How Many Steps/Day Are Enough?

Combining anchoring with financial incentives to increase physical activity: a randomized controlled trial among college students

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring.

Design and rationale for a randomized clinical trial testing the efficacy of a lifestyle physical activity intervention for people with HIV and engaged in unhealthy drinking

BACKGROUND

Among people living with HIV (PLWH), unhealthy drinking presents an increased risk for negative outcomes. Physical inactivity and sedentariness raise additional health risks. Despite evidence that physical activity (PA) is associated with improved physical and mental functioning and reduced alcohol cravings, there have been no PA studies conducted with PLWH engaged in unhealthy drinking. We describe a study protocol of a remote lifestyle physical activity (LPA) intervention to increase PA and reduce alcohol consumption among PLWH.

METHODS

Using online advertisements, 220 low-active PLWH engaged in unhealthy drinking will be recruited and randomized nationwide. After providing informed consent and completing a baseline interview, participants will receive a Fitbit. Participants will complete 15 days of ecologic momentary assessment through a phone application and up to 15 days of Fitbit wear time. Following this period, participants will be randomly assigned to a Fitbit-only control condition or a LPA and Fitbit intervention condition. Health counselors meet with control participants once (and have 6 subsequent brief check ins on Fibit use) and with intervention participants 7 times for PA counseling over a 12-week period. Follow-up assessments will be conducted at 3- and 6-months post-randomization. We hypothesize that individuals in the LPA and Fitbit condition will have lower rates of alcohol consumption and higher rates of PA at 6-month follow-up.

CONCLUSION

The randomized controlled trial described in this paper investigates remote methods to influence multimorbidity among PLWH using a LPA approach for increasing PA and reducing alcohol consumption.

Is public transport a promising strategy for increasing physical activity? Evidence from a study of objectively measured public transport use and physical activity

BACKGROUND

Greater public transport use has been linked to higher physical activity levels. However, neither the amount of physical activity associated with each daily public transport trip performed, nor the potential total physical activity gain associated with an increase in trips/day, has been determined. Using objective measures, we aimed to quantify the association between public transport use, physical activity and sedentary time.

METHODS

A longitudinal study of Australian adults living in Hobart, Tasmania, who were infrequent bus users (≥ 18 years; used bus ≤ 2 times/week). The number of bus trips performed each day was determined from objective smartcard data provided by the public transportation (bus) provider across a 36-week study timeframe. Accelerometer measured steps/day (primary outcome), moderate-to-vigorous physical activity (min/day), and sedentary time (min/day) were assessed across four separate one-week periods.

RESULTS

Among 73 participants across 1483 day-level observations, on days that public transport was used, participants achieved significantly more steps (β = 2147.48; 95%CI = 1465.94, 2829.03), moderate to vigorous physical activity (β = 22.79; 95% CI = 14.33, 31.26), and sedentary time (β = 37.00; 95% CI = 19.80, 54.21) compared to days where no public transport trips were made. The largest increase in steps per day associated with a one-trip increase was observed when the number of trips performed each day increased from zero to one (β = 1761.63; 95%CI = 821.38, 2701.87). The increase in the number of steps per day was smaller and non-significant when the number of trips performed increased from one to two (β = 596.93; 95%CI=-585.16, 1779.01), and two to three or more (β = 632.39; 95%CI=-1331.45, 2596.24) trips per day. Significant increases in sedentary time were observed when the number of trips performed increased from zero to one (β = 39.38; 95%CI = 14.38, 64.39) and one to two (β = 48.76; 95%CI = 25.39, 72.12); but not when bus trips increased from two to three or more (β=-27.81; 95%CI=-76.00, 20.37).

CONCLUSIONS

Greater public transport use was associated with higher physical activity and sedentary behaviour. Bus use may yield cumulative increases in steps that amount to 15-30% of the daily recommended physical activity target. A policy and public health focus on intersectoral action to promote public transport may yield meaningful increases in physical activity and subsequent health benefits.

A social media game to increase physical activity among older adult women: protocol of a randomized controlled trial to evaluate CHALLENGE

BACKGROUND

Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count.

METHODS

We will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews.

DISCUSSION

By taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.

Amplify Gait to Improve Locomotor Engagement in Spinal Cord Injury (AGILE SCI) trial: study protocol for an assessor blinded randomized controlled trial

BACKGROUND

Among ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.g., error augmentation) can accelerate motor learning by intensifying sensorimotor feedback and facilitating exploration of motor control strategies. These features may be beneficial for retraining walking balance after iSCI. We have developed a cable-driven robot that creates a movement amplification environment during treadmill walking. The robot applies a continuous, laterally-directed, force to the pelvis that is proportional in magnitude to real-time lateral velocity. Our purpose is to investigate the effects of locomotor training in this movement amplification environment on walking balance. We hypothesize that for ambulatory people with iSCI, locomotor training in a movement amplification environment will be more effective for improving walking balance and participation in walking activities than locomotor training in a natural environment (no applied external forces).

METHODS

We are conducting a two-arm parallel-assignment intervention. We will enroll 36 ambulatory participants with chronic iSCI. Participants will be randomized into either a control or experimental group. Each group will receive 20 locomotor training sessions. Training will be performed in either a traditional treadmill environment (control) or in a movement amplification environment (experimental). We will assess changes using measures that span the International Classification of Functioning, Disability and Health (ICF) framework including 1) clinical outcome measures of gait, balance, and quality of life, 2) biomechanical assessments of walking balance, and 3) participation in walking activities quantified by number of steps taken per day.

DISCUSSION

Training walking balance in people with iSCI by amplifying the individual's own movement during walking is a radical departure from current practice and may result in new strategies for addressing balance impairments. Knowledge gained from this study will expand our understanding of how people with iSCI improve walking balance and how an intervention targeting walking balance affects participation in walking activities. Successful outcomes could motivate development of clinically feasible tools to replicate the movement amplification environment within clinical settings.

TRIAL REGISTRATION

NCT04340063.

Use of activity trackers to improve blood pressure in young people at risk for cardiovascular disease: a pilot randomized controlled trial

BACKGROUND

Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care.

METHODS

Participants were recruited at a single academic medical center. Those aged 8-30 years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6 months.

RESULTS

Sixty-three participants were enrolled (57% male; mean age: 18 ± 4 years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6 months (- 2.3 mmHg; 95% CI - 6.5, 1.8 vs. 3.0 mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12).

CONCLUSIONS

Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6 months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).

Daily steps and all-cause mortality: An umbrella review and meta-analysis

OBJECTIVE

This study aimed to describe the variability in estimates of the association of daily steps and all-cause mortality in systematic reviews with meta-analyses, to identify the factors potentially responsible for it, and to provide an updated estimate.

METHODS

Five databases were systematically searched up to May 2024 to identify systematic reviews with meta-analyses and prospective cohort studies. A qualitative synthesis of previous reviews and an updated meta-analysis of cohort studies were performed. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using a random-effects model.

RESULTS

Eleven systematic reviews with meta-analyses and 14 cohort studies were included, revealing considerable variability in result presentation. Our updated meta-analysis showed a nonlinear association, indicating a lower risk of all-cause mortality with increased daily steps, with a protective threshold at 3143 steps/day, and a pooled HR of 0.91 (95% CI: 0.87, 0.95) per 1000 steps/day increment. Physical activity categories consistently indicated progressively reduced mortality risk, with the highly active category (>12,500 steps/day) exhibiting the lowest risk (0.35 (95% CI: 0.29, 0.42)).

CONCLUSION

Systematic reviews and meta-analyses showed considerable variability in effect estimates due to different methods of quantifying exposure. Despite it, our study underscores the importance of increased daily steps in reducing all-cause mortality, with a minimum protective dose of 3000 steps/day, although the optimal dose differed according to age and sex. It is recommended that future studies categorise daily steps by physical activity category, perform dose-response analyses, and use increments of 1000 steps/day.

Physical Activity and Sedentary Behavior as Treatable Traits for Clinical Control in Moderate-to-Severe Asthma

BACKGROUND

Physical activity and sedentary behavior are treatable traits that may impact asthma control in distinct manners, but this impact remains poorly understood.

OBJECTIVE

To evaluate the influence of physical activity and sedentary behavior on clinical control in adults with moderate-to-severe asthma.

METHODS

This cross-sectional, multicentric study included 426 individuals with moderate-to-severe asthma. Assessments included physical activity and sedentary time (actigraphy), clinical asthma control (Asthma Control Questionnaire [ACQ]), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), anthropometric data, and lung function. Participants were grouped according to physical activity levels and sedentary behavior.

RESULTS

Participants who walked ≥7500 steps/day presented better ACQ scores than those who walked <7500 steps/day (P < .05), independent of sedentary status. The percentage of patients with controlled asthma was higher in the active/sedentary (43.9%) and active/nonsedentary (43.8%) groups than in the inactive/sedentary (25.4%) and inactive/nonsedentary (23.9%) groups (P < .02). The likelihood of having uncontrolled asthma according to the treatable traits of physical inactivity (odds ratio [95% confidence interval]: 2.36 [1.55-3.59]), higher anxiety (2.26 [1.49-3.42]), and depression symptoms (1.95 [1.28-2.95]) was significant (P ≤ .002). Obesity and sedentary time were not associated with asthma control.

CONCLUSIONS

Our results show that ≥7500 steps/day is associated with better asthma control independent of sedentary time in adults with moderate-to-severe asthma. Physical inactivity, anxiety, and depression symptoms are associated with higher odds of uncontrolled asthma. These results suggest that interventions should mainly focus on increasing physical activity rather than reducing sedentary time.

The impact of goal-directed prehabilitation therapy on functional capacity in patients undergoing hepatobiliary and pancreatic surgery: A randomized clinical trial

BACKGROUND

Emerging evidence has supported the idea that goal-directed prehabilitation is a promising approach to boost functional capacity in preoperative patients. However, its usefulness has not been tested in the hepatobiliary and pancreatic fields. The objective of this trial was to investigate the efficacy of goal-directed prehabilitation for improving functional capacity in patients who were planned to undergo major hepatobiliary and pancreatic operations.

METHODS

This assessor-blinded, parallel-arm, randomized clinical trial recruited patients who were scheduled for major hepatobiliary and pancreatic surgeries for malignancy. Patients were randomly allocated into the step goal-directed prehabilitation group as the test group and into the conventional prehabilitation group as the control group. Patients in the goal-directed prehabilitation group participated in a walking prehabilitation program with an intergrading goal of the step count. Patients in the conventional prehabilitation group received standard physical and nutritional prehabilitation. The primary outcome was change in the 6-minute walking distance, which ranged from the time before starting prehabilitation (baseline) to the time after completing prehabilitation (immediately before surgery).

RESULTS

Among 180 randomized patients, 144 patients were included in the primary analysis (73 patients in the conventional prehabilitation group and 71 patients in the goal-directed prehabilitation group). The mean change in the 6-minute walking distance was 27 meters in the conventional prehabilitation group and 31 meters in the goal-directed prehabilitation group (P = .633).

CONCLUSION

In patients undergoing major hepatobiliary and pancreatic surgeries for malignancies, a goal-directed prehabilitation program did not result in a significantly greater increase in functional capacity than did conventional prehabilitation.

REGISTRATION NUMBER

UMIN000038791 (https://www.umin.ac.jp/).

Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population

Background

The haemodialysis (HD) population is sedentary, with substantial cardiovascular disease risk. In the general population, small increases in daily step count associate with significant reductions in cardiovascular mortality. This study explores the relationship between daily step count and surrogate markers of cardiovascular disease, including left ventricular ejection fraction (LVEF) and native T1 (a marker of diffuse myocardial fibrosis), within the HD population.

Methods

This was a post hoc analysis of the association between daily step count and metabolic equivalent of task (MET) and prognostically important cardiac magnetic resonance imaging parameters from the CYCLE-HD study (ISRCTN11299707). Unadjusted linear regression and multiple linear regression adjusted for age, body mass index, dialysis vintage, haemoglobin, hypertension and ultrafiltration volume were performed. Significant relationships were explored with natural cubic spline models with four degrees of freedom (five knots).

Results

A total of 107 participants were included [age 56.3 ± 14.1 years, 79 (73.8%) males]. The median daily step count was 2558 (interquartile range 1054-4352). There were significant associations between steps and LVEF (β = 0.292; P = .009) and steps and native T1 (β = -0.245; P = .035). Further modelling demonstrated most of the increase in LVEF occurred at up to 2000 steps/day and there was an inverse dose-response relationship between steps and native T1, with the most pronounced reduction in native T1 between ≈2500 and 6000 steps/day.

Conclusions

The results suggest an association between daily step count and parameters of cardiovascular health in the HD population. These findings support the recommendations for encouraging physical activity but are not the justification. Further research should evaluate whether a simple physical activity intervention improves cardiovascular outcomes in individuals receiving maintenance HD.

Exploring the Effect of Exercise versus Metformin on Insulin Resistance amongst Nigerians with Pre-diabetes: A Randomised Controlled Trial

BACKGROUND

Pre-diabetes is an important risk factor for the development of type 2 diabetes and is common in Nigeria. Effective intervention can reverse the underlying pathogenesis of insulin resistance in pre-diabetes. This study aimed to determine and compare the impact of moderate exercise and metformin interventions on insulin resistance among participants with pre-diabetes.

MATERIALS AND METHODS

Using a randomised placebo-controlled design, 54 Nigerians with pre-diabetes were selected using simple random sampling. They were offered metformin, moderate exercise or placebo treatment and followed up for 12 weeks. Insulin resistance was assessed before and after the interventions and the outcome was compared.

RESULTS

Forty-nine participants with pre-diabetes completed the study. Participants in both the exercise and metformin groups had significantly decreased insulin resistance compared to placebo after 12 weeks of intervention. However, there was a decrease in insulin resistance by 77.3% (homeostasis model assessment-insulin resistance [HOMA-IR]) and an increase in insulin sensitivity by 81.2% (quantitative insulin sensitivity check index [QUICKI]) in the exercise group. In comparison, participants in the metformin group had a decrease in insulin resistance by 66.3% (HOMA-IR) and an increase in insulin sensitivity by 76.2% (QUICKI).

CONCLUSION

Amongst Nigerians with pre-diabetes, both moderate exercise and metformin have significantly higher efficacy than placebo in improving insulin resistance. However, moderate exercise improved insulin resistance more than the metformin intervention. Participants in this study need to be followed up for a longer period to assess the long-term effects of these interventions.

Cardiovascular Health in Black and Latino Adults With Type 2 Diabetes

BACKGROUND

The incidence of type 2 diabetes (T2DM) among U.S. adults has been rising annually, with a higher incidence rate in Black and Hispanic adults than in Whites. The American Heart Association (AHA) has defined cardiovascular health according to the achievement of seven health behaviors (smoking, body mass index [BMI], physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose). Optimal cardiovascular health has been associated with a lower risk of cardiovascular disease, and awareness of this risk may influence healthy behaviors.

OBJECTIVES

This study aimed to assess cardiovascular health in a sample of Black and Hispanic adults (age: 18-40 years) with T2DM and explore the barriers and facilitators to diabetes self-management and cardiovascular health.

METHODS

This was an explanatory sequential mixed-method design. The study staff recruited adults with T2DM for the quantitative data followed by qualitative interviews with a subsample of participants using maximum variation sampling. The seven indices of cardiovascular health as defined by the AHA's "Life's Simple 7" were assessed: health behaviors (smoking, BMI, physical activity, diet) and health factors (total cholesterol, blood pressure, A1C). Qualitative interviews were conducted to explore their results as well as the effects of the pandemic on diabetes self-management. Qualitative and quantitative data were integrated into the final analysis phase.

RESULTS

The majority of the sample was female, with 63% identifying as Black and 47% as Hispanic. The factor with the lowest achievement of ideal levels was BMI, followed by a healthy diet. Less than half achieved ideal levels of blood pressure or physical activity. Themes that emerged from the qualitative data included the impact of social support, the effects of the pandemic on their lives, and educating themselves about T2DM.

DISCUSSION

Achievement of ideal cardiovascular health factors varied, but the achievement of several health factors may be interrelated. Intervening on even one factor while providing social support may improve other areas of cardiovascular health in this population.

Factors Associated With the Cardiovascular Health of Black and Latino Adults With Type 2 Diabetes

AIMS

The purpose of this study was to assess the levels of cardiovascular health (CVH) of Black and Latino adults with type 2 diabetes (T2D) and examine the association of individual and microsystem level factors with their CVH score.

METHODS

This was a cross-sectional design in 60 Black and Latino Adults aged 18-40 with T2D. Data were collected on sociodemographic, individual (sociodemographic, diabetes self-management, sleep disturbance, depressive symptoms, quality of life, and the inflammatory biomarkers IL-6 and hs-CRP) and microsystem factors (family functioning), and American Heart Association's Life's Simple 7 metrics of CVH. Factors significantly associated with the CVH score in the bivariate analyses were entered into a linear regression model.

RESULTS

The sample had a mean age 34 ± 5 years and was primarily female (75%) with a mean CVH score was 8.6 ± 2.2 (possible range of 0-14). The sample achieved these CVH factors at ideal levels: body mass index <25 kg/m2 (8%); blood pressure <120/80 (42%); hemoglobin A1c < 7% (57%); total cholesterol <200 mg/dL (83%); healthy diet (18%); never or former smoker > one year (95%); and physical activity (150 moderate-to-vigorous minutes/week; 45%). In the multivariable model, two factors were significantly associated with cardiovascular health: hs-CRP (B = -0.11621, p < .0001) and the general health scale (B = 0.45127, p = .0013).

CONCLUSIONS

This sample had an intermediate level of CVH, with inflammation and general health associated with overall CVH score.

Cutoff values of motor and cognitive measures for predicting and discriminating levels of activities of daily living after stroke: a scoping review

The various assessments performed by rehabilitation professionals not only indicate the patient's current functional status but can also help determine the future status (prediction) or the ability to perform untested tasks (discrimination). In particular, the cutoff values are the simplest predictive and discriminative tool that can be widely used in clinical practice. The purpose of this scoping review was to summarize the current literature on cutoff values of motor and cognitive function for predicting or discriminating levels of activities of daily living after stroke. A literature search was conducted using the PubMed, CINAHL, and Scopus databases. The creation of the search criteria, primary screening of titles and abstract, and secondary screening by full-text review were performed by two rehabilitation professionals. A total of 54 articles were included. The summary of the cutoff values for prediction based on longitudinal studies revealed that an NIHSS score ≤8 and mRMI score ≥19 at acute hospitalization can predict good functional independence and walking independence, respectively, indicating reliable cutoff values. Cutoff values for predicting specific ADLs, such as toilet use or dressing, were not reported, which was a potential research gap identified in this review. Alternatively, the summary of the cutoff values for discrimination based on cross-sectional studies revealed that 288-367.5 m on the 6-min walk test and 25.5-27.6 points on the FMA-LL can discriminate community and noncommunity walkers. Considering the difference between prediction and discrimination, the reliable predicted cutoff values revealed in this review are useful for planning an intervention based on early prediction. Conversely, cutoff values for discrimination can estimate different performances with simpler test, or use as target values during rehabilitation.

Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial

BACKGROUND

Physical activity is associated with a lower risk of major adverse cardiovascular events, but few individuals achieve guideline-recommended levels of physical activity. Strategies informed by behavioral economics increase physical activity, but their longer-term effectiveness is uncertain. We sought to determine the effect of behaviorally designed gamification, loss-framed financial incentives, or their combination on physical activity compared with attention control over 12-month intervention and 6-month postintervention follow-up periods.

METHODS

Between May 2019 and January 2024, participants with clinical atherosclerotic cardiovascular disease or a 10-year risk of myocardial infarction, stroke, or cardiovascular death of ≥7.5% by the Pooled Cohort equation were enrolled in a pragmatic randomized clinical trial. Participants received a wearable device to track daily steps, established a baseline, selected a step goal increase, and were randomly assigned to control (n=151), behaviorally designed gamification (n=304), loss-framed financial incentives (n=302), or gamification+financial incentives (n=305). The primary outcome of the trial was the change in mean daily steps from baseline through the 12-month intervention period.

RESULTS

A total of 1062 patients (mean±SD age, 67±8; 61% female; 31% non-White) were enrolled. Compared with control subjects, participants had significantly greater increases in mean daily steps from baseline during the 12-month intervention in the gamification arm (adjusted difference, 538.0 [95% CI, 186.2-889.9]; P=0.0027), financial incentives arm (adjusted difference, 491.8 [95% CI, 139.6-844.1]; P=0.0062), and gamification+financial incentives arm (adjusted difference, 868.0 [95% CI, 516.3-1219.7]; P<0.0001). During the 6-month follow-up, physical activity remained significantly greater in the gamification+financial incentives arm than in the control arm (adjusted difference, 576.2 [95% CI, 198.5-954]; P=0.0028), but it was not significantly greater in the gamification (adjusted difference, 459.8 [95% CI, 82.0-837.6]; P=0.0171) or financial incentives (adjusted difference, 327.9 [95% CI, -50.2 to 706]; P=0.09) arms after adjustment for multiple comparisons.

CONCLUSIONS

Behaviorally designed gamification, loss-framed financial incentives, and the combination of both increased physical activity compared with control over a 12-month intervention period, with the largest effect in gamification+financial incentives. These interventions could be a useful component of strategies to reduce cardiovascular risk in high-risk patients.

REGISTRATION

URL: https://clinicaltrials.gov; Unique Identifier: NCT03911141.

Evaluation of physical activity before and after respiratory rehabilitation in normal weight individuals with asthma: a feasibility study

Background

Individuals with asthma spend less time engaging in physical activity compared to the general population. Increasing physical activity has become a patient-centered goal for the treatment of treatable traits of individuals with asthma. There are data showing the possible effects of a pulmonary rehabilitation program on physical activity in obese individuals with asthma but not in normal-weight asthmatics. The objective of this feasibility study is to estimate the number of daily steps and time spent on activity in normal-weight individuals with asthma, measured before and after a pulmonary rehabilitation program.

Methods

Normal-weight individuals with moderate to severe asthma were evaluated. The individuals measured their daily steps with an accelerometer for 5 days before and after a pulmonary rehabilitation program. The study was registered on ClinicalTrials.gov: NCT05486689.

Results

In total, 17 participants were enrolled; one dropout and data on the time in activity of two individuals are missing due to a software error during the download. Data from 16 patients were analyzed. The median number of steps/day at baseline was 5,578 (25th, 75th percentiles = 4,874, 9,685) while the median activity time was 214 min (25th, 75th percentiles = 165, 239). After the rehabilitation program, the number of daily steps increased by a median value of 472 (p-value = 0.561) and the time in activity reduced by 17 min (p-value = 0.357). We also found a significant difference in quality of life, muscle strength, and exercise capacity.

Conclusions

The results of this study make it possible to calculate the sample size of future studies whose main outcome is daily steps in normal-weight individuals with asthma. The difficulties encountered in downloading time in activity data do not allow the same for this outcome.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT05486689.

Comparison of patient-reported outcomes of physical activity and accelerometry in people with multiple sclerosis and ambulatory impairment: A cross-sectional study

BACKGROUND

Accelerometers and patient-reported outcomes (PRO) are used to assess physical activity (PA) in people with multiple sclerosis (pwMS). So far it is unknown, however, whether these assessments represent mobility limitations in pwMS with mild and moderate to severe disability alike. The primary aim of the study was to assess the correlation between accelerometry and International Physical Activity Questionnaire (IPAQ) scores in pwMS with different degrees of ambulatory impairment. Taken its frequent use into account, the Godin Leisure Time Exercise Questionnaire (GLTEQ) was investigated as additional PRO.

METHODS

In a prospective cohort of pwMS, correlational analyses were performed between the number of daily steps, time spent in light, moderate to vigorous PA (MVPA) and time spent sitting as assessed using accelerometry (ActiGraph®-GT3X), and the respective IPAQ and GLTEQ scores. Additionally, associations of PA with disease-specific characteristics, aerobic capacity (VO2peak), walking assessments (Timed 25-Foot Walk, T25FW; 2-Minute Walk Test, 2MWT) and walking perception (Multiple Sclerosis Walking Scale-12; MSWS-12) were explored. Patient subgroups with mild (Expanded Disability Status Scale; EDSS score <4.0) and moderate to severe disability (EDSS ≥4.0) were analysed for the impact of ambulatory impairment on PA. Multiple linear regression was used to determine predictors of PA.

RESULTS

A total of 56 pwMS completed the study, with a mean (standard deviation, SD) age of 48.4 (10.3) years, disease duration of 14.8 (9.6) years and median (interquartile range) EDSS score of 3.5 (2.0 - 4.4). Moderate to weak correlations were found between daily step count and IPAQ total metabolic equivalent (MET) minutes/week (p < 0.001; r = 0.506), MVPA MET-minutes/week (p < 0.01; r = 0.479) and walking MET-minutes/week (p < 0.05; r = 0.372) in the total cohort. Time spent sitting was inversely correlated with total MET-minutes/week and MVPA MET-minutes/week (p < 0.05; r = -0.358 and r = -0.365). Subgroup analysis revealed, that daily step count was significantly correlated with total MET-minutes/week, MVPA MET-minutes/week and walking MET-minutes/week (p < 0.01, r = 0.569; p < 0.01, r = 0.531 and p < 0.05, r = 0.480, respectively) in the "mild disability" subgroup only, whereas time spent sitting was inversely correlated with total MET-minutes/week (p < 0.05; r = -0.582) in the "moderate to severe disability" subgroup. There was no association between objectively assessed PA and GLTEQ scores in any group. In the total cohort, moderate to weak correlations were found between daily step count and walking assessments (T25FW: p < 0.01, ρ = -0.508; 2MWT: p < 0.01, ρ=0.463) and MSWS-12 (p < 0.001; ρ = -0.609). Moderate to weak correlations were also observed between VO2peak and walking assessments (T25FW: p < 0.01; ρ = -0.516; 2MWT: p < 0.01, ρ=0.480). Multiple linear regression analysis identified disability and VO2peak as predictors of PA (p = 0.045; β=0.25 and p < 0.001; β=0.49).

CONCLUSION

Significant associations of objective PA measurements using accelerometry with IPAQ were found only in pwMS with "mild disability". In pwMS with "moderate to severe disability", IPAQ did not reflect the objectively assessed amount of PA. In our cohort, GLTEQ showed no association with objectively assessed PA. Thus, an MS-specific self-reported questionnaire for assessing PA is warranted.

The associations of daily steps and body mass index with incident gastroesophageal reflux disease in older adults

Background

High body mass index (BMI) is a major risk factor of gastroesophageal reflux disease (GERD), a prevalent morbidity of older adulthood linked to lower quality of life and an increased risk of esophageal cancers. Daily stepping behavior, the most common physical activity of older adulthood, is associated with an array of favorable health outcomes, sometimes independent of high BMI. Whether stepping behavior is associated with the incidence of GERD independently or in combination with BMI is currently unclear.

Materials and methods

We followed 442 individuals (58.4% female) aged 65-91 years enrolled in the Physical Activity and Aging Study. Baseline steps were obtained by pedometer and categorized by tertiles (lower, middle, upper), while BMI was categorized into normal weight, overweight, and obesity. To explore joint associations, daily steps were dichotomized into "high steps" (middle/upper tertiles) and "low steps" (lower tertile), while BMI was dichotomized into normal weight and overweight/obesity. The joint exposure categories included "low steps and overweight/obesity," "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight."

Results

We identified 35 (7.9%) cases of GERD over a mean follow-up of 2.5 years. Compared to the lower tertile of steps, the hazard ratios (HRs) [95% confidence intervals (95% CIs)] of GERD were 0.44 (0.20-0.96) and 0.17 (0.05-0.54) for the middle and upper tertiles, respectively, after adjusting for confounders (including BMI). Compared to normal weight, the HRs (95% CIs) of GERD were 1.35 (0.54-3.37) and 3.00 (1.19-7.55) for overweight and obesity, respectively, after adjusting for confounders (including steps). In a joint analysis, compared to "low steps and overweight/obesity," the HRs (95% CIs) of GERD were 0.32 (0.10-1.00), 0.23 (0.10-0.54), and 0.20 (0.07-0.58) for "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight," respectively.

Conclusion

Higher daily steps were associated with a lower risk of GERD in older adults, independent of BMI. Since accumulating steps through walking is an achievable and acceptable modality of physical activity in older adulthood, future lifestyle interventions designed to achieve high daily steps counts may have favorable implications for the development of GERD in older adults of any BMI status.

Does a Resistance Training Program Affect Between-arms Volume Difference and Shoulder-arm Disabilities in Female Breast Cancer Survivors? The Role of Surgery Type and Treatments. Secondary Outcomes of the EFICAN Trial

OBJECTIVE

The aims were (i) to assess the effects of a 12-week resistance training program on between-arms volume difference and shoulder-arm disabilities in breast cancer survivors and (ii) to evaluate whether the main risk factors for developing cancer-related lymphedema and shoulder-arm disabilities were associated with the effects of the training program.

DESIGN

Randomized controlled trial.

SETTING

University facilities.

PARTICIPANTS

60 female breast cancer survivors participated.

ELIGIBILITY CRITERIA

to be a breast cancer survivor, and to have completed surgery, chemotherapy, and/or radiotherapy up to 10 years before recruitment.

EXCLUSION CRITERIA

metastatic breast cancer, a breast reconstruction intervention planned within 6 months, any absolute contraindication for exercise, to perform more than 300 minutes/week of structured exercise.

INTERVENTIONS

Participants were randomized to an exercise group (12-week resistance training program) or a control group.

MAIN OUTCOME MEASURES

Between-arms volume difference, shoulder-arm disabilities, and upper-limb muscular strength were evaluated at baseline and at week 12. Treatment-related information was registered from medical history.

RESULTS

No between-group differences were observed on between-arms volume difference (1.207; 95% CI -0.964, 3.377; P=.270) or shoulder-arm disabilities (2.070; 95% CI -4.362, 8.501; P=.521) after the training program. Likewise, there was no association of surgery type, presence of lymph node resection, chemotherapy, radiotherapy, and hormone therapy with the changes in between-arms volume and perceived shoulder-arm disabilities after the intervention. However, a higher increase in upper limb muscular strength was associated with a reduced shoulder-arm disabilities (-0.429; P=.020) in the exercise group.

CONCLUSIONS

The findings suggest that resistance training does not affect between-arms volume difference and shoulder-arm disabilities in female breast cancer survivors. The main risk factors for developing lymphedema were not associated with the effects of the intervention, although a higher increase in upper-limb muscular strength was associated with reduced shoulder-arm disabilities.

Combined effects of sleep and objectively-measured daily physical activity on arterial stiffness in middle-aged and older adults

Although sleep quality and physical activity (PA) may influence on arterial stiffness, the combined effects of these two factors on arterial stiffness remain unknown. A total of 103 healthy middle-aged and older men and women (aged 50-83 years) with no history of cardiovascular disease and depression were included in this study. Arterial stiffness was measured using carotid-femoral pulse wave velocity (cfPWV), brachial-ankle PWV (baPWV), and femoral-ankle PWV (faPWV). Poor sleepers were defined as those with a Pittsburgh Sleep Quality Index score of >5.5. Using an accelerometer for seven consecutive days, low levels of PA were defined as low moderate-to-vigorous-intensity PA (MVPA) <19.0 min/day and low step counts <7100 steps/day, respectively. Poor sleepers with low PA levels, as determined by MVPA and daily steps, showed higher cfPWV, but not faPWV or baPWV, in middle-aged and older adults. Furthermore, in the analysis of covariance (ANCOVA) analyses adjusted for age, obesity, dyslipidemia, and sedentary behavior, the cfPWV result remained significant. Our study revealed that the coexistence of poor sleep quality and decreased PA (low MVPA or daily steps) might increase central arterial stiffness in middle-aged and older adults. Therefore, adequate sleep (good and sufficient sleep quality) and regular PA, especially at appropriate levels of MVPA (i.e., at least of 7100 steps/day), should be encouraged to decrease central arterial stiffness in middle-aged and older adults.

Training program intervention to encourage physical activity for health in people with transtibial amputation: A feasibility study

BACKGROUND

People with transtibial amputation (PTTA) would benefit from increased physical activity levels (PAL) but generic programs developed to support increased PAL do not address the barriers which PTTA experience.

OBJECTIVE

To evaluate the effect of a 12-week training program, developed for PTTA, on their PAL.

METHODS

Ten PTTA participated in a 12-week training program, which involved one instructor-led supervised group session per week. The program incorporated balance, flexibility, cardiovascular endurance, strength, and agility, as well as educational elements. Personalized starting level and progression intensity were based on the instructor's assessment in the first training session. The effect of the intervention on PAL (self-report questionnaire and accelerometer), fitness, walking symmetry, and adverse effects was determined by analysis of variance before and after the intervention.

RESULTS

There was a significant increase in self-reported time in moderate-intensity activity and accelerometer-measured step count and time in movement after the program compared with baseline ( p = 0.02). The distance walked in the Six-Minute Walk Test (6MWT) ( p < 0.001), time to perform agility test ( p = 0.01), and lower-limb strength power ( p = 0.01) and endurance ( p = 0.01) were significantly greater after the program, and no adverse effects were identified.

CONCLUSIONS

This study demonstrated an intervention designed specifically for PTTA that can increase PAL.

The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke

BACKGROUND

Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear.

OBJECTIVES

This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke.

METHODS

The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods.

RESULTS

The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05).

CONCLUSIONS

The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.

The relationship between motivation profiles for health-oriented physical activity, basic psychological needs and emotional regulation

The study of motivation toward health-oriented physical activity helps to know the reasons that guide people to practice physical activity. Moreover, different types and levels of motivation may coexist. As such, this paper aimed to analyze the combination of motivation for health-oriented physical activity profiles and examine whether profiles differed in emotional regulation and basic psychological needs. A sample of 808 Spanish adults between 18 and 65 years old (Mage = 33.90; Standard Deviation = 12.91; 366 men) participated in a cross-sectional study. Results revealed the existence of three different motivational profiles: (a) Low scores in self-determined motivation and average-high scores in non-self-determined motivation; (b) Average scores in self-determined and non-self-determined motivation; (c) High scores in self-determined motivation and average-high in non-self-determined motivation. Furthermore, participants differed in the satisfaction of basic psychological needs and cognitive-emotional regulation strategies depending on the profiles combination that they perceive. In conclusion, practitioners need to enhance an optimal combination of motivation profiles to satisfy better basic psychological needs and the use of functional cognitive-emotional regulation strategies since this could help improve psychological and emotional health in adults.

Exploring the Major Barriers to Physical Activity in Persons With Multiple Sclerosis: Observational Longitudinal Study

BACKGROUND

Physical activity (PA) represents a low-cost and readily available means of mitigating multiple sclerosis (MS) symptoms and alleviating the disease course. Nevertheless, persons with MS engage in lower levels of PA than the general population.

OBJECTIVE

This study aims to enhance the understanding of the barriers to PA engagement in persons with MS and to evaluate the applicability of the Barriers to Health Promoting Activities for Disabled Persons (BHADP) scale for assessing barriers to PA in persons with MS, by comparing the BHADP score with self-reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life, as well as sensor-measured PA.

METHODS

Study participants (n=45; median age 46, IQR 40-51 years; median Expanded Disability Status Scale score 4.5, IQR 3.5-6) were recruited among persons with MS attending inpatient neurorehabilitation. They wore a Fitbit Inspire HR (Fitbit Inc) throughout their stay at the rehabilitation clinic (phase 1; 2-4 wk) and for the 4 following weeks at home (phase 2; 4 wk). Sensor-based step counts and cumulative minutes in moderate to vigorous PA were computed for the last 7 days at the clinic and at home. On the basis of PA during the last 7 end-of-study days, we grouped the study participants as active (≥10,000 steps/d) and less active (<10,000 steps/d) to explore PA barriers compared with PA level. PA barriers were repeatedly assessed through the BHADP scale. We described the relevance of the 18 barriers of the BHADP scale assessed at the end of the study and quantified their correlations with the Spearman correlation test. We evaluated the associations of the BHADP score with end-of-study reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life with multivariable regression models. We performed separate regression analyses to examine the association of the BHADP score with different sensor-measured outcomes of PA.

RESULTS

The less active group reported higher scores for the BHADP items Feeling what I do doesn't help, No one to help me, and Lack of support from family/friends. The BHADP items Not interested in PA and Impairment were positively correlated. The BHADP score was positively associated with measures of fatigue and depression and negatively associated with self-efficacy and health-related quality of life. The BHADP score showed an inverse relationship with the level of PA measured but not when dichotomized according to the recommended PA level thresholds.

CONCLUSIONS

The BHADP scale is a valid and well-adapted tool for persons with MS because it reflects common MS symptoms such as fatigue and depression, as well as self-efficacy and health-related quality of life. Moreover, decreases in PA levels are often related to increases in specific barriers in the lives of persons with MS and should hence be addressed jointly in health care management.

Comparison of the muscle oxygenation during submaximal and maximal exercise tests in patients post-coronavirus disease 2019 syndrome with pulmonary involvement

INTRODUCTION

Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise.

OBJECTIVE

This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement.

METHODS

Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET.

RESULTS

Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO2peak) was 18.15 ± 4.75 ml/min/kg, VO2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively.

CONCLUSIONS

In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.

Factors associated with changes in walking performance in individuals 3 months after stroke or TIA: secondary analyses from a randomised controlled trial of SMS-delivered training instructions in Sweden

OBJECTIVES

This study aimed to identify factors related to changes in walking performance in individuals 3 months after a stroke or TIA.

DESIGN

Cross-sectional study with post hoc analysis of a randomised controlled study.

SETTING

University Hospital, Sweden.

PARTICIPANTS

79 individuals, 64 (10) years, 37% women, who were acutely hospitalised because of stroke or TIA between November 2016 and December 2018. Inclusion criteria were patients aged 18 or above and the major eligibility criterion was the ability to perform the 6 min walking test.

INTERVENTION

The intervention group received standard care plus daily mobile phone text messages (short message service) with instructions to perform regular outdoor walking and functional leg exercises in combination with step counting and training diaries. The control group received standard care.

OUTCOME MEASURES

Multivariate analysis was performed and age, sex, group allocation, comorbidity, baseline 6 min walk test, body mass index (BMI), cognition and chair-stand tests were entered as possible determinants for changes in the 6 min walk test.

RESULTS

Multiple regression analyses showed that age (standardised beta -0.33, 95% CI -3.8 to -1.05, p<0.001), sex (-0.24, 95% CI -66.9 to -8.0, p=0.014), no comorbidity (-0.16, 95% CI -55.5 to 5.4, p=0.11), baseline BMI (-0.29, 95% CI -8.1 to -1.6, p=0.004), baseline 6 min walk test (-0.55, 95% CI -0.5 to -0.3, p<0.001) were associated with changes in 6 min walk test 3 months after the stroke event. The regression model described 36% of the variance in changes in the 6 min walk test.

CONCLUSIONS

Post hoc regression analyses indicated that younger age, male sex, lower BMI and shorter 6 min walk test at baseline and possible no comorbidity contributed to improvement in walking performance at 3 months in patients with a recent stroke or TIA. These factors may be important when planning secondary prevention actions.

TRIAL REGISTRATION NUMBER

NCT02902367.

Daily Step Count and its Association with Arterial Stiffness Parameters in Older Adults

BACKGROUND

Daily step count is a simple parameter for assessing physical activity. However, the potential advantages of setting daily step goals below the traditional 10,000-step threshold remain unclear. The cross-sectional study aimed to determine the relationship between daily step counts and arterial stiffness outcomes in older individuals.

METHODS

Forty-eight older adults recorded their daily step counts over a 7-day period using a pedometer. The participants were classified into two groups based on their daily step count: Group 1 (n = 28) consisted of individuals taking fewer than 5000 steps per day, while Group 2 (n = 20) included those who recorded 5,000 to 9,999 steps per day. To evaluate arterial stiffness parameters, we measured pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), and ankle-brachial index (ABI). Hemodynamic and biochemical parameters were also determined.

RESULTS

Participants who accumulated fewer daily steps exhibited higher PWV compared to each group. An inverse association was observed between average steps per day and PWV. However, no significant differences were found between daily step counts and CAVI or ABI.

CONCLUSION

Conclusions: As individuals increase their daily step count, they may experience a reduction in arterial stiffness. Consequently, the assessment of daily steps has benefits for enhancing vascular health and overall well-being among older individuals.

Postural balance in COPD with obstructive sleep apnoea: a cross-sectional study

Objective

The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population.

Methods

Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months via phone calls.

Results

COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm versus 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm versus 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s-1 versus 1.30 (1.02-1.76) cm·s-1) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function.

Conclusion

Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.

Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners

Rationale & Objective

Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners.

Study Design

Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing.

Setting & Participants

Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of ≤10) and their care partners.

Analytical Approach

All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model.

Results

Patients' median age was 60 years (57 ± 63.5) and care partners' median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation.

Limitations

Participants geographically limited to Northern California.

Conclusions

Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function.

Deep Learning-Based Glucose Prediction Models: A Guide for Practitioners and a Curated Dataset for Improved Diabetes Management

Accurate short- and mid-term blood glucose predictions are crucial for patients with diabetes struggling to maintain healthy glucose levels, as well as for individuals at risk of developing the disease. Consequently, numerous efforts from the scientific community have focused on developing predictive models for glucose levels. This study harnesses physiological data collected from wearable sensors to construct a series of data-driven models based on deep learning approaches. We systematically compare these models to offer insights for practitioners and researchers venturing into glucose prediction using deep learning techniques. Key questions addressed in this work encompass the comparison of various deep learning architectures for this task, determining the optimal set of input variables for accurate glucose prediction, comparing population-wide, fine-tuned, and personalized models, and assessing the impact of an individual's data volume on model performance. Additionally, as part of our outcomes, we introduce a meticulously curated dataset inclusive of data from both healthy individuals and those with diabetes, recorded in free-living conditions. This dataset aims to foster research in this domain and facilitate equitable comparisons among researchers.

Objectively evaluated physical activity among individuals following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Objective

To compare time spent in moderate-to-vigorous physical activity (MVPA) per week, MVPA per day, and steps per day between individuals that were subjected to the anterior cruciate ligament reconstruction (ACLR) and healthy control group.

Design

Systematic review and meta-analysis of observational studies.

Data sources

Web of Science, Scopus, and PubMed have been comprehensively searched to identify relevant investigations.

Eligibility criteria for selecting studies

An observational research that objectively evaluated physical activity among respondents with a history of ACLR.

Results

Of 302 records, a total of 12 studies fulfilled the eligibility criteria. Four hundred and forty-three participants underwent the ACLR, 153 men and 290 women. The mean time between anterior cruciate ligament (ACL) surgery and evaluation of analysed outcomes was 34.8 months. The main findings demonstrated that the ACLR group spent less time in weekly MVPA (standardised mean differences (SMD)=-0.43 (95% CI -0.66 to -0.20); mean = -55.86 min (95% CI -86.45 to -25.27); p=0.0003; τ2=0.00), in daily MVPA (SMD=-0.51 95% CI -0.76 to -0.26]; mean = -15.59 min (95% CI -22.93 to -8.25); p<0.0001; τ2=0.00), and they had fewer daily steps (SMD=-0.60 95% CI -0.90 to -0.30); mean = -1724.39 steps (95% CI -2552.27 to -896.50); p<0.0001; τ2=0.00) relative to their non-injured counterparts. Additionally, available investigations indicated that individuals with a history of ACLR participated in 316.8 min of MVPA per week, 67 min in MVPA per day, and 8337 steps per day.

Conclusion

Long-term after ACLR, participants undergoing ACL surgery were less physically active compared with their non-injured peers, and they did not satisfy recommendations regarding steps per day.

PROSPERO registration number

CRD42023431991.

Physical activity, gestational weight gain in obese patients with early gestational diabetes and the perinatal outcome - a randomised-controlled trial

BACKGROUND

Excessive gestational weight gain, especially among women with gestational diabetes, is associated with several adverse perinatal outcomes. Our study aimed to analyse the impact of the use of pedometers to supervise physical activity on maternal health and the obstetric outcomes of pregnant women with obesity and early gestational diabetes.

METHODS

124 pregnant patients were enrolled in the presented research.

INCLUSION CRITERIA

singleton pregnancy, age > 18 years, gestational diabetes diagnosed in the first half of pregnancy (< 20th week of pregnancy), obesity according to the American Endocrine Society criteria. Each patient was advised to take at least 5000 steps daily. Patients were randomly assigned to pedometers (N = 62), and were recommended to monitor daily the number of steps. The group without pedometers (N = 62) was not observed. Visit (V1) was scheduled between the 28th and 32nd gestational week (GW), and visit (V2) occurred between the 37th and 39th GW. Anthropometric measurements and blood samples were collected from all patients at each appointment. Foetal and maternal outcomes were analysed at the end of the study.

RESULTS

In the group supervised by pedometers, there were significantly fewer newborns with macrosomia (p = 0,03). Only 45% of patients satisfied the recommended physical activity guidelines. Patients who walked more than 5000 steps per day had significantly higher body weight at baseline (p = 0,005), but weight gain was significantly lower than in the group that did not exceed 5000 steps per day (p < 0,001). The perinatal outcome in the group of patients performing more than 5000 steps did not demonstrate significant differences with when compared to less active group. ROC curve for weight gain above the guidelines indicated a statistically substantial cut-off point for this group at the level of 4210 steps/day (p = 0.00001).

CONCLUSIONS

Monitoring the activity of pregnant patients with gestational diabetes and obesity by pedometers did not have a significantly impact on their metabolic control and weight gain. However, it contributed to less macrosomia. Furthermore, physical activity over 5,000 steps per day positively affects weight loss, as well as contributes to improved obstetric and neonatal outcomes.

Physical activity following pulmonary embolism and clinical correlates in selected patients: a cross-sectional study

Background

There is limited knowledge regarding physical activity and clinical correlates among people who have suffered a pulmonary embolism (PE).

Objectives

To assess physical activity levels after PE and potential clinical correlates.

Methods

One hundred forty-five individuals free of major comorbidities were recruited at a mean of 23 months (range, 6-72) after PE diagnosis. Physical activity was assessed by steps/day on the Sensewear monitor for 7 consecutive days, exercise capacity with the incremental shuttle walk test, and cardiac function with left ventricular ejection fraction (LVEF). The association between physical activity and other variables was analyzed by a mixed-effects model.

Results

Participants achieved a mean of 6494 (SD, 3294; range, 1147-18.486) steps/day. The mixed-effects model showed that physical activity was significantly associated with exercise capacity (β-coefficient, 0.04; 95% CI, 0.03-0.05) and LVEF (β-coefficient, -0.81; 95% CI, -1.42 to -0.21). The analysis further showed that men became less physically active with increasing age (β-coefficient, -0.14; 95% CI, -0.24 to -0.04), whereas no change with age could be detected for women.

Conclusion

In selected post-PE patients, physical activity seems to be associated with exercise capacity and LVEF but not with quality of life, dyspnea, or characteristics of the initial PE. Men appear to become less physically active with increasing age.

College Students' Day-to-Day Maladaptive Drinking Responses to Stress Severity and Stressor-Related Guilt and Anger

BACKGROUND

Stress is a common part of college students' daily lives that may influence their physical activity (PA) and alcohol use. Understanding features of daily stress processes that predict health behaviors could help identify targets for just-in-time interventions.

PURPOSE

This study used intensive longitudinal data to examine whether prior day stress processes predict current day PA or alcohol use.

METHODS

Participants (N=58, Mage=20.5, 59% women, 70% White) were 18-to-25-year-old students who engaged in binge drinking at least twice monthly and used cannabis or tobacco in the past year. They wore activity (activPAL4) and alcohol (Secure Continuous Remote Alcohol Monitor) monitors for 11 days to assess daily PA (e.g., step counts) and alcohol use (e.g., drinking day), and completed daily surveys about yesterday's stress, including number of stressors (i.e., frequency), stressor intensity (i.e., severity), and frequency of affective states (e.g., guilt). Multilevel models examined prior day stress predicting current day PA or alcohol use.

RESULTS

Participants had higher odds of current day drinking (odds ratio=1.21) and greater area under the curve (B=0.08) when they experienced greater than usual stress severity the prior day. Participants had higher current day peak transdermal alcohol concentration (B=0.12) and area under the curve (B=0.11) when they more frequently experienced guilt due to stressors the prior day.

CONCLUSIONS

College students' unhealthy response of increasing alcohol use due to stress could adversely impact health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

Incentivised physical activity intervention promoting daily steps among university employees in the workplace through a team-based competition

Introduction

The benefits of walking on health and well-being is well established and regarded as the most accessible form of physical activity (PA) that most individuals can incorporate into their lives. Despite the benefits, the impact of a competitive walking intervention combined with a prize incentive in the workplace is yet to be established. The aim of this intervention was to promote PA among university employees through teams-based competition with a prize incentive targeted towards the recommended 10,000 steps per day.

Methods

A total of 49 employees participated and formed eight departmental teams ranging from Senior Admin management, Educational & Social work, Nursing & Midwifery, Sport & Exercise, Health Sciences, Admin Assistant, Library, and IT to compete in a walking intervention. Each team was handed an ActiGraph wGT3X-BT from Monday to Friday to record their walking steps. Steps. Post intervention participants completed an open-ended survey to provide their views about the intervention.

Results

The ActiGraph findings determined that steps increased by 4,799 per day from daily baseline of 5,959 to 10,758 throughout this intervention. The themes from qualitative data showed that the prize incentive and competitive nature of this intervention has motivated staff to walk more, changed their behaviour, enjoyed the team-based competition, and improved perceived productivity in the workplace.

Discussion and conclusion

This intervention increased employees' daily steps by 4,799 and met the 10,000 steps guideline. The 'Health Sciences' team recorded the highest steps 531,342 followed by the 'Education and Social Work' accumulating 498,045 steps throughout this intervention. This intervention with prize incentive demonstrated a positive impact on employees personal and work-based outcomes as well as contributed to the workplace PA, health, and wellbeing literature, and more specifically, to the scarce research focused on university settings.

Effects of Physical Activity and COVID-19 on Healthy Student Strengths in the University System: Implications for Post-Pandemic Management

The COVID-19 pandemic has profoundly affected the physical, mental, and social well-being of millions worldwide. It has also brought about abrupt disruptions to the entire university system, whose students form a crucial segment of society. The pandemic's effects on student education and well-being have been particularly significant. One of the primary consequences has been a drastic reduction in physical activity levels among students, leading to mental and physical health problems. Despite the rapid growth in the literature exploring student experiences during the pandemic, there is a paucity of research on how this decline in physical activity has affected the five strengths of the healthy student: optimism, self-efficacy, resilience, engagement, and hope. Therefore, the aim of this investigation is to examine the relationship between physical activity levels and the five strengths of the healthy student at two different time points (pre-COVID-19 and COVID-19) through the International Physical Activity Questionnaire (IPAQ) and the Healthy Student Questionnaire. The study involved 897 participants, with 290 participating in the pre-COVID-19 phase and 607 participating in the COVID-19 phase. The results revealed significant differences in the five strengths between the two periods. Students who engaged in physical activity exhibited significantly higher optimism scores in the pre-COVID-19 phase. During the COVID-19 phase, physically active students demonstrated significantly higher scores in optimism, resilience, and self-efficacy. These findings provide clear guidance for university administrators seeking to enhance student well-being in a post-pandemic world and in the face of future disruptions. Universities should consider implementing physical exercise programs for their students to promote psychosocial well-being and provide training and resources to equip faculty members with new skills to better understand and support students' perceptions.

The association between morning pleasant anticipation and daily positive incidental affect on adults' daily steps: An ecological momentary assessment study

OBJECTIVE

This study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry.

METHODS

A total of 152 adults in Taiwan (female = 67.1 %, age range = 18-59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February-July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates' potential effects on the study outcomes.

RESULTS

The study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p = .03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p < .01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation.

CONCLUSION

On days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the "anticipatory" affective processes on movement behaviors with the goal of promoting physical activity in daily life.

Physical activity and sedentary behaviour of Bahraini people with type 2 diabetes: A cross-sectional study

Objective

Study patterns of physical activity and sedentary behaviour and the influence of demographics and body mass index (BMI) on these behaviours amongst Bahraini adults with type 2 diabetes over 10 weeks using an activity tracker.

Method

This cross-sectional observational study was conducted at a Bahrain government health centre. Thirty-three Bahraini Arab adults, 30-60 years old, with controlled type 2 diabetes, wore a Fitbit Flex 2TM activity tracker for 10 weeks. Data on age, sex, marital and employment status, education and BMI were collected at the start of the study.

Results

A total of N = 32 participants completed the study. The average steps per day were 7859 ± 4131, and there were no differences between baseline, week 5 and 10. A third of participants were sedentary, based on a threshold of 5000 steps/day. Females accumulated fewer average daily steps than males (6728 ± 2936 vs. 10,281 ± 4623, p = 0.018). Daily averages for physical activity intensity were as follows: sedentary (786 ± 109 min), light (250 ± 76 min), moderate (9 ± 10 min) and vigorous (12 ± 18 min). Males had higher daily averages versus females for moderate (13 ± 9 vs. 5 ± 9 min, p = 0.018) and vigorous physical activity (21 ± 23 vs. 5 ± 7 min, p = 0.034). 91% of participants wore the device ≥10 h/day. The adherence rate was 79% based on percentage of days the device was worn continuously over 10 weeks.

Conclusion

Future physical activity interventions should target sedentary and female participants with type 2 diabetes. In addition, we need to understand the facilitators and barriers to physical activity and the physical activity preferences of these two subgroups.

The effect of tread patterns on slip resistance of footwear outsoles based on composite materials in icy conditions

INTRODUCTION

Falls on icy surfaces are the leading cause of injuries for outdoor workers. Footwear outsole material and geometrical design parameters are the most significant factors affecting slips-and-falls. Recently, composite materials have been incorporated into outsoles to improve traction, yet the best design parameters are not fully understood.

METHOD

In this effort, based on Taguchi orthogonal array design, 27 outsole prototypes were fabricated with different tread pattern features using our patented composites and tested in a simulated winter condition.

RESULTS

An analysis of variance (ANOVA) showed that surface area (p = 0.041, Contribution = 15.63%) was the only factor significantly affecting the slip-resistance of our prototypes. The best performance was observed for the maximized surface area covered by our composite material with circular and half circular plugs laid obliquely, mostly in the forefoot area.

PRACTICAL APPLICATIONS

These findings suggest that some tread design features of composite-based footwear have a great role in affecting slip-resistance properties of composite-based footwear.

Physical activity level and sedentary behavior in patients with bronchiectasis: A systematic review of outcome measures and determinants

BACKGROUND

Changes in respiratory functions negatively affect the physical activity (PA) levels of patients with bronchiectasis. Therefore, detecting the most frequently used assessments of PA is essential as determining related factors and improving PA. This review study aimed to investigate the PA levels, compare levels with the recommended PA guidelines, determine the outcome measurements of PA and examine the determinants related to PA in patients with bronchiectasis.

METHOD

This review was conducted using databases of MEDLINE, Web of Science, and PEDro. The searched terms were the variations of the words "bronchiectasis" and "physical activity". Full texts of cross-sectional studies and clinical trials were included. Two authors independently screened the studies for inclusion.

RESULT

The initial search identified 494 studies. A hundred articles were selected for full-text review. Following the application of the eligibility process, 15 articles were included. Twelve studies used activity monitors and five studies used questionnaires. The studies that used activity monitors presented daily step counts. The mean number of steps ranged between 4657 and 9164 for adult patients. It was approximately 5350 steps/day in older patients. One study investigated children's PA level reported 8229 steps/day. The functional exercise capacity, dyspnea, FEV1 and, quality of life as related determinants with PA have been reported in the studies.

CONCLUSION

PA levels of patients with non-cystic fibrosis bronchiectasis were lower than the recommended levels. The objective measurements were frequently used in PA assessment. In further studies, it is needed to investigate the related determinants of PA in patients.

Effects of extreme cyclic loading on the cushioning performance of human heel pads under engineering test condition

Human heel pads commonly undergo cyclic loading during daily activities. Low cyclic loadings such as daily human walking tend to have less effect on the mechanical properties of heel pads. However, the impact of cyclic loading on cushion performance, a vital biomechanical property of heel pads, under engineering test condition remains unexplored. Herein, dynamic mechanical measurements and finite element (FE) simulations were employed to explore this phenomenon. It was found that the wavy collagen fibers in the heel pad will be straightened under cycle compression loading, which resulted in increased stiffness of the heel pad. The stiffness of the heel pads demonstrated an inclination to escalate over a span of 50,000 loading cycles, consequently resulting in a corresponding increase in peak impact force over the same loading cycles. Sustained cyclic loading has the potential to result in the fracturing of the straightened collagen fibers, this collagen breakage may diminish the stiffness of the heel pad, leading to a reduction in peak impact force. This work enhances understanding of the biomechanical functions of human heel pad and may provide potential inspirations for the innovative development of healthcare devices for foot complex.

Effects of a 12-week supervised resistance training program, combined with home-based physical activity, on physical fitness and quality of life in female breast cancer survivors: the EFICAN randomized controlled trial

PURPOSE

This study assessed the effects of 12-week supervised resistance training combined with home-based physical activity on physical fitness, cancer-related fatigue, depressive symptoms, health-related quality of life (HRQoL), and life satisfaction in female breast cancer survivors.

METHODS

A parallel-group, outcome assessor-blinded, randomized controlled trial included 60 female breast cancer survivors who had completed their core treatments within the previous 10 years. Through computer-generated simple randomization, participants were assigned to resistance training (RTG; two sessions/week for 12 weeks plus instructions to undertake ≥ 10,000 steps/d) or control (CG; ≥ 10,000 steps/d only). Outcomes were evaluated at baseline and week 12. Muscular strength was assessed with electromechanical dynamometry. A standardized full-body muscular strength score was the primary outcome. Secondary outcomes included cardiorespiratory fitness, shoulder mobility, cancer-related fatigue, depressive symptoms, HRQoL, and life satisfaction.

RESULTS

Thirty-two participants were assigned to RTG (29 achieved ≥ 75% attendance) and 28 to CG (all completed the trial). Intention-to-treat analyses revealed that the standardized full-body muscular strength score increased significantly in the RTG compared to the CG (0.718; 95% CI 0.361-1.074, P < 0.001, Cohen's d = 1.04). This increase was consistent for the standardized scores of upper-body (0.727; 95% CI 0.294-1.160, P = 0.001, d = 0.87) and lower-body (0.709; 95% CI 0.324-1.094, P = 0.001, d = 0.96) strength. There was no effect on cardiorespiratory fitness, shoulder flexion, cancer-related fatigue, depressive symptoms, HRQoL, or life satisfaction. The sensitivity analyses confirmed these results.

CONCLUSION

and implication for cancer survivors. In female breast cancer survivors who had completed their core treatments within the past 10 years, adding two weekly sessions of supervised resistance training to a prescription of home-based physical activity for 12 weeks produced a large increase in upper-, lower-, and full-body muscular strength, while other fitness components and patient-reported outcomes did not improve.

TRIAL REGISTRATION NUMBER

ISRCTN14601208.

Randomized Trial of Sequential Compression Versus Ankle-Calf Movement to Increase Femoral Venous Velocity

Objective In postoperative patients with a high risk of bleeding, sequential compression devices (SCD) and ambulation are effective methods to reduce venous thromboembolic (VTE) risks. High leg venous flow decreases VTE risk. We postulated that ankle flexion and extension (AFE) while in bed increased leg venous flow velocity as well. We wished to compare the effectiveness of SCD versus AFE in increasing leg venous velocity. Methods Thirty-two healthy volunteers were recruited into the study. Each subject had two legs that were randomized into SCD or AFE. After 15 minutes of rest, SCD or AFE was applied, followed by 15 minutes of rest, and then an alternate treatment was given to the second leg. The sequence of leg and methodology was then reversed so the second treatment was applied to the first leg, and the first treatment to the second leg, and measurements were obtained. All treatments were separated by a rest period of 15 minutes. The venous velocity on each leg was measured by Doppler ultrasound at the superficial femoral vein. Venous velocity was measured initially (first cycle peak venous velocity) and during subsequent cycles. The alternate treatments on both legs with both treatments allowed for analysis in a manner where each subject could act as its control. Results Relative to baseline bed rest, SCD increased peak venous flow velocity by 112%, while AFE increased peak venous flow velocity by 161%. AFE resulted in 43% higher venous velocity on average than did SCDs (p<0.05). Conclusions AFE leads to significantly higher venous flow in the femoral veins of healthy subjects.

Comprehensive Assessment of the Activity Level of the ICF Using Both Capacity and Performance Measures: A Case Report

Individuals with neurologic conditions seek physical therapy services to improve mobility in their daily lives. While clinicians commonly track activity capacity, measurement of activity performance in daily life is an emerging yet unstandardized practice within routine clinical physical therapy. The purpose of this case report is to (1) provide an example of the structure, clinical reasoning, and implementation of both activity capacity and activity performance level assessments across an episode of outpatient physical therapy and (2) to describe how objective activity performance in daily life tracking supported the physical therapy intervention and education plan. A 42-year-old woman presented to outpatient neurologic physical therapy with a rare autoimmune-mediated disorder with primary goals of independently caring for her youngest child and grandchild, walking without limitations in the home and community, participating in exercise, and returning to work due to deconditioning and dizziness. The patient participated in 12 visits across a span of 4.5 months targeting performance in daily life (steps per day), aerobic conditioning, and vestibular habituation. Activity capacity measurement served as a standardized assessment of what the patient was able to do in the clinic, and activity performance in daily life tracking via a Samsung wrist worn consumer-grade device provided a quantitative assessment of real-world daily stepping activity. Tracking of activity performance in daily life was an essential component of physical therapy management that provided an objective quantification of daily stepping activity to identify barriers and facilitators to increasing daily performance in an individual with a medical diagnosis of Susac syndrome.

Adults with lower-limb amputation: Reduced multifidi muscle activity and extensor muscle endurance is associated with worse physical performance

Trunk muscles may be an overlooked region of deficits following lower-limb amputation (LLA). This study sought to determine the extent that trunk muscle deficits are associated with physical function following amputation. Sedentary adults with a unilateral transtibial- (n = 25) or transfemoral-level (n = 14) amputation were recruited for this cross-sectional research study. Participants underwent a clinical examination that included ultrasound imaging of the lumbar multifidi muscles, the modified Biering-Sorensen Endurance Test (mBSET), and performance-based measures, that is, the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-m Walk Test (10mWT). Associations between trunk muscle metrics and performance were explored with regression modeling, while considering covariates known to impact performance postamputation (p ≤ 0.100). Average ultrasound-obtained, lumbar multifidi activity was 14% and 16% for transfemoral- and transtibial-level amputations, respectively, while extensor endurance was 37.34 and 12.61 s, respectively. For TUG, nonamputated-side multifidi activity and an interaction term (level x non-amputated-side multifidi activity) explained 9.4% and 6.2% of the total variance, respectively. For 10mWT, beyond covariates, non-amputated-side multifidi activity and the interaction term explained 6.1% and 5.8% of the total variance, respectively. For TUG, extensor endurance and an interaction term (level x mBSET) explained 11.9% and 8.3% of the total variance beyond covariates; for BBS and 10mWT, extensor endurance explained 11.2% and 17.2% of the total variance, respectively. Findings highlight deficits in lumbar multifidi activity and extensor muscle endurance among sedentary adults with a LLA; reduced muscle activity and endurance may be important factors to target during rehabilitation to enhance mobility-related outcomes.

Identifying the Characteristics of Responders and Nonresponders in a Behavioral Intervention to Increase Physical Activity Among Patients With Moderate to Severe Asthma: Protocol for a Prospective Pragmatic Study

BACKGROUND

Previous research has suggested that most adults improve their asthma control after a short-term behavioral intervention program to increase physical activity in daily life (PADL). However, the characteristics of individuals who respond and do not respond to this intervention and the medium-term response remain unknown.

OBJECTIVE

This study aims to (1) identify the characteristics of adult responders and nonresponders with asthma to a behavioral intervention to increase physical activity and (2) evaluate the functional and clinical benefits in the medium term.

METHODS

This prospective pragmatic study will include adults with moderate to severe asthma who enroll in a behavioral intervention. All individuals will receive an educational program and an 8-week intervention to increase PADL (1 time/wk; up to 90 min/session). The educational program will be conducted in a class setting through group discussions and video presentations. Behavioral interventions will be based on the transtheoretical model using counseling, incentives, and individual feedback aiming to increase participation in physical activity. Motivational interviewing and guidelines for overcoming barriers will be used to stimulate individuals to reach their goals. Pre- and postintervention assessments will include the following: PADL (triaxial accelerometry), body composition (octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and exacerbations. "Responders" to the intervention will be defined as those who demonstrate an increase in the number of daily steps (≥2500).

RESULTS

In December 2021, the clinical trial registration was approved. Recruitment and data collection for the trial is ongoing, and the results of this study are likely to be published in late 2024.

CONCLUSIONS

The intervention will likely promote different effects according to the clinical characteristics of the individuals, including asthma control, age, anxiety and depression levels, obesity, and several comorbidities. Identifying individuals who respond or do not respond to behavioral interventions to increase PADL will help clinicians prescribe specific interventions to adults with asthma.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05159076; https://clinicaltrials.gov/ct2/show/NCT05159076.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49032.

Transparent Electronics for Wearable Electronics Application

Recent advancements in wearable electronics offer seamless integration with the human body for extracting various biophysical and biochemical information for real-time health monitoring, clinical diagnostics, and augmented reality. Enormous efforts have been dedicated to imparting stretchability/flexibility and softness to electronic devices through materials science and structural modifications that enable stable and comfortable integration of these devices with the curvilinear and soft human body. However, the optical properties of these devices are still in the early stages of consideration. By incorporating transparency, visual information from interfacing biological systems can be preserved and utilized for comprehensive clinical diagnosis with image analysis techniques. Additionally, transparency provides optical imperceptibility, alleviating reluctance to wear the device on exposed skin. This review discusses the recent advancement of transparent wearable electronics in a comprehensive way that includes materials, processing, devices, and applications. Materials for transparent wearable electronics are discussed regarding their characteristics, synthesis, and engineering strategies for property enhancements. We also examine bridging techniques for stable integration with the soft human body. Building blocks for wearable electronic systems, including sensors, energy devices, actuators, and displays, are discussed with their mechanisms and performances. Lastly, we summarize the potential applications and conclude with the remaining challenges and prospects.

Comparison of selected prooxidant-antioxidant balance and bone metabolism indicators and BDNF levels between older women with different levels of physical activity

BACKGROUND

Given a lack of studies precisely indicating how many steps elderly people should take daily for their antioxidant defence, bone metabolism, and cognitive abilities to improve, our study set out to compare the selected antioxidant, prooxidant, bone turnover, and BDNF indicators between elderly women differing in physical activity (PA) measured by the daily number of steps.

METHODS

The PA levels of 62 women aged 72.1 ± 5.4 years were assessed based on their daily number of steps and then were used to allocate the participants to three groups: group I (n = 18; <5,000 steps a day); group II (n = 22; from 5,000 to 9,999 steps a day); and group III (n = 22; ≥10,000 steps a day). Blood samples were collected from the participants in early morning hours and subjected to biochemical analysis for prooxidant-antioxidant balance indicators (SOD, CAT, GPx, GR, GSH, UA, MDA and TOS/TOC), bone metabolism indicators (Ca, 25-OH vitamin D, osteocalcin, CTX-I, and PTH), and BDNF levels.

RESULTS

The groups were not statistically significantly different in the activity of SOD, CAT, GPx, and GR, but their concentrations of GSH (H = 22.10, p < 0.001) and UA (H = 12.20, p = 0.002) proved to be significantly associated with the groups' daily PA. The between-group differences in the concentrations of MDA and TOS/TOC were not significant, with both these indicators tending to take higher values in group I than in groups II and III. Significant differences between the groups were established for the concentrations of 25-OH vitamin D (H = 24.21, p < 0.001), osteocalcin (H = 7.88, p = 0.019), CTX-I (H = 12.91, p = 0.002), and BDNF (H = 14.47, p = 0.001), but not for Ca and PTH.

CONCLUSIONS

Significantly higher concentrations of GSH, slightly lower oxidative stress indicators, significantly higher BDNF levels, and moderately better bone turnover indicators and resorption markers in the group taking more than 5,000 steps a day suggest that this level of PA can promote successful aging. More research is, however, needed to confirm this finding.

Step-Based Metrics and Translations of Physical Activity Guidelines among Adults in the HCHS/SOL

PURPOSE

In a cross-sectional sample of US Hispanic/Latino adults, we aimed to describe step-based metric distributions, estimate their associations with activity counts and self-report, and calibrate step-based translations of current (2018) US physical activity (PA) guidelines, that is, ≥150 min·wk -1 moderate-to-vigorous PA (MVPA) from accelerometer counts and self-report.

METHODS

The Hispanic Community Health Study/Study of Latinos enrolled 16,415 Hispanic/Latino adults 18-74 yr from four US cities (2008-2011). Participants completed the Global PA Questionnaire and 1 wk of Actical accelerometer wear ( n = 12,528). Weighted medians were used to describe step-based metrics, and Spearman correlations estimated their relationships with count-based and self-reported PA indicators. Receiver operator characteristic curve analyses were used to examine the ability of each step-based metric to classify participants meeting PA guidelines.

RESULTS

Overall, US Hispanic/Latino adults accumulated medians of 6770 steps per day and 6, 18, 236, and 630 min·d -1 at ≥100, ≥70, 1-69, and 0 steps per minute, respectively. Count-based time in MVPA, light PA, and sedentary behavior were most strongly correlated ( rs = 0.79-0.85) with times ≥70, 1-69, and 0 steps per minute, respectively, whereas self-reported MVPA had similar correlations with steps per day and times ≥40 and ≥70 steps per minute ( rs = 0.28-0.29). Time ≥70 steps per minute had the greatest capacity to classify participants meeting PA guidelines with both measures of MVPA.

CONCLUSIONS

This study provides the first normative values (based on percentiles) of step-based metrics for US Hispanic/Latino adults, which can facilitate surveillance, program planning, research, and data interpretation. Our finding that PA guidelines corresponded to 6000-7000 steps per day or ~20 min·d -1 at ≥70 steps per minute with an Actical accelerometer can be considered alongside dose-response relationships with health outcomes to develop step-based recommendations that are consistent with and better communicate PA guidelines.