Validation of accelerometer wear and nonwear time classification algorithm

Interplay of Physical Activity, Muscle Strength, and Depression in Cognitive Impairment among Korean Older Adults: A Cross-sectional Study

Objective

The present study was to investigate the association of physical activity (PA), relative-handgrip strength (RHGS), depressive symptoms, and cognitive impairment in Korean older adults.

Methods

This study included 512 community-dwelling Korean older adults (417 female, 95 male) aged ≥ 65 years (74.8 ± 5.4 years). PA and RHGS were assessed using an accelerometer and dynamometer, respectively. Depressive symptoms were evaluated by the Korean form of the Center for Epidemiologic Studies Depression (CES-D) Scale. Cognitive impairment was assessed through the Mini-Mental State Examination for Dementia Screening (MMSE-DS).

Results

Multiple logistic regression analysis revealed that depressive symptoms (odds ratio [OR] = 2.676, 95% confidence interval [CI]: 1.594-4.492, p < 0.001) showed a significant association with increased odds of cognitive impairment compared with normal depression status (OR = 1). Depressive symptoms had both direct and indirect effects on cognitive impairment. Both PA and RHGS partially mediated the relationship between depressive symptoms and cognitive impairment (PA: effect [B] = -0.017, 95% CI: -0.028 to -0.009, p < 0.001; RHGS: B = -0.005, 95% CI: -0.007 to -0.003, p < 0.001). Serial mediation analysis further indicated that the association between depressive symptoms and cognitive impairment was sequentially mediated by PA and RHGS (B = -0.004, 95% CI: -0.006 to -0.002, p < 0.001).

Conclusion

Promoting PA among older adults may be crucial, as this helps improve and maintain muscular strength and mitigates the negative impact of depressive symptoms on cognitive impairment.

Clustering of 24-H Movement Behaviours and Its Associations With Eating Behaviours and Adiposity Among Mongolian Preschool Children: A Cross-Sectional Study

BACKGROUND

Obesity-related behaviours such as physical activity, sedentary behaviour, sleep, screen time and diet often cluster in children. There is limited evidence on the clustering of movement behaviours among young children from low- and middle-income countries. This paper reports how 24-h movement behaviours cluster in Mongolian preschool children and their associations with eating behaviours and adiposity.

METHODS

Cross-sectional study involved 201 children aged 3-4 years attending kindergartens in urban and rural areas of Ulaanbaatar city, Tuv and Uvurkhangai provinces, Mongolia. Children wore accelerometers to measure physical activity, sedentary behaviour and sleep. Parents completed a questionnaire to report screen time and eating behaviours. To derive clusters, hierarchical and k-means cluster analyses were performed sequentially. Associations between clusters, eating behaviours and BMI z-score were analysed using ANOVA. Logistic regression was applied to estimate the odds of being overweight depending on cluster membership.

RESULTS

Three clusters were identified: All-rounders, Non-active Sleepers and Screeners. We found that around half the children exhibited at least one unhealthy behaviour and were classified into clusters with a mix of healthy and unhealthy behaviours. The clusters did not differ by sociodemographic characteristics. No significant association was found between cluster membership and BMI z-score of children. The cluster at highest risk for being overweight was Screeners (odds ratio = 1.7, 95% CI: 0.67-4.33), who exhibited two obesogenic behaviours simultaneously, screen time for > 4 h per day and regular consumption of unhealthy snacks (53%, p = 0.033) and sugary drinks (53%, p = 0.014).

CONCLUSION

Obesity prevention measures should begin in early childhood and target high-risk clusters, considering the co-occurrence of healthy and unhealthy behaviours. More research is needed in Mongolia to provide evidence for obesity prevention policies and inform targeted interventions to promote healthy behaviours from a young age.

Associations between Saturated Fat from Single Dairy Foods and Body Composition in Young Canadian Children

Purpose: To examine the associations between dairy-derived saturated fat from fluid cow's milk, cheese, and yogurt, and body composition [body mass index z-scores (BMIz), fat mass index (FMI), and waist-to-height ratio (WHtR)] in children aged 1.5-5 years. Methods: This cross-sectional study used baseline data from 267 children (3.5 ± 1.2 years) from the Guelph Family Health Study. Dairy-derived saturated fat intake (g/1000 kcal) was assessed via one 24-hour dietary recall completed by parents using the web-based Automated Self-Administered 24-Hour Dietary Assessment Tool 2016 - Canadian version. Linear regression using generalized estimating equations explored associations between dairy-derived saturated fat intake and BMIz and FMI, adjusted for physical activity, household income, parent education, and child ethnicity; WHtR was additionally adjusted for age and sex. Results: Total dairy- and milk-derived saturated fat were not associated with any body composition outcomes. Cheese-derived saturated fat intake was positively, but marginally associated with BMIz (B̂ = 0.03, 95% CI: 0.01 to 0.06, p = 0.013), while yogurt-derived saturated fat was inversely associated with FMI (B̂ = -0.19, 95% CI: -0.34 to -0.04, p = 0.015). Conclusions: These cross-sectional findings may inform dietary guidelines to recognize the neutral or potentially beneficial effects of saturated fat from dairy products on body composition in young children. Longitudinal studies are warranted.

Plant-based Dietary Index Scores are Not Associated with Body Composition in Young Children

Purpose: Plant-based diets have become increasingly popular and, in adults, have been inversely associated with body fat outcomes. We examined associations between overall, healthful, and less-healthful plant-based dietary index (PDI) scores and BMI z-score, waist circumference, waist-to-height ratio, % fat mass (%FM), and fat mass index in young children, aged 1.5-6 years. Methods: Baseline data from the Guelph Family Health Study (287 children and 211 families) were used in this cross-sectional study. PDI scores were calculated from a single dietary recall using the Automated Self-Administered 24-hour Dietary Assessment Tool - Canada. Body composition outcomes were measured by trained research staff, with FM assessed using bioelectrical impedance analysis. Associations between PDI scores and body composition outcomes were estimated using generalized estimating equations applied to linear regression models. Covariates included energy intake, physical activity, age, sex, ethnicity, household income, and gestational age. Results: After adjusting for covariates, there were no significant associations between overall, healthful, and less-healthful PDI scores and body composition outcomes. Conclusions: Proportions of plant- and animal-based food consumption were not cross-sectionally related to body composition in this sample of young children. Further research on longitudinal associations between PDI scores and health outcomes in young children is warranted.

Compositional associations of 24-h physical activities, sedentary time and sleep with depressive symptoms in urban and rural residents: a cross-sectional study

BACKGROUND

Studies investigating the associations of 24-h movement behaviours (including moderate-to-vigorous-intensity physical activity (MVPA), light-intensity PA (LPA), sedentary time (ST) and sleep) with depressive symptoms are scarce. It is also unclear whether possible associations differ between urban and rural residents. Hence, we aimed to investigate these associations in a population-based sample of middle-aged Finnish adults.

METHODS

The study population consisted of 4295 adults, aged 46 years, from the Northern Finland Birth Cohort 1966. The participants wore a hip-worn accelerometer for 14 days. Time spent in sedentary, LPA and MVPA was obtained from accelerometer data and then combined with self-reported sleep duration to obtain the 24-h composition. The residential environment was classified as urban or rural based on the participants' home addresses. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Multivariable adjusted regression analysis using a compositional data analysis approach based on isometric log-ratio transformation was used to determine the associations between movement behaviours and depressive symptoms in urban and rural residential environments.

RESULTS

The 24-h movement behaviour composition was significantly associated with the BDI-II score both in urban and rural residential environment. More time spent in sleep relative to other behaviours was associated with lower BDI-II score in rural residential environments. More time spent in ST among urban residents and in LPA among rural residents was associated with higher BDI-II scores. When modelling pairwise reallocations of time, more MVPA or more sleep at the expense of LPA or ST was associated with lower BDI-II score among rural residents. For urban residents, reallocating time from ST to any other behaviour was associated with lower BDI-II score.

CONCLUSIONS

Our findings showed that more relative time spent in MVPA and sleep was associated with lower levels of depressive symptoms among rural residents, and more relative time spent in any other behaviour at the expense of ST was associated with lower levels of depressive symptoms among urban residents. These differences should be considered in the prevention and treatment of depressive symptoms. Due to the cross-sectional design of this study, causality cannot be inferred, and further research exploring the mechanisms underlying these associations in diverse populations and longitudinal study settings are needed.

Do lumbar spine kinematics contribute to individual low back pain development in habitual sitting?

This study explored differences in activities and spine kinematics by transient low back pain status throughout a week of their usual office work. Using a 100-mm visual-analogue scale, twenty participants were classified as non-pain (NPD) and pain developers (PD; ≥10 mm). Tri-axial accelerometers measured sitting time and thorax, pelvis, and lumbar spine angles. Amplitude probability distribution functions were constructed for postures and movements. PD (n = 6) exhibited increases in pain daily, with partial or complete recovery overnight and full recovery over the weekend, hence pain did not accumulate. PD sat more than NPD (n = 14), exhibited decreased peak posterior pelvic tilt (10°) and thorax inclination (8°), and tended to demonstrate less frequent spine movements. To decrease the risk of pain with sitting, reducing seated time, reclining on the seatback, and promoting seated movements should be recommended. With habitual exposures, small differences between pain groups could suggest a pathway to sitting-related back pain over time.Practitioner Summary: The biomechanical link between habitual sitting and low back pain remains unclear. Activity, spine kinematics, and pain ratings were collected throughout a week of individuals' seated work at their own workstation. Small differences between those with and without transient low back pain could suggest a pathway to sitting-related back pain.

Directionality between cognitive function and daily physical activity patterns

INTRODUCTION

Physical activity is a modifiable risk factor for dementia, but cognitive function is also important for physical activity engagement. This study evaluated the directionality of associations between daily physical activity and cognitive function in a sample of cognitively and physically intact older adults.

METHODS

Cognitive factor scores for domains including global cognition, memory, language, executive function/attention, and visuospatial processing, and physical activity patterns from wrist accelerometry were measured at two visits (mean: 1.8 years) among 237 cognitively intact older adults in the Baltimore Longitudinal Study of Aging (BLSA) (mean age: 76.5 years). Bivariate latent change score models estimated directionality of associations between changes in cognitive factor scores and physical activity patterns. Models were adjusted for age, sex, race, education, comorbidities, and body mass index.

RESULTS

Higher total amount of activity, longer activity bouts, less sedentary time, and less activity fragmentation at baseline were associated with less annual cognitive decline across multiple cognitive domains (X 2 > 4.11, 1 df for all). In contrast, baseline cognitive factor scores were not associated with changes in any activity pattern (X 2 < 3.20, 1 df for all).

DISCUSSION

Increasing movement and/or decreasing sedentary behavior is associated with less prospective cognitive decline. Targeting reductions in sedentary time and lengthening activity bouts may slow cognitive decline among older adults at risk for dementia.

Highlights

Greater activity engagement is related to less annual cognitive decline.Baseline cognition is not associated with short-term changes in activity patterns.Promoting daily movement and lowering sedentary time may have cognitive benefits.

Effects of a physical activity-enhanced curriculum on increasing physical activity and improving physical fitness in preschoolers: Study protocol for a cluster randomized controlled trial (KID-FIT study)

Objective

Physical activity (PA) is critical for healthy development in preschoolers, with long-lasting benefits that can affect later life. The World Health Organization (WHO) recommends that children aged 5-17 years should engage in 60 min of moderate-to-vigorous PA per day. However, physical inactivity in children is on the rise globally, with declines in PA starting at the age of 4 years. Increasing PA during early childhood is important to delay adiposity rebound, promote behavioral changes, improve physical fitness, and facilitate future PA engagement. However, limited evidence has been established on the effects of school-based PA interventions on preschoolers. This study examines the effects and sustainability of a preschool-based PA intervention on increasing PA, improving physical fitness and health in preschoolers, with the exercise dose benchmarked to the WHO PA guidelines.

Methods

This assessor-blinded, two-arm cluster randomized controlled trial will include 3300 preschoolers (aged 5-6 years) from 110 kindergartens in Hong Kong, China. Kindergartens will be randomized into intervention and control groups in a 1:1 ratio. The control kindergartens will continue their usual curriculum of ∼2.5 h PA/week, whereas preschoolers in the intervention kindergartens will engage in an additional 75-min game-based PA class twice per week (extra 2.5 h PA/week) over the preschool year. This multi-component intervention will also target parents, teachers, and the kindergarten environment to further encourage PA in preschoolers and their families. Objectively measured PA, cardiorespiratory fitness and other physical fitness components (muscle strength and power, agility, balance, flexibility, body composition), and psychological health will be examined at the start (0 month) and end (10 months) of the preschool year. Maintenance effects will be assessed after preschoolers' transition into primary school (16 months). Generalized estimating equations or other appropriate statistical models will be used to examine the treatment effects with adjustment for baseline values.

Study impact

This study will investigate the effects of a preschool-based PA intervention with PA dose benchmarked to the WHO recommendations on promoting PA, physical fitness, and health in preschoolers, and its sustainability after preschoolers' transition into primary education. The findings will raise public awareness on the importance of PA in young children, and will inform policy making to facilitate early childhood educational reforms to incorporate adequate PA into preschool curriculums to improve children's health in the long run.

Trial registration

ClinicalTrials.gov (NCT05521490).

Proof-of-concept for integrating multimodal digital health assessments into lifestyle interventions for older adults with dementia risk factors

Multimodal digital health assessments overcome the limitations of patient-reported outcomes by allowing for continuous and passive monitoring but remain underutilized in older adult lifestyle interventions for brain health. Therefore, we aim to (1) report ecological momentary assessment (EMA) and ActiGraph adherence among older adults during a lifestyle intervention; and (2) use dynamic data collected via EMA and ActiGraph to examine person-specific patterns of mindfulness, steps, and sleep throughout the intervention. We analyzed EMA and ActiGraph data from a pilot study of the 8-week My Healthy Brain program (N = 10) lifestyle group for older adults (60+) with subjective cognitive decline. EMA adherence metrics included proportion of EMA completed and the proportion of days with at least 10 mindfulness minutes. ActiGraph GT9X adherence metrics included the number of valid wear days (≥ 7 h) and the number of days participants achieved their step goal. We used linear mixed-effects models to examine person-specific patterns of step count, sleep efficiency, and mindfulness practice. On average, participants completed 39 of the 49 possible EMAs (80%) during the program. ActiGraph adherence was slightly higher than EMA (M = 61.40 days, 87.71%). Participants achieved the daily mindfulness goal (10 min/day) and step goal on 46.32% and 55.10% of days, respectively. Dynamic data revealed that on average, participant step counts increased by approximately 16.5 steps per day (b = 16.495, p = 0.002). However, some participants exhibited no changes while improvements made by other participants returned to baseline levels of activity. There was substantial heterogeneity in trajectories of mindfulness practice and sleep efficiency. EMA and ActiGraph are feasible for older adults enrolled in dementia risk reduction lifestyle interventions. Future studies are needed to better understand how mechanisms of lifestyle behaviors captured by EMA and ActiGraph are related to cognitive outcomes in older adults.

Physical activity and cardiac function in patients with Duchenne muscular dystrophy

BACKGROUND

Cardiomyopathy is the leading cause of death in patients with Duchenne muscular dystrophy. The relationship between cardiac and skeletal muscle progression is unclear. The objective of this study was to evaluate the correlation between muscle activity and cardiomyopathy. We hypothesised that cardiomyopathy and skeletal muscle activity are directly related.

METHODS

Physical activity was assessed with accelerometers worn for 7 days. Average activity (vector magnitude/min) and percentage of time in different activities were reported. Cardiac MRI was used to assess left ventricular ejection fraction, global circumferential strain (Ecc), late gadolinium enhancement, and cardiac index. Associations were assessed between physical activity and cardiac variables using a Spearman correlation.

RESULTS

Duchenne muscular dystrophy subjects (n = 46) with an average age of 13 ± 4 years had a mean left ventricular ejection fraction of 57 ± 8%. All physical activity measures showed significant correlations with left ventricular ejection fraction (rho = 0.38, p = 0.01) and left ventricular cardiac index (rho = 0.51, p < 0.001). Less active subjects had lower left ventricular ejection fraction (p = 0.10) and left ventricular cardiac index (p < 0.01). Non-ambulatory patients (n = 29) demonstrated a stronger association between physical activity and left ventricular ejection fraction (rho = 0.40, p = 0.03) while ambulatory patients demonstrated a stronger association between physical activity and left ventricular cardiac index (rho = 0.53, p = 0.03). Ecc did not associate with physical activity in either cohort.

CONCLUSION

Physical activity correlates with left ventricular ejection fraction and left ventricular cardiac index and is modified by ambulation. Future analysis should assess the temporal relationship between physical activity and cardiomyopathy.

Reliability and validity of time-use surveys in assessing 24-hour movement behaviors in adults

Background

Time-use surveys are considered a valid alternative for assessing physical activity (PA) and sedentary behavior (SB). The International Classification of Activities for Time-Use Statistics (ICATUS) has been widely adopted, as a standardized framework for categorizing time-use data. A classification system has been developed to classify ICATUS-based activities into sleep, SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). This study aimed to evaluate the reliability and validity of ICATUS-based time-use classifications.

Methods

Participants aged 18-59 years were recruited from five organizations located in the Bangkok metropolitian area (n = 220). The study was conducted from September to October 2022. Participants wore an accelerometer for ten consecutive days and completed two-day time-use diaries. The intraclass correlation coefficient (ICC) was calculated to assess test-retest reliability between the first and second entries of time-use surveys, as well as for accelerometer data. Validity was assessed by comparing the two time-use surveys with corresponding accelerometer data using Spearman correlations.

Results

Test-retest reliability showed strong absolute agreement in the average time-use estimates for sleep and SB, with ICCs of 0.80 and 0.83, respectively. Moderate agreement was observed for LPA (ICC = 0.71) and MVPA (ICC = 0.51). Moderate validity correlations were found for SB, while LPA showed weak correlations, and MVPA results were inconsistent.

Conclusion

ICATUS-based time-use data demonstrated strong reliability and moderate validity for SB, and moderate reliability and low validity for PA in working adults. The classification system appears to be a verified tool, supporting its applicability of time-use data, particularly in developing countries.

Accelerometry-Assessed Physical Activity and Circadian Rhythm to Detect Clinical Disability Status in Multiple Sclerosis: Cross-Sectional Study

Background

Tools for measuring clinical disability status in people with multiple sclerosis (MS) are limited. Accelerometry objectively assesses physical activity and circadian rhythmicity profiles in the real-world environment and may potentially distinguish levels of disability in MS.

Objective

This study aims to determine if accelerometry can detect differences in physical activity and circadian rhythms between relapsing-remitting multiple sclerosis (RRMS) and progressive multiple sclerosis (PMS) and to assess the interplay within person between the 2 domains of physical activity (PA) and circadian rhythm (CR) in relation to MS type.

Methods

This study represents an analysis of the baseline data from the prospective HEAL-MS (home-based evaluation of actigraphy to predict longitudinal function in multiple sclerosis) study. Participants were divided into 3 groups based on the Expanded Disability Status Scale (EDSS) criteria for sustained disability progression: RRMS-Stable, RRMS-Suspected progression, and PMS. Baseline visits occurred between January 2021 and March 2023. Clinical outcome measures were collected by masked examiners. Participants wore the GT9X Link ActiGraph on their nondominant wrists for 2 weeks. After adjusting for age, sex, and BMI, a logistic regression model was fitted to evaluate the association of each accelerometry metric with odds of PMS versus RRMS. We also evaluated the association of accelerometry metrics in differentiating the 2 RRMS subtypes. The Joint and Individual Variation Explained (JIVE) model was used to assess the codependencies between the PA and CR domains and their joint and individual association with MS subtype.

Results

A total of 253 participants were included: 86 with RRMS-Stable, 82 with RRMS-Suspected progression, and 85 with PMS. Compared to RRMS, participants with PMS had lower total activity counts (β=-0.32, 95% CI -0.61 to -0.03), lower time spent in moderate to vigorous physical activity (β=-0.01, 95% CI -0.02 to -0.004), higher active-to-sedentary transition probability (β=5.68, 95% CI 1.86-9.5), lower amplitude (β=-0.0004, 95% CI -0.0008 to -0.0001), higher intradaily variability (β=4.64, 95% CI 1.45-7.84), and lower interdaily stability (β=-4.43, 95% CI -8.77 to -0.10). Using the JIVE model for PA and CR domains, PMS had higher first joint component (β=0.367, 95% CI 0.088-0.656), lower PA-1 component (β=-0.441, 95% CI -0.740 to -0.159), and lower PA-2 component (β=-0.415, 95% CI -0.717 to -0.126) compared to RRMS. No significant differences were detected between the 2 RRMS subtypes except for lower relative amplitude in those with suspected progression (β=-5.26, 95% CI -10.80 to -0.20).

Conclusions

Accelerometry detected differences in physical activity patterns between RRMS and PMS. More advanced analytic techniques may help discern differences between the 2 RRMS subgroups. Longitudinal follow-up is underway to assess the potential for accelerometry to detect or predict disability progression.

Associations Between Social Support, Social Control, and Stage of Change With Self-Reported and Objectively Assessed Physical Activity in Adult Latino Dyads

Health behaviors such as physical activity (PA) are socially influenced, such that individuals from shared social networks or living environments may exhibit similar habits. This cross-sectional study examined associations of social support, social control, and family member stage of change with moderate-to-vigorous self-reported and objective PA in dyads of adult Hispanic family members. We used the Godin Leisure-Time Physical Activity Questionnaire to assess self-reported PA and accelerometry for objective PA. Validated scales assessed social support, social control, and stage of change. We performed multivariable multilevel analysis using generalized estimating equations (GEE) to account for within-dyad correlations. We conducted multivariable negative binomial regression for Metabolic Equivalent Task minutes (MET-minutes) (self-reported; N = 429) and accelerometer data (N = 356) and logistic regression for meeting PA guidelines (self-reported; N = 429). Most dyads were spouses (41%) or parents and adult children (32%). Individuals with high family support had 81% higher odds of meeting PA guidelines (1.81 adjusted odds ratio (aOR); 95% confidence interval [CI] = [1.06, 3.09]; p = .030) and 58% higher leisure-time MET-minutes of PA per week (1.58 adjusted incidence rate ratio [aIRR], 95% CI = [1.30, 1.91]; p < .0001) than those with low levels of support. Participants reporting medium-to-high family punishment were 98% higher in odds of meeting PA guidelines (1.98 aOR; 95% CI = [1.09, 3.61]; p = .025) and had 70% higher leisure-time MET-minutes of PA (1.7 aIRR; 95% CI = [1.36, 2.13]; p<.0001) compared with those with low scores. Participants with study partners in action or maintenance stages had significantly higher leisure-time MET-minutes of PA per week (aIRR = 1.45, 95% CI = [1.10, 1.91], p = .009 and aIRR = 1.33, 95% CI = [1.01, 1.76], p = .041, respectively) compared with those with partners in other stages. No statistically significant associations were observed for social control with any measure of PA or between psychosocial measures and accelerometer-assessed PA. Our findings demonstrated that interventions should engage social networks and multimodal forms of PA assessment to optimize behavior change in similar populations.

24-hour movement behaviors and cognitive ability in preschool children: A compositional and isotemporal reallocation analysis

Research has supported the association between movement behaviors and cognitive ability in preschool children. However, most of the research has independently examined the various movement behaviors (e.g., physical activity, sedentary behavior, and sleep) without considering the dynamic composition of these behaviors in a 24-hour daily cycle. Therefore, this study aimed to explore the relationship between 24-hour movement behaviors and cognitive ability in preschool children. The participants were 191 Chinese preschool children from Zhuzhou aged 3-6 years. We measured light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) using the Actigraph Accelerometers and evaluated the children's sleep time based on reports from parents and teachers. The Chinese version of the Wechsler Young Children Scale of Intelligence (C-WYCSI) was used to assess cognitive ability. Compositional analysis and isotemporal substitution were performed to examine the influence of 24-hour movement behaviors on children's cognitive ability. After controlling for demographics (e.g., age and sex), the composition of 24-hour movement behaviors was significantly associated with the verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), and full intelligence quotient (FIQ). Importantly, preschool children demonstrated greater cognitive behavior when time in MVPA replaced that spent in LPA, SB, or sleep than when time spent in LPA, SB, and sleep replaced that spent in MVPA within the 24-hour cycle. Physical activity engaged in a 24-hour daily cycle has a significant effect on cognitive ability in preschool children, with increased MVPA and LPA being associated with higher PIQ and FIQ and increased sleep being associated with lower VIQ, PIQ, and FIQ. Replacing time in SB and LPA with MVPA is promising for children's cognitive development.

Associations between time spent in sedentary behaviors and metabolic syndrome risk in physically active and inactive European older adults

OBJECTIVES

To determine how clustered metabolic risk based on a validated continuous metabolic syndrome risk score is associated with objectively assessed time in sedentary behaviors (SB) in physically active and inactive older adults, while considering adherence to healthy eating habits.

DESIGN

Cross-sectional study SETTING AND PARTICIPANTS: The study comprises 871 community-dwelling older adults (age 65-79 years) recruited from four European countries.

MEASUREMENTS

Daily times spent in SB and physical activity (PA) were assessed by accelerometers (Actigraph GT3X) for a week. Waist circumference, triglycerides, HDL-cholesterol, mean arterial blood pressure, fasting glucose and insulin were determined, and a continuous metabolic syndrome risk score (cMSy) was generated using principal component analysis. Healthy eating habits were assessed by food record. General linear models stratified by adherence to PA guidelines (active/inactive) were used to examine differences in cMSy across tertiles of time in SB (Low, Medium, High) with adjustment for covariates, including healthy eating habits.

RESULTS

A significantly (p < 0.05) lower cMSy was observed among older adults in the low SB tertile compared to medium and high SB tertiles, with no difference between the latter tertiles. The favorable effect of low amounts of SB on cMSy was indicated in both active and inactive groups, and regardless of healthy eating habits. Further, being active was related to a more favorable cMSy across all SB tertiles.

CONCLUSION

Low amounts of time spent in SB are related to a lower metabolic syndrome risk regardless of adherence to PA guidelines and healthy eating habits in older adults, supporting guidelines targeting limited amounts of SB alongside engagement in moderate-to-vigorous PA for promotion of metabolic health.

Factors Associated With Physical Activity During Hospitalization for Hematopoietic Cell Transplantation and After Discharge: A Pilot Study

BACKGROUND

The importance of physical activity to support health has been widely demonstrated. Hematopoietic cell transplantation (HCT) requires lengthy hospitalizations resulting in substantial decreases in physical activity. Understanding the factors associated with physical activity during hospitalization and immediately following hospital discharge is vital to support the transition from hospital to home.

OBJECTIVE

To examine the associations among personal factors (exercise self-efficacy, physical and mental health, and symptom severity and interference) and physical activity immediately following HCT.

METHODS

In this prospective observational pilot study, accelerometers measured physical activity during hospitalization on HCT days 0 to 4 (T1) and days 5 to 9 (T2), and in the first 7 days after hospital discharge (T3). Personal factors were assessed at T1, T2, and T3. Physical activity and personal factors were evaluated for change over time (Friedman test) and associations (Spearman correlations).

RESULTS

Participants' (n = 26, 57% male; median age, 55 years [40-65.3]) accelerometer data revealed light and moderate to vigorous physical activity, and median steps decreased significantly as symptoms severity and interference increased from T1 to T2. Exercise self-efficacy was moderate to high from T1 to T3 and was correlated with increased steps at T2 (r = 0.57, P = .05) and increased light physical activity (r = 0.55, P = .05) and steps (r = 0.61, P = .01) at T3.

CONCLUSIONS

This pilot study provides preliminary evidence of the relationships between physical activity and symptoms, symptom severity, and exercise self-efficacy.

IMPLICATIONS FOR PRACTICE

Maintaining high levels of physical activity during hospitalization for HCT may not be possible. Nurses can help patients set realistic expectations for physical activity during hospitalization and immediately after hospital discharge.

Acceptability and Preliminary Efficacy of a Novel Web-Based Physical Activity for the Heart (PATH) Intervention Designed to Promote Physical Activity in Adults With Obesity: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Even in the absence of weight loss, any level of physical activity (PA) can reduce the risk of cardiovascular disease among individuals with obesity. However, these individuals face multifaceted barriers that reduce their motivation and engagement in PA. They prefer programs that are convenient, fun to engage in, and feature people who they can relate to. Yet, there is a paucity of PA interventions that are designed to incorporate these preferences. We designed the web-based PA for The Heart (PATH) intervention to address this gap.

OBJECTIVE

This study aimed to describe the protocol of a study that aims to examine the acceptability and preliminary efficacy of PATH intervention among insufficiently active adults with obesity aged at least 18 years.

METHODS

This is a 6-month pilot randomized controlled trial (RCT), using a parallel design with 1:1 allocation to intervention or control group. The PATH intervention group is given access to the PATH platform, but the resources each participant can access are tailored according to their baseline fitness level. Control group receives a self-help PA handout. Both groups self-monitor their PA using Fitbit (Google) and have Zoom (Zoom Video Communications) meetings twice a month with either the health coach (intervention) or study coordinator (control). The outcomes at 6-months include acceptability, changes in PA, and cardiometabolic risk from baseline to 6-months.

RESULTS

We screened 763 individuals for eligibility and 89 participants were enrolled and randomized to the intervention (45/504, 50.6%) and control arms (44/504, 49.4%). The average age was 48.7 (SD 12.17) years, and most participants were female (81/504, 90.1%), Black (45/504, 50.6%), and non-Hispanic (83/504, 93.3%). No systematic differences in baseline characteristics were observed between the study arms. The 6-month intervention is currently underway, and the completion of follow-up data collection is expected in February 2025, with results to be published soon after.

CONCLUSIONS

The PATH intervention offers a promising, evidence-based approach to overcoming the barriers that have hindered previous PA programs for adults with obesity. It can support new and existing programs to foster long-term maintenance of health-enhancing PA.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05803304; https://clinicaltrials.gov/study/NCT05803304.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/67972.

Exploring the association between physical activity and cognitive function among people living with dementia

BackgroundPhysical activity preserves cognitive function in people without dementia, but the relationship between physical activity and cognitive domains among people living with dementia is unclear.ObjectiveThe objective of this study was to explore the association between physical activity and cognition domains among people living with dementia.MethodsParticipants living with dementia in residential care facilities (complete case analysis: n = 24/42) completed a battery of cognitive tests (global cognition: Montreal Cognitive Assessment; executive function: Trail-Making Test, Digit Span Forward Test; perception and orientation: Benton Judgement of Line Orientation Test; language: Boston Naming Test; learning and memory: Rey Auditory Verbal Learning Test; complex attention: Digit Symbol Substitution Test). Participants wore an actigraphy monitor on their non-dominant wrist over seven days. We conducted a linear regression for total physical activity (independent variable) with race (white/black), fall risk (Morse Fall Scale), and the number of comorbidities (Functional Comorbidities Index) as covariates, and cognitive tests as variables of interest.ResultsParticipants were primarily male (75%), white (87.5%), and 50%had unspecified dementia (Alzheimer's disease: 33%). Greater physical activity was associated with poorer global cognition, better executive function, and better learning and memory (ps <  0.05). Physical activity was not related to visuospatial perception, language, or complex attention.ConclusionsPhysical activity may preserve executive function and learning and memory among people living with dementia. Wandering is more common in later stages of dementia, which may explain greater physical activity observed with lower global cognition. Regularly assessing physical activity may be useful in screening and monitoring cognitive changes.

Assessing the gut microbiota composition in older adults: connections to physical activity and healthy ageing

The composition and functionality of the gut microbiota (GM) changes throughout the life course. As we move into older age, it starts to shift towards a less healthy one, which may lead to an imbalance in the GM community. Strategies that can reverse age-related dysbiosis are an important part of healthy aging. Little is known about the GM composition of older adults with different physical activity (PA) levels and whether it might contribute to healthy ageing. The aim of this study was to compare the GM composition of older adults with different PA levels and assess if it is associated with healthy ageing. 101 participants aged between 65-85 years undertook anthropometric measures, a 6-min walking test, wore an accelerometer for 7 days and provided a faecal sample. Faecal GM composition was analysed using 16S rRNA sequencing. We found that those who fulfilled the WHO/UK PA recommendations had higher relative abundance of several health-related bacteria such as Lactobacillus, F. prausnitzii and Roseburia intestinalis and lower abundance of disease-associated bacteria such as D.piger or Enterobacterales when compared to those who did not reach PA recommendations. These findings suggest that PA might improve the GM composition and has the potential to, at least partially, revert age-associated dysbiosis and promote healthy ageing.

Methodological Choices on 24-h Movement Behavior Assessment by Accelerometry: A Scoping Review

BACKGROUND

There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups.

MAIN BODY

PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and  ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data.

CONCLUSIONS

Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options.

Lessons learned from an observational study of patients with breast cancer: adaptions for remote implementation

PURPOSE

There is increased demand for lifestyle interventions earlier on the cancer continuum (i.e., during curative-intent treatment). To address this need, researchers face unique challenges intervening in the short period of time after diagnosis, but before initiation of chemotherapy and/or surgery. During the peak of the COVID-19 pandemic, transitions to remote/digital platforms became both mandatory and immediate.

METHODS

This case study details the rapid transition to a remote/digital study embraced by our team as we recruited patients newly diagnosed with breast cancer to a pilot study. The pilot's purpose was to characterize the relationships between physical activity (PA) and cognitive and mental health during breast cancer treatment.

RESULTS

We reflect on the lessons learned during this pilot study with a particular focus on three emergent challenges: digital data collection, recruitment during active breast cancer treatment, and participant burden. We used a systematic implementation framework to track adaptations made to meet the evolving needs of patients and clinicians, while adhering to institutional protocols.

CONCLUSIONS

This case study provides important insights into the delicate balance between patient, clinician, and institutional needs in the breast cancer setting, particularly when delivering digital interventions during treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Careful attention should be paid to protocols for remote research to ensure that it is feasible, acceptable, and rigorous for all cancer survivors.

Evaluation of muscle mass relative to weight/sitting height2 improves the association with physical performance

OBJECTIVES

To compare relationships of appendicular skeletal muscle mass (ASM) with the function of the upper and lower extremities, after the former has been adjusted by five body size variables: height2; weight; body mass index (BMI); sitting height2; and weight/sitting height2.

STUDY DESIGN

A cross-sectional study of data derived from the baseline phase of the Physical Activity and Health in Older Women Study.

MAIN OUTCOME MEASURES

ASM was measured by bioelectrical impedance analysis. Grip strength and the time spent on the 5-times chair stand test (5-CST) were the evaluation indexes of upper and lower extremity function respectively. Standardized grip strength and log-transformed 5-CST were used as dependent variables, and standardized ASM adjusted by the five body size variables were used as independent variables. Multiple linear regression models then assessed the relationships of muscle mass with grip strength and 5-CST.

RESULTS

1103 community-dwelling women aged 60-70 years were included in this study. After adjustment for covariates, ASM adjusted by height2 or sitting height2 was positively associated with grip strength (β = 0.140, 0.164 respectively, all P values <0.001), and only ASM adjusted by sitting height2 was positively associated with the time spent on the 5-CST (β = 0.129, P < 0.001). Weight-adjusted ASM was associated only with the time spent on the 5-CST (β = -0.158, P < 0.001) and BMI-adjusted ASM was associated only with grip strength (β = 0.190, P < 0.001). ASM adjusted by weight/sitting height2 was positively associated with grip strength (β = 0.140, P < 0.001) and negatively associated with the time spent on the 5-CST (β = -0.076, P = 0.012).

CONCLUSIONS

Compared to ASM adjusted by the other four body size variables, ASM adjusted by weight/sitting height2 had better associations with upper and lower extremity function, which provides new perspectives for improving muscle mass and predicting adverse outcomes.

Daily Path Areas and Location Use During and After Cardiac Rehabilitation

PURPOSE

Little research has focused on the potential impact that the environment plays in shaping cardiac rehabilitation (CR) patient sedentary time (ST) and physical activity (PA). To address this, the current study generated daily path areas (DPAs) based on the locations they visited during and after they completed CR.

METHODS

Patients in CR (n = 66) completed a survey and wore an accelerometer and Global Positioning System receiver for 7 days early (first month), late (last 2 weeks of program), and 3 months after completing CR.

RESULTS

Individual DPAs were approximately 24 km 2 at baseline and remained stable over time. Location-based analyses showed that most patients' ST and PA time was spent at home, followed by other residential, commercial, work, and CR locations. However, the time spent in certain locations (eg, parks and recreation locations) fluctuated during and after CR by intensity.

CONCLUSIONS

CR patient DPA was stable over time. Within this space, they primarily engaged in ST and PA at home. However, when not home, the distribution of location use varied across a number of locations that extended well beyond their neighborhoods. Therefore, proximity to home may not be a barrier for CR patients in relation to their ST and PA.

Screening for Frailty According to Rural and Suburban Health Areas in the Context of Adapted Integrated Care for Older People Approach: The FRAGING Study

BACKGROUND

The integrated care for older people (ICOPE) program, developed by the World Health Organization, serves as a public health initiative to maintain older adults' functional abilities and promote healthier aging. Here, we adapted the ICOPE approach to assess overall prevalence of frailty in rural and semi-urban areas. We also investigated health-related quality of life and physical activity and sedentary behavior in older people.

METHODS

The FRAGING multicenter cohort study was performed on screening days dedicated to older adults (≥65 years) without chronic disease in a rural area (RU) and in a semi-urban area (SU).

RESULTS

The study included a total of 105 participants: 98.4% of participants were frail, with a mean of 4.3 [SD: 2.5] frailties per participant. RU participants had higher number of frailties (p = 0.02) and a higher percentage of frail participants in the dimensions of health-related quality of life (p < 0.0001), socioeconomical level (p = 0.008), colorectal cancer screening (p = 0.022), and tetanus booster doses (p = 0.008). Globally, women were less sedentary than men (p = 0.02) and engaged more in low physical activity (LPA) than men (p = 0.01). RU participants engaged more in LPA than SU participants (p = 0.03).

CONCLUSIONS

The prevalence of frailty is alarmingly underestimated in older adults without chronic disease. This study demonstrated the need to propose appropriate, validated screening tests that consider territorial issues and organization of care delivery. The ICOPE framework serves as a good startpoint for reorganizing person-centered healthcare pathways.

Light physical activity throughout the day and physical function in older adults: A cross-sectional study

Research has demonstrated that habitual light physical activity (LPA) in later life may contribute to preventing muscle loss and disability in older adults. Given that LPA dominated overall physical activity duration throughout the day, investigating the impact of the timing of LPA on physical function among older adults is essential for optimizing health interventions. This cross-sectional study explored the association between LPA timing and performances in four physical function tests among older adults. This study explored the associations between diurnal patterns of light physical activity and physical function performance. The study involved 200 older adults attending the geriatric outpatient clinic at National Taiwan University Hospital. Participants were on average 76.3 years old (SD = 6.6), with 55.5% being female. We collected LPA data using wrist-worn accelerometers for a continuous 7-day period. Principal component analysis (PCA) was employed to categorize daily periods of LPA. Multivariable-adjusted linear regression analyses were conducted to examine the associations between LPA timing and performance in the following physical function tests: grip strength, basic mobility (Timed Up and Go [TUG] test), walking speed, and lower limb muscle strength (five sit-to-stand test). Adjustments were made for gender, age, moderate-to-vigorous physical activity, and average daily triaxial accelerometer wear time. The findings indicated that higher LPA levels during the morning to noon period (08:00-13:00) were positively associated with improved performance across all four physical function tests. Furthermore, increased LPA in the late afternoon (12:00-17:00) and evening (18:00-24:00) was positively associated with better outcomes in the basic mobility (TUG test), walking speed (6-m walking test), and lower limb muscle strength (five sit-to-stand test), after controlling for relevant confounders. This study underscores the significance of the timing of light physical activity in enhancing various aspects of physical function in older adults independent of MVPA. Timing of LPA plays a crucial role in enhancing physical function in older adults, with morning activity being particularly beneficial. This supports tailored activity recommendations for geriatric care.

Physical Activity Monitoring in Children in the 1-Year After 3 or More Days of Invasive Ventilation: Feasibility of Using Accelerometers

OBJECTIVES

To measure physical activity in a cohort of children who survived greater than or equal to 3 days of invasive ventilation.

DESIGN

Prospective cohort study (2018-2021).

SETTING

Quaternary children's hospital PICU.

PATIENTS

Children (2-17 yr old) without a preexisting tracheostomy who were ambulatory pre-illness and received greater than or equal to 3 days of invasive ventilation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We measured duration and intensity of physical activity using hip- (< 6 yr old) or wrist- (≥ 6 yr old) worn ActiGraph GT3XP-BTLE accelerometers (ActiGraph, Pensacola, FL) for 7 days at three timepoints: hospital discharge, 3 months, and 12 months post-discharge. We measured duration of moderate or vigorous physical activity (MVPA) and nonsedentary activity, both characterized as percent of total awake wear time and total minutes per day. We categorized participants based on when they first attained a "high activity" day defined as greater than or equal to 60 minutes of MVPA or a day with percent of MVPA in the top quartile of all days measured. We evaluated 55 children of whom 43 (78%) had data from greater than or equal to 1 timepoint including 19 (35%) with data from all timepoints. Maximum daily MVPA increased across the three post-discharge timepoints (median, 16.0 min [interquartile range (IQR), 8.0-42.8 min], 48.3 min [27.8-94.3 min], and 68.4 min [34.7-111.0 min], respectively) as did maximum daily percent of awake wear time in MVPA (median, 4.3% [IQR, 2.8-9.0%], 10.1% [5.7-14.4%], and 11.1% [7.1-17.5%], respectively). Of the 43 participants, 27 achieved a high activity day: nine of 43 during the hospital discharge period, 14 of 43 during the 3 months post-discharge period, and four of 43 during the 12 months post-discharge period; 16 of 43 did not demonstrate high activity during the post-discharge year.

CONCLUSIONS

In the 1-year after PICU discharge measuring physical activity with accelerometers in children 2-17 years old is feasible. Furthermore, demonstration of variable recovery trajectories in our pilot cohort suggests it has potential to be an outcome measure in clinical trials.

Multimorbidity Trajectories From Early to Middle Adulthood and Physical Activity

INTRODUCTION

Multimorbidity is associated with lower physical function in older adults. Less is known about multimorbidity and physical activity earlier in the life course. This study examined multimorbidity trajectories across adulthood with physical activity and explores if multimorbidity accelerates age-related activity decline.

METHODS

Data are from Coronary Artery Risk Development in Young Adults (CARDIA), an ongoing prospective cohort of participants recruited when they were aged 18-30 years. Six multimorbidity trajectories from baseline (1985-1986) through year 30 follow-up exam (2015-2016; ages 48-60 years) were based on age of disease onset and rate of accumulating additional conditions: mid-20s-fast, mid-20s-slow, late-20s-slow, mid-30s-fast, mid-40s-fast, and early-50s-slow. Activity was device-measured at year 30 and year 35 (2021-2023; ages 53-65). Multivariable linear models were used to estimate differences in activity by multimorbidity trajectory at year 30 and change (%) from year 30 to year 35. Data were collected through June 2023 and analyzed in May 2024.

RESULTS

The sample included 1,425 CARDIA adults at year 30 (mean age 55.1 years) with 749 (mean age 61.3 years) wearing the device again at year 35. Compared with early-50s-slow, mid-20s-slow (β=-14.1; 95% CI= -24.6, -3.6) and mid-30s-fast (β=-14.2; 95% CI= -26.2, -2.2) had lower light-intensity physical activity and mid-20s-fast (β=-5.1; 95% CI= -9.6, -0.6) and late-20s-fast (β=-9.5; 95% CI= -14.1, -4.9) had lower moderate-to-vigorous physical activity. There were significant differences in 5-year behavior change across multimorbidity trajectories.

CONCLUSIONS

Early onset and faster accumulation of chronic conditions was associated with lower activity in midlife. Lower intensity activity for people with multimorbidity may be a feasible target for healthy aging.

Adding planning strategies to an experiential and conceptual knowledge-based intervention: Does it help to reduce sedentary time?

OBJECTIVE

The study compared the effects of an "active" control condition addressing conceptual and experiential knowledge about sedentary behavior, with an intervention condition combining conceptual and experiential knowledge together with action planning, coping planning, and behavioral substitution. We targeted a decrease in sedentary time as the primary outcome.

METHODS

A preregistered trial (#NCT04131270) was carried out with 603 participants aged 11-86 years (M = 33.57; 65.2% women), randomly assigned to the "planning + knowledge" condition or the "knowledge" condition. Sedentary time was assessed with ActiGraph wGT3X-BT accelerometers at baseline, 1-week, and 36-week follow-ups. Conceptual knowledge strategies involved information about health consequences and instructions on how to perform behaviors while experiential knowledge was enhanced by participants taking/discussing photographs of their home environment that has been triggering sedentary behavior. Action/coping plans referred to ways to substitute sedentary behavior with bouts of physical activity behaviors. Mixed models were fit.

RESULTS

No significant Time × Condition interaction was found. In the total sample, sedentary time estimated to be around 502.34 min/day at baseline, showed a significant linear decline over time (p = .002), by approximately -1.22 min per each month elapsing since baseline (-9.76 min/day across 8 months).

CONCLUSIONS

The findings suggest that applying behavior change techniques targeting both conceptual and experiential knowledge about antecedents, circumstances, and consequences of sedentary behavior may result in a small reduction of sedentary time. Adding action plans, coping planning, and behavioral substitution did not improve the effectiveness of the intervention.

Associations Between Clinical Inflammatory Risk Markers, Body Composition, Heart Rate Variability, and Accelerometer-Assessed Physical Activity in University Students with Overweight and Obesity

This cross-sectional study aimed to identify associations between clinical inflammatory risk markers, body composition, heart rate variability (HRV), and self-reported and objectively assessed physical activity (PA) in university students with overweight and obesity. Seventeen participants (eight females) completed a screening visit following a randomized controlled four-arm crossover trial period with 8 h of uninterrupted prolonged sitting, alternate sitting and standing, continuous standing, and continuous slow walking, respectively. Clinical inflammatory risk markers were obtained from venous blood samples, and PA was assessed using the International Physical Activity Questionnaire (IPAQ-SF) and ActiGraph wGT3X-BT accelerometers. HRV was recorded over 24 h using the Faros 180 Holter electrocardiogram (ECG). White blood cell (WBC) counts were significantly correlated with fat mass (FM; p = 0.03) and visceral adipose tissue (VAT; p = 0.04) and inversely correlated with moderate PA (p = 0.02). Light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA) were correlated with HRV parameters (p = 0.02), and LIPA was inversely correlated with interleukin-6 (p = 0.003) and c-reactive protein (p = 0.04) during different trial conditions. In university students with overweight and obesity, higher values of FM were negatively correlated with WBC count, and integrating LIPA and MVPA in the students' daily life strengthened their sympathetic-parasympathetic regulation and positively mediated anti-inflammatory mechanisms.

Child-, Family-, and Community-Level Correlates of 24-Hour Movement Behaviors in Ethiopian Young Children: The SUNRISE Study

BACKGROUND

Understanding the factors influencing 24-hour movement behaviors is important for designing appropriate health promotion strategies. We examined the multidimensional correlates of physical activity, sedentary behavior, screen time, and sleep among children under 5 years of age in Ethiopia.

METHODS

Cross-sectional study conducted in Adama and Lume district, Ethiopia. Children were recruited from urban kindergartens and rural villages. Physical activity, sedentary time, and sleep were assessed using accelerometry. Screen time and correlates were parent reported. Variables were selected a priori, using the social ecological model and considering country context. Linear mixed models were used to test associations between child-, family-, and community-level correlates and time spent in 24-hour movement behaviors, accounting for clustering effect.

RESULTS

Four hundred and thirty children participated (mean age 4.2 [0.6] y). Girls spent less time in total of physical activity (TPA) and moderate- to vigorous-intensity physical activity (MVPA) and more time sedentary than boys. Children who spent more time outdoors had higher TPA and MVPA, longer sleep duration, and shorter sedentary and screen time. Children of educated parents had lower TPA and MVPA and higher sedentary time than those with no formal education. Children of parents who reported using a screen device with their child for educational purposes spent less time in MVPA, had shorter sleep, and had more screen time than those who did not. Rural children had higher TPA and MVPA, longer sleep, and shorter sedentary and screen time than urban children.

CONCLUSION

We identified key correlates of 24-hour movement behaviors in Ethiopian children. Designing tailored health promotion strategies to support healthy levels of movement behaviors, particularly in urban areas, is needed.

Sedentary behavior and physical activity one year after colorectal cancer diagnosis: results from the ColoCare Study

PURPOSE

Physical activity plays key roles in colorectal cancer survivorship; however, the impact of different clinicodemographic outcomes on cross-sectional and longitudinal objectively measured physical activity 12 and 24 months post-diagnosis are unclear.

METHODS

ColoCare study participants (n = 165) wore an Actigraph GT3x accelerometer for 4-10 consecutive days to objectively assess activity levels 12 and 24 months after colorectal cancer diagnosis and resection. Associations between these clinical/demographic exposures and physical activity outcomes and longitudinal changes were determined using t-test, ANOVA F-test, and linear regression modeling, adjusting for common confounders (e.g., sex, age, stage).

RESULTS

Key physical activity and sedentary behavior variables significantly differed by demographic status, including minutes of weekly exercise by sex and age (age < 50: 364 min ± 303 min; age 50-70: 232 min ± 263 min; age > 70: 93 min ± 135 min, p < 0.001) and (%) daily sedentary time by age (age < 50: 64 ± 10%; age 50-70: 67 ± 7%; age > 70: 71 ± 7%, p = 0.003). Within the multivariate model, age was the primary measure consistently associated with activity differences. Participants who wore accelerometers 12- and 24-month post-resection (n = 52) significantly increased weekly exercise minutes (214 min ± 208 min vs. 288 min ± 316 min, p = 0.04).

CONCLUSION

Age is the primary clinicodemographic determinant separating physical activity levels in colorectal cancer survivors, and increases in exercise from 12 to 24 months are likely due to consolidation of sporadic daily physical activity into bouts of exercise.

IMPLICATIONS FOR CANCER SURVIVORS

Colorectal cancer survivors experience different volumes and changes in accelerometer-derived physical activity based on some (e.g., age) but not all (e.g., stage) clinicodemographic variables.

Physical activity and life expectancy: a life-table analysis

OBJECTIVE

Low physical activity (PA) levels are associated with increased mortality. Improved measurement has resulted in stronger proven associations between PA and mortality, but this has not yet translated to improved estimates of the disease burden attributable to low PA. This study estimated how much low PA reduces life expectancy, and how much life expectancy could be improved by increasing PA levels for both populations and individuals.

METHODS

We applied a predictive model based on device-measured PA risk estimates and a life-table model analysis, using a life-table of the 2019 US population based on 2017 mortality data from the National Centre for Health Statistics. The participants included were 40+ years with PA levels based on data from the 2003-2006 National Health and Nutritional Examination Survey. The main outcome was life expectancy based on PA levels.

RESULTS

If all individuals were as active as the top 25% of the population, Americans over the age of 40 could live an extra 5.3 years (95% uncertainty interval 3.7 to 6.8 years) on average. The greatest gain in lifetime per hour of walking was seen for individuals in the lowest activity quartile where an additional hour's walk could add 376.3 min (~6.3 hours) of life expectancy (95% uncertainty interval 321.5 to 428.5 min).

CONCLUSION

Higher PA levels provide a substantial increase in population life expectancy. Increased investment in PA promotion and creating PA promoting living environments can promote healthy longevity.

Sedentary behaviors and venous thromboembolism risk among older women: the Objective Physical Activity and Cardiovascular Health study

BACKGROUND

Venous stasis, which can occur with prolonged sedentary behavior (SB), is associated with venous thromboembolism (VTE) risk, but VTE risk associated with accelerometer-measured SB has not been quantified.

OBJECTIVES

To evaluate accelerometer-based measures of SB in relation to incident VTE.

METHODS

We included 5591 participants, aged 63 to 99 years, of the Women's Health Initiative Objective Physical Activity and Cardiovascular Health cohort study without prior VTE. Between May 2012 and April 2014, participants wore the ActiGraph GT3X+ accelerometer at the hip for 7 days. Three SB measures were classified using the Convolutional Neural Network Hip Accelerometer Posture algorithm: total sitting time, mean sitting bout duration, and total time spent in prolonged (≥30 minutes) sitting bouts. VTE events were centrally adjudicated. Multivariable-adjusted Cox models estimated hazard ratios for each SB and VTE risk. Women were censored at first VTE, death, loss to follow-up, or February 2023. Mediation by body mass index (BMI) was evaluated.

RESULTS

Over a mean follow-up of 8.2 years, 229 women experienced a VTE. In adjusted models, longer mean sitting bout duration was associated with greater incident VTE risk (hazard ratio per 5-minute increase, 1.15; 95% CI, 1.04-1.28). BMI mediated approximately 30% of this association (P < .01). We found no significant evidence that total sitting time or total time spent in prolonged sitting bouts were associated with VTE.

CONCLUSION

Longer mean sitting bout duration was associated with greater VTE risk, with substantial mediation by BMI. Behavioral efforts to reduce sedentary bout length in older women may reduce their VTE risk.

Associations between physical activity and emotional and behavioural problems in Chinese children and adolescents with intellectual disabilities

Background and purpose

Emotional and behavioural problems (EBPs) are the two main forms of mental health problems that hinder the social interactions, learning and daily living of children and adolescents with intellectual disabilities (ID). Studies have shown that sufficient moderate-to-vigorous physical activity (MVPA) is associated with mental health outcomes among children and adolescents with typically developing (TD). However, these associations have not been fully studied in children and adolescent with ID, especially in samples from China. Therefore, this study aimed to examine the associations between MVPA and EBPs in Chinese children and adolescents with ID.

Methods

A cross-sectional survey was conducted with 116 students with ID (35.34% girls) aged 6-18 years. The wGT3-BT accelerometer was used to measure physical activity (PA), and the Chinese version of the parent-rated Strengths and Difficulties Questionnaire (SDQ) was used to assess the participants' EBPs. A series of binary logical regression analyses was conducted to examine the ability of the MVPA guideline attainment in predicting EBPs in the total sample.

Results

The descriptive results showed that 43.97% of children and adolescents with ID present with EBPs. After controlling for age, sex, ID severity and weight status, logistic regression analysis indicated that the participants who meet the MVPA guideline exhibited significantly lower odds ratio for emotional symptoms (OR = 0.334, 95% CI [0.114-0.975], p = 0.045), peer problems (OR = 0.071, 95% CI [0.015-0.328], p < 0.001) and total difficulties (OR = 0.192, 95% CI [0.069-0.535], p = 0.002) compared with those who did not meet the guidelines.

Conclusion

The prevalence of EBPs in Chinese children and adolescents with ID remains high. Children and adolescents with ID meeting the MVPA guideline were more likely to have lower risks for emotional symptoms, peer problems and total difficulties than those who did not meet the guidelines. Future research adopting longitudinal or interventional designs to determine the relationships between PA and EBPs in this population are expected.

Sense of belonging and its positive association with physical activity levels and negative association with sedentary behaviors in residential aged care facilities in COVID-19 pandemic: a longitudinal study

Introduction

The COVID-19 pandemic reduced physical activity levels and increased sedentary behavior among older adults in residential care facilities. Another effect of this crisis was that facilitating a sense of social belonging through in-person social activities, such as group exercises or communal meals, became difficult. This study examines the relationship between physical activity, sedentary behavior, and sense of social belonging in older adults.

Methods

This longitudinal study, which lasted 10 months, involved 57 older adults in residential care facilities. Participants completed the Échelle de mesure du Sentiment d'Appartenance Sociale (ESAS) questionnaire three times and wore an accelerometer on their waists for 1 week each time to measure sedentary time and physical activity levels. The ESAS questionnaire, a validated tool for evaluating social belonging in older adults, measures social belonging through a series of questions that assess an individual's feelings of acceptance and intimacy within their social group.

Results

Participants were predominantly sedentary (7.30 h/day) and engaged in low-intensity physical activities (2.9 h/day). They did not meet the recommended 150 min/week of moderate-to-vigorous physical activity. The sense of social belonging was high, with mean scores of 6.75 (ESAS), 7.08 (Acceptance), and 6.43 (Intimacy). Light physical activity was negatively associated with sedentary time. The sense of social belonging was positively associated with light physical activity and negatively correlated to sedentary time.

Conclusion

This study underscores the importance of light physical activity and a sense of social belonging in reducing sedentary behavior among older adults in residential care facilities. By promoting social interactions and light physical activity, we can enhance the well-being of this population, especially during pandemic conditions. The study's findings should inspire future interventions to focus on these aspects, thereby improving health outcomes in residential care facilities for older adults.

Factors Associated With Physical Activity in Alzheimer's Disease: A Cross-Sectional Study of Individuals and Their Caregivers

INTRODUCTION

Physical activity (PA) is associated with better outcomes in individuals living with Alzheimer's and related dementia (ADRD). We examined environmental, intra-, and interpersonal correlates of PA for persons living with ADRD.

METHODS

PA (accelerometry), cognitive function, physical function, and sociodemographic factors were collected in adults with ADRD and their caregivers. Spearman's correlations and generalized linear models were used to evaluate factors associated with PA of persons living with ADRD.

RESULTS

Valid data were obtained from 65 pairs of adults living with ADRD (73.6 ± 8.4 years, 39.4% female) and caregivers (69.4 ± 9.4 years, 69.2% female, 93.8% spouse). Moderate-to-vigorous PA (MVPA) and light PA of persons living with ADRD were correlated with upper and lower body strength, aerobic fitness, and agility. MVPA and sedentary time of persons living with ADRD were associated with that of their caregiver.

CONCLUSION

Physical function and caregiver PA may be targets for interventions in those living with ADRD.

Validation of a Brief Physical Activity Assessment Tool for Adults With Limited Resources

OBJECTIVE

To validate a Brief Physical Activity Assessment Tool for the Expanded Food and Nutrition Program (EFNEP).

DESIGN

Phase 1: test-retest reliability based on 2 survey administrations; Phase 2: concurrent validity triangulated with accelerometer data; Phase 3: sensitivity to change and responsiveness and secondary analysis of EFNEP national dataset.

SETTING

Community centers and/or EFNEP classes across the US.

PARTICIPANTS

Phase 1: 75 adults; Phase 2: 106 adults; and Phase 3: 53,393 adults.

MAIN OUTCOME MEASURES

Test-retest reliability, concurrent validity, and sensitivity to change and responsiveness.

ANALYSIS

Test-retest reliability: intraclass correlation, κ, and Spearman correlation coefficient (SCC); concurrent validity: SCC; sensitivity to change: standardized response mean, effect size, and paired t tests; responsiveness: minimal important difference.

RESULTS

The Brief Physical Activity Assessment Tool's test-retest results were moderate (intraclass correlation = 0.77-0.84; κ = 0.55-0.61; SCC = 0.59-0.84). Concurrent validity differed by questions but was highest for the muscle-strengthening question (SCC = 0.87). All questions demonstrated moderate sensitivity to change and responsiveness. Patterns between non-Hispanics and Hispanics were similar.

CONCLUSIONS AND IMPLICATIONS

The study resulted in a brief, validated, nationally tested questionnaire for evaluating physical activity changes for non-Hispanic adults with limited resources, which could be included in short surveys. It could be further validated among other populations.

Effects of a daylight intervention in the morning on circadian rhythms and sleep in geriatric patients: a randomized crossover trial

PURPOSE

During hospitalization, circadian rhythms and sleep are often disrupted, which has negative effects on health outcomes. Therefore, we aimed to investigate whether a daylight intervention in the morning could improve the circadian rhythms of cortisol and melatonin and enhance objective and subjective sleep quality in geriatric patients.

METHODS

The present study is a randomized, two-period crossover trial conducted in a geriatric ward in 15 non-demented geriatric trauma patients with a mean age of 83.1 ± 5.4 years. All patients underwent a daylight intervention period, during which they were exposed to a daylight lamp from 8:00 to 13:00 h, and a control period of 6 days each. Cortisol and melatonin levels were measured on day 5 of each period. Objective and subjective sleep quality were assessed using actigraphy and questionnaires, respectively. Within-participant differences between periods were investigated for all parameters.

RESULTS

A trend towards improvement in cortisol and melatonin rhythmicity was found. An increase in mean melatonin levels from 0.3 ± 0.1 to 0.9 ± 0.8 ng/L was observed during the intervention period (p = .063). There was also a trend towards increased sleep efficiency, whereas subjective sleep quality tended to decrease. None of the results were significant.

CONCLUSION

A daylight intervention in the morning led to a positive trend in cortisol and melatonin rhythmicity, whereas no improvement in subjective sleep quality was found.

TRIAL REGISTRATION

DRKS00028626 at German Clinical Trials Register, 13.06.2022.

Theoretical Behavior Substitutions during the 24-h Day in Pregnancy and Infant Growth Outcomes

PURPOSE

The purpose of this study is to assess associations of theoretically reallocating time from sleep, sedentary behavior, or light-intensity physical activity (LPA) to moderate/vigorous-intensity physical activity (MVPA) during pregnancy with infant growth outcomes.

METHODS

We used data from a cohort of pregnant individuals with overweight or obesity ( n = 116). At 9 to 15 and 30 to 36 wk of gestation, waking movement was measured using wrist-worn accelerometers and sleep duration was self-reported. Outcomes were obtained from delivery electronic health records (birth) and study visits (12 months). We used compositional isotemporal substitution models.

RESULTS

In early pregnancy, reallocating 10 min of sleep, sedentary behavior, or LPA to MVPA was associated with 20% (relative risk [RR] = 0.80; 95% CI, 0.75-0.85), 21% (RR = 0.79; 95% CI, 0.75-0.84), and 25% (RR = 0.75; 95% CI, 0.70-0.81) lower risk of large-for-gestational age (LGA) birthweight, respectively, and 17% (RR = 0.83; 95% CI, 0.75-0.91), 18% (RR = 0.82; 95% CI, 0.75-0.91), and 22% (RR = 0.78; 95% CI, 0.70-0.88) lower risk of rapid infant growth (birth to 12 months), respectively. In late pregnancy, reallocating 10 min to MVPA was associated with 18% to 22% lower risk of LGA birthweight, but was not associated with rapid infant growth. Reallocating time to MVPA in early or late pregnancy was not associated with high newborn body fat percentage.

CONCLUSIONS

Our findings suggest beneficial associations of theoretically reallocating time from sleep, sedentary behavior, or LPA to MVPA, especially during early pregnancy, for reducing LGA birthweight and rapid infant growth.

Early Gait Biomechanics Linked to Daily Steps After Anterior Cruciate Ligament Reconstruction

CONTEXT

Gait biomechanics and daily steps are important aspects of knee-joint loading that change after anterior cruciate ligament reconstruction (ACLR). Understanding their relationship during the first 6 months post-ACLR could help clinicians develop comprehensive rehabilitation interventions that promote optimal joint loading after injury, thereby improving long-term knee-joint health.

OBJECTIVES

To compare biomechanical gait waveforms throughout stance at early time points post-ACLR in individuals with different daily step behaviors at 6 months post-ACLR and to examine how these gait waveforms compare with those of uninjured controls.

DESIGN

Case-control study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 32 individuals with primary ACLR assigned to the low-step group (LSG; n = 13) or the high-step group (HSG; n = 19) based on their average daily steps at 6 months post-ACLR and 32 uninjured matched controls.

MAIN OUTCOME MEASURE(S)

Gait biomechanics were collected at 2, 4, and 6 months post-ACLR for the ACLR groups and at a single session for the control group. Knee-adduction moment, knee-extension moment (KEM), and knee-flexion angle (KFA) waveforms were calculated during gait stance and then compared via functional waveform analyses. Mean differences and corresponding 95% CIs between groups were reported.

RESULTS

Primary results demonstrated less KFA (1%-45% versus 79%-92% of stance) and greater KEM (65%-93% of stance) at 2 months and greater knee-adduction moment (14%-20% versus 68%-92% of stance) at 4 months post-ACLR for the HSG compared with the LSG. Knee-adduction moment, KEM, and KFA waveforms differed across various proportions of stance at all time points between the step and control groups.

CONCLUSIONS

Differences in gait biomechanics were present at 2 and 4 months post-ACLR between step groups, with the LSG demonstrating an overall more flexed knee and more profound stepwise underloading throughout stance than the HSG. The results indicate a relation between early gait biomechanics and later daily step behaviors post-ACLR.

The association between the circadian misalignment of serum cortisol acrophase and sleep end time with chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of chemotherapy. The objective of this prospective observational study was to examine the association between circadian misalignment (CM), as measured by phase angle difference (PAD) of biological and behavioral rhythms and CIPN. The PAD of cortisol acrophase and actigraphy-based sleep end time in breast cancer patients was measured and categorized into low PAD (n = 11) and high PAD (n = 12) groups based on median value. CIPN was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN20 (CIPN20). The assessment of CM revealed that the sleep end time of the low PAD group was more delayed in relation to cortisol acrophase compared to the high PAD group. The low PAD group demonstrated significantly higher CIPN20 global and sensory scale scores compared to the high-PAD group at one month post-chemotherapy, with an estimated group difference of 17.63 ± 4.75 and 27.07 ± 6.70 (p = 0.001 and p < 0.001, respectively). The present findings indicate that the low PAD group, which exhibited a relatively delayed behavioral rhythm with respect to its biological rhythm, displayed an increased susceptibility to CIPN. Further large-sample research is necessary to attain a comprehensive understanding of the mechanisms through which CM affects CIPN.

Physical activity levels in patients with chronic venous insufficiency

BACKGROUND

Increasing the levels of physical activity (PA) is widely recommended for people with chronic venous insufficiency (CVI). However, studies investigating the patterns of PA and adherence to PA guidelines using objective measures are lacking.

OBJECTIVE

The primary aim was to examine the patterns of PA and adherence to PA guidelines among patients with CVI. A secondary aim was to identify whether adherence to PA recommendations differed according to patients' sociodemographic and clinical characteristics.

METHODS

This cross-sectional study included 96 patients with CVI with Clinical-Etiology-Anatomy-Pathology (CEAP) C3 to C6 (69.1% women 59 ± 11 years; 51.5% C5-C6 on CEAP classification). Objective time spent in PA was measured by a triaxial accelerometer. To examine adherence to PA guidelines, patients were grouped as meeting (or) the recommendations if they had at least 150 min/week of moderate to vigorous PA. Sociodemographic and clinic characteristics were obtained by self-report. Binary logistic regression was employed to examine whether sociodemographic and clinical characteristics were associated with adherence to PA guidelines. T-tests were employed to compare PA levels at different intensities according to patients' age.

RESULTS

Patients spent an average of 311.4 ± 91.5 min/week, 42.1 ± 28.0 min/week, and 19.8 ± 17.8 min/week in low-light PA, high-light PA, and moderate-to-vigorous PA, respectively. The proportion of patients meeting PA recommendations was 36.2%, and older patients had lower odds (OR = 0.94; 95%CI: 0.89 to 0.99). Additional analysis reinforced that by showing lower time in high-light PA (51.2 ± 30.0 min/day vs. 31.9 ± 21.8 min/day; p = .001) and moderate-to-vigorous PA (24.3 ± 15.8 min/day vs. 14.8 ± 18.8 min/day; p = .012) among older patients than their peers younger.

CONCLUSION

Our findings showed that 36,2% of CVI patients met PA recommendations, with lower odds found among older patients. Public health interventions to enhance PA engagement among CVI patients should prioritize those who are older.

The association of physical activity fragmentation with all-cause mortality in Hispanics: a prospective cohort study

Background

Physical activity fragmentation represents the frequency of transitioning from an active to sedentary state. The prognostic information of physical activity fragmentation is unclear in Hispanics/Latinos. This study examined the association of PA fragmentation with all-cause mortality in Hispanic/Latino adults.

Methods

We investigated 11,992 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (18-74 yr; 52.2% women), from four United States urban communities (Bronx, New York; Chicago, Illinois; Miami, Florida; San Diego, California), that wore an accelerometer for one week. Physical activity fragmentation was calculated using the active-to-sedentary transition probability (ASTP) as the reciprocal of the average active bout duration. Daily total log-transformed activity count (TLAC) was used as a measure of total physical activity. The residual of ASTP regressed on TLAC (TLAC-adjusted ASTP) was explored to investigate the association of ASTP independent of total physical activity. Deaths were identified from annual follow-up interviews, obituary searches, or matches to the National Death Index through December 31, 2021. Cox regression models were fitted according to physical activity fragmentation.

Findings

There were 745 deaths (6.2%) over a mean follow-up of 11.2 (SD 2.2) years. The highest compared to the lowest tertile of ASTP showed a HR of 1.45 (95% CI 1.10-1.92) of all-cause mortality after accounting for confounders. The mortality risk also increased for each 0.10-unit increase of ASTP, as a continuous variable, by 22% (HR 1.22; 95% CI 1.07-1.39). The results were similar considering TLAC-adjusted ASTP.

Interpretation

Among Hispanic/Latino adults, more fragmented physical activity was associated with elevated all-cause mortality, independent of total physical activity volume.

Funding

HCHS/SOL was supported by the National Institutes of Health.

Guided Self-Help vs Group Treatment for Children With Obesity: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

Family-based behavioral treatment (FBT) for children with obesity is provided in weekly parent and child groups over 6 months. A guided self-help FBT program (gshFBT) is provided to the dyad in short meetings. Both interventions provide the same content; however, gshFBT provides this content in less time (FBT = 23 hours, gshFBT = 5.3 hours). This study aimed to evaluate whether gshFBT is noninferior to FBT on child weight loss and cost-effectiveness.

METHODS

150 children aged between 7.0 and 12.9 years with a BMI between the 85th and 99.9th percentile and their parent were recruited and randomized to a 6-month program of gshFBT (n = 75) or FBT (n = 75) and were followed 12 months post-treatment.

RESULTS

A total of 150 children (mean age = 10.1 years, 49% female, mean BMIz = 2.09) and their parent (mean age = 41.5 years, 87% female, 45% Hispanic, 37% White non-Hispanic, 9.7% Asian, 4.8% Black, 7.3% other) were recruited from the San Diego Metropolitan area. Joint LME models showed that gshFBT was noninferior to FBT on child weight loss (ΔBMIz = -0.02 [90% credible interval [CI] -0.08-0.05, P = .65]; ΔBMIp95% = -1.57 [90% CI -4.46-1.31, P = .28]) and cost less (cost/dyad gshFBT = $1498; FBT = $2775).

CONCLUSION

The gshFBT program provided similar weight losses for children with less contact hours and with lower cost than FBT. The reduced time and ease of scheduling for the family in gshFBT will allow for an increased reach of treatment to a greater proportion of families in need.

A scoping review of sleep discrepancy methodology: What are we measuring and what does it mean?

STUDY OBJECTIVES

To examine how past studies have conceptualised sleep discrepancy and identify and evaluate the methods used for its measurement and analysis.

METHOD

We searched MEDLINE, Embase, PsycINFO, CINAHL Plus, PubMed, Scopus, and Web of Science in April 2022 for studies comparing self-report and objective measures of sleep. Methodological information was extracted from relevant studies and included measures of self-report and objective sleep, sleep variables (e.g., total sleep time), derived discrepancy indices (e.g., difference scores), handling of repeated measurements, and methods of measure comparison (e.g., Bland-Altman analyses).

RESULTS

Two hundred and forty-four relevant records were identified. Studies varied according to objective sleep measure; actigraphy algorithm, software, and rest interval; polysomnography setting and scoring criteria; sleep variables; self-report sleep measure; number of nights of objective recording; time frame of self-report measure; self-report sleep variable definition; sleep discrepancy derived index; presence and handling of repeated measurements; and statistical method for measure comparison.

CONCLUSIONS

Sleep discrepancy was predominantly conceived as discordance in sleep states or sleep time variables, and various forms of this discordance differed in their conceptual distance to sleep misperception. Furthermore, studies varied considerably in methodology with critical conceptual and practical implications that have received little attention to date. Substantive methodological issues were also identified relating to the use of derived indices for operationalising sleep discrepancy, defining objective sleep onset latency, calculating actigraphy rest intervals, measuring correlation and concordance, averaging sleep variables across nights, and defining sleep quality discrepancy. Solutions and recommendations for these issues are discussed.

Health-related quality of life associated with fatigue, physical activity and activity pacing in adults with chronic conditions

BACKGROUND

Fatigue and inactivity are linked to decreased health-related quality of life (HRQoL) in chronic conditions. A multidimensional approach to activity pacing may improve HRQoL by promoting physical activity (PA) and alleviating fatigue. Addressing fatigue across chronic conditions is crucial, especially when underlying causes are unknown. This study aimed to (1) examine associations between HRQoL, fatigue, pacing, risk of overactivity, PA, and self-regulation of PA in adults with chronic conditions and (2) examine if these associations differ across HRQoL domains: physical, social, emotional, and functional well-being.

METHODS

Sixty-six adults with chronic conditions were recruited from UK fatigue clinics and the community. HRQoL, pacing, risk of overactivity, PA, and self-regulation of PA were assessed with standardised questionnaires and Actigraph monitor. Associations were analysed with linear mixed models, correcting for confounders.

RESULTS

HRQoL was significantly associated with fatigue (B=-7.82), pacing (B=-0.23), and self-regulation of PA (B = 0.11). Interaction effects revealed fatigue's impact on HRQoL varied significantly in physical (β=-13.49), social (β=-6.81), and emotional (β=-4.10) domains. Pacing showed significant differences in physical (β=-0.49), social (β=-7.12), and emotional (β=-7.45) domains. Perceived overactivity differed in social domain (β=-6.27), while device-based PA differed in physical (β = 0.35) and social (β = 5.73).

CONCLUSION

The negative association between fatigue and HRQoL underscores the importance of effective fatigue management. Higher pacing engagement and lower HRQoL may indicate higher fatigue. Positive associations between self-regulation and PA with HRQoL emphasise benefits of appropriate PA behaviours. The stronger impact of decreased fatigue, increased pacing, and PA on physical well-being suggests a multidimensional fatigue management approach.

Daily physical activity and cardiorespiratory fitness in adults with Down syndrome with and without congenital heart disease

BACKGROUND

Individuals with Down syndrome (DS) typically exhibit lower cardiorespiratory fitness and reduced moderate-to-vigorous physical activity (MVPA) compared to persons without disability. Approximately 50-55 % of individuals with DS have congenital heart disease (CHD), which is associated with cardiopulmonary deficiencies and reduced MVPA participation in non-DS populations. It is unknown if CHD related comorbidities compound with DS associated deficits in physical activity and fitness.

OBJECTIVE

To compare physical activity, cardiorespiratory fitness, and cardiovascular function, of persons with DS with and without CHD.

METHODS

Baseline data were used from a 12-month randomized controlled physical activity intervention of adults with DS. Participants with DS were age and sex matched based on presence of CHD. Measures of physical activity through accelerometry (n = 42; CHD, n = 21), cardiorespiratory fitness (VO2peak; n = 34, CHD n = 17), and cardiovascular function (anaerobic threshold, chronotropic index, O2 pulse; n = 34, CHD n = 17) were compared by CHD status using Wilcoxon rank sum tests.

RESULTS

There were no differences in VO2peak between those with and without CHD (CHD 20.3 ml/kg/min; no CHD 21.3 ml/kg/min, p = 0.44). MVPA was lower for those with CHD vs. without CHD (10.0 vs 13.3 min/week, p = 0.05). There were no differences in cardiovascular function by group.

CONCLUSION

Fitness and physical activity were low regardless of CHD status. Adults with DS and CHD may engage in less physical activity than those without CHD, however fitness and cardiovascular function were not further impaired by CHD. Given the prevalence of CHD in DS, it is important to include those with CHD in work increasing physical activity and fitness.

Within-person changes in objectively measured activity levels as a predictor of brain atrophy in multiple sclerosis

Objective

The evaluate the association between changes in accelerometry-derived activity patterns and brain atrophy in people with multiple sclerosis (PwMS).

Methods

We included PwMS aged ≥40 years with approximately annual brain MRI who wore GT9X Actigraph accelerometers every three months over two years. Functional principal components analysis (fPCA) summarized overall activity and timing. Additional indices included total and 2-hour specific activity, sedentary time, and circadian rhythm parameters. Whole brain segmentation used SLANT-CRUISE. Generalized estimating equations quantifying between- and within-person effects modeled associations between accelerometry changes and MRI outcomes, adjusting for demographic and clinical factors.

Results

We included 233 PwMS (mean age: 54.4 years, SD: 8.6, 30% male) who wore accelerometers an average of 6.3 times over 58 days across two years. fPCA showed within-person increases in the first fPC, representing low nighttime and high morning activity, were associated with slower brain atrophy (per 1 SD increase: 0.24%; 95% CI: 0.10, 0.40; p=0.0009). Similarly, a 10% increase in 8:00-10:00 AM activity was associated with 0.49% higher whole brain volume (95% CI: 0.19, 0.79; p=0.001) over time, while increased nighttime activity (0:00-2:00) was linked to -0.28% brain volume loss (95% CI: -0.48, -0.08; p=0.007). Higher moderate-to-vigorous activity and daytime activity were associated with greater brain volume preservation longitudinally.

Interpretation

Changes in activity patterns, particularly increased nighttime activity and reduced morning activity, are linked to brain atrophy in PwMS. Accelerometry offers a scalable, sensitive method for tracking MS progression and may be beneficial as a recruitment or outcome measure in trials.

A systematic review of passive data for remote monitoring in psychosis and schizophrenia

There is increasing use of digital tools to monitor people with psychosis and schizophrenia remotely, but using this type of data is challenging. This systematic review aimed to summarise how studies processed and analysed data collected through digital devices. In total, 203 articles collecting passive data through smartphones or wearable devices, from participants with psychosis or schizophrenia were included in the review. Accelerometers were the most common device (n = 115 studies), followed by smartphones (n = 46). The most commonly derived features were sleep duration (n = 50) and time spent sedentary (n = 41). Thirty studies assessed data quality and another 69 applied data quantity thresholds. Mixed effects models were used in 21 studies and time-series and machine-learning methods were used in 18 studies. Reporting of methods to process and analyse data was inconsistent, highlighting a need to improve the standardisation of methods and reporting in this area of research.

Nation-wide cohort of device-measured sedentary time and physical activity in the USA-the Cancer Prevention Study-3 (CPS-3) Accelerometry Substudy: cohort profile

PURPOSE

This paper describes the data collection and management methods for the Cancer Prevention Study-3 (CPS-3) Accelerometry Substudy, a nested cohort of device-based physical activity and sedentary time data.

PARTICIPANTS

US-based CPS-3 participants (initially enrolled 2006-2013) who completed the 2018 follow-up survey and had a valid email address were invited to the Accelerometry Substudy (n=109 780). Among the 23 111 participants who registered and were shipped an ActiGraph GT3X+ accelerometer, 21 219 participants returned the device with a complete wear log (91.8%) and 20 950 (90.6%) provided at least three adherent days of data (eg, days with at least 10 hours of wear).

FINDINGS TO DATE

Participants with ≥3 adherent days were predominantly female (n=16 187, 77.3%), non-Latino white (n=17 977, 85.8%) and had an average age of 58 years (SD=9.8). The median daily wear time was 15.3 hours, which did not vary considerably by wear day. The median time spent in moderate-intensity aerobic physical activity was 29 min/day (IQR=36), and the median time in vigorous physical activity was 3 min/day (IQR=13). Participants were sedentary for 9.4 hours (564 min, IQR=171 min) and accumulated a median of 6474 steps per day (IQR=5348).

FUTURE PLANS

The full CPS-3 cohort will be linked with the National Death Index and state cancer registries biennially. Participants will be sent triennial surveys for the next two decades. Future analyses within the CPS-3 Accelerometry Substudy more specifically aim to identify relationships between physical activity, sedentary time and health outcomes, primarily cancer incidence, survival and survivorship.