The Importance of Walking to Public Health

The impact of mobility scooters on their users. Does their usage help or hinder?: A state of the art review

As older people start to have difficulty in walking many choose to use a mobility scooter to help them move around. Benefitting from improved design, mobility scooters are becoming an increasingly popular mobility device and are a common sight on many streets. However, very little is known about their usage or their impact in terms of either quality of life or functional health. Whilst mobility scooters may help to improve the quality of life of their users, it is also possible that the sedentary nature of their usage results in a decline of physical functionality and therefore reduced capabilities. Before any substantial research can be carried out it is crucial to understand the importance of a mobility scooter on the lives of the people that use them and to review the initial research published on the effect of scooter use on physical health. This paper is a state-of-the-art review. It describes the current research knowledge on mobility scooters, shows where gaps in knowledge exist and where future research needs to focus.

Unsupervised exercise and mobility loss in peripheral artery disease: a randomized controlled trial

Background

Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease (PAD). Among people with PAD, we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control.

Methods and Results

One hundred ninety-four PAD participants were randomized. During months 1 to 6, the intervention group met weekly with other PAD participants and a facilitator. Group support and self-regulatory skills were used to help participants adhere to walking exercise. Ninety-percent of exercise was conducted at or near home. The control group attended weekly lectures. During months 6 to 12, each group received telephone contact only. Primary outcomes have been reported. Here we compare changes in exploratory outcomes of mobility loss (the inability to climb a flight of stairs or walk one-quarter mile without assistance), walking velocity, and the Short Physical Performance Battery. Compared to controls, fewer participants randomized to the intervention experienced mobility loss at 6-month follow-up: 6.3% versus 26.5%, P=0.002, odds ratio=0.19 (95% CI=0.06 to 0.58) and at 12-month follow-up: 5.2% versus 18.5%, P=0.029, odds ratio=0.24 (95% CI=0.06 to 0.97). The intervention improved fast-paced 4-m walking velocity at 6-month follow-up (P=0.005) and the Short Physical Performance Battery at 12-month follow-up (P=0.027), compared to controls.

Conclusions

In exploratory analyses, a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients.

Clinical Trial Registration

URL: http://clinicaltrials.gov. Unique identifier: NCT00693940.

The impact of a home-based walking programme on falls in older people: the Easy Steps randomised controlled trial

BACKGROUND

walking is the most popular form of exercise in older people but the impact of walking on falls is unclear. This study investigated the impact of a 48-week walking programme on falls in older people.

METHODS

three hundred and eighty-six physically inactive people aged 65+ years living in the community were randomised into an intervention or control group. The intervention group received a self-paced, 48-week walking programme that involved three mailed printed manuals and telephone coaching. Coinciding with the walking programme manual control group participants received health information unrelated to falls. Monthly falls calendars were used to monitor falls (primary outcome) over 48 weeks. Secondary outcomes were self-reported quality of life, falls efficacy, exercise and walking levels. Mobility, leg strength and choice stepping reaction time were measured in a sub-sample (n = 178) of participants.

RESULTS

there was no difference in fall rates between the intervention and control groups in the follow-up period (IRR = 0.88, 95% CI: 0.60-1.29). By the end of the study, intervention group participants spent significantly more time exercising in general, and specifically walking for exercise (median 1.69 versus 0.75 h/week, P < 0.001).

CONCLUSION

our finding that a walking programme is ineffective in preventing falls supports previous research and questions the suitability of recommending walking as a fall prevention strategy for older people. Walking, however, increases physical activity levels in previously inactive older people.

Awareness of moderate-to-vigorous physical activity: can information on guidelines prevent overestimation?

Background

Mass-media campaigns such as Change4Life use messaging to promote physical activity guidelines. Raising knowledge of MVPA guidelines within UK adults is a main goal of current mass media campaigns aimed at increasing engagement in MVPA. As this may help to inform accurate perceptions of adults’ own MVPA level it is an important area of investigation. Subjective norms, health status and normal walking intensity may also influence adult’s awareness of their own MVPA behaviour. The aim of this study was to examine the hypothesis that greater knowledge of MVPA guidelines, supportive subjective norms, lower self-reported health status and intensity of typical walking pace are associated with accurate awareness of MVPA engagement within a sample of UK adults.

Methods

A cross-sectional study of UK adults was conducted. UK adults who subscribed to the National Academic Mailing List Service (JISCMail) were sent an invitation to complete an online survey. 1,724 UK adults completed the online survey which included items on minutes spent in MVPA, awareness of MVPA using constructs highlighted by the precaution adoption process model, subjective norms, knowledge of guidelines, health status and demographics.

Results

The sample was 70% female, 57% aged under 45, 93% White and 69% in full-time employment. 62% reported their health to be above average, while 62% demonstrated accurate awareness of their own physical activity level, only 18% correctly reported the MVPA guidelines and 51% reported high subjective norms towards MVPA. Logistic regression analyses identified high subjective norms (OR = 1.84, CI: 1.29, 2.63, p = .001), average or below average health status (OR = .71, CI: .53 .97, p = .001), and a self-reported regular walking pace of moderate-to-vigorous (OR = 1.31, CI: 1.05, 1.63, p = .02) to be associated with accurate MVPA awareness. Knowledge of MVPA guidelines was not associated with MVPA awareness.

Conclusions

Mass media campaigns, such as Change4Life, inform the general public of MVPA guidelines. Campaign messages may be more influential targeting subjective norms instead of knowledge of guidelines, thereby raising awareness of personal MVPA behaviour amongst inactive adults and increasing motivation to engage in more MVPA.

Hierarchical approaches to estimate energy expenditure using phone-based accelerometers

Physical inactivity is linked with increase in risk of cancer, heart disease, stroke, and diabetes. Walking is an easily available activity to reduce sedentary time. Objective methods to accurately assess energy expenditure from walking that is normalized to an individual would allow tailored interventions. Current techniques rely on normalization by weight scaling or fitting a polynomial function of weight and speed. Using the example of steady-state treadmill walking, we present a set of algorithms that extend previous work to include an arbitrary number of anthropometric descriptors. We specifically focus on predicting energy expenditure using movement measured by mobile phone-based accelerometers. The models tested include nearest neighbor models, weight-scaled models, a set of hierarchical linear models, multivariate models, and speed-based approaches. These are compared for prediction accuracy as measured by normalized average root mean-squared error across all participants. Nearest neighbor models showed highest errors. Feature combinations corresponding to sedentary energy expenditure, sedentary heart rate, and sex alone resulted in errors that were higher than speed-based models and nearest-neighbor models. Size-based features such as BMI, weight, and height produced lower errors. Hierarchical models performed better than multivariate models when size-based features were used. We used the hierarchical linear model to determine the best individual feature to describe a person. Weight was the best individual descriptor followed by height. We also test models for their ability to predict energy expenditure with limited training data. Hierarchical models outperformed personal models when a low amount of training data were available. Speed-based models showed poor interpolation capability, whereas hierarchical models showed uniform interpolation capabilities across speeds.

Do relationships between environmental attributes and recreational walking vary according to area-level socioeconomic status?

Residents of areas with lower socioeconomic status (SES) are known to be less physically active during leisure time. Neighborhood walkability has been shown to be related to recreational walking equally in low and high SES areas. This cross-sectional study tested whether associations of specific environmental attributes, measured objectively and subjectively, with walking for recreation were moderated by area-level SES. The data of the North West Adelaide Health Study collected in 2007 (n = 1500, mean age 57) were used. Self-reported walking frequency was the outcome of the study. Environmental exposure measures included objectively measured walkability components (residential density, intersection density, land use mix, and net retail area ratio) and perceived attributes (access to destinations, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety). Participants' suburbs were categorized into low and high SES areas using an indicator of socioeconomic disadvantage. Low SES areas had lower scores in residential density, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety. Recreational walking was associated with residential density, access to destinations, esthetics, traffic/barriers, and crime safety. Effect modification was observed for two attributes (out of nine): residential density was associated with walking only in low SES areas, while walking infrastructure was associated with walking only in high SES areas. The associations of neighborhood environmental attributes with recreational walking were largely consistent across SES groups. However, low SES areas were disadvantaged in most perceived environmental attributes related to recreational walking. Improving such attributes in low SES neighborhoods may help close socioeconomic disparities in leisure time physical activity.

Positive messaging promotes walking in older adults

Walking is among the most cost-effective and accessible means of exercise. Mounting evidence suggests that walking may help to maintain physical and cognitive independence in old age by preventing a variety of health problems. However, older Americans fall far short of meeting the daily recommendations for walking. In 2 studies, we examined whether considering older adults' preferential attention to positive information may effectively enhance interventions aimed at promoting walking. In Study 1, we compared the effectiveness of positive, negative, and neutral messages to encourage walking (as measured with pedometers). Older adults who were informed about the benefits of walking walked more than those who were informed about the negative consequences of failing to walk, whereas younger adults were unaffected by framing valence. In Study 2, we examined within-person change in walking in older adults in response to positively- or negatively-framed messages over a 28-day period. Once again, positively-framed messages more effectively promoted walking than negatively-framed messages, and the effect was sustained across the intervention period. Together, these studies suggest that consideration of age-related changes in preferences for positive and negative information may inform the design of effective interventions to promote healthy lifestyles. Future research is needed to examine the mechanisms underlying the greater effectiveness of positively- as opposed to negatively-framed messages and the generalizability of findings to other intervention targets and other subpopulations of older adults.

Environmental Correlates of Recreational Walking in the Neighborhood

PURPOSE

To assess environmental correlates of neighborhood recreational walking.

DESIGN

The study used a cross-sectional survey.

SETTING

The study was conducted in the local community.

SUBJECTS

Participants were adults who recently relocated and walk for recreation in their current neighborhood.

MEASURES

The outcome measure was participant-reported neighborhood recreational walking in participants' prior neighborhood. Exposure measures were (1) participant-reported social and environmental characteristics of the prior neighborhood and (2) geographic information system-derived environmental characteristics assessed within a buffer around participant's prior address.

ANALYSIS

Participants reporting current neighborhood recreational walking (n = 231) were characterized by whether they walked for recreation in their prior neighborhood. Associations between neighborhood characteristics and neighborhood recreational walking were assessed using logistic regression.

RESULTS

Neighborhood recreational walking was associated with perceptions of the presence of recreational facilities (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.29-4.84), interesting things to see (OR = 2.82, 95% CI = 1.46-5.45), and others being active (OR = 3.56, 95% CI = 1.80-7.05), and was inversely associated with concerns about crime (OR = .40, 95% CI = .20-.77) and traffic (OR = .43, 95% CI = .22-.87). This behavior was associated with objectively measured presence of walking trails (OR = 3.58, 95% CI = 1.07-4.46), percentage of street length with speed limits ≤25 mph (OR = 1.31 for 10% increase, 95% CI = 1.08-1.61), and percentage of tree canopy coverage (OR = 1.55 for 10% increase, 95% CI = 1.12-2.14).

CONCLUSION

Recreational walking may be influenced by environmental factors that support a safe, enjoyable, and social experience, attributes that are not necessarily prioritized in transportation walking. Outcome and exposure specificity are important when studying recreational walking.

Mobility Disability in Older Adults: At the Intersection of People and Places

PURPOSE

Mobility disability is associated with poor lower body function among older adults. This study examines whether specific types of neighborhood characteristics moderate that association.

DESIGN AND METHODS

This study is based on a cross-sectional sample of 884 people aged ≥ 65 years identified through service organizations in Alameda County, CA; Cook County, IL; Allegheny County, PA; and Wake and Durham counties, NC. In-person interviews focus on neighborhood characteristics, physical and cognitive function, depression, and walking. Functional capacity is tested using objective measures of lower body strength, balance, and walking speed. Mobility disability, the main study outcome, is measured as self-reported level of difficulty in walking 2-3 neighborhood blocks. Estimates of main and interactive effects are derived from logistic regression models.

RESULTS

Among older adults with poor lower body function, those who report less proximity to goods and services and barriers to walking report more mobility disability than other older adults. In contrast, among older adults with good lower body function, there is a low prevalence of mobility disability and little association between perceptions of the neighborhood and mobility disability.

IMPLICATIONS

In addition to more refined longitudinal studies, this research provides a foundation for innovative place-based rehabilitation and hospital discharge programs for older adults newly diagnosed and treated for chronic health conditions.

Street connectivity and walking for transport: role of neighborhood destinations

OBJECTIVE

Built environment attributes may be important determinants of physical activity. Greater street connectivity has been shown in several studies to be associated with adults' walking for transport (WFT). We examined the extent to which this association can be explained by the availability of utilitarian destinations.

METHODS

Adults (n=2544) participating in the Physical Activity in Localities and Community Environments (PLACE) study in Adelaide, Australia during 2003-2004, reported their WFT and perceived distances to 16 utilitarian destinations. Connectivity was calculated as the ratio of the number of intersections to Census Collection District land area. Marginal models via generalized estimating equations were used and the product-of-coefficients test was used to test mediation effects.

RESULTS

Connectivity was significantly associated with destination availability and with WFT frequency. The connectivity-WFT relationship was attenuated after taking availability of destinations into account, but remained significant. Availability of destinations accounted for 16% of the total effect of connectivity on WFT.

CONCLUSIONS

Higher connectivity can be associated with more frequent WFT, partly because more utilitarian destinations are available in areas with well-connected street networks. Further clarification of these relationships and other pathways through which connectivity influences residents' walking can inform urban design initiatives to promote physical activity.

Environmental conditions around itineraries to destinations as correlates of walking for transportation among adults: the RECORD cohort study

Introduction

Assessing the contextual factors that influence walking for transportation is important to develop more walkable environments and promote physical activity. To advance previous research focused on residential environments and overall walking for transportation, the present study investigates objective environmental factors assessed around the residence, the workplace, the home – work itinerary, and the home – supermarket itinerary, and considered overall walking for transportation but also walking to work and to shops.

Methods

Data from the RECORD Study involving 7290 participants recruited in 2007–2008, aged 30–79 years, and residing in the Paris metropolitan area were analyzed. Multilevel ordinal regression analyses were conducted to investigate environmental characteristics associated with self-reported overall walking for transportation, walking to work, and walking to shops.

Results

High individual education was associated with overall walking for transportation, with walking to work, and walking to shops. Among workers, a high residential neighborhood education was associated with increased overall walking for transportation, while a high workplace neighborhood education was related to an increased time spent walking to work. The residential density of destinations was positively associated with overall walking for transportation, with walking to work, and with walking to shops, while the workplace density of destinations was positively associated with overall walking for transportation among workers. Environmental factors assessed around the itineraries were not associated with walking to work or to the shops.

Conclusion

This research improves our understanding of the role of the environments on walking for transportation by accounting for some of the environments visited beyond the residential neighborhood. It shows that workers' walking habits are more influenced by the density of destinations around the workplace than around the residence. These results provide insight for the development of policies and programs to encourage population level active commuting.

Physical activity adoption to adherence, lapse, and dropout: a self-determination theory perspective

Grounded in Self-Determination Theory, we aimed to explore and identify key motivational processes involved in the transition from a physically inactive to an active lifestyle, and the processes involved in lapse and dropout behavior within a walking program. We implemented a qualitative, longitudinal case study method, using semistructured interviews and theoretical thematic analyses. Fifteen women were interviewed over 10 months and three profiles were generated: (a) nonadherence, (b) lapse/readoption of physical activity, and (c) adherence. Internalization of walking behavior was key to adherence. Satisfaction of the needs for competence and relatedness were central for participation during exercise at the adoption stages, and autonomy was particularly pertinent in facilitating adherence. Those who lapsed and restarted physical activity experienced feelings of autonomy at the point of readoption. Sources of support were driving forces in the adoption and adherence phases.

On your feet: protocol for a randomized controlled trial to compare the effects of pole walking and regular walking on physical and psychosocial health in older adults

Background

Physical activity is associated with better physical and mental health in older adults. Pole walking is a form of walking which may have additional health benefits in older adults, because of the addition of hand held poles, and consequent upper limb involvement. However, few studies have examined the potential additional effects of pole walking on physical and psychosocial health in older adults compared with walking. The aim of this study is to compare the effect of a pole walking program with the effects of a walking program, on physical and psychosocial wellbeing, in older adults in assisted living facilities.

Methods/Design

Sixty men and women from assisted living communities over 65 years will be recruited from senior retirement facilities and randomized into a group based, pole walking program, or walking program. The pole walking group will use the Exerstrider method of pole walking. Total duration of the programs is 12 weeks, with three sessions per week, building from 20 minute to 30 minute sessions.

The primary outcome is physical function, as measured by items from the Seniors Fitness Test and hand grip strength. Secondary outcomes include, physical activity levels, sedentary behaviour, joint pain, and quality of life. All outcomes will be assessed before and after the programs, using valid and reliable measures.

Discussion

The study will add to the evidence base for the effects of pole walking, compared with walking, on physical and psychosocial health and physical function, in healthy older adults. This will improve understanding about the feasibility of pole walking programs and its specific benefits in this population.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12612001127897.

Perceived neighbourhood environmental attributes associated with adults׳ recreational walking: IPEN Adult study in 12 countries

This study examined the strength and shape of associations between perceived environmental attributes and adults' recreational walking, using data collected from 13,745 adult participants in 12 countries. Perceived residential density, land use mix, street connectivity, aesthetics, safety from crime, and proximity to parks were linearly associated with recreational walking, while curvilinear associations were found for residential density, land use mix, and aesthetics. The observed associations were consistent across countries, except for aesthetics. Using data collected from environmentally diverse countries, this study confirmed findings from prior single-country studies. Present findings suggest that similar environmental attributes are associated with recreational walking internationally.

Contribution of the physical environment to socioeconomic gradients in walking in the Whitehall II study

Socioeconomic gradients in walking are well documented but the underlying reasons remain unclear. We examined the contribution of objective measures of the physical environment at residence to socioeconomic gradients in walking in 3363 participants (50-74years) from the Whitehall II study (2002-2004). Individual-level socioeconomic position was measured as most recent employment grade. The contribution of multiple measures of the physical environment to socioeconomic position gradients in self-reported log transformed minutes walking/week was examined by linear regression. Objective measures of the physical environment contributed only to a small extent to socioeconomic gradients in walking in middle-aged and older adults living in Greater London, UK. Of these, only the number of killed and seriously injured road traffic casualties per km of road was predictive of walking. More walking in areas with high rates of road traffic casualties per km of road may signal an effect not of injury risk but of more central locations with multiple destinations within short distances ('compact neighbourhoods'). This has potential implications for urban planning to promote physical activity.

Texting to Increase Physical Activity Among Teenagers (TXT Me!): Rationale, Design, and Methods Proposal

Background

Physical activity decreases from childhood through adulthood. Among youth, teenagers (teens) achieve the lowest levels of physical activity, and high school age youth are particularly at risk of inactivity. Effective methods are needed to increase youth physical activity in a way that can be maintained through adulthood. Because teens text a great deal, text messages promoting walking, a low cost physical activity, may be an effective method for promoting sustainable physical activity.

Objective

The objective of our study was to determine the effect of pedometers, self selected step goals, and texts grounded in the self-determination theory (SDT) on physical activity among the teens.

Methods

“TXT Me!” was a 12 week intervention that texted 14-17 year olds to increase their daily physical activity by increasing the number of steps they take each day. The intervention was grounded in the SDT. Formative research with the teens helped construct the intervention and develop the texts. A total of 84 texts were developed (12 to set a step goal, and 72 promoting autonomy, competence, and relatedness). The pilot evaluation used a four group, randomized design (n=160). After baseline data collection, the participants were randomized to one of four conditions (no treatment control, pedometer only, pedometer + weekly prompts, pedometer + weekly prompts + SDT grounded texts). Data were collected at baseline and immediately upon completion of the study. The primary outcome was physical activity, measured by 7 days of accelerometry. Basic psychological needs, physical activity motivation, process evaluation, and program satisfaction data were also collected.

Results

To our knowledge, this is one of the first studies to explore the use of stand alone, SDT grounded texts, supported by pedometers and prompts to set a self selected step goal, as a method for increasing physical activity among teens.

Conclusions

This pilot study will contribute valuable information regarding whether theoretically grounded text messages show promise as an effective method to increase physical activity among teens.

Trial Registration

Clinicaltrials.gov NCT01482234; http://clinicaltrials.gov/ct2/show/NCT01482234 (Archived by WebCite at http://www.webcitation.org/6NYvRMOoq).

Effectiveness of a primary care-based intervention to reduce sitting time in overweight and obese patients (SEDESTACTIV): a randomized controlled trial; rationale and study design

BACKGROUND

There is growing evidence suggesting that prolonged sitting has negative effects on people's weight, chronic diseases and mortality. Interventions to reduce sedentary time can be an effective strategy to increase daily energy expenditure. The purpose of this study is to evaluate the effectiveness of a six-month primary care intervention to reduce daily of sitting time in overweight and mild obese sedentary patients.

METHOD/DESIGN

The study is a randomized controlled trial (RCT). Professionals from thirteen primary health care centers (PHC) will randomly invite to participate mild obese or overweight patients of both gender, aged between 25 and 65 years old, who spend 6 hours at least daily sitting. A total of 232 subjects will be randomly allocated to an intervention (IG) and control group (CG) (116 individuals each group). In addition, 50 subjects with fibromyalgia will be included.Primary outcome is: (1) sitting time using the activPAL device and the Marshall questionnaire. The following parameters will be also assessed: (2) sitting time in work place (Occupational Sitting and Physical Activity Questionnaire), (3) health-related quality of life (EQ-5D), (4) evolution of stage of change (Prochaska and DiClemente's Stages of Change Model), (5) physical inactivity (catalan version of Brief Physical Activity Assessment Tool), (6) number of steps walked (pedometer and activPAL), (7) control based on analysis (triglycerides, total cholesterol, HDL, LDL, glycemia and, glycated haemoglobin in diabetic patients) and (8) blood pressure and anthropometric variables. All parameters will be assessed pre and post intervention and there will be a follow up three, six and twelve months after the intervention. A descriptive analysis of all variables and a multivariate analysis to assess differences among groups will be undertaken. Multivariate analysis will be carried out to assess time changes of dependent variables. All the analysis will be done under the intention to treat principle.

DISCUSSION

If the SEDESTACTIV intervention shows its effectiveness in reducing sitting time, health professionals would have a low-cost intervention tool for sedentary overweight and obese patients management.

TRIAL REGISTRATION

A service of the U.S. National Institutes of Health. Developed by the National Library of Medicine. ClinicalTrials.gov NCT01729936.

Effectiveness of three different walking prescription durations on total physical activity in normal- and overweight women

OBJECTIVE

While there is a dose-response relationship between physical activity (PA) and health benefit, little is known about the effectiveness of different PA prescriptions on total daily PA.

AIM

To test, under real-life conditions and using an objective, non-invasive measurement technique (accelerometry), the effect of prescribing additional physical activity (walking only) of different durations (30, 60 and 90 min/day) on compliance (to the activity prescribed) and compensation (to total daily PA). Participants in each group were prescribed 5 sessions of walking per week over 4 weeks.

METHODS

55 normal-weight and overweight women (mean BMI 25 ± 5 kg/m(2), height 165 ± 1 cm, weight 68 ± 2 kg and mean age 27 ± 1 years) were randomly assigned to 3 prescription groups: 30, 60 or 90 min/day PA.

RESULTS

Walking duration resulted in an almost linear increase in the number of steps per day during the prescription period from an average of about 10,000 steps per day for the 30-min prescription to about 14,000 for the 90-min prescription. Compliance was excellent for the 30-min prescription but decreased significantly with 60-min and 90-min prescriptions. In parallel, degree of compensation subsequent to exercise increased progressively as length of prescription increased.

CONCLUSION

A 30-min prescription of extra walking 5 times per week was well tolerated. However, in order to increase total PA further, much more than 60 min of walking may need to be prescribed in the majority of individuals. While total exercise 'volume' increased with prescriptions longer than 30 min, compliance to the prescription decreased and greater compensation was evident.

An adaptive physical activity intervention for overweight adults: a randomized controlled trial

Background

Physical activity (PA) interventions typically include components or doses that are static across participants. Adaptive interventions are dynamic; components or doses change in response to short-term variations in participant's performance. Emerging theory and technologies make adaptive goal setting and feedback interventions feasible.

Objective

To test an adaptive intervention for PA based on Operant and Behavior Economic principles and a percentile-based algorithm. The adaptive intervention was hypothesized to result in greater increases in steps per day than the static intervention.

Methods

Participants (N = 20) were randomized to one of two 6-month treatments: 1) static intervention (SI) or 2) adaptive intervention (AI). Inactive overweight adults (85% women, M = 36.9±9.2 years, 35% non-white) in both groups received a pedometer, email and text message communication, brief health information, and biweekly motivational prompts. The AI group received daily step goals that adjusted up and down based on the percentile-rank algorithm and micro-incentives for goal attainment. This algorithm adjusted goals based on a moving window; an approach that responded to each individual's performance and ensured goals were always challenging but within participants' abilities. The SI group received a static 10,000 steps/day goal with incentives linked to uploading the pedometer's data.

Results

A random-effects repeated-measures model accounted for 180 repeated measures and autocorrelation. After adjusting for covariates, the treatment phase showed greater steps/day relative to the baseline phase (p<.001) and a group by study phase interaction was observed (p = .017). The SI group increased by 1,598 steps/day on average between baseline and treatment while the AI group increased by 2,728 steps/day on average between baseline and treatment; a significant between-group difference of 1,130 steps/day (Cohen's d = .74).

Conclusions

The adaptive intervention outperformed the static intervention for increasing PA. The adaptive goal and feedback algorithm is a “behavior change technology” that could be incorporated into mHealth technologies and scaled to reach large populations.

Trial Registration

ClinicalTrials.gov NCT01793064

Initiating and maintaining recreational walking: a longitudinal study on the influence of neighborhood green space

OBJECTIVE

This study examined prospective relationships of green space attributes with adults initiating or maintaining recreational walking.

METHODS

Postal surveys were completed by 1036 adults living in Adelaide, Australia, at baseline (two time points in 2003-04) and follow-up (2007-08). Initiating or maintaining recreational walking was determined using self-reported walking frequency. Green space attributes examined were perceived presence, quality, proximity, and the objectively measured area (total and largest) and number of green spaces within a 1.6 km buffer drawn from the center of each study neighborhood. Multilevel regression analyses examined the odds of initiating or maintaining walking separately for each green space attribute.

RESULTS

At baseline, participants were categorized into non-regular (n = 395), regular (n = 286), and irregular walkers (n = 313). Among non-regular walkers, 30% had initiated walking, while 70% of regular walkers had maintained walking at follow-up. No green space attributes were associated with initiating walking. However, positive perceptions of the presence of and proximity to green spaces and the total and largest areas of green space were significantly associated with a higher likelihood of walking maintenance over four years.

CONCLUSION

Neighborhood green spaces may not assist adults to initiate walking, but their presence and proximity may facilitate them to maintain recreational walking over time.

Walking kinematics and kinetics following eccentric exercise-induced muscle damage

The goal of this investigation was to investigate how walking patterns are affected following muscle-damaging exercise by quantifying both lower limb kinematics and kinetics. Fifteen young women conducted a maximal isokinetic eccentric exercise (EE) muscle damage protocol (5×15) of the knee extensors and flexors of both legs at 60°/s. Three-dimensional motion data and ground reaction forces (GRFs) were collected 24h pre-EE while the participants walked at their preferred self-selected walking speed (SWS). Participants were asked to perform two gait conditions 48h post-EE. The first condition (COND1) was to walk at their own speed and the second condition (COND2) to maintain the SWS (±5%) they had 24h pre-EE. Walking speed during COND1 was significantly lower compared to pre-exercise values. When walking speed was controlled during COND2, significant effects of muscle damage were noticed, among other variables, for stride frequency, loading rate, lateral and vertical GRFs, as well as for specific knee kinematics and kinetics. These findings provide new insights into how walking patterns are adapted to compensate for the impaired function of the knee musculature following muscle damage. The importance to distinguish the findings caused by muscle damage from those exhibited in response to changes in stride frequency is highlighted.

Achieving recommended daily physical activity levels through commuting by public transportation: unpacking individual and contextual influences

This paper estimates the amount of daily walking associated with using public transportation in a large metropolitan area and examines individual and contextual characteristics associated with walking distances. Total walking distance to and from transit was calculated from a travel diary survey for 6913 individuals. Multilevel regression modelling was used to examine the underlying factors associated with walking to public transportation. The physical activity benefits of public transportation varied along gender and socio-economic lines. Recommended minutes of daily physical activity can be achieved for public transportation users, especially train users living in affluent suburbs.

A 24-h assessment of physical activity and cardio-respiratory fitness among female hospital cleaners: a pilot study

The aim of this study was to evaluate the feasibility of methods for objective 24-h sampling of physical activity among cleaners. Twenty cleaners participated in three 24-h measurements. Amount of steps, heart rate (HR), cardio-respiratory fitness, body mass index (BMI) and blood pressure were measured. The methods were feasible for the objective 24-h sampling of physical activity and cardio-respiratory fitness among cleaners. Measurements showed that the cleaners walked 20,198 ± 4,627 steps per day. During working hours, the average cardio-respiratory load was 25 ± 6% of heart rate reserve (HRR). The cleaners had a low estimated cardio-respiratory fitness (34 mlO2/kg/min), a high BMI (50%, >25 kg/m(2)) and blood pressure (50%, >120/>80 mmHg). The high amount of steps, the relatively high cardiovascular load at work and low cardio-respiratory fitness illustrate the need for further investigation of the relationship between physical activity at work and in leisure, and cardiovascular health in this population.

PRACTITIONER SUMMARY

This study evaluated the feasibility of methods for objective 24-h sampling of physical activity among cleaners; the methods used were found to be feasible. The cleaners had a high cardiovascular load at work and low cardio-respiratory fitness, suggesting that there is a need for further investigations.

Daily step count predicts acute exacerbations in a US cohort with COPD

Background

COPD is characterized by variability in exercise capacity and physical activity (PA), and acute exacerbations (AEs). Little is known about the relationship between daily step count, a direct measure of PA, and the risk of AEs, including hospitalizations.

Methods

In an observational cohort study of 169 persons with COPD, we directly assessed PA with the StepWatch Activity Monitor, an ankle-worn accelerometer that measures daily step count. We also assessed exercise capacity with the 6-minute walk test (6MWT) and patient-reported PA with the St. George's Respiratory Questionnaire Activity Score (SGRQ-AS). AEs and COPD-related hospitalizations were assessed and validated prospectively over a median of 16 months.

Results

Mean daily step count was 5804±3141 steps. Over 209 person-years of observation, there were 263 AEs (incidence rate 1.3±1.6 per person-year) and 116 COPD-related hospitalizations (incidence rate 0.56±1.09 per person-year). Adjusting for FEV₁ % predicted and prednisone use for AE in previous year, for each 1000 fewer steps per day walked at baseline, there was an increased rate of AEs (rate ratio 1.07; 95%CI = 1.003–1.15) and COPD-related hospitalizations (rate ratio 1.24; 95%CI = 1.08–1.42). There was a significant linear trend of decreasing daily step count by quartiles and increasing rate ratios for AEs (P = 0.008) and COPD-related hospitalizations (P = 0.003). Each 30-meter decrease in 6MWT distance was associated with an increased rate ratio of 1.07 (95%CI = 1.01–1.14) for AEs and 1.18 (95%CI = 1.07–1.30) for COPD-related hospitalizations. Worsening of SGRQ-AS by 4 points was associated with an increased rate ratio of 1.05 (95%CI = 1.01–1.09) for AEs and 1.10 (95%CI = 1.02–1.17) for COPD-related hospitalizations.

Conclusions

Lower daily step count, lower 6MWT distance, and worse SGRQ-AS predict future AEs and COPD–related hospitalizations, independent of pulmonary function and previous AE history. These results support the importance of assessing PA in patients with COPD, and provide the rationale to promote PA as part of exacerbation-prevention strategies.

Reach and equity of primary care-based counseling to promote walking among the adult population of Spain

OBJECTIVES

Some controlled trials have shown that brief counseling in primary care settings can increase walking. We examined the prevalence of primary care-based counseling to promote walking and assessed its reach and equity in Spain.

DESIGN

Data were taken from a cross-sectional study conducted in 2008-2010 among 11,951 individuals representative of the non-institutionalized population aged 18-years and older in Spain.

METHODS

Information on whether advice was received, adherence to advice, and time spent walking was self-reported. Analyses were adjusted for proxies of the need for physical activity (age, subjective health, and classic cardiovascular risk factors, including physical activity other than walking and body mass index), equity (sex and educational level), and factors enabling counseling (use of primary care services).

RESULTS

Overall, 46.2% (95% confidence interval [CI] 45.0-47.4) of adults in Spain received counseling to promote walking. Older adults, those with worse subjective health, lower physical activity, with overweight or obesity, and higher use of primary care services were more likely to be counseled. For equal need, counseling was less frequent in men and those with lower socioeconomic position. A total of 69.2% (95% CI 67.8-70.6) of adults who received counseling reported following it. There was no difference in the time spent walking between those who received and did not receive counseling (+0.4 min/day; 95% CI -0.1 to 0.9).

CONCLUSIONS

A substantial proportion of Spanish adults has been encouraged to walk by primary care physician and nurses, but counseling did not translate into longer walking time.

Is walkability associated with a lower cardiometabolic risk?

Walkability of residential environments has been associated with more walking. Given the health benefits of walking, it is expected that people living in locations with higher measured walkability should have a lower risk of cardiometabolic diseases. This study tested the hypothesis that higher walkability was associated with a lower cardiometabolic risk (CMR) for two administrative spatial units and three road buffers. Data were from the North West Adelaide Health Study first wave of data collected between 2000 and 2003. CMR was expressed as a cumulative sum of six clinical risk markers, selected to reflect components of the metabolic syndrome. Walkability was based on an established methodology and operationalised as dwelling density, intersection density, land-use mix and retail footprint. Walkability was associated with lower CMR for the three road buffer representations of the built environment but not for the two administrative spatial units. This may indicate a limitation in the use of administrative spatial units for analyses of walkability and health outcomes.

Step rate-determined walking intensity and walking recommendation in Chinese young adults: a cross-sectional study

There is lack of data on the physiological characteristics of over ground walking and walking recommendations for Chinese young adult. The purpose of the study was to measure walking-related energy expenditure during field testing, to identify step-rate cut-point associated with moderate and vigorous intensity, and to translate physical activity (PA) guidelines into walking goals for Chinese young adults.

DESIGN

Cross-sectional analytic study.

SETTING

Two communities from Beijing and Shanghai in China.

PARTICIPANTS

A sample of 226 Chinese adults (117 men, 109 women) with a mean age of 21.7 (±0.2) years, volunteered to participate in the study. All Participants were recreationally active without orthopaedic limitations, free of chronic diseases, not taking any medications that affect metabolism and non-smokers.

OUTCOME MEASURES

All the participants completed four 6 minincremental over ground walking at different speeds of 3.8, 4.8, 5.6 and 6.4 km/h, respectively. Indirect calorimeter was used to measure energy expenditure at each speed. Receiver operating characteristic curves were used to determine the step-rate cut-points associated with moderate and vigorous intensity activity.

RESULTS

At the same walking speed, step counts per minute were higher in women than in men. No significant differences were found in VO(2) per weight (ml/kg/min) between women and men. Step-rate cut-point associated with walking at 3 metabolic equivalents (METs) and 6METs were 105 and 130 step/min when analysing men and women together. There were slight differences on the cut-points between women and men if data were analysed separately.

CONCLUSIONS

In order to meet PA guidelines, Chinese young adult should walk 30 min with at least 105 step/min or 3150 steps or 2 km with the same step-rate per day. Walking at a higher speed of 130 step/min might provide additional health benefit.

Health benefits of Nordic walking: a systematic review

CONTEXT

Modern lifestyle, with its lack of everyday physical activity and exercise training, predisposes people to chronic diseases such as diabetes mellitus, obesity, hypertension, and coronary artery diseases. Brisk walking as a simple and safe form of exercise is undisputedly an effective measure to counteract sedentary lifestyle risks even in the most unfit and could lead to a reduction of the prevalence of chronic diseases in all populations. The purpose of this review is to systematically summarize, analyze, and interpret the health benefits of Nordic walking (walking with poles), and to compare it to brisk walking and jogging.

EVIDENCE ACQUISITION

A systematic and comprehensive literature search was performed between November 2010 and May 2012. Data were analyzed between April 2011 and May 2012.

EVIDENCE SYNTHESIS

Sixteen RCTs with a total of 1062 patients and 11 observational studies with 831 patients were identified. The current analysis revealed that with regard to short- and long-term effects on heart rate, oxygen consumption, quality of life, and other measures, Nordic walking is superior to brisk walking without poles and in some endpoints to jogging.

CONCLUSIONS

Nordic walking exerts beneficial effects on resting heart rate, blood pressure, exercise capacity, maximal oxygen consumption, and quality of life in patients with various diseases and can thus be recommended to a wide range of people as primary and secondary prevention.

Access to commercial destinations within the neighbourhood and walking among Australian older adults

Background

Physical activity, particularly walking, is greatly beneficial to health; yet a sizeable proportion of older adults are insufficiently active. The importance of built environment attributes for walking is known, but few studies of older adults have examined neighbourhood destinations and none have investigated access to specific, objectively-measured commercial destinations and walking.

Methods

We undertook a secondary analysis of data from the Western Australian state government’s health surveillance survey for those aged 65–84 years and living in the Perth metropolitan region from 2003–2009 (n = 2,918). Individual-level road network service areas were generated at 400 m and 800 m distances, and the presence or absence of six commercial destination types within the neighbourhood service areas identified (food retail, general retail, medical care services, financial services, general services, and social infrastructure). Adjusted logistic regression models examined access to and mix of commercial destination types within neighbourhoods for associations with self-reported walking behaviour.

Results

On average, the sample was aged 72.9 years (SD = 5.4), and was predominantly female (55.9%) and married (62.0%). Overall, 66.2% reported some weekly walking and 30.8% reported sufficient walking (≥150 min/week). Older adults with access to general services within 400 m (OR = 1.33, 95% CI = 1.07-1.66) and 800 m (OR = 1.20, 95% CI = 1.02-1.42), and social infrastructure within 800 m (OR = 1.19, 95% CI = 1.01-1.40) were more likely to engage in some weekly walking. Access to medical care services within 400 m (OR = 0.77, 95% CI = 0.63-0.93) and 800 m (OR = 0.83, 95% CI = 0.70-0.99) reduced the odds of sufficient walking. Access to food retail, general retail, financial services, and the mix of commercial destination types within the neighbourhood were all unrelated to walking.

Conclusions

The types of neighbourhood commercial destinations that encourage older adults to walk appear to differ slightly from those reported for adult samples. Destinations that facilitate more social interaction, for example eating at a restaurant or church involvement, or provide opportunities for some incidental social contact, for example visiting the pharmacy or hairdresser, were the strongest predictors for walking among seniors in this study. This underscores the importance of planning neighbourhoods with proximate access to social infrastructure, and highlights the need to create residential environments that support activity across the life course.

Destination and route attributes associated with adults' walking: a review

BACKGROUND

Increasing adults' physical activity through environmental initiatives that promote walking as a public health priority. To this end, evidence relevant to the urban planning and transport sectors is required. This review synthesized findings on destination and route attributes associated with utilitarian and recreational walking.

METHODS

A literature search was conducted in April 2011 using Web of Science, PubMed, Transport Research Information Services, GEOBASE, and SPORTDiscus. Environmental attributes were classified into the domains of utilitarian and recreational destinations (presence, proximity, quality) and route (sidewalks, connectivity, aesthetics, traffic, safety). Forty-six studies examining associations of these attributes with utilitarian and/or recreational walking were identified. Specific destination and route attributes associated with each type of walking were summarized.

RESULTS

Adults' utilitarian walking was consistently associated with presence and proximity of retail and service destinations (in 80% of the studies reviewed). It was also associated with functional aspects of routes (sidewalks and street connectivity) in 50% of studies. Recreational walking was associated with presence, proximity, and quality of recreational destinations (35% of studies) and route aesthetic (35% of studies). Both types of walking were found unrelated to route safety and traffic in most studies.

CONCLUSIONS

There is consistent evidence that better access to relevant neighborhood destinations (e.g., local stores, services, transit stops) can be conducive to adults' utilitarian walking. Some evidence also suggests that availability of sidewalks and well-connected streets can facilitate utilitarian walking. To better inform initiatives to promote adults' walking in the planning and transport sectors, future studies need to examine how accessible such destinations should be, as well as the effect of the quality of recreational destinations.

Health-related quality of life in relation to walking habits and fitness: a population-based study of 75-year-olds

PURPOSE

To assess health-related quality of life (HRQL) in relation to walking habits and fitness status in older persons. A second aim was to examine fitness status as a mediator in the relation between walking habits and HRQL.

METHODS

A cross-sectional population-based sample of 75-year-olds from Gothenburg, Sweden, was examined (n = 698, response rate 61 %). Walking habits were assessed as weekly frequency and duration. HRQL was assessed with the Short Form-36 (SF-36) and fitness with maximal and self-selected gait speed, chair-stand, stair-climbing capacity, grip strength and one-leg stance.

RESULTS

The proportion of 75-year-olds who attained recommended levels of moderate physical activity (≥ 150 min/week), described as walking, was 60 %. This was positively associated with most subscales of SF-36 and with all fitness tests except grip strength. Maximal gait speed was the fitness test with the highest correlations to all SF-36 subscales. Fitness, described with maximal gait speed, was a partial mediator in most relations between walking habits and SF-36. After adjustment for confounders, associations between regular walking and SF-36 were no longer significant, except for Role Physical, General Health and Role Emotional in women.

CONCLUSIONS

Attaining recommended levels of walking, as well as a high fitness status, is positively associated with several aspects of HRQL in older persons. Fitness, described with maximal gait speed, seems to have a partial role in the relation between walking habits and HRQL, suggesting that other mechanisms are also involved.

Depression is associated with reduced physical activity in persons with heart failure

OBJECTIVE

Reduced physical activity is common in persons with heart failure (HF). However, studies of correlates and modifiers of physical activity in this population rarely employ objective measures. Motivational and mood related factors that may exacerbate inactivity in HF patients are also rarely investigated. In this study, we examined the relationship between physical activity as assessed by accelerometry, and depression in older adults with HF.

METHODS

At baseline, older adults with HF (N = 96; 69.81 ± 8.79) wore an accelerometer for seven days, and completed a brief fitness assessment, neuropsychological testing, and psychosocial measures including the Beck Depression Inventory-II (BDI-II). Medical and demographic history was obtained through record review and self-report.

RESULTS

Accelerometer measures showed that HF patients averaged 587 minutes of sedentary time and just 0.31 minutes of vigorous activity per day. Lower daily step count was associated with poorer quality of life and reduced cognitive function. A multiple linear regression adjusting for important demographic and medical variables found that greater number of depressive symptoms on the BDI-II independently predicted lower physical activity levels.

CONCLUSION

Consistent with past work, the current study found that low physical activity is common in older adults with HF. Depression is an independent predictor of physical activity in older adults with HF and reduced physical activity is associated with numerous adverse psychosocial outcomes. Future studies need to determine whether treatment of depression can boost physical activity and thus improve health outcomes in this population.

Mobility and aging: new directions for public health action

Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms.

Walking, bicycling, and sports in postmenopausal breast cancer survivors--results from a German patient cohort study

OBJECTIVES

Physical activity (PA) is increasingly discussed as a means to achieve both physical and psychological benefits for breast cancer patients and survivors. However, little is known about activity-specific PA behavior following diagnosis. Our objectives were to describe sports and active transportation in the course of breast cancer and to identify factors associated with these activities.

METHODS

We used data from a German cohort study including 1067 postmenopausal breast cancer survivors aged 50-75 years. Data were collected about walking and bicycling for transportation purposes and sports before diagnosis, during therapy, and 1 year after surgery. Associations between these activities and clinical, behavioral, and social characteristics were analyzed with logistic regression.

RESULTS

The proportions of physically active women decreased significantly during therapy compared with before diagnosis (walking: 75.1% vs. 89.7%; bicycling: 19.3% vs. 56.5%; sports: 14.8% vs. 64.5%; all p < 0.001). Calisthenics, swimming, and walking for exercise were the most frequent types of sport. Chemotherapy/radiotherapy was negatively associated with sports (odds ratio [OR]: 0.35 [0.17-0.73]) but positively associated with walking during therapy (OR: 2.08 [1.04-4.15]). Although sociodemographic factors showed weak associations with PA, participation in rehabilitation increased the likelihood for bicycling (OR: 1.48 [1.06-2.09]) and sports (OR: 1.88 [1.38-2.58]) 1 year after surgery.

CONCLUSIONS

The majority of women stopped exercising and bicycling during breast cancer therapy. Interventions promoting in particular moderate activities after breast cancer diagnosis are required for this population. Increasing participation in rehabilitation might help to increase the proportion of women who bicycle and engage in sports after breast cancer diagnosis.

Promoting walking among office employees - evaluation of a randomized controlled intervention with pedometers and e-mail messages

BACKGROUND

The purpose of the study was to evaluate a 6-month intervention to promote office-employees' walking with pedometers and e-mail messages.

METHODS

Participants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N = 241) were randomized to a pedometer (STEP, N = 123) and a comparison group (COMP, N = 118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12 months), process evaluation and interviews (12 months).

RESULTS

The intervention reached 29% (N = 646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2 months in "walking for transportation" (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6 months in "walking for leisure" (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of "walking stairs" at 2 and 6 months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12 months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in "walking stairs" (OR 2.24, 95%CI 0.94 to 5.31) and in "walking for leisure" (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant.

CONCLUSIONS

The findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment. TRIAL REGISTERATION: ISRCTN79432107.

Lifestyle physical activity among urban Palestinians and Israelis: a cross-sectional comparison in the Palestinian-Israeli Jerusalem risk factor study

BACKGROUND

Urban Palestinians have a high incidence of coronary heart disease, and alarming prevalences of obesity (particularly among women) and diabetes. An active lifestyle can help prevent these conditions. Little is known about the physical activity (PA) behavior of Palestinians. This study aimed to determine the prevalence of insufficient PA and its socio-demographic correlates among urban Palestinians in comparison with Israelis.

METHODS

An age-sex stratified random sample of Palestinians and Israelis aged 25-74 years living in east and west Jerusalem was drawn from the Israel National Population Registry: 970 Palestinians and 712 Israelis participated. PA in a typical week was assessed by the Multi-Ethnic Study of Atherosclerosis (MESA) questionnaire. Energy expenditure (EE), calculated in metabolic equivalents (METs), was compared between groups for moderate to vigorous-intensity physical activity (MVPA), using the Wilcoxon rank-sum test, and for domain-specific prevalence rates of meeting public health guidelines and all-domain insufficient PA. Correlates of insufficient PA were assessed by multivariable logistic modeling.

RESULTS

Palestinian men had the highest median of MVPA (4740 METs-min*wk-1) compared to Israeli men (2,205 METs-min*wk-1 p < 0.0001), or to Palestinian and Israeli women, who had similar medians (2776 METs-min*wk-1). Two thirds (65%) of the total MVPA reported by Palestinian women were derived from domestic chores compared to 36% in Israeli women and 25% among Palestinian and Israeli men. A high proportion (63%) of Palestinian men met the PA recommendations by occupation/domestic activity, compared to 39% of Palestinian women and 37% of the Israelis. No leisure time PA was reported by 42% and 39% of Palestinian and Israeli men (p = 0.337) and 53% and 28% of Palestinian and Israeli women (p < 0.0001). Palestinian women reported the lowest level of walking. Considering all domains, 26% of Palestinian women were classified as insufficiently active versus 13% of Palestinian men (p < 0.0001) who did not differ from the Israeli sample (14%). Middle-aged and elderly and less educated Palestinian women, and unemployed and pensioned Palestinian men were at particularly high risk of inactivity. Socio-economic indicators only partially explained the ethnic disparity.

CONCLUSIONS

Substantial proportions of Palestinian women, and subgroups of Palestinian men, are insufficiently active. Culturally appropriate intervention strategies are warranted, particularly for this vulnerable population.

How diverse was the leisure time physical activity of older Australians over the past decade?

OBJECTIVES

Public health recommendations for older adults highlight the need to engage in a combination of aerobic, muscle strength, flexibility and balance activities. This study characterised leisure time physical activity in older Australians (≥ 65 years), examining the diversity in reported activities

DESIGN

Cross-sectional monitoring.

METHODS

The Exercise Recreation and Sport Surveys (2001-2009) were combined and analysed for 22,050 elderly.

RESULTS

Walking was reported by 45.6%, of those 53% engaged exclusively in walking. Prevalent sports (i.e., >1%) were bowls (9.4%), aerobics/callisthenics exercise (9.1%), golf (7.7%), swimming (6.4%), gym work (5.2%), cycling (3.2%), tennis (2.9%), dancing (2.1%), fishing (2.0%), tai chi (1.4%), weight lifting (1.2%) and yoga (1.1%). Significant gender differences were apparent. Over time, significant increases were reported in walking, aerobic/callisthenics and gym workout in both genders. In the previous year, 32.0% of older adults participated in "nil" activity, 40.6% engaged in one activity, 19.5% and 8.0% participated in two or three or more activities, respectively. Common combinations were walking with another aerobic activity. Only 2.6% reported a combination of aerobic, balance and strength activities. Multiple-activity participation increased over the years, but declined with increasing age, education and for the most disadvantaged, compared to single-activity participation. Partially or exclusively organised participation, combined, was reported by 42.5% of older adults. Women were more likely to combine mode of participation. Geographic region was associated with multiple-activity participation and organised-only participation.

CONCLUSIONS

Most elderly people engage in one activity, if at all. An increase in participation in balance enhancing activities and weight training is warranted to maximize health benefits.

The effect of walking on falls in older people: the 'Easy Steps to Health' randomized controlled trial study protocol

Background

Falls in older people continue to be a major public health issue in industrialized countries. Extensive research into falls prevention has identified exercise as a proven fall prevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in falls prevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time.

Methods/Design

This study uses a randomised controlled trial design.

A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme.

Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status.

Discussion

Certain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is shown to reduce falls the public health implications could be enormous. Conversely, if walking does not reduce falls in older people, or even puts older people at greater risk, then health resources targeting falls prevention need to be invested elsewhere.

Trial Registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000380099

Walking for leisure among adults from three Brazilian cities and its association with perceived environment attributes and personal factors

BACKGROUND

Walking is a popular form of physical activity and a convenient option to prevent chronic diseases. However, most of the evidence on this topic derives from high-income countries and little is known about walking patterns and its association with environmental features in low and middle income countries.

OBJECTIVES

To describe walking for leisure and to identify its association with perceived environment and personal factors among residents of three state capitals from different regions of Brazil

METHODS

Cross sectional phone surveys were conducted in Recife, Curitiba and Vitória (n = 6,166) in 2007, 2008 and 2009 respectively. Physical activity was measured using the leisure-time sections of the long version of the International Physical Activity Questionnaire (IPAQ). Perceived environment characteristics were assessed using a modified version of the Neighborhood Environment Walkability Scale (NEWS). Multivariable analysis tested the associations between walking for leisure and perceived environment characteristics across the cities using logistic regression.

RESULTS

The proportions of respondents meeting physical activity recommendations through walking for leisure were 9.6%, 16.0% and 8.8% in Curitiba, Recife and Vitoria, respectively. Engaging in 150 min/wk or more of walking for leisure was significantly associated with younger age, higher education, better self-rated health and with lack of sidewalks on nearby streets. We did not find positive associations between walking for leisure and traffic conditions and safety related to cycling/walking during the day or night.

CONCLUSION

Most environmental features were not associated with walking for leisure. Personal factors were stronger predictors of walking for leisure as compared with perceived environment factors.

Effects of walking speed and step frequency on estimation of physical activity using accelerometers

This study evaluated the accuracy of assessing step counts and energy costs under walking conditions altered by step frequency changes at given speeds using uni- (LC) and tri-axial accelerometers (AM, ASP). Healthy young men and women (n=18) volunteered as subjects. Nine tests were designed to manipulate three step frequencies, low (-15% of normal), normal, and high (+15%), at each walking speed (55, 75, and 95 m/min). A facemask connected to a Douglas bag was attached to subjects, who wore accelerometers around their waist. LC underestimated the step counts at normal or high step frequency at 55 m/min and AM also at all step frequencies at 55 m/min, whereas ASP did not in all trials. LC underestimated metabolic equivalents (METs) at low or normal step frequency at all walking speeds. AM underestimated METs at low step frequency at all walking speeds and at high step frequency of 95 m/min. ASP gave underestimates only at low step frequency of 95 m/min. The degree of the percentage error of METs for AM and ASP was affected by step frequency. Significant interaction between step frequency and speed was found that for LC. These results suggest that LC and AM can cause errors in step-count functions at a low walking speed. Furthermore, LC may show low accuracy of the METs measurement during walking altered according to step frequency and speed, whereas AM and ASP, which are tri-axial accelerometers, are more accurate but the degree of the percentage error is affected by step frequency.

Walking to work in Canada: health benefits, socio-economic characteristics and urban-regional variations

Background

There is mounting concern over increasing rates of physical inactivity and overweight/obesity among children and adult in Canada. There is a clear link between the amount of walking a person does and his or her health. The purpose of this paper is to assess the health factors, socio-economic characteristics and urban-regional variations of walking to work among adults in Canada.

Methods

Data is drawn from two cycles of the Canadian Community Health Survey: 2001 and 2005. The study population is divided into three groups: non-walkers, lower-duration walkers and high-duration walkers. Logistic regression modeling tests the association between levels of walking and health related outcomes (diabetes, high blood pressure, stress, BMI, physical activity), socio-economic characteristics (sex, age, income, education) and place of residence (selected Census Metropolitan Areas).

Results

In 2005, the presence of diabetes and high blood pressure was not associated with any form of walking. Adults within the normal weight range were more likely to be high-duration walkers. Females and younger people were more likely to be lower-duration walkers but less likely to be high-duration walkers. There was a strong association between SES (particularly relative disadvantage) and walking to work. In both 2001 and 2005, the conditions influencing walking to work were especially prevalent in Canada's largest city, Toronto, as well as in several small to medium sized urban areas including Halifax, Kingston, Hamilton, Regina, Calgary and Victoria.

Conclusion

A number of strategies can be followed to increase levels of walking in Canada. It is clear that for many people walking to work is not possible. However, strategies can be developed to encourage adults to incorporate walking into their daily work and commuting routines. These include mass transit walking and workplace walking programs.

Prevalence of exercise and non-exercise physical activity in Chinese adolescents

Non-exercise physical activity (NEPA) is an important part of energy expenditure. This study aimed to investigate the prevalence of exercise and NEPA among adolescents. In the HKSOS project 2006-2007, the proportions of Hong Kong Chinese adolescents (N=32,005) achieving 60-minute exercise and 60-minute NEPA per day were analyzed. Exercise was defined as structured and planned physical activities, and NEPA was defined as unstructured and unplanned physical activities including walking for transportation and climbing stairs. The prevalence of exercise was higher in boys than girls (after school: 63.8% vs 39.6%; holidays: 78.7% vs 60.0%), but the prevalence of NEPA in boys was similar to that in girls (after school: 72.2% vs 68.0%; holidays: 80.3% vs 79.4%). In general, the prevalence of both exercise and NEPA decreased with age in boys and girls, but was more marked for exercise than NEPA. In conclusion, the prevalence of exercise was lower in adolescent girls than boys, and decreased more rapidly with age than NEPA. NEPA seems to be easier to accumulate than exercise among adolescents regardless of sex and age.