baseline grip strength (-0.029, -95%CI -0.034, -0.024, n = 19,903), and with less strong evidence, decreasing fitness (-0.024, 95%CI -0.070, 0.022, n = 3048).

CONCLUSION

This is the largest ever study to date to identify that lower physical activity, grip strength, and potentially cardiovascular fitness over time is associated with accelerated lung function decline. Although the effect sizes appear modest, such changes at population levels can have a substantial overall impact. This study provides evidence for adding 'lung health benefits' to the current physical activity guidelines.

Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy

Background: Symptoms in children with acute lymphocytic leukemia (ALL) change over the trajectory of treatment but little is known about their symptoms as treatment ends. Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60 min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.

Accelerometry Measured Movement Behaviors in Middle-Aged and Older Adults: Cross-Sectional Analysis of the ELSA-Brasil Study

BACKGROUND

Little investigation of accelerometry assessed movement behaviors and physical inactivity was carried out in middle-aged and older adults in low-middle-income countries.

OBJECTIVE

Describe accelerometry-measured movement behaviors and prevalence of physical inactivity in middle-aged and older adults.

METHODS

We collected raw accelerometry data during the third visit (2017-2019) of ELSA-Brasil, a large-scale multicenter Brazilian cohort. Participants wore an ActiGraph wGT3X-BT on the waist for 24 hours for 7 days and documented sleep in a diary.

RESULTS

Nine thousand two hundred and seventy-nine participants had valid data (73.4% of the eligible cohort). Overall activity was higher for men (11.82mg; 95% confidence interval [CI], 11.7 to 11.93) than women (10.69mg; 95% CI, 10.6 to 10.77) and lower in older groups-women (-0.12mg/y; 95% CI, -0.13 to -0.11), men (-0.16mg/y; 95% CI, -0.17 to -0.14). Participants were more active from noon to midnight. Distribution of movement behaviors varied with sex and age, and sleep duration was longer in older individuals. Overall, 14.4% (95% CI, 13.7 to 15.1) were inactive, with inactivity being more frequent in women (16.4%; 95% CI, 15.4 to 17.4) than men (12.2%; 95% CI, 11 to 13). Higher rates were observed in the oldest. Retirement was associated with a higher prevalence of physical inactivity in both sexes.

CONCLUSION

Women were less active than men. Older individuals showed a high prevalence of physical inactivity, probably related to transition into retirement. These findings strengthen evidence for public policies promoting physical activity by emphasizing the need to target women, older individuals, and those transitioning to retirement to improve and/or maintain physical activity levels throughout the course of their lives.

Accelerometer-assessed physical activity patterns during the first two years after a non-surgically treated ACL injury

OBJECTIVES

To describe physical activity patterns and analyze changes during the first two years after a non-surgically treated ACL injury, and to assess correlations between accelerometer-assessed physical activity and self-reported knee function and knee-related quality of life.

DESIGN

Prospective cohort study.

PARTICIPANTS

128 patients (61 females, 25.2 ± 7.1 years) with acute ACL injury.

MAIN OUTCOME MEASURES

Physical activity patterns were measured with accelerometry. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form, and knee-related quality of life was assessed using the Anterior Cruciate Ligament Quality of Life questionnaire.

RESULTS

Moderate to vigorous physical activity (MVPA) and steps per day increased from baseline to 3 months (p < .001), with no further increase from 3 to 24 months (p > .05). Time in MVPA did not correlate to patient-reported outcome measures at 3, 6, 12, or 24 months (p > .05).

CONCLUSIONS

Physical activity increased from acute phase to 3 months after non-surgically treated ACL injury, but almost one in four patients did not reach recommended levels of physical activity. Physical activity did not correlate with knee function or quality of life. Patients may need improved support to return to physical activity after ACL injury.

LEVEL OF EVIDENCE

Level II.

TRIAL REGISTRATION

NCT02931084.

Associations between physical activity, physical fitness, and body composition in adults living in Germany: A cross-sectional study

BACKGROUND & AIMS

Body composition (BC) changes with age and is associated with morbidity and mortality. A physically active lifestyle influences BC and represents an important predictor of successful aging. To emphasize this, the World Health Organization established activity recommendations for all age groups. We describe BC during adulthood using a cross-sectional sample from a German community and investigate the associations between physical activity (PA), physical fitness (PF), and BC.

METHODS

Data from 329 men and women aged 35 to 86 years were analyzed. PA was measured by questionnaire and classified into sport activity and habitual activity. PF was measured through physical performance tests and BC by bioelectrical impedance analysis. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated to represent height-adjusted BC. Associations between PA, PF, and BC were analyzed using linear regression models.

RESULTS

For both sexes, strength was positively associated with FFMI (♂: ß = 0.313; ♀: ß = 0.213) and phase angle (♂: ß = 0.357; ♀: ß = 0.409). For FMI, a significant negative association with strength was found only in women (ß = -0.189). Cardiorespiratory fitness showed a negative association with FMI (ß = -0.312) and FFMI (ß = -0.201) for men, while in women a positive association was found for FFMI (ß = 0.186). For coordination, a significant association with FMI was observed only in women (ß = -0.190). Regarding PA only one significant relationship between sport activity and FMI among women (ß = -0.170) was found.

CONCLUSIONS

In our sample, PF was closer related to BC than PA. Strength and cardiorespiratory fitness were the strongest predictors for BC. This supports the World Health Organization's activity recommendations to include both resistance and endurance training in the weekly sports program to maintain a healthy BC.

Objectively and subjectively measured physical activity levels in individuals with whiplash associated disorder and aged-matched healthy controls

BACKGROUND

Whiplash associated disorders (WAD) are the most common non-hospitalised injuries resulting from a motor vehicle crash. Half of individuals with WAD experience ongoing pain and disability. Furthermore, individuals with persistent WAD have lower levels of aerobic capacity and isometric strength compared with age-matched controls. It is not known whether these differences are associated with increased levels of pain and disability, or with reduced physical activity (PA) participation.

OBJECTIVE

Our primary aim was to compare PA levels in individuals with persistent WAD with healthy controls. Secondary aims were to: compare objective and subjective measurements of PA; explore factors that may influence PA; and describe proportions of these populations meeting World Health Organisation PA guidelines.

METHODS

Objective (ActiGraph accelerometer; seven days) and subjective (International Physical Activity Questionnaire (IPAQ)) PA data were collected for n = 53 age-matched participants (WAD n = 28; controls n = 25).

RESULTS

Independent sample t-tests showed no significant difference in objectively measured PA (p>0.05) between WAD and controls. For the subjective measure (IPAQ), controls reported more overall weekly PA (t = 0.219, p<0.05), while WAD participants reported more weekly walking minutes (t = -0.712, p<0.05). Linear regression showed mental health quality-of-life predicted objectively measured moderate intensity PA (R2 = 0.225, F (2, 44) = 6.379, p<0.004) and subjectively reported overall PA (R2 = 0.132, F (1, 41) = 6.226, p<0.017). Bland-Altman analyses indicated that subjects over-reported MVPA and under-reported sedentary time using the IPAQ.

CONCLUSIONS

Individuals with WAD had levels of physical and mental health quality-of-life significantly lower than controls and below population norms yet participated in similar levels of PA. Given that increased perceptions of mental health quality-of-life were positively associated with objectively measured MVPA and subjectively reported overall PA, strategies to help people with WAD achieve adequate doses of MVPA may be beneficial. ActiGraph-measured and IPAQ-reported PA were discordant. Hence, IPAQ may not be a reliable measure of habitual PA in WAD.

A Comparison of the Physical Activity and Sedentary Behavior between Autologous and Allogeneic Hematopoietic Stem Cell Transplantation Survivors

Objective The treatment background, as well as the frequency and type of complications, in autologous (auto-) and allogeneic (allo-) hematopoietic stem cell transplantation (HSCT) survivors influence the appearance of moderate to vigorous physical activity (MVPA) or sedentary behavior. We therefore assessed differences in the MVPA and sedentary behavior between auto- and allo-HSCT survivors. Methods This prospective observational study included 13 auto- and 36 allo-HSCT survivors (approximately 4 years after HSCT). The MVPA and sedentary behavior were assessed using a triaxial accelerometer. Results There were no significant between-group differences in the MVPA or sedentary behavior (p=0.768 and 0.739, respectively). In allo-HSCT survivors, the MVPA was negatively correlated with the Hospital Anxiety and Depression Scale score (r=-0.358, p=0.032). A stepwise multiple regression analysis showed that age was a significant predictor of sedentary behavior in allo-HSCT survivors (β=0.400, p=0.016). Conclusion We observed no significant between-group differences in the MVPA or sedentary behavior. Our results suggest that it may be unnecessary to change the rehabilitation program according to the donor type in interventions for promoting MVPA and reducing sedentary behavior in long-term HSCT survivors.

Physical activity and physical fitness assessments in adolescents and young adults diagnosed with cancer: a scoping review

PURPOSE

This scoping review describes the assessment methodologies for physical activity (PA) and physical fitness assessments used in studies focusing on adolescents and young adults (AYAs) diagnosed with cancer.

METHODS

A search of the literature was conducted in PubMed, CINAHL, Web of Science, and Cochrane Library following the PRISMA-ScR statement. A total of 34 studies were included in this review.

RESULTS

PA was primarily assessed via self-reported questionnaires (30/34) either completed in-person (n = 17) or online (n = 13) at different time points and different stages along the cancer trajectory (i.e., from diagnosis onward). A total of 9 studies conducted a physical fitness assessment.

CONCLUSIONS

PA and physical fitness measurements are key when trying to describe outcomes, assess for associations, track changes, measure intervention adherence, and test intervention efficacy and effectiveness. Considerable heterogeneity across studies was reported limiting the generation of formal recommendations or guidance for researchers, healthcare providers, and policy makers.

Traditional surveys versus ecological momentary assessments: Digital citizen science approaches to improve ethical physical activity surveillance among youth

The role of physical activity (PA) in minimizing non-communicable diseases is well established. Measurement bias can be reduced via ecological momentary assessments (EMAs) deployed via citizen-owned smartphones. This study aims to engage citizen scientists to understand how PA reported digitally by retrospective and prospective measures varies within the same cohort. This study used the digital citizen science approach to collaborate with citizen scientists, aged 13-21 years over eight consecutive days via a custom-built app. Citizen scientists were recruited through schools in Regina, Saskatchewan, Canada in 2018 (August 31-December 31). Retrospective PA was assessed through a survey, which was adapted from three validated PA surveys to suit smartphone-based data collection, and prospective PA was assessed through time-triggered EMAs deployed consecutively every day, from day 1 to day 8, including weekdays and weekends. Data analyses included paired t-tests to understand the difference in PA reported retrospectively and prospectively, and linear regressions to assess contextual and demographic factors associated with PA reported retrospectively and prospectively. Findings showed a significant difference between PA reported retrospectively and prospectively (p = 0.001). Ethnicity (visible minorities: β = - 0.911, 95% C.I. = -1.677, -0.146), parental education (university: β = 0.978, 95% C.I. = 0.308, 1.649), and strength training (at least one day: β = 0.932, 95% C.I. = 0.108, 1.755) were associated with PA reported prospectively. In contrast, the number of active friends (at least one friend: β = 0.741, 95% C.I. = 0.026, 1.458) was associated with retrospective PA. Physical inactivity is the fourth leading cause of mortality globally, which requires accurate monitoring to inform population health interventions. In this digital age, where ubiquitous devices provide real-time engagement capabilities, digital citizen science can transform how we measure behaviours using citizen-owned ubiquitous digital tools to support prevention and treatment of non-communicable diseases.

Physical activity and associations with health-related quality of life in adults born small for gestational age at term: a prospective cohort study

BACKGROUND

Adults born small for gestational age (SGA) have increased risk of adverse health outcomes. Physical activity (PA) is a key determinant of health and health-related quality of life (HRQoL). We aimed to investigate if being born SGA at term is associated with lower objectively measured and self-reported PA during adulthood. We also examined if objectively measured and self-reported PA were associated with HRQoL.

METHODS

As part of the 32-year follow-up in the NTNU Low Birth Weight in a Lifetime Perspective study, SGA and non-SGA control participants wore two tri-axial accelerometers for seven days (37 SGA, 43 control), and completed the International Physical Activity Questionnaire (IPAQ) (42 SGA, 49 control) and the Short Form 36 Health Survey (SF-36) (55 SGA, 67 control). Group differences in objectively measured daily metabolic equivalent of task (MET) minutes spent sedentary (lying, sitting), on feet (standing, walking, running, cycling), on the move (walking, running, cycling) and running/cycling, and group differences in self-reported daily MET minutes spent walking and in moderate and vigorous PA were examined using linear regression. Associations with SF-36 were explored in a general linear model.

RESULTS

Mean (SD) daily MET minutes on the move were 218 (127) in the SGA group and 227 (113) in the control group. There were no group differences in objectively measured and self-reported PA or associations with HRQoL. In the SGA group, one MET minute higher objectively measured time on the move was associated with 4.0 (95% CI: 0.6-6.5, p = 0.009) points higher SF-36 physical component summary.

CONCLUSION

We found no differences in objectively measured and self-reported PA or associations with HRQoL between term-born SGA and non-SGA control participants in adulthood.

Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study

BACKGROUND

Mobility is a meaningful aspect of an individual's health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring.

OBJECTIVE

Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies.

METHODS

We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure.

RESULTS

In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device-based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time.

CONCLUSIONS

We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions.

Decreasing Sedentary Behaviors in Youth to Prevent and Manage Childhood Obesity: Is It Realistic?

PURPOSE OF REVIEW

Decreasing sedentary behaviors has been proposed as one approach to reduce the rate of obesity in youth. This review summarizes the contemporary literature examining the efficacy of these interventions in the school and community along with an additional focus on the role of socioeconomic status in these interventions.

RECENT FINDINGS

Studies that focus on decreasing sedentary behavior have utilized a wide variety of strategies in a number of settings. The effects of these interventions are often hindered by non-standard outcome measures, study infidelity, and subjective measures of sedentary time. However, interventions that incorporate engaged stakeholders and include younger subjects appear to be the most likely to succeed. Promising interventions to decrease sedentary behaviors have been shown in recent clinical trials; however, replicating and sustaining these results is challenging. From the available literature, school-based interventions have the potential of reaching the largest group of children. In contrast, interventions in younger children, particularly those with invested parents, seem to be the most effective.

Number of days required to measure sedentary time and physical activity using accelerometery in rheumatoid arthritis: a reliability study

This study aimed to determine the minimum number of days required to reliably estimate free-living sedentary time, light-intensity physical activity (LPA) and moderate-intensity physical activity (MPA) using accelerometer data in people with Rheumatoid Arthritis (RA), according to Disease Activity Score-28-C-reactive protein (DAS-28-CRP). Secondary analysis of two existing RA cohorts with controlled (cohort 1) and active (cohort 2) disease was undertaken. People with RA were classified as being in remission (DAS-28-CRP < 2.4, n = 9), or with low (DAS-28-CRP ≥ 2.4-≤ 3.2, n = 15), moderate (DAS-28-CRP > 3.2-≤ 5.1, n = 41) or high (DAS-28-CRP > 5.1, n = 16) disease activity. Participants wore an ActiGraph accelerometer on their right hip for 7 days during waking hours. Validated RA-specific cut-points were applied to accelerometer data to estimate free-living sedentary time, LPA and MPA (%/day). Single-day intraclass correlation coefficients (ICC) were calculated and used in the Spearman Brown prophecy formula to determine the number of monitoring days required to achieve measurement reliability (ICC ≥ 0.80) for each group. The remission group required ≥ 4 monitoring days to achieve an ICC ≥ 0.80 for sedentary time and LPA, with low, moderate and high disease activity groups requiring ≥ 3 monitoring days to reliably estimate these behaviours. The monitoring days required for MPA were more variable across disease activity groups (remission =  ≥ 3 days; low =  ≥ 2 days; moderate =  ≥ 3 days; high =  ≥ 5 days). We conclude at least 4 monitoring days will reliably estimate sedentary time and LPA in RA, across the whole spectrum of disease activity. However, to reliably estimate behaviours across the movement continuum (sedentary time, LPA, MPA), at least 5 monitoring days are required.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Physical Literacy for Communities (PL4C): physical literacy, physical activity and associations with wellbeing

BACKGROUND

Physical literacy (PL) is considered an important determinant of children's physical activity through which health benefits may be derived. The purpose of this study is to describe a sample of Canadian children's baseline levels of PL and movement behaviors, and explore whether the associations between PL and their mental wellbeing, if any, are mediated by moderate-to-vigorous physical activity (MVPA).

METHODS

All grade two children in 14 elementary schools in the West Vancouver School District, Canada were invited to participate in a two-year longitudinal project. PL was assessed through PLAYfun and PLAYself tools. Physical activity was measured by wrist-worn accelerometers (GT3X + BT) for seven days. Children's mental well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). A score of total difficulties was aggregated for internalizing and externalizing problems.

RESULTS

A total of 355 children aged 7-9 (183 boys, 166 girls, 6 non-binary) participated with 258 children providing valid accelerometer data. Children exhibited an average of 111.1 min of MVPA per day, with 97.3% meeting the physical activity guidelines. Approximately 43% (108/250) of participants were meeting the Canadian 24-h movement guidelines. Children were at an 'emerging' level of overall physical competence (45.8 ± 5.6) and reported a mean score of 68.9 (SD = 12.3) for self-perceived PL, with no significant differences between boys and girls. PL was significantly associated with MVPA (r = .27) and all SDQ variables (rs = -.26-.13) except for externalizing problems. Mediation analyses showed PL was negatively associated with internalizing problems and total difficulties when the association with MVPA was considered. However, the mediating role of MVPA was found only between PL and internalizing problems, β = -.06, 95%CI [-.12, -.01].

CONCLUSIONS

Although most of our sample was physically active and showed higher adherence to 24-H movement guidelines than comparable population data, the motor competence and self-perceived PL of our sample were similar to those of previous studies. PL has an independent association with children's internalizing problems and total difficulties. Ongoing assessment will investigate the relationships between PL and children's mental health from a longitudinal perspective.

Self-reported and accelerometer-based assessment of physical activity in older adults: results from the Berlin Aging Study II

Physical activity (PA) has a substantial impact on health and mortality. Besides questionnaires that rely on subjective assessment of activity levels, accelerometers can help to objectify an individual's PA. In this study, variables estimating PA and sleep time obtained through the wGT3X-BT activity monitor (ActiGraph LLC, USA) in 797 participants of the Berlin Aging Study II (BASE-II) were analyzed. Self-reports of PA and sleep time were recorded with Rapid Assessment of Physical Activity (RAPA) and the Pittsburgh Sleep Quality Index sleep questionnaire (PSQI). Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), fasting glucose, and hemoglobin A1c (HbA1c) were determined in an accredited standard laboratory. Of all participants, 760 fulfilled the PA wear-time criteria. In this sample mean age was 75.6 years (SD: 3.8 years, range 66.0-94.1 years) and 53% of the included participants were women. Average wear time was 23.2 h/day (SD 1.3 h/day). Statistically significant differences between RAPA groups were found for all accelerometric variables except energy expenditure. Post-hoc analysis, however, suggested low agreement between subjective and device-based assessment of physical activity. TC, HDL-C, LDL-C, TG, fasting glucose and HbA1c were weakly correlated with accelerometric variables (Pearson's r ≤ 0.25). Device-based average sleep time per night (mean sleep time = 6.91 h, SD = 1.3, n = 720) and self-reported average sleep time per night (mean sleep time = 7.1 h, SD = 1.15 h, n = 410) were in a comparable range and moderately correlated (Pearson's r = 0.31, p < 0.001, n = 410). Results from this study suggest that self-reported PA obtained through the RAPA and device-based measures assessed by accelerometers are partially inconsistent in terms of the physical activity level of the participants. Self-reported and device-based measures of average sleep time per night, however, were comparable.

Combined association of physical activity and sitting time with cardiometabolic risk factors in Chilean adults

In this study we examined the combined association of physical activity and sitting time with cardiometabolic risk factors in adults in Chile. This is a cross-sectional study based on 3201 adults aged from 18 to 98 years from the Chilean National Health Survey (2016-2017) who responded to the GPAQ questionnaire. Participants were considered inactive if spent < 600 METs-min/wk^-1 in physical activity. High sitting time was defined as ≥ 8 h/day. We classified participants into the following 4 groups: active and low sitting time; active and high sitting time; inactive and low sitting time; inactive and high sitting time. The cardiometabolic risk factors considered were metabolic syndrome, body mass index, waist circumference, total cholesterol, and triglycerides. Multivariable logistic regression models were performed. Overall, 16.1% were classified as inactive and high sitting time. Compared to active participants with low sitting time, both inactive participants with low (OR: 1.51; 95% CI 1.10, 1.92) and high sitting time (1.66; 1.10, 2.22) had higher body mass index. Similar results were found for high waist circumference: inactive participants with low (1.57; 1.14, 2.00) and high sitting time (1.84; 1.25, 2.43). We found no combined association of physical activity and sitting time with metabolic syndrome, total cholesterol, and triglycerides. These findings may be useful to inform programs focused on obesity prevention in Chile.

Sedentary and physical activity time differs between self-reported ATLS-2 physical activity questionnaire and accelerometer measurements in adolescents and young adults in the United Arab Emirates

BACKGROUND

Most young adults and adolescents in the United Arab Emirates (UAE) do not meet the established internationally recommended physical activity levels per day. The Arab Teen Lifestyle Study (ATLS) physical activity questionnaire has been recommended for measuring self-reported physical activity of Arab adolescents and young adults (aged 14 years to mid-twenties). The first version of the ATLS has been validated with accelerometers and pedometers (r ≤ 0.30). The revised version of the questionnaire (ATLS-2, 2021) needs further validation. The aim of this study was to validate the self-reported subjective sedentary and physical activity time of the ATLS-2 (revised version) physical activity questionnaire with that of Fibion accelerometer-measured data.

METHODS

In this cross-sectional study, 131 healthy adolescents and young adults (aged 20.47 ± 2.16 [mean ± SD] years (range 14-25 years), body mass index 23.09 ± 4.45 (kg/m2) completed the ATLS-2 and wore the Fibion accelerometer for a maximum of 7 days. Participants (n = 131; 81% non-UAE Arabs (n = 106), 13% Asians (n = 17) and 6% Emiratis (n = 8)) with valid ATLS-2 data without missing scores and Fibion data of minimum 10 h/day for at least 3 weekdays and 1 weekend day were analyzed. Concurrent validity between the two methods was assessed by the Spearman rho correlation and Bland-Altman plots.

RESULTS

The questionnaire underestimated sedentary and physical activity time compared to the accelerometer data. Only negligible to weak correlations (r ≤ 0.12; p > 0.05) were found for sitting, walking, cycling, moderate intensity activity, high intensity activity and total activity time. In addition, a proportional/systematic bias was evident in the plots for all but two (walking and moderate intensity activity time) of the outcome measures of interest.

CONCLUSIONS

Overall, self-reported ATLS-2 sedentary and physical activity time had low correlation and agreement with objective Fibion accelerometer measurements in adolescents and young adults in the UAE. Therefore, sedentary and physical activity assessment for these groups should not be limited to self-reported measures.

Accelerometer-derived physical activity and sedentary behavior patterns among Korean adults

PURPOSE

This study aimed to provide an overview of accelerometer-derived physical activity (PA) and sedentary behavior (SB) patterns among Korean adults. We also investigated the association between participant characteristics and the likelihood of adherence to moderate-to-vigorous physical activity (MVPA), SB, and the MVPA-SB guidelines.

METHODS

Data from the 2014-2017 Korea National Health and Nutrition Examination Survey were used. The study involved a nationally representative sample of 2,260 Korean adults aged ≥20 years. Accelerometers were used to measure PA and SB for seven days. Multivariate logistic regression models were used to assess the association between the participant characteristics and the likelihood of adhering to the MVPA, SB, and MVPA-SB guidelines.

RESULTS

SB (60.61%), light intensity (26.22%), and lifestyle activities (9.4%) accounted for the majority of the participants' days. MVPA and vigorous physical activity (VPA) accounted for 3.72% and 0.06% of the days, respectively. The MVPA guidelines were more likely to be adhered to by men, older adults, participants with higher education, non-smokers, and individuals without multimorbidity. Participants with higher education and household income were less likely to adhere to the SB guidelines. Women (OR=0.51), participants with high education levels (OR=0.54), current smokers (OR=0.47), and patients with multimorbidity (OR=0.46) were less likely to adhere to the MVPA-SB guidelines.

CONCLUSION

This study found that participants were predominantly sedentary, with only a small proportion engaging in VPA. There were differences related to demographic factors and health status. Most Korean adults do not adhere to the recommended MVPA-SB guidelines, and that is a serious public health concern. These findings highlight the need to promote PA and reduce SB through public health policies and interventions, particularly for adults facing PA barriers.

Association of Longitudinal Activity Measures and Diabetes Risk: An Analysis From the National Institutes of Health All of Us Research Program

CONTEXT

Prior studies of the relationship between physical activity and incident type 2 diabetes mellitus (T2DM) relied primarily on questionnaires at a single time point.

OBJECTIVE

We sought to investigate the relationship between physical activity and incident T2DM with an innovative approach using data from commercial wearable devices linked to electronic health records in a real-world population.

METHODS

Using All of Us participants' accelerometer data from their personal Fitbit devices, we used a time-varying Cox proportional hazards models with repeated measures of physical activity for the outcome of incident T2DM. We evaluated for effect modification with age, sex, body mass index (BMI), and sedentary time using multiplicative interaction terms.

RESULTS

From 5677 participants in the All of Us Research Program (median age 51 years; 74% female; 89% White), there were 97 (2%) cases of incident T2DM over a median follow-up period of 3.8 years between 2010 to 2021. In models adjusted for age, sex, and race, the hazard of incident diabetes was reduced by 44% (95% CI, 15%-63%; P = 0.01) when comparing those with an average daily step count of 10 700 to those with 6000. Similar benefits were seen comparing groups based on average duration of various intensities of activity (eg, lightly active, fairly active, very active). There was no evidence for effect modification by age, sex, BMI, or sedentary time.

CONCLUSION

Greater time in any type of physical activity intensity was associated with lower risk of T2DM irrespective of age, sex, BMI, or sedentary time.

Consistent pattern between physical activity measures and chronic pain levels: the Tromsø Study 2015 to 2016

ABSTRACT

Epidemiological literature on the relationship between physical activity and chronic pain is scarce and inconsistent. Hence, our aim was to assess the relationship applying comprehensive methodology, including self-reported and accelerometer measures of physical activity and different severity levels of chronic pain. We used data from the Tromsø Study (2015-2016). All residents in the municipality, aged 40 years and older were invited to participate (n = 32,591, 51% women). A total of 21,083 (53%) women reported on questionnaires. Additionally, 6778 participants (54% women) were invited to wear accelerometers (6125 with complete measurements). Our exposure measures were self-reported leisure time physical activity, exercise frequency, duration, and intensity and 2 accelerometer measures (steps per day and minutes of moderate to vigorous physical activity per day). Outcome measurements were chronic pain and moderate-to-severe chronic pain. We used Poisson regression to estimate chronic pain prevalence and prevalence ratios for each physical activity measure, with adjustments for sex, age, education level, smoking history, and occupational physical activity. Our main analyses showed an inverse dose-response relationship between all physical activity measures and both severity measures of chronic pain, except that the dose-response relationship with exercise duration was only found for moderate-to-severe pain. All findings were stronger for the moderate-to-severe pain outcomes than for chronic pain. Robustness analyses gave similar results as the main analyses. We conclude that an inverse dose-response association between physical activity and chronic pain is consistent across measures. To summarize, higher levels of physical activity is associated with less chronic pain and moderate-to-severe chronic pain.

Physical activity, sleep and affective wellbeing on the following day: An experience sampling study

This study aims to investigate the temporal links between physical activity, sleep and affective wellbeing in young adults. In particular, the aim was to examine whether physical activity is associated with sleep indicators in subsequent nights and, in turn, whether sleep was associated with improved affective wellbeing the next morning. Relatedly, moderation by baseline levels of depressive symptoms, sleep quality, habitual physical activity and gender was analysed. One-hundred and forty-seven individuals (85.7% female) aged 18-25 years old participated in an experience sampling study over 14 consecutive days. Participants received seven prompts per day, and answered questions about their physical activity and affective states. Every morning, participants also reported their sleep. Physical activity throughout the day was not related to sleep during the following night or to affective wellbeing the next morning. An exception to that pattern was that physical activity before 14:00 hours was associated with longer subsequent sleep duration. Better subjective sleep quality predicted affective wellbeing the next morning. Associations of physical activity, sleep and affective wellbeing were not moderated by baseline depressive symptoms, sleep quality or habitual physical activity. However, investigation of gender as a moderator revealed that moderate physical activity was associated with better subsequent sleep quality for males, but not for females. Overall, we found that physical activity is associated with better subsequent sleep for males, but not for females. Also, our study provides further evidence that better sleep quality is associated with the next morning's affective wellbeing.

Wrist Accelerometer Estimates of Physical Activity Intensity During Walking in Older Adults and People Living With Complex Health Conditions: Retrospective Observational Data Analysis Study

BACKGROUND

Accurate measurement of daily physical activity (PA) is important as PA is linked to health outcomes in older adults and people living with complex health conditions. Wrist-worn accelerometers are widely used to estimate PA intensity, including walking, which composes much of daily PA. However, there is concern that wrist-derived PA data in these cohorts is unreliable due to slow gait speed, mobility aid use, disease-related symptoms that impact arm movement, and transient activities of daily living. Despite the potential for error in wrist-derived PA intensity estimates, their use has become ubiquitous in research and clinical application.

OBJECTIVE

The goals of this work were to (1) determine the accuracy of wrist-based estimates of PA intensity during known walking periods in older adults and people living with cerebrovascular disease (CVD) or neurodegenerative disease (NDD) and (2) explore factors that influence wrist-derived intensity estimates.

METHODS

A total of 35 older adults (n=23 with CVD or NDD) wore an accelerometer on the dominant wrist and ankle for 7 to 10 days of continuous monitoring. Stepping was detected using the ankle accelerometer. Analyses were restricted to gait bouts ≥60 seconds long with a cadence ≥80 steps per minute (LONG walks) to identify periods of purposeful, continuous walking likely to reflect moderate-intensity activity. Wrist accelerometer data were analyzed within LONG walks using 15-second epochs, and published intensity thresholds were applied to classify epochs as sedentary, light, or moderate-to-vigorous physical activity (MVPA). Participants were stratified into quartiles based on the percent of walking epochs classified as sedentary, and the data were examined for differences in behavioral or demographic traits between the top and bottom quartiles. A case series was performed to illustrate factors and behaviors that can affect wrist-derived intensity estimates during walking.

RESULTS

Participants averaged 107.7 (SD 55.8) LONG walks with a median cadence of 107.3 (SD 10.8) steps per minute. Across participants, wrist-derived intensity classification was 22.9% (SD 15.8) sedentary, 27.7% (SD 14.6) light, and 49.3% (SD 25.5) MVPA during LONG walks. All participants measured a statistically lower proportion of wrist-derived activity during LONG walks than expected (all P<.001), and 80% (n=28) of participants had at least 20 minutes of LONG walking time misclassified as sedentary based on wrist-derived intensity estimates. Participants in the highest quartile of wrist-derived sedentary classification during LONG walks were significantly older (t₁₆=4.24, P<.001) and had more variable wrist movement (t₁₆=2.13, P=.049) compared to those in the lowest quartile.

CONCLUSIONS

The current best practice wrist accelerometer method is prone to misclassifying activity intensity during walking in older adults and people living with complex health conditions. A multidevice approach may be warranted to advance methods for accurately assessing PA in these groups.

An Algorithm to Classify Real-World Ambulatory Status From a Wearable Device Using Multimodal and Demographically Diverse Data: Validation Study

BACKGROUND

Measuring the amount of physical activity and its patterns using wearable sensor technology in real-world settings can provide critical insights into health status.

OBJECTIVE

This study's aim was to develop and evaluate the analytical validity and transdemographic generalizability of an algorithm that classifies binary ambulatory status (yes or no) on the accelerometer signal from wrist-worn biometric monitoring technology.

METHODS

Biometric monitoring technology algorithm validation traditionally relies on large numbers of self-reported labels or on periods of high-resolution monitoring with reference devices. We used both methods on data collected from 2 distinct studies for algorithm training and testing, one with precise ground-truth labels from a reference device (n=75) and the second with participant-reported ground-truth labels from a more diverse, larger sample (n=1691); in total, we collected data from 16.7 million 10-second epochs. We trained a neural network on a combined data set and measured performance in multiple held-out testing data sets, overall and in demographically stratified subgroups.

RESULTS

The algorithm was accurate at classifying ambulatory status in 10-second epochs (area under the curve 0.938; 95% CI 0.921-0.958) and on daily aggregate metrics (daily mean absolute percentage error 18%; 95% CI 15%-20%) without significant performance differences across subgroups.

CONCLUSIONS

Our algorithm can accurately classify ambulatory status with a wrist-worn device in real-world settings with generalizability across demographic subgroups. The validated algorithm can effectively quantify users' walking activity and help researchers gain insights on users' health status.

Project MOVE: A randomized controlled trial of Interventions for initiating and maintaining physical activity in depressed individuals

Objective

To test interventions for increasing aerobic exercise in depressed individuals.

Methods

We conducted a 3-arm randomized controlled trial aimed at increasing minutes of moderate-to-vigorous physical activity (MVPA) in depressed adults (N = 242). Each successive arm included an added component that might serve to increase and maintain physical activity. Arms were: 1) Brief advice (BA) to aerobic exercise; 2) BA + supervised and home-based aerobic exercise (SHE) + health education (HE); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining aerobic exercise (CBEX). HE was intended to serve as a control for CBEX. Assessments were conducted at baseline, Month 1.5, end of intervention (Month 3), Month 6, and Month 9. The primary outcome of MVPA was assessed via accelerometry. Secondary outcomes included self-reported MVPA, depression severity, and other aspects of mood and affect.

Results

At 3 months (the pre-designated primary outcome timepoint), the simple effect of treatment was statistically significant (F2, 569.0 = 4.17, p = .016), with BA+SHE+CBEX being superior to BA. We did not observe differences between BA+SHE+HE and either of the other arms. There were no statistically significant differences between treatment groups at 6- or 9-months. Treatment effects were not statistically significant for secondary outcomes.

Conclusions

Supervised and home-based exercise, when combined with a cognitive-behavioral exercise intervention, is effective in increasing aerobic exercise in depressed adults in the short-term, although the impact diminishes post-intervention period.

Physical Activity Is Associated With Macular Thickness: A Multi-Cohort Observational Study

Purpose

To assess the association between physical activity and spectral-domain optical coherence tomography (SD-OCT)-measured rates of macular thinning in an adult population with primary open-angle glaucoma.

Methods

The correlation between accelerometer-measured physical activity and rates of macular ganglion cell-inner plexiform layer (GCIPL) thinning was measured in 735 eyes from 388 participants of the Progression Risk of Glaucoma: RElevant SNPs with Significant Association (PROGRESSA) study. The association between accelerometer-measured physical activity and cross-sectional SD-OCT macular thickness was then assessed in 8862 eyes from 6152 participants available for analysis in the UK Biobank who had SD-OCT, ophthalmic, comorbidity, and demographic data.

Results

Greater physical activity was associated with slower rates of macular GCIPL thinning in the PROGRESSA study (beta = 0.07 µm/y/SD; 95% confidence interval [CI], 0.03-0.13; P = 0.003) after adjustment for ophthalmic, demographic and systemic predictors of macular thinning. This association persisted in subanalyses of participants characterized as glaucoma suspects (beta = 0.09 µm/y/SD; 95% CI, 0.03-0.15; P = 0.005). Participants in the upper tertile (greater than 10,524 steps/d) exhibited a 0.22-µm/y slower rate of macular GCIPL thinning than participants in the lower tertile (fewer than 6925 steps/d): -0.40 ± 0.46 µm/y versus -0.62 ± 0.55 µm/y (P = 0.003). Both time spent doing moderate/vigorous activity and mean daily active calories were positively correlated with rate of macular GCIPL thinning (moderate/vigorous activity: beta = 0.06 µm/y/SD; 95% CI, 0.01-0.105; P = 0.018; active calories: beta = 0.06 µm/y/SD; 95% CI, 0.006-0.114; P = 0.032). Analysis among 8862 eyes from the UK Biobank revealed a positive association between physical activity and cross-sectional total macular thickness (beta = 0.8 µm/SD; 95% CI, 0.47-1.14; P < 0.001).

Conclusions

These results highlight the potential neuroprotective benefits of exercise on the human retina.

Comparison of different software for processing physical activity measurements with accelerometry

Several raw-data processing software for accelerometer-measured physical activity (PA) exist, but whether results agree has not been assessed. We examined the agreement between three different software for raw accelerometer data, and associated their results with cardiovascular risk. A cross-sectional analysis conducted between 2014 and 2017 in 2693 adults (53.4% female, 45-86 years) living in Lausanne, Switzerland was used. Participants wore the wrist-worn GENEActive accelerometer for 14 days. Data was processed with the GENEActiv manufacturer software, the Pampro package in Python and the GGIR package in R. For the latter, two sets of thresholds "White" and "MRC" defining levels of PA and two versions (1.5-9 and 1.11-1) for the "MRC" threshold were used. Cardiovascular risk was assessed using the SCORE risk score. Time spent (mins/day) in stationary, light, moderate and vigorous PA ranged from 633 (GGIR-MRC) to 1147 (Pampro); 93 (GGIR-White) to 196 (GGIR-MRC); 19 (GGIR-White) to 161 (GENEActiv) and 1 (GENEActiv) to 26 (Pampro), respectively. Spearman correlations between results ranged between 0.317 and 0.995, while concordance coefficients ranged between 0.035 and 0.968. With some exceptions, the line of perfect agreement was not in the 95% confidence interval of the Bland-Altman plots. Compliance to PA guidelines varied considerably: 99.8%, 98.7%, 76.3%, 72.6% and 50.2% for Pampro, GENEActiv, GGIR-MRC v.1.11-1, GGIR-MRC v.1.4-9 and GGIR-White, respectively. Cardiovascular risk decreased with increasing time spent in PA across most software packages. We found large differences in PA estimation between software and thresholds used, which makes comparability between studies challenging.

Movement Behaviour and Health Outcomes in Rural Children: A Systematic Review

BACKGROUND

Studies with rural children are limited, and results are divergent regarding the information on movement behaviours.

PURPOSE

to (i) describe the physical activity and sedentary behaviour in children; (ii) synthetize the year and place of publication, methodological quality, and instruments used to measure physical activity and sedentary behaviour; and (iii) to analyse the relationship between physical activity, sedentary behaviour, and health outcomes in these children.

METHODS

We use the databases PubMed, Web of Science, SPORTDiscus, Scopus, Virtual Health Library, and SciELO, considering papers published until October 2021. A total of 12,196 studies were identified, and after the exclusion of duplicate, title and abstract screening, and the full-text assessment, a total of 68 were included in the study.

RESULTS

A cross-sectional design was dominant among the studies, with sample sizes ranging from 23 to 44,631 children of both sexes. One-third of the studies were conducted in North America and Europe, and most of them used device-based measurements. Inequalities were observed regarding sex, age, economic level, race, and physical activity domains within and between the places of residence. Sociodemographic characteristics were also related to health outcomes for children living in rural and urban areas.

CONCLUSION

It is necessary to increase the evidence on movement behaviours among children living in the countries of South America and Oceania, as well as to increase the level of evidence on the role of school for physical activity in children in rural areas, given the inconsistent findings.

Activity-to-sedentary ratio provides novel insight into mortality reduction among male survivors of cardiovascular disease in the United States: national health and nutrition examination survey, 2007-2014

BACKGROUND

Lower physical activity and sedentary behavior have been identified as modifiable risk factors for cardiovascular disease (CVD). However, the quantitative, dose-response association between activity-to-sedentary ratio (ASR) and mortality is unknown.

METHODS

Prospective cohort studies with participants 50 to 80 years that reported the association between recreational physical activity, sedentary behavior, and all-cause mortality were included from the 2007 to 2014 United States National Health and Nutrition Examination Survey (NHANES) and followed through December 31, 2015. Cox or Weibull regression models and restricted cubic splines were used to determine the association between ASR and all-cause mortality.

RESULTS

Sixty deaths occurred among 498 CVD survivors, with a median of 56 months of follow-up. After accounting for all covariates, CVD survivors with an ASR between 0.21 and 0.57 (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.25-0.87) and those with an ASR more than 0.57 (HR, 0.40; 95% CI, 0.20-0.81) were at significantly lower risk for mortality than participants with an ASR <  0.21. Moreover, a nonlinear negative association and an L-shaped association were observed for the level of ASR with risk of mortality among CVD survivors (P for nonlinearity = 0.004). What's more, adjusting for covariates, a statistically significant interaction (P for interaction = 0.016) between sex and ASR, an increase of ASR more than and equal to 0.18 was associated with a lower risk of mortality among males (HR, 0.23; 95% CI, 0.12-0.46).

CONCLUSIONS

An negative correlation between ASR and mortality in CVD survivors, especially in males when ASR is more than 0.18. Our novel findings provide further insights into easing the global burden of deaths.

Physical, Leisure, and Daily Living Activities in Patients Before, During, and After Radiotherapy for Cancer: Which Patients Need Support in Activities?

BACKGROUND

Avoiding inactivity and staying active during cancer therapy have great health effects.

OBJECTIVE

The aims of this study were to describe level of daily, leisure, and physical activities before, during, and after radiotherapy and to investigate whether patients who had not restored activity level after radiotherapy differed from patients who had restored activity level regarding different characteristics.

METHODS

In this descriptive longitudinal study, 196 patients undergoing pelvic-abdominal radiotherapy reported their activity level at baseline, weekly during radiotherapy, and at 1 month after radiotherapy.

RESULTS

Patients decreased activity level during radiotherapy (P < .001 for all activities): physical activity (34% of patients decreased level), walking (26%), leisure activities (44%), social activities (15%), housework (34%), shopping (28%), and activities in general (28%). Almost half (47%) had not restored activity level after radiotherapy. Patients with colorectal cancer, older than 65 years, who had less education than university, and high capacity in overall daily activities at baseline were more likely than other patients not to restore activity level after radiotherapy. The patients not restoring their activity level after radiotherapy were more likely than others to experience anxious mood (P = .016), depressed mood (P = .003), and poor quality of life (P = .003) after radiotherapy.

CONCLUSION

Patients' activity level decreased during radiotherapy, and almost half of patients did not restore activity level after radiotherapy.

IMPLICATIONS FOR PRACTICE

Given that restored activity level after radiotherapy was less common in certain subgroups and that patients who restored activity level experienced better quality of life and less frequent anxious and depressed mood, cancer nursing professionals should consider supporting these subgroups of patients in performing activities.