Estimation of energy expenditure from physical activity measures: determinants of accuracy

Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study

Background

Accurately assessing an individual's diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message.

Objective

This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool.

Methods

This study used a randomized crossover design to examine the intraindividual effect of 3 prompt settings on the number of images captured in an image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomized to 1 of 6 study sequences, each with a unique order of the 3 prompt settings, with each 3-day image-based dietary record separated by a washout period of at least 7 days. The qualitative component comprised semistructured interviews and questionnaires exploring the experience of dietary assessment.

Results

A total of 37 people were recruited, and 30 participants (11 male, 19 female; mean age 30, SD 10.8 years), completed all image-based dietary records. The image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P≤.001). We found that 13/21 (62%) of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via an image after a meal had been consumed.

Conclusions

Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness.

Exploring Physical Activity Levels in Patients with Cardiovascular Disease-A Preliminary Study

Increased physical activity may prevent disease onset and severity in individuals with cardiovascular disease. However, studies evaluating physical activity in people with cardiovascular disease are limited. This prospective observational study aimed to objectively assess the level of physical activity in patients with cardiovascular disease and determine the actual extent of physical activity in their daily lives. Participants aged 20 years or older with cardiovascular disease at a cardiology clinic were included. Physical activity was measured using an activity meter with a three-axis acceleration sensor. Overall, 58 patients were included in the study. Household activities were found to be more frequent sources of physical activity. The step count was related to age and housework, while total physical activity and household activity were related to age and work. Locomotive activity was related to sex and housework. Total physical and household activities tended to decrease with age. These findings indicate the influence of work and household chores on physical activity and suggest that physical activity may be underestimated if household activity is not also assessed. These fundamental findings may provide clinical evidence to underpin physical activity for patients with cardiovascular disease.

Design and Rationale for the Deep South Interactive Voice Response System-Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial

BACKGROUND

The rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region's lower rates of literacy and internet access, interactive voice response (IVR) system-automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System-Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties.

OBJECTIVE

This paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System-Supported Active Lifestyle intervention.

METHODS

A two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System-Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity-related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O'Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts.

RESULTS

This study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County.

CONCLUSIONS

IVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29245.

Comparison of total and activity energy expenditure estimates from physical activity questionnaires and doubly labelled water: a systematic review and meta-analysis

Physical activity questionnaires (PAQ) could be suitable tools in free-living people for measures of physical activity, total and activity energy expenditure (TEE and AEE). This meta-analysis was performed to determine valid PAQ for estimating TEE and AEE using doubly labelled water (DLW). We identified data from relevant studies by searching Google Scholar, PubMed and Scopus databases. This revealed thirty-eight studies that had validated PAQ with DLW and reported the mean differences between PAQ and DLW measures of TEE (TEEDLW - TEEPAQ) and AEE (AEEDLW - AEEPAQ). We assessed seventy-eight PAQ consisting of fifty-nine PAQ that assessed TEE and thirty-five PAQ that examined AEE. There was no significant difference between TEEPAQ and TEEDLW with a weighted mean difference of -243·3 and a range of -841·4 to 354·6 kJ/d, and a significant weighted mean difference of AEEDLW - AEE PAQ 414·6 and a range of 78·7-750·5. To determine whether any PAQ was a valid tool for estimating TEE and AEE, we carried out a subgroup analysis by type of PAQ. Only Active-Q, administered in two seasons, and 3-d PA diaries were correlated with TEE by DLW at the population level; however, these two PAQ did not demonstrate an acceptable limit of agreement at individual level. For AEE, no PAQ was correlated with DLW either at the population or at the individual levels. Active-Q and 3-d PA diaries were identified as the only valid PAQ for TEE estimation. Further well-designed studies are needed to verify this result and identify additional valid PAQ.

The association of sleep duration and feeling rested with health in U.S. Hispanic women

This study aims to understand the health correlates of sleep deficiencies in non-elderly U.S. Hispanic¹ women. Data from a sample of U.S. Hispanic women (n = 1531; ages 18-65 [M = 39.98; SD = 12.85]) who completed the 2017 National Health Interview Survey were analyzed to understand (1) sleep duration and quality; (2) the association of sleep patterns with key health indicators; and (3) whether these relationships are mediated by health behaviors (ie, healthy eating and physical activity). Shorter sleep duration was associated with a higher likelihood of often feeling anxious and having hypertension. Worse sleep quality was associated with a higher likelihood of being overweight, having fair or poor health status, often feeling depressed, often feeling anxious, having high cholesterol, and having asthma. Doctor's recommendation to engage in physical activity and to decrease calorie intake served as mediators in some of these relationships. Results indicate that among Hispanic women: (1) sleep is an important determinant of a variety of health outcomes and (2) the association of sleep and many health outcomes are mediated by healthy eating and physical activity. Further research on the association of sleep and risk of chronic disease among Hispanic women is needed.

Association between metformin and physical activity with glucose control in adults with type 2 diabetes

Objective

To examine the combined association between metformin use and physical activity on HbA1c in adults with type 2 diabetes.

Research Design and Methods

Adults with type 2 diabetes from NHANES continuous survey (1999-2018, n = 6447) were classified as active and inactive based on self-reported engagement in moderate-to-vigorous or vigorous physical activity (MVPA or VigPA) and metformin use over the last month.

Results

There was a significant negative main effect of metformin usage on HbA1c levels, independent of whether individuals engaged in modest levels of MVPA or VigPA. Moreover, there was a higher prevalence of metformin users with a HbA1c < 6.5% than non-metformin users with no differences by activity status (36.1%-39.5% versus 24.9%-29.7%, respectively). There was a significantly lower HbA1c level (P = .007) and trend for a higher odds of having a HbA1c that achieved the clinical target of <7% (OR, 95% CI = 1.2, 1.0-1.4, P = .06) in the MVPA than non-MVPA group for only those not using metformin. For those using metformin, there was no difference in HbA1c levels by either MVPA or VigPA (both P > .05).

Conclusions

There appears to be independent benefits of metformin and regular physical activity on glucose control, but the impact of these two treatments are not necessarily additive. Based on this analyses, the benefit of physical activity on HbA1c levels in type 2 diabetes is likely more apparent in those not taking metformin, as compared to those who are.

Ethnic and biological differences in the association between physical activity and survival after breast cancer

Physical activity is recommended for most cancer patients as a nonpharmacological therapy to improve prognosis. Few studies have investigated the association between physical activity and breast cancer prognosis by ethnicity, biological, and modifiable risk factors for mortality. We investigated the association between physical activity and long-term survival among breast cancer survivors. A total of 397 survivors (96 Hispanic and 301 non-Hispanic White (NHW)) from the New Mexico HEAL study contributed baseline and biological data approximately 6 months after diagnosis. Study outcomes included all-cause, breast cancer-specific, and non-breast cancer mortality. The exposure was self-reported physical activity within the past month. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox Proportional Hazards regression. A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. Engaging in >6.9 metabolic equivalent hours/week (MET-h/week) of moderate to vigorous physical activity (active) was inversely associated with all-cause mortality among all women (HR 0.66, 95% CI 0.43-0.99) and NHWs (HR 0.58, 95% CI 0.36-0.94). Active NHW women also had a reduced risk of non-breast cancer mortality (HR 0.56, 95% CI 0.31-0.99), compared to inactive women (0 MET-h/week). In subgroups, we observed the inverse associations with all-cause mortality among women >58 years old (p-interaction= 0.03) and with localized stage (p-interaction = 0.046). Our results confirm the protective association between physical activity and mortality after breast cancer diagnosis, and demonstrate that this association significantly differs by age and cancer stage. Larger studies are warranted to substantiate our findings.

Immediate Effects of an Inverted Body Position on Energy Expenditure and Blood Lactate Removal after Intense Running

We compared the immediate effects of a cool-down strategy including an inverted body position (IBP: continuous 30-s alternations of supine and IBP) after a short period of an intense treadmill run with active (walking) and passive (seated) methods. Fifteen healthy subjects (22 years, 172 cm, 67 kg) completed three cool-down conditions (in a counterbalanced order) followed by a 5-min static stretch on three separate days. Heart rate, energy expenditure, blood lactate concentration, fatigue perception, and circumference of thighs and calves were recorded at pre- and post-run at 0, 5, 10, 20, and 30 min. At 5 min post-run, subjects performing the IBP condition showed (1) a 22% slower heart rate (p < 0.0001, ES = 2.52) and 14% lower energy expenditure (p = 0.01, ES = 0.48) than in the active condition, and (2) a 23% lower blood lactate than in the passive condition (p = 0.001, ES = 0.82). Fatigue perception and circumferences of thighs and calves did not differ between the conditions at any time point (F10,238 < 0.96, p < 0.99 for all tests). IBP appears to produce an effect similar to that of an active cool-down in blood lactate removal with less energy expenditure. This cool-down strategy is recommended for tournament sporting events with short breaks between matches, such as Taekwondo, Judo, and wrestling.

The association between physical activity, sleep, and quality of life in patients in bio-chemical remission from Cushing's syndrome

PURPOSE

Cushing's syndrome can negatively affect patient's quality of life (QoL) after treatment and remission. Exposure to increased cortisol over time can result in visceral obesity, which makes this population vulnerable to cardiovascular risk factors associated with visceral obesity. Sleep disturbances are present in patients in remission from Cushing's syndrome, impacting QoL. Moderate intensity physical activity performed 3 times a week decreases visceral obesity and improves sleep quality, therefore, engaging in physical activity after remission may improve patient's QoL. The current study aims to explore the association between sleep quality, physical activity, and QoL in patients in remission of Cushing's syndrome.

METHODS

Patients in bio-chemical remission from Cushing's syndrome (N = 147) were recruited through the Cushing's Support and Research Foundation. Quality of life was assessed using the Cushing Quality of Life Questionnaire (CushingQoL), sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and physical activity levels were assessed with the Godin-Sheppard Leisure-Time Physical Activity Questionnaire (GSLTPAQ).

RESULTS

Sleep quality was significantly associated with both subscales of the CushingQoL (both p < .001), but physical activity was not significantly associated with either subscale. Sleep was not significantly associated with physical activity engagement in this sample.

CONCLUSION

Results suggest that patients in remission from Cushing's syndrome experience sleep disturbances that are significantly associated with impaired QoL. Future research should focus on ameliorating the persisting clinical features of Cushing's syndrome that are associated with impaired QoL after bio-chemical remission to improve QoL and expedite complete functional remission.

Validity of One-Day Physical Activity Recall for Estimating Total Energy Expenditure in Elderly Residents at Long-Term Care Facilities: CLinical EValuation of Energy Requirements Study (CLEVER Study)

Malnutrition is a severe problem among elderly residents living in long-term care facilities. A simple and accurate estimation for total daily energy expenditure (TEE) is required in order to provide them with an adequate amount of food. The purpose of this study was to validate a physical activity assessment tool for estimating TEE among elderly residents. The data of 58 subjects aged 69-99 y were analyzed in this study. The one-day physical activity recall was filled out by facility staff for a typical day. TEE was measured by the doubly labeled water (DLW) method (TEE_DLW), and predicted by one-day physical activity recall using the basal metabolic rate (pTEE_BMR) and body weight (pTEE_BW). The TEE_DLW, pTEE_BMR and pTEE_BW were 1,129±196 kcal/d, 1,186±251 kcal/d and 1,326±236 kcal/d, respectively. In a regression model, body weight, movement means and sex explained 39.0% of the variance in the difference between pTEE_BMR and TEE_DLW (p<0.05). Percentage of fat mass, body weight, and Barthel Index except mobility explained 47.3% of the variance in the difference between pTEE_BW and TEE_DLW (p<0.05). The current results suggested that pTEE_BW is not recommended to estimate TEE because the error depends on body size, and pTEE_BMR was significantly correlated with TEE_DLW but also included systematic errors in elderly residents. In order to improve the accuracy of the present assessment to estimate TEE, it is necessary to establish a new equation of basal metabolic rate for elderly residents and consider sex and movement means to estimate TEE.

Comparison of psychometric properties between recall methods of interview-based physical activity questionnaires: a systematic review

BACKGROUND

This systematic review examined the methodological quality of studies and assessed the psychometric qualities of interview-administered Past-week and Usual-week Physical Activity Questionnaires (PAQs). Pubmed and Embase were used to retrieve data sources.

METHODS

The studies were selected using the following eligibility criteria: 1) psychometric properties of PAQs were assessed in adults; 2) the PAQs either consisted of recall periods of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were interview-administered. The COSMIN taxonomy was utilised to critically appraise study quality and a previously established psychometric criteria employed to evaluate the overall psychometric qualities.

RESULTS

Following screening, 42 studies were examined to determine the psychometric properties of 20 PAQs, with the majority of studies demonstrating good to excellent ratings for methodological quality. For convergent validity (i.e., the relationship between PAQs and other measures), similar overall associations were found between Past-week PAQs and Usual-week PAQs. However, PAQs were more strongly associated with direct measures of physical activity (e.g., accelerometer) than indirect measures of physical activity (i.e., physical fitness), irrespective of recall methods. Very few psychometric properties were examined for each PAQ, with the majority exhibiting poor ratings in psychometric quality. Only a few interview-administered PAQs exhibited positive ratings for a single psychometric property, although the other properties were either rated as poor or questionable, demonstrating the limitations of current PAQs.

CONCLUSION

Accordingly, further research is necessary to explore a greater number of psychometric properties, or to develop new PAQs by addressing the psychometric limitations identified in the current review.

Different analysis methods of Scottish and English child physical activity data explain the majority of the difference between the national prevalence estimates

Background

The percentages of children in Scotland and England meeting the aerobic physical activity (PA) recommendation differ greatly according to estimates derived from the respective national health surveys. The Scottish Health Survey (SHeS) usually estimates over 70% meeting the recommendation; Health Survey for England (HSE) estimates are usually below 25%. It is plausible that these differences originate from different analysis methods. The HSE monitors the percentage of children in England that undertake 60 min of moderate-to-vigorous PA on each day of the week (‘Daily Minimum Method’ (DMM)). The SHeS monitors the proportion that undertakes at least seven sessions of moderate-to-vigorous PA, with an average daily duration ≥60 min in Scotland (‘Weekly Average Method’ (WAM)). We aimed to establish how much this difference in analysis methods influences prevalence estimates.

Methods

PA data from 5 to 15 year olds in the 2015 HSE and SHeS were reanalysed (weighted n = 3840 and 965, respectively). Two comparable pairs of estimates were derived: a DMM and WAM estimate from the HSE not including travel to/from school, and WAM estimates from the HSE and the SHeS including travel to/from school. It is not possible to calculate a DMM estimate from the SHeS due to questionnaire design. Results were presented for the total samples, and by sex and age sub-groups.

Results

The HSE WAM estimate was 31.7 (95% CI: 30.2–33.3) percentage points higher than the DMM estimate (54.3% (95% CI: 52.6–56.0) and 22.6% (95% CI: 21.2–24.1) respectively). The magnitude of this difference differed by age group but not sex. When comparable WAM estimates were derived from the SHeS and the HSE, the SHeS was 11.8 percentage points higher (73.6% (95% CI: 69.8–77.1) and 61.8% (95% CI: 60.2–63.5) respectively). The magnitude of this difference differed by age group and sex.

Conclusions

The results indicate that the difference in the analysis method explains the majority (approximately 30 percentage points) of the difference in the child PA prevalence estimates between Scotland and England (leaving approximately 12 percentage points representing true differences or related to questionnaire differences). These results will help national surveillance determine how to increase comparability between the U.K. home nations.

Physical Activity and Related Psychosocial Outcomes From a Pilot Randomized Trial of an Interactive Voice Response System-Supported Intervention in the Deep South

BACKGROUND

Physical activity exerts cancer-protective effects, yet most Americans are inactive, especially in the South, where cancer incidence rates are generally higher. Telephone-based approaches can help overcome physical activity intervention barriers in this region (literacy, costs, lack of transportation/technology, distance from facilities) and can be automated via interactive voice response (IVR) systems for improved reach and cost-effectiveness.

AIMS

To evaluate the Deep South IVR-supported Active Lifestyle (DIAL) intervention.

METHOD

A pilot randomized controlled trial was conducted among 63 underactive adults in Birmingham, Alabama, from 2015 to 2017.

RESULTS

Retention was 88.9% at 12 weeks, and ≥75% adherence (IVR contact on at least 63 out of 84 days) was noted among 62.5% of intervention participants. Intervention participants reported larger increases in self-reported minutes of moderate-to-vigorous intensity physical activity from baseline to 12 weeks than the wait-list control arm (median change = 47.5 vs. 5.0 minutes, respectively, p = .09). Moreover, the intervention produced significantly greater increases in physical activity self-regulation ( p < .001) and social support from family ( p = .001) and friends ( p = .009) from baseline to 12 weeks, compared with the wait-list control. Significant decreases in self-reported sleep disturbance also were found in the intervention arm but not among the controls, p < .05. Overall, intervention participants reported being satisfied with the DIAL program (71.4%) and would recommend it to friends (92.9%).

DISCUSSION

Findings support the feasibility, acceptability, and preliminary efficacy of the DIAL intervention.

CONCLUSION

Next steps include intervention refinement in preparation for a fully powered efficacy trial and eventual dissemination to rural counties.

Rationale, design, and baseline findings from a pilot randomized trial of an IVR-Supported physical activity intervention for cancer prevention in the Deep South: the DIAL study

Telephone-delivered interventions do not require frequent clinic visits, literacy, or costly technology and thus may represent promising approaches to promoting physical activity in the Deep South, a largely rural U.S. region, with generally lower physical activity, income, and education levels. Building on past Interactive Voice Response (IVR) system-based HIV studies and extensive formative research (11 focus groups on physical activity intervention needs/preferences in the Deep South), the resulting IVR-supported physical activity intervention is now being tested in a randomized controlled trial with a waitlist control. The sample (n=63) includes mostly obese (Mean BMI=30.1) adults (Mean age=43 years) in Birmingham, AL. Both genders (55.6% male) and African Americans (58.7%) are well-represented. Most participants reported at least some college (92%), full time employment (63.5%), and household income <$50,000 per year (61.9%). Baseline physical activity (Mean=39.6 minutes/week, SD=56.4), self-efficacy, self-regulation, and social support were low. However, high physical activity enjoyment and outcome expectations bode well. Self-report physical activity was associated with physical activity enjoyment (r=.36) and social support (friends r=.25, p's<.05) at baseline. Consequently, these may be important variables to emphasize in our program. Depression and anxiety were negatively correlated with some early indicators of behavior change (e.g., physical activity self-regulation; r's =-.43 and -.46, respectively, p's<.01) and thus may require additional attention. Such technology-supported strategies have great potential to reach underserved populations and address physical activity-related health disparities in this region.

Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Background

Using longitudinal panel data, the aim of this study was to examine the contribution of age, period, and cohort effects on changes in physical activity over time in a population-based sample of Canadians. We focused on three domains of physical activities: leisure time, commuting (i.e. walking and cycling), and daily activities (i.e. sedentary behavior). We also examined whether changes in sedentary behavior related to changes in participation in leisure time and commuting activities.

Methods

We used data from the Longitudinal National Population Health Survey (1994–2011): 10050 participants born between 1935 and 1984 grouped in five 10-years birth cohorts. We examined three outcomes: moderate-to-vigorous leisure time physical activity, active commuting, and sedentary behavior. We also included education, income, and body mass index as covariates. We used hierarchical age-period-cohort analysis to examine the contribution of age, period, and cohort effects to changes over time for each outcome.

Results

We found that recent cohorts were more likely to report sedentary behavior and greater participation in leisure time physical activities and active commuting. We also found a significant trend of increasing participation in active leisure time physical activity and active commuting among Canadians from 1994/95 to 2010/11 and, at the same time, an increase in sedentary behavior. The greater participation in leisure time physical activities and active commuting in each succeeding recent cohort was partially related to the secular trend of increasing participation in physical activities over time in the population. Furthermore, those with sedentary behavior were less likely to report participation in physical activities. Overall, obese individuals were less likely to be physically active and more likely to be sedentary, while the effect of socio-economic status varied by outcome.

Conclusions

The greater participation in physical activities (leisure time and commuting) in recent cohorts is encouraging and was substantially explained by period effects, which reflect broad social and environmental factors affecting the whole population. The large cohort effect of increasing sedentary behavior and the inverse relationship between sedentary behavior and physical activity is concerning, and identifies a target group for future interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5189-z) contains supplementary material, which is available to authorized users.

A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study

The links between increased participation in Physical Activity (PA) and improvements in health are well established. As this body of evidence has grown, so too has the search for measures of PA with high levels of methodological effectiveness (i.e. validity, reliability and responsiveness to change). The aim of this “review of reviews” was to provide a comprehensive overview of the methodological effectiveness of currently employed measures of PA, to aid researchers in their selection of an appropriate tool. A total of 63 review articles were included in this review, and the original articles cited by these reviews were included in order to extract detailed information on methodological effectiveness.

Self-report measures of PA have been most frequently examined for methodological effectiveness, with highly variable findings identified across a broad range of behaviours. The evidence-base for the methodological effectiveness of objective monitors, particularly accelerometers/activity monitors, is increasing, with lower levels of variability observed for validity and reliability when compared to subjective measures. Unfortunately, responsiveness to change across all measures and behaviours remains under-researched, with limited information available.

Other criteria beyond methodological effectiveness often influence tool selection, including cost and feasibility. However, researchers must be aware of the methodological effectiveness of any measure selected for use when examining PA. Although no “perfect” tool for the examination of PA in adults exists, it is suggested that researchers aim to incorporate appropriate objective measures, specific to the behaviours of interests, when examining PA in free-living environments.

Evidence for energetic tradeoffs between physical activity and childhood growth across the nutritional transition

Despite broad implications for understanding human life history, energetics, and health, the impact of physical activity on childhood growth remains unclear. Particularly understudied is the effect of secular changes in physical activity on child development. We address these shortcomings using data spanning the transition from traditional to semi-developed economy among Yucatec Maya agriculturalists. Anthropometric and behavioral observation data were collected from children living in a subsistence-based rural community in 1992 and again in 2012 following the introduction of a school and mechanized technologies but minimal overt dietary change. Multiple regression analyses demonstrate dramatic twenty-year transformations in how children spent their time. This behavioral change was associated with large declines in estimated physical activity level (PAL), associated activity energy expenditure savings of several hundred kilocalories/day, and sizable increases in mean height, weight, and triceps skinfold thickness. Controlling for observed frequency of market food consumption, PAL was inversely related to child body size and subcutaneous fat stores and significantly mediated the effects of data collection year on anthropometric indices. These findings indicate that physical activity can considerably influence childhood growth, highlighting the role of energy allocation tradeoffs between physical activity and competing life tasks in shaping patterns of human ontogeny and health.

Design and Evaluation of a Computer-Based 24-Hour Physical Activity Recall (cpar24) Instrument

Background

Widespread access to the Internet and an increasing number of Internet users offers the opportunity of using Web-based recalls to collect detailed physical activity data in epidemiologic studies.

Objective

The aim of this investigation was to evaluate the validity and reliability of a computer-based 24-hour physical activity recall (cpar24) instrument with respect to the recalled 24-h period.

Methods

A random sample of 67 German residents aged 22 to 70 years was instructed to wear an ActiGraph GT3X+ accelerometer for 3 days. Accelerometer counts per min were used to classify activities as sedentary (<100 counts per min), light (100-1951 counts per min), and moderate to vigorous (≥1952 counts per min). On day 3, participants were also requested to specify the type, intensity, timing, and context of all activities performed during day 2 using the cpar24. Using metabolic equivalent of task (MET), the cpar24 activities were classified as sedentary (<1.5 MET), light (1.5-2.9 MET), and moderate to vigorous (≥3.0 MET). The cpar24 was administered twice at a 3-h interval. The Spearman correlation coefficient (r) was used as primary measure of concurrent validity and test-retest reliability.

Results

As compared with accelerometry, the cpar24 underestimated light activity by −123 min (median difference, P difference <.001) and overestimated moderate to vigorous activity by 89 min (P difference <.001). By comparison, time spent sedentary assessed by the 2 methods was similar (median difference=+7 min, P difference=.39). There was modest agreement between the cpar24 and accelerometry regarding sedentary (r=.54), light (r=.46), and moderate to vigorous (r=.50) activities. Reliability analyses revealed modest to high intraclass correlation coefficients for sedentary (r=.75), light (r=.65), and moderate to vigorous (r=.92) activities and no statistically significant differences between replicate cpar24 measurements (median difference for sedentary activities=+10 min, for light activities=−5 min, for moderate to vigorous activities=0 min, all P difference ≥.60).

Conclusion

These data show that the cpar24 is a valid and reproducible Web-based measure of physical activity in adults.

Dietary intake is independently associated with the maximal capacity for fat oxidation during exercise

Background: Substantial interindividual variability exists in the maximal rate of fat oxidation (MFO) during exercise with potential implications for metabolic health. Although the diet can affect the metabolic response to exercise, the contribution of a self-selected diet to the interindividual variability in the MFO requires further clarification.Objective: We sought to identify whether recent, self-selected dietary intake independently predicts the MFO in healthy men and women.Design: The MFO and maximal oxygen uptake ([Formula: see text]O₂ max) were determined with the use of indirect calorimetry in 305 healthy volunteers [150 men and 155 women; mean ± SD age: 25 ± 6 y; body mass index (BMI; in kg/m²): 23 ± 2]. Dual-energy X-ray absorptiometry was used to assess body composition with the self-reported physical activity level (SRPAL) and dietary intake determined in the 4 d before exercise testing. To minimize potential confounding with typically observed sex-related differences (e.g., body composition), predictor variables were mean-centered by sex. In the analyses, hierarchical multiple linear regressions were used to quantify each variable's influence on the MFO.Results: The mean absolute MFO was 0.55 ± 0.19 g/min (range: 0.19-1.13 g/min). A total of 44.4% of the interindividual variability in the MFO was explained by the [Formula: see text]O₂ max, sex, and SRPAL with dietary carbohydrate (carbohydrate; negative association with the MFO) and fat intake (positive association) associated with an additional 3.2% of the variance. When expressed relative to fat-free mass (FFM), the MFO was 10.8 ± 3.2 mg · kg FFM^-1 · min^-1 (range: 3.5-20.7 mg · kg FFM^-1 · min^-1) with 16.6% of the variability explained by the [Formula: see text]O₂ max, sex, and SRPAL; dietary carbohydrate and fat intakes together explained an additional 2.6% of the variability. Biological sex was an independent determinant of the MFO with women showing a higher MFO [men: 10.3 ± 3.1 mg · kg FFM^-1 · min^-1 (3.5-19.9 mg · kg FFM^-1 · min^-1); women: 11.2 ± 3.3 mg · kg FFM^-1 · min^-1 (4.6-20.7 mg · kg FFM^-1 · min^-1); P < 0.05].Conclusion: Considered alongside other robust determinants, dietary carbohydrate and fat intake make modest but independent contributions to the interindividual variability in the capacity to oxidize fat during exercise. This trial was registered at clinicaltrials.gov as NCT02070055.

Relationship between Social Isolation and Indoor and Outdoor Physical Activity in Community-Dwelling Older Adults in Germany: Findings from the ActiFE Study

The purpose of this study was to establish the feasibility of using an aerobics class to produce potentially bone protective vertical impacts of ≥ 4g in older adults and to determine whether impacts can be predicted by physical function. Participants recruited from older adult exercise classes completed an SF-12 questionnaire, short physical performance battery, and an aerobics class with seven different components, performed at low and high intensity. Maximum g and jerk values were identified for each activity. Forty-one participants (mean 69 years) were included. Mean maximal values approached or exceeded the 4g threshold for four of the seven exercises. In multivariate analyses, age (–0.53; –0.77, –0.28) (standardized beta coefficient; 95% CI) and 4-m walk time (–0.39; –0.63, –0.16) were inversely related to maximum g. Aerobics classes can be used to produce relatively high vertical accelerations in older individuals, although the outcome is strongly dependent on age and physical function.

Measurement of physical activity in obese persons: how and why? A review

[Purpose] Overweight and obesity are major risk factors for poor health, especially in children. Reduced physical activity, prompted by a sedentary lifestyle, is a major contributor. Hence, it is important to assess physical activity using standardized methods in public health to identify the risks associated with obesity. There have been no recent reports comparing such modalities for use by clinicians and researchers. In this article, some of these methods for use in the assessment of physical activity are reviewed, and their advantages and disadvantages are described. [Subjects and Methods] Electronic databases including PubMed, Medline, and Google Scholar were searched for literature, using key words Obesity, Physical activity, and Physical Behavior Monitoring. [Results] With advances in technology, various novel methods have been developed to assess physical behavior, but conventional methods are still relevant and easy to administer. [Conclusion] There are various measurement options available. Researchers may choose devices providing more accurate measurements, while clinicians may prefer portability and affordability for patients.

Rationale, design, and baseline findings from HIPP: A randomized controlled trial testing a home-based, individually-tailored physical activity print intervention for African American women in the Deep South

African American women report high rates of physical inactivity and related health disparities. In our previous formative research, we conducted a series of qualitative assessments to examine physical activity barriers and intervention preferences among African American women in the Deep South. These data were used to inform a 12-month Home-based, Individually-tailored Physical activity Print (HIPP) intervention, which is currently being evaluated against a wellness contact control condition among 84 post-menopausal African American women residing in the metropolitan area of Birmingham, Alabama. This paper reports the rationale, design and baseline findings of the HIPP trial. The accrued participants had an average age of 57 (SD=4.7), a BMI of 32.1 kg/m(2) (SD=5.16) with more than half (55%) having a college education and an annual household income under $50,000 (53.6%). At baseline, participants reported an average of 41.5 min/week (SD=49.7) of moderate intensity physical activity, and 94.1% were in the contemplation or preparation stages of readiness for physical activity. While social support for exercise from friends and family was low, baseline levels of self-efficacy, cognitive and behavioral processes of change, decisional balance, outcome expectations, and enjoyment appeared promising. Baseline data indicated high rates of obesity and low levels of physical activity, providing strong evidence of need for intervention. Moreover, scores on psychosocial measures suggested that such efforts may be well received. This line of research in technology-based approaches for promoting physical activity in African American women in the Deep South has great potential to address health disparities and impact public health.

Sedentary Behavior as a Risk Factor for Physical Frailty Independent of Moderate Activity: Results From the Osteoarthritis Initiative

OBJECTIVES

This prospective longitudinal study investigated the association between baseline objectively measured sedentary time and 2-year onset of physical frailty.

METHODS

We studied 1333 Osteoarthritis Initiative participants 55 to 83 years of age who were at risk for physical frailty, as assessed via low gait speed (< 0.6 m per second) or inability to perform a single chair stand. Baseline sedentary time was assessed through accelerometer monitoring. Hazard ratios (HRs) for physical frailty onset were estimated with discrete survival methods that controlled for moderate physical activity, sociodemographic characteristics, baseline gait and chair stand functioning, and health factors.

RESULTS

The incidence of physical frailty in this high-risk group was 20.7 per 1000 person-years. Greater baseline sedentary time (adjusted HR = 1.36 per sedentary hour; 95% confidence interval [CI] = 1.02, 1.79) was significantly related to incident physical frailty after control for time spent in moderate-intensity activities and other covariates.

CONCLUSIONS

Our prospective data demonstrated a strong relationship between daily sedentary time and development of physical frailty distinct from insufficient moderate activity. Interventions that promote reductions in sedentary behaviors in addition to increases in physical activity may help decrease physical frailty onset.

Sedentary behavior and physical function: objective evidence from the Osteoarthritis Initiative

OBJECTIVE

Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity (MVPA) levels.

METHODS

Sedentary behavior was objectively measured by accelerometer on 1,168 participants ages 49-83 years in the Osteoarthritis Initiative with radiographic knee OA at the 48-month clinic visit. Physical function was assessed using 20-meter walk and chair stand testing. Sedentary behavior was identified by accelerometer activity counts/minute <100. The cross-sectional association between sedentary quartiles and physical function was examined by multiple linear regression, adjusting for demographic factors (age, sex, race/ethnicity, education level), health factors (comorbidity, body mass index, knee pain, knee OA severity, presence of knee symptoms), and average daily MVPA minutes.

RESULTS

Adults with knee OA spent two-thirds of their daily time in sedentary behavior. The average gait speed among the most sedentary quartile was 3.88 feet/second, which was significantly slower than the speed of the less sedentary groups (4.23, 4.33, and 4.33 feet/second, respectively). The average chair stand rate among the most sedentary group was significantly lower (25.9 stands/minute) than the rates of the less sedentary behavior groups (28.9, 29.1, and 31.1 stands/minute, respectively). These trends remained significant in multivariable analyses adjusted for demographic factors, health factors, and average daily MVPA minutes.

CONCLUSION

Being less sedentary was related to better physical function in adults with knee OA independent of MVPA time. These findings support guidelines to encourage adults with knee OA to decrease time spent in sedentary behavior in order to improve physical function.

The Godin-Shephard leisure-time physical activity questionnaire: validity evidence supporting its use for classifying healthy adults into active and insufficiently active categories

This study provided validity evidence for the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) to classify respondents into active and insufficiently active categories. Members of a fitness center [45 women and 55 men; mean (SD) age=45.5 (10.6) yr.] completed the questionnaire. Using only moderate and strenuous scores, those with a leisure score index≥24 were classified as active; those with a score≤23 were classified as insufficiently active. VO2max, percentage of body fat, and electronic records of fitness center attendance were the validation variables. In a visit to the fitness center, participants completed the GSLTPAQ and a certified exercise specialist performed a physical fitness evaluation. A multivariate analysis of covariance (MANCOVA) indicated the group of respondents classified as active had higher VO2max and lower percentage of body fat than the group of respondents classified as insufficiently active. An analysis of covariance (ANCOVA) indicated the group of respondents classified as active had higher electronic records of fitness center attendance than the group of respondents classified as insufficiently active. Therefore, these pieces of validity evidence support the use of the questionnaire's classification system among healthy adults.

Physical activity and survival among Hispanic and non-Hispanic white long-term breast cancer survivors and population-based controls

PURPOSE

We investigated the association of physical activity with survival for 601 Hispanic women and 682 non-Hispanic white women who participated in the population-based breast cancer case-control New Mexico Women's Health Study.

METHODS

We identified 240 deaths among cases diagnosed with a first primary invasive breast cancer between 1992 and 1994, and 88 deaths among controls. Follow-up extended through 2012 for cases and 2008 for controls. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.

RESULTS

Higher levels of total physical activity were inversely associated with all-cause mortality among Hispanic cases (Quartile (Q)4: HR = 0.55, 95% CI 0.31-0.99). A non-significant trend was observed for recreational activity in Hispanic cases also (Q4: HR = 0.50, 95% CI 0.23-1.09, p for trend = 0.08). No significant associations were noted for non-Hispanic white cases or for controls.

CONCLUSIONS

The results suggest that increasing physical activity may be protective against mortality in Hispanic women with breast cancer, despite reporting lower levels of recreational activity than non-Hispanic white women or Hispanic controls.

IMPLICATIONS FOR CANCER SURVIVORS

Public health programs in Hispanic communities should promote physical activity in women as a means of decreasing breast cancer risk and improving survival.

Validation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire classification coding system using accelerometer assessment among breast cancer survivors

PURPOSE

The aim of this research was to provide convergent validity evidence for the use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) to classify breast cancer survivors into active and insufficiently active categories.

METHODS

Data were collected among a sample of breast cancer survivors (N = 199; mean age = 55 years) to examine the association between physical activity assessed with a GT3X triaxial accelerometer and the use of the GSLTPAQ's coding system recently proposed by Godin (2011). Participants self-reported moderate and vigorous physical activity (MVPA) performed in a typical week on the GSLTPAQ and those with MVPA leisure score index ≥ 24 were classified as active.

RESULTS

ANCOVA revealed that the adjusted mean [95% CI] number of recorded MVPA minutes was higher for respondents classified as active (145.54 [127.26; 163.83]) compared to respondents classified as insufficiently active (86.99 [74.04; 99.94]). The GSLTPAQ and accelerometer classified 33.8 and 27.2% of participants as active, respectively (agreement = 70.8%). Sensitivity and specificity values were 75.3 and 58.5%, respectively.

CONCLUSION

The GSLTPAQ can be used to classify cancer survivors into active and insufficiently active categories in reference to cancer survivors' physical activity guidelines. However, it has greater capacity to correctly identify insufficiently active respondents.

IMPLICATIONS FOR CANCER SURVIVORS

The use of the GSLTPAQ's classification coding in oncology research could improve the quality of physical activity recommendations and interventions handed out to cancer survivors.

Accelerometer-monitored sedentary behavior and observed physical function loss

OBJECTIVES

We examined whether objectively measured sedentary behavior is related to subsequent functional loss among community-dwelling adults with or at high risk for knee osteoarthritis.

METHODS

We analyzed longitudinal data (2008-2012) from 1659 Osteoarthritis Initiative participants aged 49 to 83 years in 4 cities. Baseline sedentary time was assessed by accelerometer monitoring. Functional loss (gait speed and chair stand testing) was regressed on baseline sedentary time and covariates (baseline function; socioeconomics [age, gender, race/ethnicity, income, education], health factors [obesity, depression, comorbidities, knee symptoms, knee osteoarthritis severity, prior knee injury, other lower extremity pain, smoking], and moderate-to-vigorous activity).

RESULTS

This cohort spent almost two thirds of their waking hours (average=9.8 h) in sedentary behaviors. Sedentary time was significantly positively associated with subsequent functional loss in both gait speed (-1.66 ft/min decrease per 10% increment sedentary percentage waking hours) and chair stand rate (-0.75 repetitions/min decrease), controlling for covariates.

CONCLUSIONS

Being less sedentary was related to less future decline in function, independent of time spent in moderate-to-vigorous activity. Both limiting sedentary activities and promoting physical activity in adults with knee osteoarthritis may be important in maintaining function.

Moderating Effects of Health Literacy on Change in Physical Activity Among Latinas in a Randomized Trial

INTRODUCTION

Latinas report low rates of physical activity (PA) and are at risk for poor health outcomes. Language and literacy barriers impede access and utilization of PA-related resources. This study examined health literacy as a moderator on changes in moderate-to-vigorous physical activity (MVPA) in 196 Latinas enrolled in Seamos Saludables, a randomized-controlled trial of a 6-month culturally and linguistically adapted PA print intervention

METHODS

Secondary analyses were conducted on demographics, acculturation and generation status, and health literacy (Newest Vital Sign). MVPA was determined by 7 day physical activity recall, assessed at baseline and 6 months. General linear models examined interaction effects between health literacy (HL), experimental condition (treatment vs. control), and generation status.

RESULTS

Health literacy moderated change in MVPA from baseline to 6 months. The intervention effect was greater among first-generation Latinas with limited health literacy.

DISCUSSION

Differences in health literacy level appear to influence MVPA outcomes. Formative research is recommended to ensure that materials are appropriate when developing print-based PA interventions, particularly among first-generation Latinas who are more likely to have limited health literacy.

Cardiovascular fitness is associated with bias between self-reported and objectively measured physical activity

The aim of this research study was to determine whether the level of agreement between self-reported and objective measures of physical activity (PA) is influenced by cardiovascular fitness. Participants (n = 113) completed the Global Physical Activity Questionnaire (GPAQ), a health risk assessment and a sub-maximal 12-minute step test. Age-predicted VO2max was used to classify participants as lower fit and higher fit (HF). ActiGraph (GT3X) accelerometers were worn for 7 consecutive days. Matthews cut points were used to calculate minutes of moderate and vigorous PA (MVPA) per week. Bland-Altman plots were used to measure limits of agreement between GPAQ and ActiGraph MVPA. The participants' mean age was 37.9 ± 12.7 years and more than 60% were categorised as HF (n = 71). Moderate PA was over-reported in 39% of all participants. Most of the over-reporters for moderate PA were in the HF group (64.1%). Vigorous PA was over-reported by 72.6% of all participants. The discrepancy between self-reported and objective measures of vigorous PA increased with increasing self-reported time spent in vigorous PA. Fitter individuals appear to over-report PA more than lesser fit participants, suggesting that fitness could influence the level of agreement between self-reported and objective measures of PA.

Physical activity and cancer survivorship

There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management.

METHODS

This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors.

RESULTS

The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort.

CONCLUSIONS

Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.

Comparison of self-reported measure of sitting time (IPAQ) with objective measurement (activPAL)

This study compared sitting time measured by a questionnaire (International Physical Activity Questionnaire; IPAQ) with concurrently measured objective sitting time from an accelerometer-based measure of thigh inclination (activPAL).Adults (n = 69), wore an activPAL for a week, and then completed the long-form 7 d recall IPAQ questionnaire. IPAQ reported sitting time (including and excluding transportation sitting) for the week, weekdays and weekend days were compared to activPAL (criterion measure) sitting time using intraclass correlation coefficients and Bland Altman plots.Confidence intervals between the IPAQ and the activPAL were wide, while correlations between the two measures were low and non-significant (0.112-0.275). Compared to a direct measure of postural sitting (activPAL), the IPAQ underestimated sitting time across the group for the whole week, both when including (mean 2.2 h d(-1)) and excluding (mean 3.4 h d(-1)) transportation sitting. Sitting was less accurately reported on weekend days than weekdays, and at lower levels of sitting on weekdays.Agreement between the IPAQ and the activPAL, a direct measure of sitting, in this study was poor. The direction of group agreement was different to comparisons using a measure of low accelerometer counts (Actigraph) as the criterion measure in previous research. Future studies should use a direct measure of sitting as a criterion measure to validate subjective measurement tools.

Improving physical activity in arthritis clinical trial (IMPAACT): study design, rationale, recruitment, and baseline data

Over 21 million Americans report an arthritis-attributable activity limitation. Knee osteoarthritis (OA) and rheumatoid arthritis (RA) are two of the most common/disabling forms of arthritis. Various forms of physical activity (PA) can improve a variety of health outcomes and reduce health care costs, but the proportion of the US population engaging in the recommended amount of PA is low and even lower among those with arthritis. The Improving Motivation for Physical Activity in Arthritis Clinical Trial (IMPAACT) is a randomized clinical trial that studied the effects of a lifestyle PA promotion intervention on pain and physical function outcomes. The IMPAACT intervention was based on a chronic care/disease management model in which allied health professionals promote patient self-management activities outside of traditional physician office encounters. The program was a motivational interviewing-based, individualized counseling and referral intervention, directed by a comprehensive assessment of individual patient barriers and strengths related to PA performance. The specific aims of IMPAACT were to test the efficacy of the IMPAACT intervention for persons with arthritis (N=185 persons with RA and 155 persons with knee OA) in improving arthritis-specific and generic self-reported pain and Physical Function outcomes, observed measures of function, and objectively measured and self-reported PA levels. Details of the stratified-randomized study design, subject recruitment, and data collection are described. The results from IMPAACT will generate empiric evidence pertaining to increasing PA levels in persons with arthritis and result in widely applicable strategies for health behavior change.

The Seamos Saludables study: A randomized controlled physical activity trial of Latinas

BACKGROUND

Latinas in the U.S. are less physically active than non-Latino white women and also report higher levels of diabetes, obesity, and other conditions related to inactivity. Interventions are needed to address disparities in this high-risk group.

PURPOSE

To evaluate the efficacy of a culturally adapted, Spanish-language, individually tailored, computer expert system-driven physical activity print-based intervention for adult Latinas.

DESIGN

RCT.

SETTING/PARTICIPANTS

Participants were 266 inactive adult Latinas who participated between 2009 and 2012.

INTERVENTION

Participants were randomized to one of two treatment arms: a 6-month tailored physical activity intervention condition or wellness contact control. For both conditions, print materials were delivered by mail.

MAIN OUTCOME MEASURES

The main outcome measure was change in weekly moderate-to-vigorous physical activity (MVPA) measured by the 7-Day Physical Activity Recall interview, which was administered at baseline and post-intervention (6 months). Participants also wore accelerometers for a week at baseline and follow-up. Analyses were conducted in 2013.

RESULTS

Increases in minutes/week of MVPA measured by the 7-Day PAR were significantly greater in the intervention group compared to the control group (mean difference=41.36, SE=7.93, p<0.01). This difference was corroborated by accelerometer readings (rho=0.44, p<0.01). Further, results indicate that intervention participants had greater increases in self-efficacy, cognitive processes, and behavioral processes at 3 months compared to control paricipants (p's<0.05).

CONCLUSIONS

The tailored Spanish-language intervention was effective in increasing MVPA among predominantly low-income, less-acculturated Latinas. Such print-based interventions are poised for widespread dissemination, and thus may help address health disparities.

Adults in all body mass index categories underestimate daily energy requirements

OBJECTIVE

To compare the difference between self-reported and calculated daily energy requirements of adults within different body mass index (BMI) categories.

METHODS

Adults (n = 978) self-reported daily energy requirements, demographic information, and height, weight, age, and physical activity level (PAL) to calculate total energy expenditure.

RESULTS

The main effects of BMI, gender, PAL, and dieting status on the difference between self-reported and calculated energy requirements for weight maintenance were significant (P < .05); age, race/ethnicity, level of education, and being in a health-related field had no effect. Individuals across all BMI categories underestimated their energy requirements, but obese individuals underestimated to the greatest degree. Males, current dieters, and those who reported a low-active or active PAL underestimated to the greatest extent in each category.

CONCLUSIONS AND IMPLICATIONS

There is a lack of basic nutrition knowledge about personal energy needs in individuals across all BMI categories regardless of age, race/ethnicity, level of education, or work/training in a health-related field.

Developing an intervention to address physical activity barriers for African-American women in the deep south (USA)

AIM

To address high rates of inactivity and related chronic diseases among African-American women.

MATERIALS & METHODS

Eleven focus groups on physical activity barriers for African-American women in the deep south (USA) were conducted (n = 56). Feedback guided an intervention development process. The resulting Home-Based Individually Tailored Physical Activity Print intervention was vetted with the target population in a 1-month, single arm, pre-post test demonstration trial (n = 10).

RESULTS

Retention was high (90%). Intent-to-treat analyses indicated increases in motivational readiness for physical activity (70% of sample) and physical activity (7-day Physical Activity Recall) from baseline (mean: 89.5 min/week, standard deviation: 61.17) to 1 month (mean: 155 min/week, standard deviation: 100.86). Small improvements in fitness (6-Min Walk Test), weight and psychosocial process measures were also found.

CONCLUSION

Preliminary findings show promise and call for future randomized controlled trials with larger samples to determine efficacy. Such low-cost, high-reach approaches to promoting physical activity have great potential for addressing health disparities and benefiting public health.

Obesity and other modifiable factors for physical inactivity measured by accelerometer in adults with knee osteoarthritis

OBJECTIVE

To investigate the public health impact of obesity and other modifiable risk factors related to physical inactivity in adults with knee osteoarthritis (OA).

METHODS

The frequency of inactivity as defined by the US Department of Health and Human Services was assessed from objective accelerometer monitoring of 1,089 participants (ages 49-84 years) with radiographic knee OA during the Osteoarthritis Initiative 48-month visit (2008-2010). The relationship between modifiable factors (weight status, dietary fat, fiber, smoking, depressive symptoms, knee function, knee pain, and knee confidence) with inactivity was assessed using odds ratios (ORs) and attributable fractions (AFs), controlling for descriptive factors (age, sex, race, education, lives alone, employment, frequent knee symptoms, and comorbidity).

RESULTS

Almost half (48.9%) of participants with knee OA were inactive. Being overweight (OR 1.8, 95% confidence interval [95% CI] 1.2-2.5) or obese (OR 3.9, 95% CI 2.6-5.7), having inadequate dietary fiber intake (OR 1.6, 95% CI 1.2-2.2), severe knee dysfunction (OR 1.9, 95% CI 1.3-2.8), and severe pain (OR 1.7, 95% CI 1.1-2.5) were significantly related to inactivity, controlling for descriptive factors. Modifiable factors with significant average AFs were being overweight or obese (AF 23.8%, 95% CI 10.5-38.6%) and inadequate dietary fiber (AF 12.1%, 95% CI 0.1-24.5%), controlling for all factors.

CONCLUSION

Being obese or overweight, the quality of the diet, severe pain, and severe dysfunction are significantly associated with physical inactivity in adults with knee OA. All components should be considered in designing physical activity interventions that target arthritis populations with low activity levels.

Prevalence of vitamin D insufficiency and low bone mineral density in elderly Thai nursing home residents

Background

Numerous emerging data from research on osteoporosis among Asians found differences from Caucasians. Therefore, the aim of this study was to determine the prevalence of vitamin D insufficiency and osteoporosis in elderly participants from two nursing homes in Thailand, a country located near the equator.

Methods

The subjects of this cross-sectional study comprised 93 elderly Thai women who were living in institutional long-term nursing homes for the aged. Demographic data, daily food and calcium intake, physical activity, and sunlight exposure were measured. Lumbar spine and femoral neck bone mineral density (BMD) and biochemical levels including serum 25 hydroxyvitamin D [25(OH)D] and bone turnover markers were assessed. Vitamin D insufficiency was defined as 25(OH)D level < 70 nmol/l.

Results

The mean age of subjects was 75.2 ± 6.0 (SD) years. Dietary calcium intake was low (322 ± 158 mg/day) The mean 25(OH)D level was 64.3 ± 14.9 nmol/L and the prevalence of vitamin D insufficiency was 38.7% (95% CI: 28.8%, 49.4%). There was no correlation between serum 25(OH)D concentrations and age (r = −.11, p = 0.3). The mean BMD of lumbar spine and femoral neck were 0.92 ± 0.19 and 0.65 ± 0.10 g/cm², respectively. Nearly a half of the subjects had osteopenia (44.1%, 95% CI: 33.8%, 54.8%) and osteoporosis (47.3%, 95% CI: 36.9%, 57.9%). Circulating C-terminal telopeptide of type I collagen (CTx) level correlated significantly with both lumbar spine (r = −0.26, p = 0.01) and femoral neck BMD (r = −0.25, p = 0.02).

Conclusions

More than one-third of Thai elderly women residing in nursing homes had vitamin D insufficiency. Almost all nursing home residents had osteoporosis and/or osteopenia.

Rationale, design, and baseline findings from Seamos Saludables: a randomized controlled trial testing the efficacy of a culturally and linguistically adapted, computer- tailored physical activity intervention for Latinas

BACKGROUND

Latinos are now the largest (and fastest growing) ethnic minority group in the United States. Latinas report high rates of physical inactivity and suffer disproportionately from obesity, diabetes, and other conditions that are associated with sedentary lifestyles. Effective physical activity interventions are urgently needed to address these health disparities.

METHOD/DESIGN

An ongoing randomized controlled trial will test the efficacy of a home-based, individually tailored physical activity print intervention for Latinas (1R01NR011295). This program was culturally and linguistically adapted for the target population through extensive formative research (6 focus groups, 25 cognitive interviews, iterative translation process). This participant feedback was used to inform intervention development. Then, 268 sedentary Latinas were randomly assigned to receive either the Tailored Intervention or the Wellness Contact Control arm. The intervention, based on Social Cognitive Theory and the Transtheoretical Model, consists of six months of regular mailings of motivation-matched physical activity manuals and tip sheets and individually tailored feedback reports generated by a computer expert system, followed by a tapered dose of mailings during the second six months (maintenance phase). The main outcome is change in minutes/week of physical activity at six months and one year as measured by the 7-Day Physical Activity Recall (7-Day PAR). To validate these findings, accelerometer data will be collected at the same time points.

DISCUSSION

High reach, low cost, culturally relevant interventions to encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.

Evaluation of a cell phone-based physical activity diary

PURPOSE

Physical activity (PA) diaries reduce the recall error inherent in self-reported PA but are burdensome. The purpose of this study was to compare a cell phone-based diary with a paper diary and examine the reliability and validity of the cell phone diary.

METHODS

In a pilot study, 25 women and 23 men, age 45-65 yr, completed cell phone and paper PA diaries 4 d·wk(-1) for three consecutive weeks and a user satisfaction survey. In the subsequent validation study, 623 middle-age participants (52.5% women) were asked to complete the cell phone diary and wear an accelerometer for two 7-d periods, approximately 6 months apart. They also completed two PA questionnaires. Fitness, body mass index, and percent body fat were obtained as indirect validation criteria.

RESULTS

Estimates of PA from the cell phone and paper diaries were similar (mean within person difference = -43.8 MET·min·d(-1) of total PA, SD = 360, P = 0.49, 7.4 min·d(-1) of moderate-vigorous PA, SD = 66, P = 0.53). Users preferred the cell phone diary over the paper diary (59.6% vs 35.4%). In the subsequent study, intraclass correlations for the cell phone diary ranged from 0.55 for light PA to 0.63 for vigorous PA. Although PA estimates from the cell phone diary were generally significantly higher than those from the accelerometer and the questionnaires, correlations for moderate and vigorous PA were moderate (ρ = 0.25-0.59 with the questionnaires and 0.27-0.35 with the accelerometer). The correlations between the cell phone diary and the indirect validation criteria were generally in the expected direction and of moderate magnitude.

CONCLUSIONS

A cell phone-based PA diary is equivalent to a paper diary, acceptable to users, and a relatively reliable and valid approach to self-reported PA.

Differential accuracy of physical activity self-report by body mass index

OBJECTIVES

To examine whether agreement between self-reported and accelerometer-measured physical activity varies by BMI category in a low-income black sample.

METHODS

Participants completed a questionnaire and wore an accelerometer for 4-6 days. Using one- and 10-minute bouts, accelerometers measured light, moderate, and vigorous physical activity time.

RESULTS

Correlations varied by obesity (nonobese: one-minute r=0.41; 10-minute r=0.47; obese: one-minute r=0.21; 10-minute r=0 .14). Agreement was highest among nonobese persons (one-minute kappa = 0.48, 10-minute kappa = 0.023; obese: one-minute kappa = -0.024, 10- minute kappa = -0.020).

CONCLUSIONS

We found compromised questionnaire performance among obese participants.

2011 Compendium of Physical Activities: a second update of codes and MET values

PURPOSE

The Compendium of Physical Activities was developed to enhance the comparability of results across studies using self-report physical activity (PA) and is used to quantify the energy cost of a wide variety of PA. We provide the second update of the Compendium, called the 2011 Compendium.

METHODS

The 2011 Compendium retains the previous coding scheme to identify the major category headings and specific PA by their rate of energy expenditure in MET. Modifications in the 2011 Compendium include cataloging measured MET values and their source references, when available; addition of new codes and specific activities; an update of the Compendium tracking guide that links information in the 1993, 2000, and 2011 compendia versions; and the creation of a Web site to facilitate easy access and downloading of Compendium documents. Measured MET values were obtained from a systematic search of databases using defined key words.

RESULTS

The 2011 Compendium contains 821 codes for specific activities. Two hundred seventeen new codes were added, 68% (561/821) of which have measured MET values. Approximately half (317/604) of the codes from the 2000 Compendium were modified to improve the definitions and/or to consolidate specific activities and to update estimated MET values where measured values did not exist. Updated MET values accounted for 73% of all code changes.

CONCLUSIONS

The Compendium is used globally to quantify the energy cost of PA in adults for surveillance activities, research studies, and, in clinical settings, to write PA recommendations and to assess energy expenditure in individuals. The 2011 Compendium is an update of a system for quantifying the energy cost of adult human PA and is a living document that is moving in the direction of being 100% evidence based.

Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met?

OBJECTIVE

Osteoarthritis (OA) clinical practice guidelines identify a substantial therapeutic role for physical activity, but objective information about the physical activity of this population is lacking. The aim of this study was to objectively measure levels of physical activity in adults with knee OA and report the prevalence of meeting public health physical activity guidelines.

METHODS

Cross-sectional accelerometry data from 1,111 adults with radiographic knee OA (49-84 years old) participating in the Osteoarthritis Initiative accelerometry monitoring ancillary study were assessed for meeting the aerobic component of the 2008 Physical Activity Guidelines for Americans (≥150 minutes/week moderate-to-vigorous-intensity activity lasting ≥10 minutes). Quantile regression was used to test median sex differences in physical activity levels.

RESULTS

Aerobic physical activity guidelines were met by 12.9% of men and 7.7% of women with knee OA. A substantial proportion of men and women (40.1% and 56.5%, respectively) were inactive, having done no moderate-to-vigorous activity that lasted 10 minutes or more during the 7 days. Although men engaged in significantly more moderate-to-vigorous activity (average daily minutes 20.7 versus 12.3), they also spent more time in no or very-low-intensity activity than women (average daily minutes 608.2 versus 585.8).

CONCLUSION

Despite substantial health benefits from physical activity, adults with knee OA were particularly inactive based on objective accelerometry monitoring. The proportions of men and women who met public health physical activity guidelines were substantially less than those previously reported based on self-reported activity in arthritis populations. These findings support intensified public health efforts to increase physical activity levels among people with knee OA.

Cognitive and behavioral approaches in the treatment of obesity

The research reviewed within this article provides support for both the cognitive and behavioral components of cognitive behavioral weight-loss interventions. Lifestyle based treatments have produced markedly improved results in the past 20 years, in part attributable to changes in treatment structure. Use of pretreatment participant preparation strategies, extended treatment periods with clearly defined weight-loss goals, combining multiple dietary and physical activity strategies, and increasing emphasis on long-term provider contact and relapse prevention have modestly improved long-term weight maintenance. Several investigators have emphasized the need to incorporate additional cognitive components into the cognitive-behavioral treatment of obesity to improve both short- and long-term outcomes. Furthermore, continued insights into metabolic changes producing an energy gap after weight loss should no doubt continue to refine insights into the behavioral requirements of long-term weight loss. Despite increased awareness and behavioral treatment advances, the worldwide prevalence of obesity and weight-related chronic illnesses continues to expound. Behavioral treatment is inherently challenging and time-consuming, and readily available to only a fraction of the population who may benefit from inclusion. Several investigators have cautioned that individual or small group-based interventions are insufficient to serve the population masses requiring treatment, and that continued development of community or Web-based programs, and community-development tactics to increase healthy lifestyles, are needed. The call has been sounded to conceptualize obesity as a chronic health condition requiring lifelong treatment. As such, the conceptualization of cognitive-behavioral therapies as a one-time treatment is passe´ . As the current number of obesity specialists and behaviorally trained professionals is insufficient to combat this problem; an increased emphasis upon training nontraditional weight specialists and nonbehavioral community providers is obviated.

The association of education with body mass index and waist circumference in the EPIC-PANACEA study

Background

To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Method

This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.

Results

Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m² lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m²). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.

Conclusion

In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.

A short walk a day shortens the hospital stay: physical activity and the demand for hospital services for older adults

OBJECTIVES

To estimate the impact of increased physical activity on utilization of hospital services among older adults in Canada.

METHODS

The paper uses the Canadian Community Health Survey Cycle 2.1, and count data regression models. The study sample includes 18,196 adults aged 65 and above. Specification tests are used in order to identify the appropriate count data model, and sensitivity analyses are conducted to check the robustness of the results.

RESULTS

The paper shows that physical activity is negatively associated with the probability of staying in the hospital as well as the numbers of hospital stay among users. However, the potential gain decreases as current activity level increases. The results also imply that an additional 20-minute daily walk by inactive older Canadians would decrease total hospital stays by about 2% of the total annual inpatient days. This is equivalent to 1.2% of total hospital bed capacity in a given year.

CONCLUSIONS

Health promotion efforts to increase the level of activity among older adults may create significant savings for the health care system. The total potential gain from additional physical activity is substantial, especially for those who are inactive. However, these gains can be materialized if people stay active enough to derive positive health benefits of physical activity. These results, therefore, should be evaluated in the light of findings from related literature on health and physical activity.

Overweight, obesity, high blood pressure and lifestyle factors among Mexican children and their parents

OBJECTIVE

The objective of this study was to identify associations in the prevalence of overweight, obesity and high blood pressure between children and their parents, as well as their eating and physical patterns.

METHODS

In this cross-sectional study, we obtained data on 83 pairs of school-aged children and one of their parents relating to dietary habits and various physical parameters, including the body mass index (BMI) and blood pressure of the children, which were adjusted by age and gender. Both the children and the parents were asked to complete a questionnaire aimed at providing measures of eating behavior. The questions focused on the consumption of fruit and vegetables and soda drinks as well as on physical activity patterns. Parent BMI was calculated from self-reported height and weight values.

RESULTS

Obesity was diagnosed in 10.8% of the children, and the prevalence of overweight was 28.9%. There was a relationship between a child's weight status and that of his/her parent according to the BMI; 45% of overweight/obese children had overweight/obese parents. In addition, a parent's fruit and vegetable consumption was associated with his/her child's fruit and vegetable consumption (r = 0.47, p < 0.001), and both were associated with soda drink consumption in both parents and children (r = 0.30, p < 0.001).

CONCLUSION

Our results confirmed that there is a relationship between the weight status, fruit and vegetable consumption and soda drink intake of children and those of their parents.