Pilot study: can older inactive adults learn how to reach the required intensity of physical activity guideline?

Determination of moderate walking intensity using step rate and VO2 reserve in healthy men

OBJECTIVE

This study investigated step rates (SR) during overground walking to estimate the relative aerobic capacity that corresponds to a moderate intensity.

METHODS

The present study utilized a repeated measure, within-subjects design incorporating a counterbalanced order. A total of twenty-three healthy men walked on a 119-meter oval track with artificial turf at self-selected pace (FP), 100, 120, and 140 steps/min for 6 min each while oxygen uptake (VO2), speed (in km/h), distance (in m), and steps (in steps/min) were measured.

RESULTS

During FP, participants walked an average cadence of 117 ± 9.3 steps/minclose to 120 steps/min, which corresponds to 4.7 metabolic equivalents (METs). The estimated VO2 reserve was 30.5% of VO2 reserve at the FP and was close to the 120 steps/min of 33.3%. At the 100 and 140 steps/min, the VO2 reserve were 24.1% and 45.2%, respectively. The regression analysis revealed that an SR of 88.2 elicited 3METs and 17.1% of VO2reserve. Additionally, an SR of 129 elicited 5.9METs and 40% of VO2 reserve.

CONCLUSIONS

This study demonstrated that a moderate walking intensity for young, healthy men corresponded to 128.9 steps per minute. A range of 120 ~ 140 steps/min for walking could be recommended as a general guideline for moderate-intensity exercise. However, concerning providing public guidelines, caution should be taken regarding determining the moderate walking intensity due to the individual's fitness level.

Cadence-based classification of moderate-intensity overground walking in 41- to 85-year-old adults

BACKGROUND

Walking cadence (steps/min) has emerged as a valid proxy of physical activity intensity, with consensus across numerous laboratory-based treadmill studies that ≥100 steps/min approximates absolutely defined moderate intensity (≥3 metabolic equivalents; METs). We recently reported that this cadence threshold had a classification accuracy of 73.3% for identifying moderate intensity during preferred pace overground walking in young adults. The purpose of this study was to evaluate and compare the performance of a cadence threshold of ≥100 steps/min for correctly classifying moderate intensity during overground walking in middle- and older-aged adults.

METHODS

Participants (N = 174, 48.3% female, 41-85 years of age) completed laboratory-based cross-sectional study involving an indoor 5-min overground walking trial at their preferred pace. Steps were manually counted and converted to cadence (total steps/5 min). Intensity was measured using indirect calorimetry and expressed as METs. Classification accuracy (sensitivity, specificity, accuracy) of a cadence threshold of ≥100 steps/min to identify individuals walking at ≥3 METs was calculated.

RESULTS

The ≥100 steps/min threshold demonstrated accuracy of 74.7% for classifying moderate intensity. When comparing middle- vs. older-aged adults, similar accuracy (73.4% vs. 75.8%, respectively) and specificity (33.3% vs. 34.5%) were observed. Sensitivity was high, but was lower for middle- vs. older-aged adults (85.2% vs. 93.9%, respectively).

CONCLUSION

A cadence threshold of ≥100 steps/min accurately identified moderate-intensity overground walking. Furthermore, accuracy was similar when comparing middle- and older-aged adults. These findings extend our previous analysis in younger adults and confirm the appropriateness of applying this cadence threshold across the adult lifespan.

Shifting to Primary Prevention for an Aging Population: A Scoping Review of Health Promotion Initiatives for Community-Dwelling Older Adults in Canada

Older adults are healthier and living independently within our communities for longer. This demonstrates the need to build capacity in geriatric preventative services, with the potential to utilize health promotion to encourage successful aging. This scoping review examines the availability and potential of health promotion initiatives for community-dwelling older adults in Canada. Two research databases were searched for empirical articles published in Canada, in English, since 2000. A total of 17 articles met our inclusion criteria. The empirical literature demonstrates successful implementation of different primary prevention programs, with various facilitation methods used to address several health issues in late life. Most programs targeted falls prevention, often using education or exercise programming. Participants reported positive results in various biopsychosocial aspects of aging. Reported positive health outcomes and high engagement rates across examined programs may represent the ability for health promotion to successfully address the needs of older adults in the community, as well as meet the existing desire for participation in such initiatives. Further implementation and investment into health promotion for older adults can increase the accessibility of these programs across Canada, address new needs amongst this population, and alleviate the future healthcare burden posed by the growing aging demographic. The need for preventative services in gerontology is universal, thus the success seen in health promotion programs and policy, and the need for expansion, in Canada may also be relevant in countries with similar demographics.

Dissemination and implementation of national physical activity, sedentary behaviour, and/or sleep guidelines among community-dwelling adults aged 18 years and older: a systematic scoping review and suggestions for future reporting and research

Strategies for dissemination (purposive distribution of a guideline to specific audiences) and implementation (actions to support the general public in meeting guideline recommendations/behavioural benchmarks) of national movement guidelines (physical activity (PA), sedentary behaviour, and sleep) have yet to be synthesized. The purpose of this systematic scoping review was to identify strategies for dissemination and implementation of national PA, sedentary behaviour, and/or sleep guidelines among community-dwelling adults (aged >18 years) and/or stakeholders in Canada and analogous countries. Five search approaches (e.g., published literature, grey literature, targeted web-based, custom Google, and content expert consultation) identified records (e.g., empirical studies, organizational reports, website pages, or guideline messages) that discussed and/or evaluated dissemination or implementation strategies for a prespecified list of guidelines. A modified strategy classification system was developed to chart the data. Forty-seven reports met inclusion criteria. Dissemination strategies (n = 42) were more frequently reported than implementation strategies (n = 24). Implementation strategies were more frequently evaluated (n = 13 vs. 7 dissemination strategies) and associated with positive outcomes. The 13 studies that evaluated strategies were at high or serious risk of bias. We identified limited information about the dissemination and implementation of national movement guidelines and identified strategies were rarely evaluated. Greater efforts are required to increase the impact of guidelines among the general public and stakeholders and to build the evidence base in this field. (Open Science Framework registration: https://osf.io/4tyw3.) Novelty An adapted movement guideline dissemination and implementation strategy classification framework is provided. Knowledge translation efforts should be documented and evaluated to advance science and practice in the movement guideline field.

The Implication of Wearables and the Factors Affecting Their Usage among Recreationally Active People

Regular physical activity (PA) is associated with health and well-being. Recent findings show that PA tracking using technological devices can enhance PA behavior. Consumer devices can track many different parameters affecting PA (e.g., number of steps, distance, and heart rate). However, it remains unclear what factors affect the usage of such devices. In this study, we evaluated whether there was a change in usage behavior across the first weeks of usage. Further we investigated whether external factors such as weather and day of the week influence usage behavior. Thirty nine participants received a Fitbit Charge 2 fitness tracker for a nine-week period. All participants were asked to wear the device according to their wishes. The usage time and amount of PA were assessed, and the influencing factors, such as weather conditions and day of the week, were analyzed. The results showed that usage behavior differed largely between individuals and decreased after five weeks of usage. Moreover, the steps per worn hour did not change significantly, indicating a similar amount of activity across the nine-week period when wearing the device. Further influencing factors were the day of the week (the tracker was used less on Sundays) and the temperature (usage time was lower with temperatures >25°). Tracking peoples’ activity might have the potential to evaluate different interventions to increase PA.

Validation of Practical Tools to Identify Walking Cadence to Reach Moderate Intensity

It is recommended that adults get at minimum 150 minutes of moderate-to-vigorous physical activity in bouts of 10 minutes or greater every week. Walking cadence (steps per minute) is one easy way to estimate intensity required, however tools that claim to quantify walking intensity via walking cadence have not been validated in adults. We aimed to validate: 1- the accuracy of walking cadence measurement by the Piezo RxD pedometer, Polar Stride Sensor Bluetooth Smart foot pod, and Garmin Ant+ foot pod at different speeds and slopes and 2- the ability of the Piezo RxD to identify bouts of walking at moderate intensity using walking cadence. Inclusion criteria included being aged 19+ and the ability to reach moderate intensity when walking without incline as determined by a treadmill cardiorespiratory fitness test to determine 40% of VO2 reserve. Walking cadence measured from the three tools was compared to a manual count of walking cadence during a series of walking stages at several speeds (2.5-5.5 km/h) and inclines (0-15%). The ability of the Piezo RxD to quantify a 10-minute bout was determined by walking for 12 minutes at 40% of VO2 reserve measured by indirect calorimetry. All correlations between manual walking cadence counts and all devices were significant regardless of speed (r ranging from 0.469 to 0.999; p ≤ 0.05) and slope (r ranging from 0.887 to 0.996; p ≤ 0.05). The Piezo RxD was able to correctly measure a 10-minute bout of walking at moderate intensity for 50 of 51 participants. We found that all walking cadence devices provided accurate measurements of walking cadence. The Piezo RxD is an effective tool to quantify bouts of walking done at a minimum of moderate intensity.

The Impact of Exercise Intensity Feedback Using Technology for Children During Active Play: Pilot Study

BACKGROUND

Most children do not engage in enough exercise at the recommended intensity. Using technological devices may increase the time children spend at greater intensities while exercising.

OBJECTIVE

This study aimed to determine if children who are receiving instant feedback on their exercise intensity using technology would spend more time in moderate-vigorous intensity (≥70% of maximum capacity) during active play sessions. It also aimed to explore if the children's physical characteristics were associated with the average percentage of maximal heart rate (HR) reached during sessions.

METHODS

Participants were asked to wear a HR monitor, attached around their chest, for 4 sessions out of the 15 sessions offered. Twenty children aged 5 to 11 years received feedback for 2 random sessions. When receiving feedback, color-coded intensity based on HR was projected onto a wall. Green corresponded to moderate intensity (≥70% of max HR) and red corresponded to a HR below moderate intensity. Age, anthropometric measures, muscle strength, body composition, physical activity level, and fitness level were measured.

RESULTS

The average percentage of maximal HR during a session was similar whether feedback was provided (70.7%, SD 6.4%) or not (71.1%, SD 4.1%) with P=.93. No personal characteristics were associated with the average intensity recorded during the exercise sessions.

CONCLUSIONS

Receiving instant exercise intensity feedback is not associated with a higher proportion of time spent at moderate intensity or above in children aged 5 to 11 years when involved in an active play program. Personal characteristics are not associated with the intensity recorded when participating in an active play program.

How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review

Background

Cadence (steps/min) may be a reasonable proxy-indicator of ambulatory intensity. A summary of current evidence is needed for cadence-based metrics supporting benchmark (standard or point of reference) and threshold (minimums associated with desired outcomes) values that are informed by a systematic process.

Objective

To review how fast, in terms of cadence, is enough, with reference to crafting public health recommendations in adults.

Methods

A comprehensive search strategy was conducted to identify relevant studies focused on walking cadence and intensity for adults. Identified studies (n=38) included controlled (n=11), free-living observational (n=18) and intervention (n=9) designs.

Results

There was a strong relationship between cadence (as measured by direct observation and objective assessments) and intensity (indirect calorimetry). Despite acknowledged interindividual variability, ≥100 steps/min is a consistent heuristic (e.g, evidence-based, rounded) value associated with absolutely defined moderate intensity (3 metabolic equivalents (METs)). Epidemiological studies report notably low mean daily cadences (ie, 7.7 steps/min), shaped primarily by the very large proportion of time (13.5 hours/day) spent between zero and purposeful cadences (<60 steps/min) at the population level. Published values for peak 1-min and 30-min cadences in healthy free-living adults are >100 and >70 steps/min, respectively. Peak cadence indicators are negatively associated with increased age and body mass index. Identified intervention studies used cadence to either prescribe and/or quantify ambulatory intensity but the evidence is best described as preliminary.

Conclusions

A cadence value of ≥100 steps/min in adults appears to be a consistent and reasonable heuristic answer to ’How fast is fast enough?' during sustained and rhythmic ambulatory behaviour.

Trial registration number

NCT02650258

Can older adults improve the identification of moderate intensity using walking cadence?

BACKGROUND

The majority of older adults do not reach the physical activity guidelines. One possible explanation for this may be that older adults overestimate their physical activity levels, because they are unable to identify exercise intensity.

METHODS

Forty-four older adults were recruited and randomly assigned into two walking groups lasting 6 weeks. The intervention group was asked to walk a minimum of 150 min per week at moderate intensity using walking cadence indicated with a pedometer. The control group did not get any feedback on walking intensity.

RESULTS

The ability to identify moderate intensity while walking did not significantly improve in neither groups (p = 0.530). However, participants in the intervention group increased significantly the time spent at moderate intensity, in 10 min bouts (p < 0.01).

DISCUSSION

A pedometer providing walking cadence to reach moderate intensity is a good tool for increasing time walked at the recommended intensity, but not because participants know more what is considered moderate intensity.

Efficacy of moderate-intensity walking provided feedback by ECE PEDO on abdominal fat in overweight and obese women: A randomized, exercise study

Objectives

The aim of this study was to investigate the effectiveness of walking with Equipment for Clever Exercise (ECE PEDO) compared to supervised, moderate-intensity, aerobic, treadmill walking exercise in overweight and obese women.

Patients and methods

Between September 2014 and January 2015, 28 women with overweight and obesity were assigned to two groups: supervised treadmill walking (Group 1, n=14) or walking with ECE PEDO (Group 2, n=14). The target heart rate (HR) corresponding to values of 50 to 70% VO2max were determined by submaximal treadmill test. Group 1 was instructed walking at their target HR on treadmill. The number of steps in a min corresponding to the target HR was calculated by a criterion pedometer and Group 2 was instructed walking in this step range recorded to the ECE PEDO giving audible feedback. Before and after a 12-week exercise program, all participants were evaluated by Body Mass Index (BMI) and waist circumference (WC). Ultrasonographic visceral fat thickness (VFT) and ergospirometric VO2max.

Results

The VFT decreased in both walking groups in association with reduced WC and weight loss and also significant increases in the VO2max after exercise intervention (p<0.05). The VFT decreased only in women by walking with ECE PEDO compared to the other group (p<0.05).

Conclusion

Our study results showed that both moderate-intensity exercise provided by a novel pedometer and supervised treadmill walking showed significant improvements in abdominal obesity and VO2max.

Prescribing of Electronic Activity Monitors in Cardiometabolic Diseases: Qualitative Interview-Based Study

BACKGROUND

The prevalence of noncommunicable diseases, including those such as type 2 diabetes, obesity, dyslipidemia, and hypertension, so-called cardiometabolic diseases, is high and is increasing worldwide. Strong evidence supports the role of physical activity in management of these diseases. There is general consensus that mHealth technology, including electronic activity monitors, can potentially increase physical activity in patients, but their use in clinical settings remains limited. Practitioners' requirements when prescribing electronic activity monitors have been poorly described.

OBJECTIVE

The aims of this qualitative study were (1) to explore how specialist physicians prescribe electronic activity monitors to patients presenting with cardiometabolic conditions, and (2) to better understand their motivation for and barriers to prescribing such monitors.

METHODS

We conducted qualitative semistructured interviews in March to May 2016 with 11 senior physicians from a public university hospital in France with expertise in management of cardiometabolic diseases (type 1 and type 2 diabetes, obesity, hypertension, and dyslipidemia). Interviews lasted 45 to 60 minutes and were audiotaped, transcribed verbatim, and analyzed using directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS

Most physicians we interviewed had never prescribed electronic activity monitors, whereas they frequently prescribed blood glucose or blood pressure self-monitoring devices. Reasons for nonprescription included lack of interest in the data collected, lack of evidence for data accuracy, concern about work overload possibly resulting from automatic data transfer, and risk of patients becoming addicted to data. Physicians expected future marketing of easy-to-use monitors that will accurately measure physical activity duration and intensity and provide understandable motivating feedback.

CONCLUSIONS

Features of electronic activity monitors, although popular among the general public, do not meet the needs of physicians. In-depth understanding of physicians' expectations is a first step toward designing technologies that can be widely used in clinical settings and facilitate physical activity prescription. Physicians should have a role, along with key health care stakeholders-patients, researchers, information technology firms, the public, and private payers-in developing the most effective methods for integrating activity monitors into patient care.

Impact of Walking Cadence Prescription to Reach the Global Physical Activity Recommendations in Older Adults

Walking cadence is a new monitoring strategy used to increase bouts of time at moderate intensity. Inactive older adults were instructed to walk 150 min per week at no specified intensity during phase one. In phase two, the intervention group (N = 23) received instructions on how to reach moderate intensity, using a pedometer and an individualized walking cadence, while the control group (N = 22) did not. The main outcomes were time at moderate intensity and moderate intensity in 10-min bouts. During phase two only the intervention group increased time at moderate intensity and moderate intensity in 10-min bouts compared with phase one and compared with the control group (p ≤ .01). Older adults can increase time walked at moderate intensity in 10-min bouts weekly by using individually prescribed walking cadence, a pedometer to track intensity, and practicing walking at this cadence.

The prevalence of physical activity and its associated effects among students in the São Paulo public school network, Brazil

The current study evaluated physical activity (PA) level and its associated effects among students in the public network of São Paulo, Brazil. A cross-sectional study was taken using a representative sample of students in São Paulo public school system. International Physical Activity Questionnaire determined PA level. Students who reported at least 300 minutes/week of PA were considered active. The independente variables were: gender, age, body mass index, education, region, recognition of the Agita São Paulo program. The prevalence of regular PA was 71.7%. Males (PR = 1.09, 95% CIs = 1.04 -1.15) at least 17 years old (PR = 1.16, 95% CIs 1.09-1.24) in their 3rd year of high school (PR = 1.20, 95% CIs = 1.12-1.29) who resided in the Midwest region (PR = 1.27, 95% CIs 1.16-1.38) were most likely to be active. Males at least 17 years old in their 3rd year of high school who lived in the Midwest and recognized the Agita São Paulo/Agita Galera program had higher levels of PA. São Paulo students presented a high level of PA. Moreover, males older than 17 years, attending their 3rd year of high school, who lived in the Midwest region, and recognized the Agita São Paulo/Agita Galera program were the most likely to be more active.

Walking Cadence to Exercise at Moderate Intensity for Adults: A Systematic Review

Background. Most adults choose walking as a leisure activity. However, many do not reach the international physical activity guidelines for adults, which recommend moderate intensity aerobic activity for at least 150 minutes/week in bouts of 10 minutes. Purpose. This systematic review provides an update on the walking cadence required to reach moderate intensity in adults and older adults, identifies variables associated with reaching moderate intensity, and evaluates how walking cadence intensity should be measured, but the main purpose is to report the interventions that have been attempted to prescribe walking cadence to increase time spent at moderate intensity or other outcomes for adults and older adults. Methods. SportDISCUS, Scopus, and PubMed databases were searched. We identified 3,917 articles and 31 were retained for this systematic review. Only articles written in English were included. Results. In general, 100 steps/minute is prescribed for adults to achieve moderate intensity, but older adults may require a higher cadence. Currently, few studies have explored using walking cadence prescription as an intervention to increase physical activity levels. Conclusion. Prescribing walking cadence as a way to increase physical activity levels has potential as a practical and useful strategy, but more evidence is required to assess its ability to increase physical activity levels at moderate intensity.

Cadence Feedback With ECE PEDO to Monitor Physical Activity Intensity: A Pilot Study

The purpose of this study was to examine the monitoring capabilities of the equipment for clever exercise pedometer (ECE PEDO) that provides audible feedback when the person exceeds the upper and lower limits of the target step numbers per minute and to compare step counts with Yamax SW-200 (YX200) as the criterion pedometer.A total of 30 adult volunteers (15 males and 15 females) were classified as normal weight (n = 10), overweight (n = 10), and obese (n = 10). After the submaximal exercise test on a treadmill, the moderate intensity for walking was determined by using YX200 pedometer and then the number of steps taken in a minute was measured. Lower and upper limits of steps per minute (cadence) were recorded in ECE PEDO providing audible feedback when the person's walking speed gets out of the limits. Volunteers walked for 30 minutes in the individual step count range by attaching the ECE PEDO and YX200 pedometer on both sides of the waist belt in the same session. Step counts of the volunteers were recorded. Wilcoxon, Spearman correlation, and Bland-Altman analyses were performed to show the relationship and agreement between the results of 2 devices.Subjects took an average of 3511 ± 426 and 3493 ± 399 steps during 30 minutes with ECE PEDO and criterion pedometer, respectively. About 3500 steps taken by ECE PEDO reflected that this pedometer has capability of identifying steps per minute to meet moderate intensity of physical activity. There was a strong correlation between step counts of both devices (P < 0.001, r = 0.96). Correlations across all three BMI categories and both sex remained consistently high ranging from 0.92 to 0.95. There was a high level of agreement between the ECE PEDO and YX200 pedometer in the Bland-Altman analysis.Although both devices showed a strong similarity in counting steps, the ECE PEDO provides monitoring of intensity such that a person can walk in a specified time with a desired speed.

People who perceive themselves as active cannot identify the intensity recommended by the international physical activity guidelines

Background

Many national and international organizations recommend that adults achieve at least 150 minutes of aerobic physical activity (PA) weekly, at a minimum moderate intensity to optimize health benefits. It is unknown if people who consider themselves as active have the ability to identify what is considered moderate intensity.

Methods

Fifty-one participants who reported achieving a minimum 150 minutes per week at a minimum of moderate intensity PA were recruited through a local fitness facility. All participants underwent a single assessment involving questionnaires, clinical measures, and a treadmill test to measure the ability to perceive moderate intensity. Following the visit, participants’ PA level was evaluated by heart rate monitor, while exercising, for 7 consecutive days.

Results

Eighty percent of participants overestimated moderate intensity on the treadmill test; they were at vigorous intensity compared to what is considered moderate. Only 11.8% of participants accurately identified moderate intensity; all of them were women (P=0.03), had a high level of education (P=0.04), and knew that moderate intensity was the minimum intensity recommended by health organizations (P<0.01). Only 69.2% of participants reached the aerobic component of the International Physical Activity Guidelines with no significant advantage for those correctly identifying moderate intensity.

Conclusion

Most people who perceive themselves as active are exercising at vigorous intensity while believing they are at moderate intensity. In addition, in this active sample, one-third of the participants were not reaching the aerobic component of the International Physical Activity Guidelines.

Walking cadence and mortality among community-dwelling older adults

BACKGROUND

Older adults are encouraged to walk ≥100 steps∙minute(-1) for moderate-intensity physical activity (i.e., brisk walking). It is unknown if the ability to walk ≥100 steps∙minute(-1) predicts mortality.

OBJECTIVE

To determine if the ability to walk ≥100 steps∙minute(-1) predicts mortality among older adults.

DESIGN, SETTING, AND PATIENTS

A population-based cohort study among 5,000 older adults from the Third National Health and Nutrition Survey (NHANES III; 1988-1994). Vital status and cause of death were collected through December 31, 2006. Median follow-up was 13.4 years. Average participant age was 70.6 years.

MEASUREMENTS

Walking cadence (steps∙minute(-1)) was calculated using a timed 2.4-m walk. Walking cadence was dichotomized at 100 steps∙minute(-1) (≥100 steps∙minute(-1) versus <100 steps∙minute(-1)) to demarcate the lower threshold of absolutely defined moderate-intensity physical activity. Walking cadence was also analyzed as a continuous variable. Predicted survival was compared between walking cadence and gait speed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular-specific and cancer-specific mortality and mortality from other causes.

RESULTS

Among 5,000 participants, 3,039 (61 %) walked ≥100 steps∙minute(-1). During follow-up, 3,171 subjects died. In multivariable-adjusted analysis, ability to walk ≥100 steps∙minute(-1) predicted a 21 % reduction in all-cause mortality (hazard ratio [HR], 0.79; 95 % confidence interval [95 % CI], 0.71-0.89, p < 0.001). Each ten-step increase in walking cadence predicted a 4 % reduction in all-cause mortality (HR, 0.96, [0.94-0.98], p < 0.001). In secondary analyses, ability to walk ≥100 steps∙minute(-1) predicted reductions in cardiovascular-specific mortality (HR, 0.79 [0.67-0.92], p = 0.002), cancer-specific mortality (HR, 0.76 [0.58-0.99], p = 0.050), and mortality from other causes (HR, 0.82 [0.68-0.97], p = 0.025). Predicted survival, adjusted for age and sex, was not different using walking cadence versus gait speed.

LIMITATIONS

Walking cadence was a cross-sectional measurement.

CONCLUSIONS

The ability to walk ≥100 steps∙minute(-1) predicts a reduction in mortality among a sample of community-dwelling older adults.