Physical activity assessment with accelerometers: an evaluation against doubly labeled water

The effects of alternate-day fasting on sleep and physical activity in poor sleeping adults: A randomized control trial

Utilizing a randomized control design, 42 healthy adults (22.5 ± 2.8 years) participated in alternate-day modified fasting over a 12-day treatment period. Assessments of sleep included sleep time, efficiency, latency and wake after sleep onset, and assessments of physical activity included steps, energy expenditure, sedentary time, time spent in light physical activity and time spent in moderate-to-vigorous activity. Additional measurements included body composition and mood. The alternate-day modified fasting group consumed 25.8% ± 0.3% fewer calories compared with the control group (p = 0.03). There were no differences between groups for change in body mass index (p = 0.87), total fat mass (p = 0.91) or total lean mass (p = 0.88). Daily energy expenditure did not differ between groups (p = 0.11). On fast days, participants spent 34.5 ± 12.7 more minutes sedentary (p = 0.01), took 1100 ± 362 fewer steps (p < 0.01), and engaged in 27.2 ± 8.4 fewer minutes of moderate-to-vigorous physical activity (p = 0.00) compared with non-fasting days. Sleep duration, efficiency, latency or wake after sleep onset were not different between conditions (p = 0.92, p = 0.10, p = 0.09 and p = 0.66, respectively). We conclude that alternate-day modified fasting does not alter sleep time, efficiency, latency or wake after sleep onset in people reporting poor sleep quality, and does not alter overall physical activity. Although average daily physical activity is not altered, fasting in this manner does tend to result in more sedentary time and less physical activity with compensation on non-fasting days.

Daily physical activity habits influence surgeons' stress in the operating room: a prospective cohort study

BACKGROUND

Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons' physical activity habits and their stress, assessed as heart rate variability, at the start of surgery.

MATERIALS AND METHODS

This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons.

RESULTS

We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42-55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Surgeon professors presented lower lnRMSSD (-0.437, -0.749 to -0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (-0.337, -0.646 to -0.027, P = 0.033), compared to their counterparts.

CONCLUSIONS

Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons' stress in the operating room.

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

OBJECTIVE

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

DESIGN

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

SETTING

Community centers and/or EFNEP classes across the US.

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

ANALYSIS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

Measuring Changes in Upper Body Movement Due to Fasting Using a Camera

Understanding activity levels during fasting is important for promoting healthy fasting practices. While most existing studies focus on step counts to objectively assess the impact of fasting on activity levels and behavioral changes, the results have been mixed. Despite evidence showing that individuals spend a significant amount of time sitting while fasting, there has been no objective measurement of body movement or activity levels during sitting and fasting. This research employs a video-based, unobtrusive human body movement measurement system to monitor upper body movements during fasting and non-fasting periods over several days. Key movement features, such as inactivity, movement speed, and movement scale, were automatically extracted from the video monitoring data using a computer vision pipeline. These features were then statistically compared using t tests between fasting and non-fasting periods, analyzed by hour of the day and across different days. The results of the monitoring of five participants during typical daily sitting office work and fasting for 3-5 days indicate no consistent pattern of upper body movement changes due to fasting among the participants.

The Relationship Between Psychological Factors and Nutritional Status in Adolescence

BACKGROUND

The aim of the research is to explore the relationship between psychological factors and nutritional status in adolescence. The issue of adolescent nutrition is related to several psychological problems, as well as to developmental changes during this period. Research on body image dissatisfaction has confirmed that most adolescents are dissatisfied with their bodies. Developmentally oriented scientists are unique in their approach to explaining the problem of body image, focusing on multiple aspects and attempting to understand the intrapersonal and interpersonal factors that are important for the formation of body image.

METHODS

The sample included 260 adolescents aged 11 to 15. The assessment of sociodemographic factors, emotional states, physical activity levels, and eating habits was included in the questionnaires filled out by the parents (DASS-21 and the Physical Activity & Nutrition Behaviors Monitoring Form questionnaire). Body Mass Index (BMI) was calculated based on information about the height and weight of the adolescents.

RESULTS

The results of the correlation between psychological characteristics and BMI indicate a negative low correlation with all psychological aspects: depression (r = -0.25; p < 0.05), anxiety (r = -0.30; p < 0.05), and stress (r = -0.28; p < 0.05). Over 70% of adolescents are classified in the category of normal BMI.

CONCLUSIONS

The results indicate that subjects who are of normal weight experience less pronounced depression, anxiety, and stress.

Evaluation of the ActiMotus Software to Accurately Classify Postures and Movements in Children Aged 3-14

BACKGROUND

ActiMotus, a thigh-accelerometer-based software used for the classification of postures and movements (PaMs), has shown high accuracy among adults and school-aged children; however, its accuracy among younger children and potential differences between sexes are unknown. This study aimed to evaluate the accuracy of ActiMotus to measure PaMs among children between 3 and 14 years and to assess if this was influenced by the sex or age of children.

METHOD

Forty-eight children attended a structured ~1-hour data collection session at a laboratory. Thigh acceleration was measured using a SENS accelerometer, which was classified into nine PaMs using the ActiMotus software. Human-coded video recordings of the session provided the ground truth.

RESULTS

Based on both F1 scores and balanced accuracy, the highest levels of accuracy were found for lying, sitting, and standing (63.2-88.2%). For walking and running, accuracy measures ranged from 48.0 to 85.8%. The lowest accuracy was observed for classifying stair climbing. We found a higher accuracy for stair climbing among girls compared to boys and for older compared to younger age groups for walking, running, and stair climbing.

CONCLUSIONS

ActiMotus could accurately detect lying, sitting, and standing among children. The software could be improved for classifying walking, running, and stair climbing, particularly among younger children.

Validity of predictive equations for total energy expenditure against doubly labeled water

Variations in physical activity energy expenditure can make accurate prediction of total energy expenditure (TEE) challenging. The purpose of the present study was to determine the accuracy of available equations to predict TEE in individuals varying in physical activity (PA) levels. TEE was measured by DLW in 56 adults varying in PA levels which were monitored by accelerometry. Ten different models were used to predict TEE and their accuracy and precision were evaluated, considering the effect of sex and PA. The models generally underestimated the TEE in this population. An equation published by Plucker was the most accurate in predicting the TEE in our entire sample. The Pontzer and Vinken models were the most accurate for those with lower PA levels. Despite the levels of accuracy of some equations, there were sizable errors (low precision) at an individual level. Future studies are needed to develop and validate these equations.

Relationship of physical activity and cognitive functioning among breast cancer survivors: a cross-sectional analysis

Introduction

Cancer related cognitive decline is a common long-term side effect of cancer and its treatments among breast cancer survivors. Physical activity is a modifiable risk factor related to cognitive decline. However, existing research lacks consensus regarding the relationship between cognition and exercise as well as the impact of cancer treatments on this relationship. Baseline data from an ongoing randomized clinical trial was utilized to examine the relationship between self-reported and objectively measured cognition with physical activity. Exploratory analyses examined cancer treatments as potential moderators.

Methods

Breast cancer survivors (N = 253) completed a battery of neurocognitive tests, the PROMIS Cognitive abilities questionnaire, medical charts abstracted for treatment information, and wore an ActiGraph accelerometer at the waist for 7 days. Data were analyzed using multiple linear regression models.

Results

Participants were on average 58.5 (SD = 8.88) years old, diagnosed 3 years prior to enrollment (SD = 1.27) with 57% treated with chemotherapy and 80% receiving hormone therapy at baseline. Better self-reported cognitive ability was significantly associated with greater min of moderate to vigorous physical activity (MVPA; β = 0.070, se = 0.028, p = 0.012). There were no significant associations with any objectively measured cognitive domains. Time since diagnosis (years) was a significant moderator of MVPA and Processing Speed (β = -0.103, se = 0.043, p = 0.017). Treatment with chemotherapy and/or hormones did not significantly moderate the relationship between MVPA and any of the cognitive measures or domains.

Conclusion

Findings suggest that physical activity is related to self-reported cognition but not objectively measured cognition. Greater physical activity was associated with faster processing speed in participants closer in time to their cancer diagnosis. These results emphasize the need for more research to understand when cancer survivors may benefit from physical activity and what aspects of cognition may be improved.

Effects of Childcare Hands-On Gardening on Preschoolers' (3-5 Years) Physical Activity in Semi-Arid Climate Zone

How hands-on gardening impacts behaviors including healthy eating and physical activity during early childhood can be of critical importance for preventing the early onset of obesity. This study investigates how participating in hands-on gardening impacts preschoolers' (3-5 years old) physical activity (measured by accelerometers) in childcare centers in the semi-arid climate zone. The research was conducted in eight licensed childcare centers located in West Texas with 149 children (n = 149). Four childcare centers in the experimental group received hands-on garden interventions; the other four in the control group did not. In both experimental (intervention) and control (non-intervention) centers, children wore Actigraph GT3X+ accelerometers continuously for 5 days before and for 5 days after intervention (a total of 10 days). Results show that the duration of sedentary behavior of children in the experimental (intervention) group significantly decreased compared to children in the control (non-intervention) group. The finding suggests that the positive effects of childcare hands-on gardening on physical activity extend to semi-arid climate zones where gardening is challenging due to high temperatures and lack of annual rainfall. The research emphasizes the critical need to incorporate hands-on gardening in childcare centers as an obesity prevention strategy nationally in the US and beyond.

Incorporating otolith-isotope inferred field metabolic rate into conservation strategies

Fluctuating ocean conditions are rearranging whole networks of marine communities-from individual-level physiological thresholds to ecosystem function. Physiological studies support predictions from individual-level responses (biochemical, cellular, tissue, respiratory potential) based on laboratory experiments. The otolith-isotope method of recovering field metabolic rate has recently filled a gap for the bony fishes, linking otolith stable isotope composition to in situ oxygen consumption and experienced temperature estimates. Here, we review the otolith-isotope method focusing on the biochemical and physiological processes that yield estimates of field metabolic rate. We identify a multidisciplinary pathway in the application of this method, providing concrete research goals (field, modeling) aimed at linking individual-level physiological data to higher levels of biological organization. We hope that this review will provide researchers with a transdisciplinary 'roadmap', guiding the use of the otolith-isotope method to bridge the gap between individual-level physiology, observational field studies, and modeling efforts, while ensuring that in situ data is central in marine policy-making aimed at mitigating climatic and anthropogenic threats.

Responsiveness of Patient-Reported and Device-Based Physical Activity Measures: Secondary Analysis of Four Randomized Trials

PURPOSE

This study aimed to compare the responsiveness of patient-reported and device-based instruments within four physical activity trials.

METHODS

This was a secondary analysis of four randomized trials that used both a patient-reported outcome measure (the Incidental and Planned Exercise Questionnaire (IPEQ)) and a device-based instrument (ActiGraph or ActivPAL) to measure physical activity. The four trials included were (i) Activity and MObility UsiNg Technology (AMOUNT), digitally enabled exercises in those undertaking aged care and neurological rehabilitation; (ii) Balance Exercise Strength Training at Home, home-based balance and strength exercises in community-dwelling people 65 yr or older; (iii) Coaching for Healthy Ageing (CHAnGE), physical activity coaching and fall prevention intervention in community-dwelling people 60 yr or older; and (iv) Fitbit trial, fall prevention and physical activity promotion with health coaching and activity monitor in community-dwelling people 60 yr or older. We estimated treatment effects for all variables within each physical activity instrument using regression analyses and expressed results as effect sizes (ES).

RESULTS

Overall, device-based instruments were more responsive among healthy older adults (ES range, 0.01 to 0.32), whereas the IPEQ was more responsive among adults requiring rehabilitation (ES range, -0.06 to 0.35). Both the IPEQ and device-based instruments were more responsive in trials that promoted walking via coaching participants to increase their daily steps (AMOUNT (ES range, -0.06 to 0.35), CHAnGE (ES range, -0.24 to 0.22), and Fitbit trial (ES range, -0.23 to 0.32)). Individual variables within the IPEQ and device-based instruments varied in their responsiveness (ES range, -0.13 to 0.20).

CONCLUSIONS

Both the IPEQ and device-based instruments are able to detect small changes in physical activity levels. However, responsiveness varies across different interventions and populations. Our findings provide guidance for researchers and clinicians in selecting an appropriate instrument to measure changes in physical activity.

Individually optimized estimation of energy expenditure in rescue workers using a tri-axial accelerometer and heart rate monitor

Objectives: This study aimed to provide an improved energy expenditure estimation for heavy-load physical labor using accelerometer data and heart rate (HR) measured by wearables and to support food preparation and supply management for disaster relief and rescue operations as an expedition team. Methods: To achieve an individually optimized estimation for energy expenditure, a model equation parameter was determined based on the measurements of physical activity and HR during simulated rescue operations. The metabolic equivalent of task (MET), which was measured by using a tri-axial accelerometer and individual HR, was used, where two (minimum and maximum) or three (minimum, intermediate, and maximum) representative reference points were selected for each individual model fitting. In demonstrating the applicability of our approach in a realistic situation, accelerometer-based METs and HR of 30 males were measured using the tri-axial accelerometer and wearable HR during simulated rescue operations over 2 days. Results: Data sets of 27 rescue operations (age:34.2 ± 7.5 years; body mass index (BMI):22.9 ± 1.5 kg/m2) were used for the energy expenditure estimation after excluding three rescue workers due to their activity type and insufficient HR measurement. Using the combined approach with a tri-axial accelerometer and HR, the total energy expenditure increased by 143% for two points and 133% for three points, compared with the estimated total energy expenditure using only the accelerometer-based method. Conclusion: The use of wearables provided a reasonable estimation of energy expenditure for physical workers with heavy equipment. The application of our approach to disaster relief and rescue operations can provide important insights into nutrition and healthcare management.

Estimated Energy Expenditure in Youth While Playing Active Video Games: A Systematic Review

Sedentary behavior and inadequate energy expenditure are serious global public health concerns among youngsters. The exponential growth in technology emerges as a valuable opportunity to foster physical activity, particularly through active video games. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, Cochrane, and Scopus to provide a comprehensive view of the literature on energy expenditure levels among adolescents while playing active video games. Among the 574 manuscripts identified at the first screening stage, 23 were retained for analysis. Ten studies were characterized by longitudinal and thirteen by cross-sectional designs. The results showed that short-term active video games elicited energy expenditure values comparable to moderate-intensity physical activity (3-6 METs). However, in intervention programs (with at least six weeks) the results indicate no significant effects of active video games on youngsters' energy expenditure levels and physical activity profiles between baseline and follow-up assessments. Overall, active video games based on sports and dance were the most used, and boys tended to achieve higher energy expenditure than girls. The diversity of methods implemented limits comparing results and drawing generalized conclusions. However, considering its attractiveness to youth, active video games might emerge as a complementary tool to traditional physical activities promoted in schools and local communities. Details regarding gender differences and contradictory results of longitudinal approaches should be considered in future research based on standardized methods.

Prevalence and association of compliance with the Canadian 24-hour movement guidelines with sociodemographic aspects in Brazilian adults: a cross-sectional epidemiological study

BACKGROUND

The physical inactivity is a global health concern, so that recommendations on sufficient physical activity levels are elaborated worldwide, such as in Brazil. However, the Canadian 24-Hour Movement Guidelines were first in the world to consider time-specific recommendations for physical activity, sedentary behavior and sleep, which is still not developed for Latin-American population. The present study aimed to verify the adherence to Canadian 24-hour guidelines in a Brazilian inner city and to analyze its association with sociodemographic aspects.

METHODS

A cross-sectional epidemiological study, with a sample composed by 250 adults (140 women), with a median age of 41.0 years. Objective measures of moderate-to-vigorous physical activity (MVPA) and sedentary behavior were collected by accelerometry. Sleep duration and sociodemographic aspects (ethnicity, gender, age, educational attainment and socioeconomic level) were obtained through a face-to-face questionnaire. Canadian 24-hour guidelines considered ≥ 150 min/week of MVPA, <8 h/day of sedentary behavior and daily sleep time between 7 and 9 h, being analyzed separately and in combination. Poisson regression with robust variance estimator was used to analyze the prevalence ratio (PR) of meeting the 24-hour guidelines according to the categories of sociodemographic variables, being performed by the software IBM SPSS version 25.0.

RESULTS

The complete 24-hour guidelines were met only by 24.4% of sample (n = 61). Sedentary behavior was the most met guideline (88%), followed by MVPA (56.8%) and sleep (53.2%), without significant difference according to sex. When compared to elderly participants, those participants in younger groups (18-39 years and 40-59 years) were more likely to meet MVPA guideline (PR = 2.51 [95%CI = 1.47; 4.28] and PR = 2.60 [95%CI = 1.52; 4.45], respectively), as well as the combination of MVPA and sedentary behavior (PR = 1.98 [95%CI = 1.13; 3.44] and PR = 2.17 [95%CI = 1.25; 3.79], respectively) and MVPA with the sleep guideline (PR = 2.39 [95%CI = 1.09; 5.27] only for 18-39 years group). Men were more likely to meet MVPA guideline than women (PR = 1.29 [95%CI = 1.04; 1.59]).

CONCLUSION

Younger aged and male adults were more likely to meet the Canadian 24-hour guidelines in a small Brazilian city. However, further studies with larger and representative samples of sociodemographic stratum are still needed.

BAYESIAN HIERARCHICAL MODELING AND ANALYSIS FOR ACTIGRAPH DATA FROM WEARABLE DEVICES

The majority of Americans fail to achieve recommended levels of physical activity, which leads to numerous preventable health problems such as diabetes, hypertension, and heart diseases. This has generated substantial interest in monitoring human activity to gear interventions toward environmental features that may relate to higher physical activity. Wearable devices, such as wrist-worn sensors that monitor gross motor activity (actigraph units) continuously record the activity levels of a subject, producing massive amounts of high-resolution measurements. Analyzing actigraph data needs to account for spatial and temporal information on trajectories or paths traversed by subjects wearing such devices. Inferential objectives include estimating a subject's physical activity levels along a given trajectory; identifying trajectories that are more likely to produce higher levels of physical activity for a given subject; and predicting expected levels of physical activity in any proposed new trajectory for a given set of health attributes. Here, we devise a Bayesian hierarchical modeling framework for spatial-temporal actigraphy data to deliver fully model-based inference on trajectories while accounting for subject-level health attributes and spatial-temporal dependencies. We undertake a comprehensive analysis of an original dataset from the Physical Activity through Sustainable Transport Approaches in Los Angeles (PASTA-LA) study to ascertain spatial zones and trajectories exhibiting significantly higher levels of physical activity while accounting for various sources of heterogeneity.

The dilemma of physical activity questionnaires: Fitter people are less prone to over reporting

Physical activity questionnaires (PAQs) are a popular method of monitoring physical activity, although their validity is usually low. Descriptions of physical activity levels in questionnaires usually rely on physical responses to physical activity. Therefore, we hypothesised that the validity of PAQs would be higher in the more physically fit group of participants. To test this, we conducted a validation study with 179 adults whom we divided into three fitness groups based on their cardiovascular fitness and age. Participants were measured for one week using the UKK RM42 accelerometer and self-reported their physical activity using IPAQ-SF, GPAQ, and EHIS-PAQ. We analysed the differences between fitness groups in terms of validity for each PAQ using ANOVA. We also performed an equivalence testing to compare the data obtained with the PAQs and the accelerometers. The results showed a significant trend toward higher validity for moderate to vigorous physical activity from the low to high fitness group as assessed by GPAQ and IPAQ-SF (low, intermediate and high fitness group: 0.06-0.21; 0.26-0.29; 0.40, respectively). The equivalence testing showed that all fitness groups overestimated their physical activity and underestimated their sedentary behaviour, with the high fitness group overestimating their physical activity the least. However, EHIS-PAQ was found to agree best with accelerometer data in assessing moderate to vigorous physical activity, regardless of fitness group, and had a validity greater than 0.4 for all fitness groups. In conclusion, we confirmed that when using PAQs describing physical responses to physical activity, participants' fitness should be considered in the interpretation, especially when comparing results internationally.

Test-Retest Reliability, Agreement and Criterion Validity of Three Questionnaires for the Assessment of Physical Activity and Sedentary Time in Patients with Myocardial Infarction

Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test-retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test-retest reliability, criterion validity and agreement were assessed using Spearman's rho and linearly weighted kappa. Test-retest reliability was moderate for three of the six-sub questions (k = 0.43-0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41-0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.

A remotely delivered, peer-led intervention to improve physical activity and quality of life in younger breast cancer survivors

Younger breast cancer survivors (YBCS) consistently report poorer quality of life (QOL) than older survivors. Increasing physical activity (PA) may improve QOL, but this has been understudied in YBCS. This single arm pilot study evaluated the feasibility and acceptability of a 3-month, peer-delivered, remote intervention to increase PA and improve QOL in YBCS. Data were collected from October 2019 - July 2020. Participants (n = 34, 43.1 ± 5.5 years old, 46 ± 34.4 months post-diagnosis, BMI = 30.2 ± 7.4 kg/m2) completed six video sessions with a trained peer mentor; self-monitored PA with a Fitbit activity tracker; and interacted with a private Fitbit Community for social support. At baseline, 3-and 6-months, participants completed QOL questionnaires and PA was measured through accelerometer (moderate-to-vigorous PA [MVPA]) and self-report (strength and flexibility). A parallel mixed-methods approach (qualitative interviews and quantitative satisfaction survey at 3-months) explored intervention feasibility and acceptability. One-way repeated-measures ANOVAs examined impacts on PA and QOL at 3-and 6-months. The intervention was feasible as evidenced by efficient recruitment, high retention, and adherence to intervention components. Remote delivery, working with a peer mentor, and using Fitbit tools were highly acceptable. From baseline to 3-months, participants increased time spent in objectively measured MVPA, strength, and flexibility exercises, and reported meaningful improvements to body image, fatigue, anxiety, and emotional support. A fully remote, peer-to-peer intervention is an acceptable and promising strategy to increase PA and improve QOL in YBCS. Refinements to the intervention and its delivery should be further assessed in future studies, toward the goal of disseminating an evidence-based, scalable intervention to the growing number of YBCS.Trial registration Prospectively registered as NCT04064892.

Associations between changes in physical activity and perceived social exclusion and loneliness within middle-aged adults - longitudinal evidence from the German ageing survey

BACKGROUND

Previous research showed negative associations between physical activity and loneliness in older adults. However, information on associations among middle-aged adults is scarce. In this prognostic factor study, we investigated if starting or stopping to follow the WHO physical activity recommendations was associated with changes in perceived social exclusion and loneliness in this age bracket.

METHODS

We used longitudinal representative data of participants aged 40 to 64 years from the German Ageing Survey waves in 2014 and 2017 (analytical sample = 4,264 observations, 54% women). Perceived social exclusion was investigated with the scale from Bude and Lantermann. Loneliness was quantified with the 6-items loneliness scale from De Jong Gierveld. Information from the International Physical Activity Survey items on the time spend in moderate and vigorous physical activity per week was dichotomized. Participants were coded as either following or not following the WHO´s physical activity recommendations of spending at least 150 min of moderate, 75 min of vigorous or an appropriated combination of physical activity per week. We investigated the within (individual) association between starting and stopping to follow WHO´s physical activity recommendations and perceived social exclusion as well as loneliness in asymmetric fixed effects regressions. Analyses were adjusted for age, marital status, employment status, social-network size, general self-efficacy, depressive symptoms, self-rated health, BMI, comorbidities, and physical functioning (SF-36).

RESULTS

Stopping to follow the physical activity recommendations from the WHO was associated with perceived social exclusion (ß= 0.09 p = 0.04) but not with loneliness (ß=-0.01, p = 0.71). Starting to follow the WHO physical activity recommendations was neither associated with social exclusion (ß=-0.02, p = 0.54) nor with loneliness (ß=-0.01, p = 0.74) in adjusted asymmetric fixed effects regressions.

CONCLUSION

In middle-aged adults, longitudinal associations were found for physical activity and perceived social exclusion. Perceived social exclusion may be prevented by maintaining at least 150 min of moderate physical activities per week, which is the WHO physical activity recommendation. Future research should investigate moderators and mediators in the association between physical activity and social exclusion as well as loneliness.

Acceptability and use of waist-worn physical activity monitors in Jamaican adolescents: lessons from the field

OBJECTIVE

We report our experience with a validated waist-worn activity monitor in Jamaican adolescents attending urban high schools. Seventy-nine adolescents from the Global Diet and Activity Research (GDAR) study, recruited from 5 urban Jamaican high schools (two coeducational (n = 37), two all-female schools (n = 32) and one all-boys school (n = 10)) were asked to wear Actigraph wGT3X-BT accelerometers for 7 days (24-h), removing the device only when bathing or swimming. They also logged wake up and bed times in an activity diary. Accelerometry was considered valid if at least 4 days with ≥ 10-h monitor wear were recorded. Validity was compared by adolescent demographic and school characteristics. We also reviewed the students' written feedback on objective physical activity measurement.

RESULTS

Participants, 80.5% female, had a mean age of 15.5 ± 0.8 years with 60% attending schools in low-income communities. Accelerometer return rates were > 98% with 84% providing valid data. Validity did not vary by age group, sex and school setting. While participants were excited about participating in the accelerometer sub-study, commonly reported challenges included monitor discomfort during sleep and maintaining the study diary. Objective measurement of physical activity using 24-h waist-worn accelerometers is feasible and acceptable in Jamaican adolescents.

Physical Activity, Psychological and Functional Outcomes in Non-Ambulatory Stroke Patients during Rehabilitation-A Pilot Study

Despite the extensive literature on stroke rehabilitation, there are few studies that comprehensively show non-ambulatory stroke patients. The aim of the study was to explore the dynamics of the change in physical activity (PA), psychological and functional outcomes, and the correlation between them in non-ambulatory patients during early in-patient post-stroke rehabilitation. Measurements were taken on 21 participants at the beginning of and 6 weeks post-conventional rehabilitation with the Barthel Index (BI), Berg Balance Scale (BBS), Trunk Control Test (TCT), Stroke Impact Scale (SIS), General Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire (SSEQ), the original scale of belief in own impact on recovery (BiOIoR), Hospital Anxiety and Depression Scale, Acceptance of Illness Scale and when the patient could walk—Time Up & Go and 6 Minute Walk Test. Daily PA was assessed over 6 weeks using a Caltrac accelerometer. Only outcomes for BI, BBS, TCT, SIS, and SSEQ significantly improved 6 weeks post-rehabilitation. PA energy expenditure per day significantly increased over time (p < 0.001; effect size = 0.494), but PA only increased significantly up to the third week. PA change was correlated with BiOIoR post-treatment. Self-efficacy in self-management mediated improvement in SIS. The BiOIoR and confidence in self-management could be important factors in the rehabilitation process.

High daily energy expenditure of Tuvan nomadic pastoralists living in an extreme cold environment

Research investigating thermoregulatory energy costs in free-living humans is limited. We determined the total energy expenditure (TEE) of Tuvan pastoralists living in an extreme cold environment and explored the contribution of physical activity and cold-induced thermogenesis. Twelve semi-nomadic pastoralists (47 ± 8 years, 64 ± 8 kg) living under traditional circumstances, in Tuva, south-central Siberia, Russia, were observed during two consecutive 6-day periods in winter. TEE was measured via the doubly labelled water technique. Skin and ambient temperatures, and physical activity were continuously monitored. The outdoor temperature during the observation period was - 27.4 ± 5.4 °C. During the daytime, the participants were exposed to ambient temperatures below 0 °C for 297 ± 131 min/day. The Tuvan pastoralists were more physically active compared to western populations (609 ± 90 min/day of light, moderate, and vigorous physical activity). In addition, TEE was 13.49 ± 1.33 MJ/day (3224 ± 318 kcal/day), which was significantly larger by 17% and 31% than predicted by body mass, and fat-free mass, respectively. Our research suggests the daily cold exposure combined with high levels of physical activity contributed to the elevated TEE. Future research should reconsider the assumption that energy costs due to thermoregulation are negligible in free-living humans.

Prediction of activity-related energy expenditure under free-living conditions using accelerometer-derived physical activity

The purpose of the study was to develop prediction models to estimate physical activity (PA)-related energy expenditure (AEE) based on accelerometry and additional variables in free-living adults. In 50 volunteers (20–69 years) PA was determined over 2 weeks using the hip-worn Actigraph GT3X + as vector magnitude (VM) counts/minute. AEE was calculated based on total daily EE (measured by doubly-labeled water), resting EE (indirect calorimetry), and diet-induced thermogenesis. Anthropometry, body composition, blood pressure, heart rate, fitness, sociodemographic and lifestyle factors, PA habits and food intake were assessed. Prediction models were developed by context-grouping of 75 variables, and within-group stepwise selection (stage I). All significant variables were jointly offered for second stepwise regression (stage II). Explained AEE variance was estimated based on variables remaining significant. Alternative scenarios with different availability of groups from stage I were simulated. When all 11 significant variables (selected in stage I) were jointly offered for stage II stepwise selection, the final model explained 70.7% of AEE variance and included VM-counts (33.8%), fat-free mass (26.7%), time in moderate PA + walking (6.4%) and carbohydrate intake (3.9%). Alternative scenarios explained 53.8–72.4% of AEE. In conclusion, accelerometer counts and fat-free mass explained most of variance in AEE. Prediction was further improved by PA information from questionnaires. These results may be used for AEE prediction in studies using accelerometry

Agreement between Fitbit and ActiGraph Estimates of Physical Activity in Young Children

Physical activity (PA) estimates from the Fitbit Flex 2 were compared to those from the ActiGraph GT9X Link in 123 elementary school children. Steps and intensity-specific estimates of PA and 3-month PA change were calculated using two different ActiGraph cut-points (Evenson and Romanzini). Fitbit estimates were 35% higher for steps compared to the ActiGraph. Fitbit and ActiGraph intensity-specific estimates were closest for sedentary and light PA while estimates of moderate and vigorous PA varied substantially depending upon the ActiGraph cut-points used. Spearman correlations between device estimates were higher for steps (rs=.70) than for moderate (rs =.54 to .55) or vigorous (rs =.29 to .48) PA. There was low concordance between devices in assessing PA changes over time. Agreement between Fitbit Flex 2 and ActiGraph estimates may depend upon the cut-points used to classify PA intensity. However, there is fair to good agreement between devices in ranking children's steps and MVPA.

Reliability of the accelerometer to control the effects of physical activity in older adults

Background

Reliable physical activity measurements in community-dwelling older adults are important to determine effects of targeted health promotion interventions. Many exercise interventions aim to improve time spent sedentary (SED), in light-intensity-physical-activity (LPA) and moderate-to-vigorous-intensity-physical-activity (MVPA), since these parameters have independently proposed associations with health and longevity. However, many previous studies rely on self-reports which have lower validity compared to accelerometer measured physical activity patterns. In addition, separating intervention-effects from reactivity measurements requires sufficient test-retest reliability for accelerometer assessments, which is lacking in older adults.

Objectives

The study objective was to investigate the reliability of sensor-based PA-patterns in community-dwelling older adults. Furthermore, to investigate change over time of physical activity patterns and examine any compensatory-effect from the eight-week supervised exercise-intervention.

Methods

An exercise-group (n = 78, age-range:65-91yrs) performed two 1h-exercise sessions/week during eight-weeks. PA-pattern was assessed (using hip-worn accelerometers), twice before and once during the last-week of the intervention. A control-group (n = 43, age-range:65-88yrs) performed one pre-test and the end-test with no exercise-intervention. A dependent-t-test, mean-difference (95%-CI), limits-of-agreement and intraclass-correlation-coefficient-ICC were used between the two pre-tests. Repeated-measures-ANOVA were used to analyze any intervention-effects.

Results

The exercise-groups´ two pre-tests showed generally no systematic change in any PA- or SED-parameter (ICC ranged 0.75–0.90). Compared to the control group, the exercise intervention significantly (time x group-interaction, p<0.05) increased total-PA-cpm (exercise-group/control-group +17%/+7%) and MVPA-min/week (+41/-2min) and decreased %-of-wear-time for SED-total (-4.7%/-2.7%) and SED-bouts (-5.7%/-1.8%), and SED-bouts min/d (-46/-16min). At baseline level, no significant differences were found between the two groups for any parameter.

Conclusions

The current study presents a good test-retest-reliability of sensor-based-one-week-assessed-PA-pattern in older-adults. Participating in an 8-week supervised exercise intervention improved some physical activity and sedentary parameters compared to the control group. No compensatory-effect was noted in the intervention-group i.e., no decrease in any PA-parameter or increase in SED at End-test (in %-of-wear-time, min/day or total-PA).

Concurrent validity of the combined HRV/ACC sensor and physical activity diary when monitoring physical activity in university students during free-living days

The purpose of this research was to determine if the scientific research device combined heart rate variability combined with an acceleration sensor (Firstbeat Bodyguard 2, BG2) was valid and reliable for time spent in different intensity zones in free-living. A total of 55 healthy participants performed 48-h physical activity (PA) monitoring with BG2, ActiGraph GT3X+ (GT3X+), and completed Bouchard Physical Activity Diary (Bouchard) every night. In the available studies, GT3X+ is considered the gold standard scientific research device for PA monitor. We compared BG2 and Bouchard with GT3X+ by difference, correlation, and agreement of PA and energy expenditure (EE) in free-living. The results showed that BG2 estimated PA more accurately than Bouchard, with a modest correlation (r > 0.49), strong agreement (τ > 0.29), and they had the lowest limits of agreement when estimating moderate to vigorous physical activity (MVPA). The EE estimated by Bouchard was the highest among the three methods, and the correlation and agreement between the three methods were high. Our findings showed that the BG2 is valid and reliable for estimating time spent in different intensity zones in free-living, especially in MVPA.

Wearables for Measuring the Physical Activity and Sedentary Behavior of Patients With Axial Spondyloarthritis: Systematic Review

BACKGROUND

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA.

OBJECTIVE

This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA.

METHODS

PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device-measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study's characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted.

RESULTS

A total of 31 studies were initially identified; 13 (13/31, 42%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23%), lower back (3/13, 23%), right hip (3/13, 23%), waist (2/13, 15%), anterior thigh (1/13, 8%), or right arm (1/13, 8%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77% (10/13) of studies had a monitoring period of 1 week, including weekend days.

CONCLUSIONS

To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device-measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA.

TRIAL REGISTRATION

PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/23359.

Testing and Optimizing Guided Thinking Tasks to Promote Physical Activity: Protocol for a Randomized Factorial Trial (Preprint)

Background

Objective

Methods

Results

Conclusions

Trial Registration

International Registered Report Identifier (IRRID)

The Role of Remote Monitoring in Evaluating Fatigue in Multiple Sclerosis: A Review

Fatigue is one of the most common multiple sclerosis (MS) symptoms. Despite this, monitoring and measuring fatigue (subjective lack of energy)- and fatigability (objectively measurable and quantifiable performance decline)- in people with MS have remained challenging. Traditionally, administration of self-report questionnaires during in-person visits has been used to measure fatigue. However, remote measurement and monitoring of fatigue and fatigability have become feasible in the past decade. Traditional questionnaires can be administered through the web in any setting. The ubiquitous availability of smartphones allows for momentary and frequent measurement of MS fatigue in the ecological home-setting. This approach reduces the recall bias inherent in many traditional questionnaires and demonstrates the fluctuation of fatigue that cannot be captured by standard measures. Wearable devices can assess patients' fatigability and activity levels, often influenced by the severity of subjective fatigue. Remote monitoring of fatigue, fatigability, and activity in real-world situations can facilitate quantifying symptom-severity in clinical and research settings. Combining remote measures of fatigue as well as objective fatigability in a single construct, composite score, may provide a more comprehensive outcome. The more granular data obtained through remote monitoring techniques may also help with the development of interventions aimed at improving fatigue and lowering the burden of this disabling symptom.

Measuring change in adolescent physical activity: Responsiveness of a single item

Self-report measures are frequently used to assess change in physical activity (PA) levels. Given the limited data from adolescent populations, the primary objective of this study was to examine the responsiveness of a single item measure (SIM) of PA for adolescents to detect change in moderate-to-vigorous physical activity (MVPA) using accelerometer data as the reference measure. A secondary objective was to provide further data on the validity of the measure at one point in time. The validity of the SIM to determine the number of days ≥60 minutes of MVPA was based on data from 200 participants (62% female; age: 14.0 ± 1.6 years) and analysis of change was based on data from 177 participants (65% female; age: 14.0 ± 1.6 years). Validity of change in days ≥60 minutes of MVPA was examined through agreement in classification of change between the SIM and accelerometry as the reference measurement and Spearman’s correlation. Cohen’s d and standardised response means were used to assess the responsiveness to change of the measure. The responsiveness of the SIM and accelerometer data were comparable and modest (0.27–0.38). The correlation for change in number of days ≥60 minutes MVPA between the SIM and accelerometery was low (r = 0.11) and the accuracy of the SIM for detecting change, using accelerometry as the reference, was only marginally above chance (53%). Therefore, the adolescent version of the SIM is adequate for assessing PA at a single time point but not recommended for assessing change.

Motivation and Lifestyle-Related Changes among Participants in a Healthy Life Centre: A 12-Month Observational Study

Healthy Life Centers (HLCs) have been established throughout Norway to support lifestyle changes and promote physical and mental health. We conducted a 12-month observational study among participants in an HLC that aimed to improve physical activity (PA) and dietary behaviors, and this study examined predictors of completion, and changes in psychological variables, lifestyle behaviors, and physical health indicators. The participants (N = 120, 71% female, mean age = 44 years) reported symptoms of psychological distress (77%) and were obese (77%). No baseline characteristics were found to be consistent predictors of completion (42%). Completers had significant improvements in autonomous motivation for PA (d = 0.89), perceived competence for PA (d = 1.64) and diet (d = 0.66), psychological distress (d = 0.71), fruit intake (d = 0.64), vegetable intake (d = 0.38), BMI among all participants (d = 0.21) and obese participants (d = 0.34), body fat percentage among all participants (d = 0.22) and obese participants (d = 0.33), and lower body strength (d = 0.91). Fat-free mass and all forms of PA remained unchanged from baseline to 12 months. Hence, there were indications of improvement among completers on psychological variables, lifestyle behaviors, and physical health indicators. The low rate of completion was a concern, and the unchanged levels of PA reflect an important area of focus for future interventions in the context of HLCs.

Wearable activity trackers-advanced technology or advanced marketing?

Wearable devices represent one of the most popular trends in health and fitness. Rapid advances in wearable technology present a dizzying display of possible functions: from thermometers and barometers, magnetometers and accelerometers, to oximeters and calorimeters. Consumers and practitioners utilize wearable devices to track outcomes, such as energy expenditure, training load, step count, and heart rate. While some rely on these devices in tandem with more established tools, others lean on wearable technology for health-related outcomes, such as heart rhythm analysis, peripheral oxygen saturation, sleep quality, and caloric expenditure. Given the increasing popularity of wearable devices for both recreation and health initiatives, understanding the strengths and limitations of these technologies is increasingly relevant. Need exists for continued evaluation of the efficacy of wearable devices to accurately and reliably measure purported outcomes. The purposes of this review are (1) to assess the current state of wearable devices using recent research on validity and reliability, (2) to describe existing gaps between physiology and technology, and (3) to offer expert interpretation for the lay and professional audience on how best to approach wearable technology and employ it in the pursuit of health and fitness. Current literature demonstrates inconsistent validity and reliability for various metrics, with algorithms not publicly available or lacking high-quality validation studies. Advancements in wearable technology should consider standardizing validation metrics, providing transparency in used algorithms, and improving how technology can be tailored to individuals. Until then, it is prudent to exercise caution when interpreting metrics reported from consumer-wearable devices.

Effects of Exercise Frequency and Intensity on Reducing Depressive Symptoms in Older Adults With Insomnia: A Pilot Randomized Controlled Trial

Background

The effects of exercise frequency and intensity on alleviating depressive symptoms in older adults with insomnia are unclear.

Purpose

The purpose of this study was to investigate the influence of different exercise frequencies and intensities on prescribed aerobic-type physical activity (i.e., 75 min of vigorous-intensity exercise or 150 min of moderate-intensity exercise weekly) for reducing depressive symptoms in older adults living with insomnia, as recommended by the WHO.

Design

This study is a randomized, controlled, assessor-blinded trial.

Setting

This study is conducted at a single research site in Hong Kong.

Participants

This study includes older adults aged 50 years or above with depressive symptoms and insomnia.

Intervention

Participants were randomly assigned in a 1:1:1:1:1 ratio to the following groups: attention control (CON), moderate walking once weekly (MOD × 1/week), moderate walking thrice weekly (MOD × 3/week), vigorous walking once weekly (VIG × 1/week), and vigorous walking thrice weekly (VIG × 3/week). The total weekly exercise volumes among the walking groups were matched to the minimum recommended physical activity volume.

Measurements

Depression, anxiety, self-perceived sleep quality, insomnia severity, actigraphy-assessed 7-day sleep data, 7-day sleep diary, cardiorespiratory fitness, adherence, and habitual physical activity were examined at baseline and after 12 weeks of intervention.

Results

Both MOD × 3/week and VIG × 3/week groups demonstrated reduced depression (Hospital Anxiety and Depression Scale [HADS] – Depression: MOD × 3/wk: −68.6%; VIG × 3/week: −67.4%) and anxiety levels (HADS – Anxiety: MOD × 3/week: −54.3%; VIG × 3/week: −59.8%) compared with CON (both p < 0.01). Self-perceived sleep quality was improved in MOD × 3/week (−31.4% of the Pittsburgh Sleep Quality Index [PSQI]), VIG × 1/week (−34.1% of PSQI), and VIG × 3/week (−38.3% of PSQI), but not in MOD × 1/week, when compared with CON (p < 0.05). No serious adverse events were observed in this study.

Conclusion

The effects of walking training on reducing depressive symptoms appeared to be dependent on exercise frequency. Our findings suggest that three sessions of walking per week at either moderate or vigorous-intensity effectively alleviate depressive symptoms in older adults with insomnia. Additional research is needed to further verify the effects of exercise frequency on depression.

Clinical Trial Registration

[ClinicalTrials.gov], identifier [NCT04354922].

Association of cardiac autonomic modulation with different intensities of physical activity in a small Brazilian inner city: a gender analysis

AbstractPhysical activity has been linked to higher cardiac autonomic modulation. However, it is not clear in the literature which type of intensity of physical activity (sedentary, light, moderate, or vigorous) could be related to better cardiac autonomic modulation and whether this relationship is similar in men and women. The aim of this study was to analyze the relationship between cardiac autonomic modulation and the different intensities of physical activity in men and women. The sample included 100 men and 131 women. Cardiac autonomic modulation was obtained by heart rate variability (SDNN, RMSSD, LF un, HF un, SD1, and SD2). Time spent in different intensities (sedentary, light, moderate, and vigorous intensity physical activity) was measured using a waist-worn accelerometer for seven days. Linear regression was used to verify the relationship between physical activity and cardiac autonomic modulation, considering the adjustment for age, ethnicity, and socioeconomic level. Among men, a significant relationship of moderate intensity was observed with SDNN (β=2.442; p = 0.021) and SD2 (β=2.936, p = 0.028), and of vigorous intensity with SDNN (β=12.826, p = 0.028), RMSSD (β=16.370, p = 0.018), and SD1 (β=12.344, p = 0.025) indices. Among women, light-intensity physical activity was significantly related with LFnu (β= .655, p = 0.005) and HFnu (β= -.590, p = 0.010). Moderate and vigorous physical activity was associated with better cardiac autonomic modulation in men. Light physical activity was associated with lower sympathetic modulation in women.

Socioecological approach for identifying the determinants of objectively measured physical activity: A prospective study of the UK Biobank

The socioecological approach emphasises that health promotion should focus on a variety of factors that surround individuals simultaneously, yet there is little evidence on how these factors relatively affect physical activity (PA). The main objective was to identify relevant determinants of PA by examining the associations between factors within multilayered socioecological categories and PA. A prospective analysis was conducted with 84,052 participants participating in the accelerometer measurement from the UK Biobank. Time spent in moderate-to-vigorous PA (MVPA) was calculated from participants who wore a wrist-worn accelerometer for seven days; a questionnaire-based self-reported leisure-time physical activity was also assessed. A categorical principal component analysis was conducted to reduce the dimensions of 184 variables. The associations between principal components (PCs) and PA were evaluated using general linear models. A network of PCs was constructed to assess the comprehensive association with PA. PCs related to body composition and chronic diseases were suggested as key determinants of objectively measured MVPA and found to be clustered in the network. PCs related to body composition and socio-economic status were proposed as the key regulatory hubs in the network because they exhibited the highest level of indirect linkages with other components. In the environmental category, PCs related to greenness and air pollution were revealed to be key factors in the self-reported walking for pleasure. Using a socioecological approach, it was discovered that obesity and disease-related factors were the most important determinants, and they had an integrative influence with other factors in different categories.

The evolutionary significance of human brown adipose tissue: Integrating the timescales of adaptation

While human adaptability is regarded as a classical topic in anthropology, recent work provides new insight into metabolic adaptations to cold climates and the role of phenotypic plasticity in human evolution. A growing body of literature demonstrates that adults retain brown adipose tissue (BAT) which may play a role in non-shivering thermogenesis. In this narrative review, we apply the timescales of adaptation framework in order to explore the adaptive significance of human BAT. Human variation in BAT is shaped by multiple adaptive modes (i.e., allostasis, acclimatization, developmental adaptation, epigenetic inheritance, and genetic adaptation), and together the adaptive modes act as an integrated system. We hypothesize that plasticity in BAT facilitated the successful expansion of human populations into circumpolar regions, allowing for selection of genetic adaptations to cold climates to take place. Future research rooted in human energetics and biocultural perspectives is essential for understanding BAT's adaptive and health significance.

Count- versus MAD-based accelerometry-assessed movement behaviors and associations with child adiposity and fitness

Estimations of time spent sedentary and in various physical activity intensities may vary according to data reduction methods applied. This study compared associations between children's accelerometer data and adiposity and fitness markers using open source (mean amplitude deviation, MAD) and proprietary (counts) data reduction methods. Complete-case accelerometer, adiposity (Body Mass Index z-score, waist circumference), and fitness (cardiorespiratory, musculoskeletal) data from 118 children (10.4 ± 0.6 years, 49% girls) were analyzed. Estimates of sedentary behavior, light-, moderate-, vigorous- (VPA), and moderate- to vigorous-intensity (MVPA) physical activity were calculated using count- and MAD-based data reduction methods. Linear regression models between time in movement behaviours and fitness and adiposity markers were conducted. Significant differences in estimates of time spent in all intensities were observed between MAD-based and count-based methods. Both methods produced evidence to suggest that sedentary behavior was detrimentally, and physical activity (any intensity) was beneficially, associated with waist circumference. MVPA and VPA were beneficially associated with fitness markers using both data reduction measures. Overall, findings suggest that estimates of sedentary time and physical activity were not comparable. However, the strength and direction of the associations obtained between the different data reduction methods and adiposity and fitness outcomes were fairly comparable, with both methods finding stronger associations for VPA compared to MVPA. This suggests that future studies may be able to pool data using different data reduction approaches when examining associations between activity and health risk factors, albeit with caution.

An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

Background

Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.

Objectives

To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.

Design

The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.

Setting

Norfolk/Suffolk counties, UK.

Participants

Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.

Interventions

The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.

Main outcome measures

Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.

Data sources review

Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).

Review methods

Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.

Inclusion criteria

Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.

Results

The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.

Limitations

Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.

Conclusions

This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.

Future work

Further refinements to intervention delivery and recruitment methods should be investigated.

Study registration

Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

The Importance of Parents' Income and Education Level in Relation to Their Preschool Children's Activity Level at Leisure

Previous research indicate that socioeconomic status positively corresponds with adults’ and adolescents’ physical activity levels. This study investigated the relationship between parents’ education and income, and preschool children’s physical activity level. A total of 244 Norwegian preschool children aged four to six and their parents were enrolled in the study. The children wore an Actigraph GT1M accelerometer for seven consecutive days to measure their physical activity level. Parents completed a questionnaire that provided information about their education level and income level. To examine the relationship between the parents’ education and income and their children’s physical activity level at leisure, the Kruskal-Wallis H test was conducted. The results revealed that neither mothers’ nor fathers’ education level or income, were associated with their children’s minutes in moderate to vigorous physical activity (MVPA) at leisure. The preschool curriculum of Norway may be one explanation why socioeconomic status was not linked to physical activity in this study. Another possibility is that this study was limited to full-time students with two parents. More research is needed to determine whether parent income or education is linked to physical activity among more diverse or older children in Norway.

Associations of changes in reported and estimated protein and energy intake with changes in insulin resistance, glycated hemoglobin, and BMI during the PREVIEW lifestyle intervention study

BACKGROUND

Observed associations of high-protein diets with changes in insulin resistance are inconclusive.

OBJECTIVES

We aimed to assess associations of changes in both reported and estimated protein (PRep; PEst) and energy intake (EIRep; EIEst) with changes in HOMA-IR, glycated hemoglobin (HbA1c), and BMI (in kg/m2), in 1822 decreasing to 833 adults (week 156) with overweight and prediabetes, during the 3-y PREVIEW (PREVention of diabetes through lifestyle intervention and population studies In Europe and around the World) study on weight-loss maintenance. Eating behavior and measurement errors (MEs) of dietary intake were assessed. Thus, observational post hoc analyses were applied.

METHODS

Associations of changes in EIEst, EIRep, PEst, and PRep with changes in HOMA-IR, HbA1c, and BMI were determined by linear mixed-model analysis in 2 arms [high-protein-low-glycemic-index (GI) diet and moderate-protein-moderate-GI diet] of the PREVIEW study. EIEst was derived from energy requirement: total energy expenditure = basal metabolic rate × physical activity level; PEst from urinary nitrogen, and urea. MEs were calculated as [(EIEst - EIRep)/EIEst] × 100% and [(PRep - PEst)/PEst] × 100%. Eating behavior was determined using the Three Factor Eating Questionnaire, examining cognitive dietary restraint, disinhibition, and hunger.

RESULTS

Increases in PEst and PRep and decreases in EIEst and EIRep were associated with decreases in BMI, but not independently with decreases in HOMA-IR. Increases in PEst and PRep were associated with decreases in HbA1c. PRep and EIRep showed larger changes and stronger associations than PEst and EIEst. Mean ± SD MEs of EIRep and PRep were 38% ± 9% and 14% ± 4%, respectively; ME changes in EIRep and En% PRep were positively associated with changes in BMI and cognitive dietary restraint and inversely with disinhibition and hunger.

CONCLUSIONS

During weight-loss maintenance in adults with prediabetes, increase in protein intake and decrease in energy intake were not associated with decrease in HOMA-IR beyond associations with decrease in BMI. Increases in PEst and PRep were associated with decrease in HbA1c.This trial was registered at clinicaltrials.gov as NCT01777893.

Sensing leg movement enhances wearable monitoring of energy expenditure

Physical inactivity is the fourth leading cause of global mortality. Health organizations have requested a tool to objectively measure physical activity. Respirometry and doubly labeled water accurately estimate energy expenditure, but are infeasible for everyday use. Smartwatches are portable, but have significant errors. Existing wearable methods poorly estimate time-varying activity, which comprises 40% of daily steps. Here, we present a Wearable System that estimates metabolic energy expenditure in real-time during common steady-state and time-varying activities with substantially lower error than state-of-the-art methods. We perform experiments to select sensors, collect training data, and validate the Wearable System with new subjects and new conditions for walking, running, stair climbing, and biking. The Wearable System uses inertial measurement units worn on the shank and thigh as they distinguish lower-limb activity better than wrist or trunk kinematics and converge more quickly than physiological signals. When evaluated with a diverse group of new subjects, the Wearable System has a cumulative error of 13% across common activities, significantly less than 42% for a smartwatch and 44% for an activity-specific smartwatch. This approach enables accurate physical activity monitoring which could enable new energy balance systems for weight management or large-scale activity monitoring.

Assessment of Physical Activity in Adults using Wrist Accelerometers

The health benefits of physical activity have been widely recognized, yet traditional measures of physical activity including questionnaires and category-based assessments of volume and intensity provide only broad estimates of daily activities. Accelerometers have advanced epidemiologic research on physical activity by providing objective and continuous measurement of physical activity in free-living conditions. Wrist-worn accelerometers have become especially popular due to low participant burden. However, the validity and reliability of wrist-worn devices for adults have yet to be summarized. Moreover, accelerometer data provide rich information on how physical activity is accumulated throughout the day, but only a small portion of these rich data have been utilized by researchers. Lastly, new methodological developments that aim to overcome some of the limitations of accelerometers are emerging. The purpose of this review is to provide an overview of accelerometry research, with a special focus on wrist-worn accelerometers. We describe briefly how accelerometers work, summarize the validity and reliability of wrist-worn accelerometers, discuss the benefits of accelerometers including measuring light-intensity physical activity, and discuss pattern metrics of daily physical activity recently introduced in the literature. A summary of large-scale cohort studies and randomized trials that implemented wrist-worn accelerometry is provided. We conclude the review by discussing new developments and future directions of research using accelerometers, with a focus on wrist-worn accelerometers.

A Mindfulness-Based Physical Activity Intervention: A Randomized Pilot Study

OBJECTIVE

Most US adults are insufficiently active. One strategy individuals could use to increase physical activity is to exercise mindfully (i.e., while paying attention to present-moment experiences with acceptance. A mindfulness-based intervention for exercise can be delivered via an audio recording, which is advantageous in regard to time demands, cost, and dissemination potential. The aims of this parallel two-arm pilot randomized controlled trial were to assess the feasibility and acceptability of an audio-recorded mindfulness-based intervention and to assess whether the intervention resulted in a clinically meaningful difference in physical activity compared with the control condition.

METHODS

Physically underactive adults (N = 50) were randomized to a mindfulness intervention condition in which they were instructed to exercise while listening to an audio-recorded mindfulness-intervention or an active control group in which they were instructed to exercise while using a heart rate monitor. Participants completed a 30-minute moderate intensity treadmill exercise bout during a baseline in-laboratory session in the manner in which they were randomized (i.e., mindfulness recording versus using a heart rate monitor) and instructed to exercise in this manner for the next week. At follow-up, acceptability was measured by self-report, feasibility by frequency of intervention use, and physical activity using both self-reported physical activity recall and an accelerometer.

RESULTS

The audio-recorded mindfulness-based physical activity intervention was rated as acceptable and feasible to use. Compared with the control group, the intervention also resulted in clinically meaningful differences in self-reported moderate-to-vigorous physical activity minutes (mean difference = 67.16 minutes) and accelerometer-measured minutes (mean difference = 35.48 minutes) during a 1-week follow-up.

CONCLUSIONS

The audio-recorded mindfulness-based physical activity intervention is a promising approach to increasing physical activity with good dissemination potential.

Development and Content Validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to Assess Physical Activity in Children between 5 and 7 Years

Childhood is a critical period in the development and consolidation of healthy habits, such as the practice of physical activity (PA). It is essential to have valid instruments to measure PA from an early age. The aim of this study was to design and evaluate the content validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to measure the PA level in children aged 5-7 years. The first version of the questionnaire was tested by a 2-round Delphi study. It was established as a consensus criterion that the relative interquartile range (RIR) and/or the coefficient of variation (CV) were ≤20%. The most significant discrepancies in the Delphi survey (n = 11-13) were observed for items about hours of Physical Education or similar activities at school (item 7: RIR = 20, CV = 38.73) and for items about participation in Physical Education (item 8: RIR = 25, CV = 15.45). The cognitive interviews (n = 5) confirmed the version agreed by the experts. The results show that the PAQ-YC presents adequate content validity in terms of relevance, comprehensiveness and comprehensibility.

Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial

Background

Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight removal and studies suggest better clinical/patient-reported outcomes compared with hemodialysis (HD).

Methods

HDFIT was a randomized controlled trial at 13 clinics in Brazil that aimed to investigate the effects of HDF on measured PA (step counts) as a primary outcome. Stable HD patients (vintage 3–24 months) were randomized to receive HDF or high-flux HD. Treatment effect of HDF on the primary outcome from baseline to 3 and 6 months was estimated using a linear mixed-effects model.

Results

We randomized 195 patients (HDF 97; HD 98) between August 2016 and October 2017. Despite the achievement of a high convective volume in the majority of sessions and a positive impact on solute removal, the treatment effect HDF on the primary outcome was +538 [95% confidence interval (CI) −330 to 1407] steps/24 h after dialysis compared with HD, and was not statistically significant. Despite a lack of statistical significance, the observed size of the treatment effect was modest and driven by steps taken between 1.5 and 24.0 h after dialysis, in particular between 20 and 24 h (+197 steps; 95% CI −95 to 488).

Conclusions

HDF did not have a statistically significant treatment effect on PA 24 h following dialysis, albeit effect sizes may be clinically meaningful and deserve further investigation.

Interrupting Sitting Time in Postmenopausal Women: Protocol for the Rise for Health Randomized Controlled Trial

Background

Many older adults spend the majority of their waking hours sitting, which increases their risk of chronic diseases. Given the challenges that many older adults face when engaging in moderate-to-vigorous physical activity, understanding the health benefits of decreasing sitting time and increasing the number of sit-to-stand transitions is needed to address this growing public health concern.

Objective

The aim of this 3-arm randomized controlled trial is to investigate how changes in sitting time and brief sit-to-stand transitions impact biomarkers of healthy aging and physical, emotional, and cognitive functioning compared with a healthy attention control arm.

Methods

Sedentary and postmenopausal women (N=405) will be recruited and randomly assigned to 1 of the 3 study conditions for 3 months: healthy living attention control (Healthy Living), reduce sitting time (Reduce Sitting), and increase sit-to-stand transitions (Increase Transitions). Assessments conducted at baseline and 3 months included fasting blood draw, blood pressure, anthropometric measurements, physical functioning, cognitive testing, and 7 days of a thigh-worn accelerometer (activPAL) and a hip-worn accelerometer (ActiGraph). Blood-based biomarkers of healthy aging included those associated with glycemic control (glycated hemoglobin, fasting plasma insulin and glucose, and homeostatic model assessment of insulin resistance).

Results

Recruitment began in May 2018. The intervention is ongoing, with data collection expected to continue through the end of 2022.

Conclusions

The Rise for Health study is designed to test whether 2 different approaches to interrupting sitting time can improve healthy aging in postmenopausal women. Results from this study may inform the development of sedentary behavior guidelines and interventions to reduce sitting time in older adults.

Trial Registration

ClinicalTrials.gov NCT03473145; https://clinicaltrials.gov/ct2/show/NCT03473145

International Registered Report Identifier (IRRID)

DERR1-10.2196/28684

Instruments to Assess Physical Activity in Primary Education Students with Autism Spectrum Disorder: A Systematic Review

The scientific evidence supports that physical inactivity in childhood is a reality throughout the world which generates important consequences in the global development of children. Young people with Autism Spectrum Disorder (ASD), due to the characteristics of the disorder they suffer, constitute a group at risk. Therefore, assessing the levels of physical activity (PA) in this group is fundamental for subsequent decision making and implementation of PA promotion programmes. Consequently, the aim of this systematic review was to identify, summarise and analyse the main instruments used to assess the levels of PA (in terms of time and/or intensity) in primary school children diagnosed with ASD. Scientific articles in English and Spanish published in five databases were reviewed: PsycINFO, WOS, SPORTDiscus, Scopus and PubMed, following the guidelines of the PRISMA statement. Out of the 605 articles identified, 12 met the previously established inclusion criteria. The instruments used by the studies analysed were divided into two main groups: accelerometers and questionnaires. Both showed different strengths and limitations but agreed on the low levels registered of PA in children with ASD. For this reason, it is considered necessary that further research be carried out in this field, as well as the development and implementation of sports programmes adjusted and adapted to the needs and characteristics of the ASD group.

An exploratory study of discrepancies between objective and subjective measurement of the physical activity level in female patients with chronic fatigue syndrome

OBJECTIVE

To explore the ability of a self-report activity diary to measure the physical activity level (PAL) in female patients with chronic fatigue syndrome (CFS) and whether illness-related complaints, health-related quality of life domains (HRQOL) or demographic factors are associated with discrepancies between self-reported and objectively measured PAL.

METHODS

Sixty-six patients with CFS, recruited from the chronic fatigue clinic of a university hospital, and twenty matched healthy controls wore an accelerometer (Actical) for six consecutive days and registered their activities in an activity diary in the same period. Participants' demographic data was collected and all subjects completed the CFS Symptom List (illness-related complaints) daily and Short-Form-36 (HRQOL domains) during the first and second appointment.

RESULTS

A significant, but weak association between the activity diary and Actical was present in patients with CFS (r_s = 0.376 and r_s = 0.352; p < 0.001) and a moderately strong association in healthy controls (r_s = 0.605; and r_s = 0.644; p < 0.001) between week and weekend days, respectively. A linear mixed model identified a negative association between age and the discrepancy between the self-reported and objective measure of PA in both patients with CFS and healthy controls.

CONCLUSION

The activity diary showed limited ability to register the PAL in female patients with CFS. The discrepancy between measures was not explained by illness-related complaints, HRQOL domains or demographic factors. The activity diary cannot replace objective activity monitoring measured with an accelerometer, but may provide additional information about the perceived activity.