Physical activity, sedentary time, and pericardial fat in healthy older adults

The Impact of Exercise Training Plus Dietary Interventions on Ectopic Fat in Population with Overweight/Obesity with and without Chronic Disease: A Systematic Review, Meta-analysis, and Metaregression of Randomized Clinical Trials

Background

The growing prevalence of obesity and related chronic diseases has led to increased interest in interventions targeting ectopic fat reduction to which its accumulation is linked to metabolic dysfunction.

Objectives

This study aimed to evaluate the effects of combined exercise training combined with dietary interventions compared with dietary interventions alone on ectopic fat [visceral fat area (VFA), liver fat, intramuscular fat (IMF), pancreatic fat, renal sinus fat, and pericardial and epicardial fats] in adults with overweight and obesity, both with and without chronic diseases.

Methods

Web of Science, Scopus, and PubMed were searched for original articles up to 1 March, 2024, that included exercise compared with control interventions on body weight and ectopic fat in adults with overweight or obesity. Weighted mean differences (WMD) for body weight, liver fat, pancreatic fat, and renal sinus fat and standardized mean differences (SMD) for VFA, IMF, pericardial and epicardial fats, and 95% confidence intervals were determined using random-effects models.

Results

Thirty-two studies, including 1488 participants and 38 intervention groups, met the inclusion criteria. The combined intervention of exercise and diet did not reduce body weight (WMD = -0.23 kg, P = 0.180), liver fat (WMD = 0.05%, P = 0.730), IMF (SMD = -0.08, P = 0.640), pericardial and epicardial fats (SMD = -0.12, P = 0.280), pancreatic fat (WMD = -0.24%, P = 0.370), and renal sinus fat (WMD = 0.01 cm2, P = 0.170) when compared with a diet-only group. Interestingly, exercise combined with diet significantly reduced VFA in participants with obesity (SMD = -0.12, P = 0.040) and healthy males (SMD = -0.33, P = 0.001) when compared with a diet-only group.

Conclusions

The findings suggest that combined exercise and dietary interventions did not lead to significant reductions in most ectopic fat depots when compared with diet alone. However, a modest reduction in VFA was observed in participants with obesity and healthy males. These results highlight the nuanced impact of exercise in combination with dietary interventions and the need to consider specific fat depots and participant characteristics in obesity management strategies.The trial was registered at PROSPERO as CRD42024546770.

Assessment of Epicardial Fat in Children: Its Role as a Cardiovascular Risk Factor and How It Is Influenced by Lifestyle Habits

Epicardial adipose tissue (EAT) stands out as a distinctive repository of visceral fat, positioned in close anatomical and functional proximity to the heart. EAT has emerged as a distinctive reservoir of visceral fat, intricately interlinked with cardiovascular health, particularly within the domain of cardiovascular diseases (CVDs). The aim of our overview is to highlight the role of EAT as a marker for cardiovascular risk in children. We also explore the influence of unhealthy lifestyle habits as predisposing factors for the deposition of EAT. The literature data accentuate the consequential impact of lifestyle choices on EAT dynamics, with sedentary behavior and unwholesome dietary practices being contributory to a heightened cardiovascular risk. Lifestyle interventions with a multidisciplinary approach are therefore pivotal, involving a nutritionally balanced diet rich in polyunsaturated and monounsaturated fatty acids, regular engagement in aerobic exercise, and psychosocial support to effectively mitigate cardiovascular risks in children. Specific interventions, such as high-intensity intermittent training and circuit training, reveal favorable outcomes in diminishing the EAT volume and enhancing cardiometabolic health. Future clinical studies focusing on EAT in children are crucial for advancing our understanding and developing targeted strategies for cardiovascular risk management in this population.

Monitoring Gait and Physical Activity of Elderly Frail Individuals in Free-Living Environment: A Feasibility Study

INTRODUCTION

Frailty is conventionally diagnosed using clinical tests and self-reported assessments. However, digital health technologies (DHTs), such as wearable accelerometers, can capture physical activity and gait during daily life, enabling more objective assessments. In this study, we assess the feasibility of deploying DHTs in community-dwelling older individuals, and investigate the relationship between digital measurements of physical activity and gait in naturalistic environments and participants' frailty status, as measured by conventional assessments.

METHODS

Fried Frailty Score (FFS) was used to classify fifty healthy individuals as non-frail (FFS = 0, n/female = 21/11, mean ± SD age: 71.10 ± 3.59 years), pre-frail (FFS = 1-2, n/female = 23/9, age: 73.74 ± 5.52 years), or frail (FFS = 3+, n/female = 6/6, age: 70.70 ± 6.53 years). Participants wore wrist-worn and lumbar-worn GENEActiv accelerometers (Activinsights Ltd., Kimbolton, UK) during three in-laboratory visits, and at-home for 2 weeks, to measure physical activity and gait. After this period, they completed a comfort and usability questionnaire. Compliant days at-home were defined as follows: those with ≥18 h of wear time, for the wrist-worn accelerometer, and those with ≥1 detected walking bout, for the lumbar-worn accelerometer. For each at-home measurement, a group analysis was performed using a linear regression model followed by ANOVA, to investigate the effect of frailty on physical activity and gait. Correlation between at-home digital measurements and conventional in-laboratory assessments was also investigated.

RESULTS

Participants were highly compliant in wearing the accelerometers, as 94% indicated willingness to wear the wrist device, and 66% the lumbar device, for at least 1 week. Time spent in sedentary activity and time spent in moderate activity as measured from the wrist device, as well as average gait speed and its 95th percentile from the lumbar device were significantly different between frailty groups. Moderate correlations between digital measurements and self-reported physical activity were found.

CONCLUSIONS

This work highlights the feasibility of deploying DHTs in studies involving older individuals. The potential of digital measurements in distinguishing frailty phenotypes, while unobtrusively collecting unbiased data, thus minimizing participants' travels to sites, will be further assessed in a follow-up study.

Pericardial Fat, Socioeconomic Status, and Biological Responses to Acute Mental Stress

OBJECTIVE

Central adiposity is associated with impaired biological responses to mental stress, and socioeconomic status (SES) might moderate this relationship. However, evidence for associations between pericardial fat, a fat depot implicated in the pathogenesis of cardiovascular disease (CVD), with cardiovascular and inflammatory responses to mental stress is lacking, and moderation by SES is unknown.

METHODS

The sample was 473 healthy men and women (mean age = 62.8 years) from the Whitehall II study. Cardiovascular and inflammatory responses to laboratory-induced mental stress, consisting of a 5-minute Stroop task and 5-minute mirror tracing task, were assessed. Pericardial fat volume was measured using electron bean computed tomography and adjusted for body surface area. SES was defined by grade of employment within the British civil service (higher/intermediate/lower).

RESULTS

Pericardial fat was associated with lower heart rate variability, raised heart rate, plasma interleukin-6, fibrinogen, and C-reactive protein at baseline. Furthermore, greater pericardial fat was associated with lower systolic blood pressure reactivity to mental stress, independent of sociodemographics, smoking status, waist-to-hip ratio, and baseline systolic blood pressure. There were no interactions between pericardial fat and SES for any outcome.

CONCLUSIONS

Greater pericardial fat was associated with numerous cardiovascular and inflammatory factors implicated in CVD. It was also related to reduced systolic blood pressure reactivity to acute mental stress, independent of central adiposity and baseline systolic blood pressure. This association did not vary by SES. Reduced systolic blood pressure reactivity to mental stress might contribute to the association between greater pericardial fat and CVD.

Associations of the Mediterranean-Style Dietary Pattern Score with Coronary Artery Calcification and Pericardial Adiposity in a Sample of US Adults

Several studies have identified improvements in the risks of cardiovascular disease in adults following a Mediterranean dietary pattern. However, data are scarce on its association with coronary artery calcification (CAC) and pericardial adiposity (PAT) in US adults with and without diabetes. To address this gap, we conducted a case-control study using baseline data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1255; Type 1 Diabetes (T1D): n = 563; non-Diabetes Mellitus (non-DM): n = 692]. Participants completed a validated food frequency questionnaire, fasting (12 h overnight fast) biochemical analyses, and a physical examination including anthropometric measures. CAC and PAT were measured using electron beam-computed tomography. Logistic regression models were used to examine the associations of the Mediterranean-Style Dietary Pattern Score (MSDPS) with CAC (presence or absence), and linear regression models were applied to PAT analyses. In all of the adjusted models, no significant associations with CAC were found. For PAT, an increasing MSDPS was consistently associated with its lower volume in models adjusted for age, sex, diabetes status, total calories, and body mass index (all p < 0.05). The association between MSDPS and PAT was attenuated after adjusting for serum lipids and physical activity. In conclusion, the baseline data from the CACTI study show that a greater adherence to MSDPS is associated with a lower PAT volume and provide evidence that the Mediterranean dietary pattern is associated with lower cardiovascular risk markers.

Association between depressive symptoms and pericardial fat in healthy older men and women

Depressive symptoms are associated with increased risk for cardiovascular disease (CVD), and inflammation may contribute to this relationship. Pericardial fat, a highly metabolically active fat depot, is implicated in the pathogenesis of CVD, but its association with depressive symptoms is unclear. This study examined the cross-sectional and longitudinal association between depressive symptoms and pericardial fat over a three-year period. Participants were 543 healthy men and women (mean age = 62.9 years) without history or objective signs of coronary heart disease from the Whitehall II cohort. In men, depressive symptoms were positively associated with pericardial fat at baseline after adjustment for sociodemographics, waist to hip ratio and conventional cardiovascular risk factors. Inflammation, indexed by plasma interleukin 6 concentration, accounted for 17% of this association. Longitudinally, depressive symptoms did not predict pericardial fat three years later in men once baseline levels of pericardial fat were accounted for. No significant associations between depressive symptoms and pericardial fat were found in women. Overall, our findings suggest that greater pericardial fat might be a mechanism by which depressive symptoms are associated with increased risk for CVD in men, and inflammation may also lie on this pathway.

Ten-Year Changes in Television Viewing and Physical Activity Are Associated With Concurrent 10-Year Change in Pericardial Adiposity: The Coronary Artery Risk Development in Young Adults Study

BACKGROUND

Longitudinal association of television (TV) viewing and moderate- to vigorous-intensity physical activity (MVPA) with pericardial adipose tissue (PAT) is unclear.

METHODS

We studied Coronary Artery Risk Development in Young Adults Study participants transitioning from early to middle age at Coronary Artery Risk Development in Young Adults (CARDIA) exam years 15 (2000-2001; N = 1975, mean age = 40.4, 55.4% women, 45.3% Black) and 25 (2010-2011). TV viewing (in hours per day) and MVPA (in exercise units) were measured using a self-report questionnaire. PAT volume (in milliliters) was measured using computed tomography. Multivariable linear regression was used to examine the associations of tertiles of 10-year change (years 25-15) in TV viewing and MVPA with a concurrent change in PAT with adjustments for covariates.

RESULTS

Participants in the highest tertile of 10-year increase in TV viewing had a greater increase in PAT (β = 2.96 mL, P < .01). Participants in both middle (β = -3.93 mL, P < .01) and highest (β = -6.22 mL, P < .01) tertiles of 10-year changes in MVPA had smaller mean increases in PAT over 10 years when compared with the lowest tertile in fully adjusted models.

CONCLUSIONS

Reducing or maintaining early-midlife levels of TV viewing and increasing MVPA may be associated with less PAT accumulation with age.

Cross-Sectional and Longitudinal Associations of Lifestyle Behaviors with Pericardial Adipose Tissue: The MESA Study

PURPOSE

We examined associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) with pericardial adipose tissue (PAT).

METHODS

Adults from the Multi-Ethnic Study of Atherosclerosis were included from exam years 1 (2000-2002; N = 6057; mean age, 62.2 yr; 52.9% female, 38.0% White; 12.8% Chinese American, 26.7% African American, 22.5% Hispanic American), 2 (2002-2004), and 3 (2004-2005). Weekly volume of SB, LPA, and MVPA (in MET-hours per week) was reported using a questionnaire. PAT volume (in cubic centimeters) was quantified using computed tomography, analysis of covariance, and repeated-measures linear mixed models with adjustment for covariates (sociodemographics, cardiovascular disease risk factors, inflammation, waist circumference) tested cross-sectional and longitudinal associations, respectively.

RESULTS

In cross-sectional analysis, the highest tertile of SB (β = 2.71; 95% confidence interval (CI), 0.69 to 4.73; P < 0.01) and the middle tertile of MVPA (β = -1.97; 95% CI, -3.92 to -0.02; P < 0.05) were associated with PAT, whereas no association was observed for LPA in fully adjusted models. In longitudinal models, SB, LPA, and MVPA were not associated with PAT in the full study sample; however, LPA was inversely associated with PAT among Whites in stratified analysis (β = -0.54; 95% CI, -0.95 to -0.13; P < 0.05).

CONCLUSIONS

Lower SB and higher LPA (among Whites only) and MVPA may be associated with lower PAT, but additional longitudinal research is needed.

Combined Physical Activity and Sitting Time Association on Older Adults' Body Mass Index: Cross-Sectional Findings From the Brazilian Longitudinal Study of Aging

This study examined isolated and combined associations of physical activity (PA) and sitting time (ST) with body mass index (BMI) among older Brazilian adults. We have analyzed baseline data of 8,177 participants aged 50 years and older from the Brazilian Longitudinal Study of Aging. Respondents were categorized into sufficient PA/low ST, sufficient PA/high ST, insufficient PA/low ST, or insufficient PA/high ST using the Short Version of International Physical Activity Questionnaire. Multinomial logistic regression analysis examined the associations of being underweight (BMI, <18 kg/m2), overweight (BMI, 25-29.9 kg/m2), and obese (BMI, ≥30 kg/m2) with PA and ST categories. High ST (≥165 min/day) was associated with overweight (odds ratio, 1.26; 95% confidence interval [1.11, 1.44]) and obesity (odds ratio, 1.43; 95% confidence interval [1.21, 1.70]). However, no association was observed between PA and BMI. Participants in the insufficient and sufficient PA/high ST categories were more likely to be obese after adjusting for sociodemographic and health condition. Our findings call for public health initiatives that consider reducing ST in older adults.

Disentangling the relationship between sedentariness and obesity: Activity intensity, but not sitting posture, is associated with adiposity in women

BACKGROUND

The relationship between free-living sedentary behaviour (SB) and obesity is unclear. Studies may arrive at disparate conclusions because of inconsistencies and limitations when defining and measuring free-living SB. The aim of this cross-sectional study was to examine whether the relationship between SB and adiposity differed depending on the way SB was operationally defined and objectively measured.

METHODS

Sixty-three female participants aged 37.1 years (SD = 13.6) with a body mass index (BMI) of 29.6 kg/m² (SD = 4.7) had their body composition measured (BodPod, Concord, CA) then were continuously monitored for 5-7 days with the SenseWear Armband (SWA; sleep and activity intensity) and the activPAL (AP; posture). Data from both activity monitors were analysed separately and integrated resulting in a third measure of SB (activity intensity and posture; SED^INT). SB outputs were compared according to week or weekend day averages then correlated against body composition parameters after adjusting for moderate-to-vigorous physical activity (MVPA).

RESULTS

SED^SWA resulted in the most sedentary time 11.74 h/day (SD = 1.60), followed by SED^AP 10.16 h/day (SD = 1.75) and SED^INT 9.10 h/day (SD = 1.67). There was a significant positive association between SED^SWA and body mass [r(61) = 0.29, p = .02], BMI [r (61) = 0.33, p = .009] and fat mass [r(61) = 0.32, p = .01]. SED^AP and SED^INT were not associated with any of the indices of adiposity. Correlations between SB and adiposity were non-significant when controlling for MVPA.

CONCLUSIONS

The relationship between SB and adiposity differed depending on how SB was operationally defined and measured, and was dependent on MVPA. The definition of SB based on a sitting posture (SED^AP) was not strongly related to body fat, whereas the accumulation of any behaviour (sitting or standing) with an intensity of <1.5 METs (SED^SWA) (offset by the presence of MVPA) was positively associated with indices of adiposity. These data suggest that the postural element of SB (sitting) is not sufficient for the accumulation of adiposity, rather activities requiring low EE (<1.5 METs) and the absence of MVPA, regardless of posture, are associated with higher fat mass.

Allostatic load as a predictor of grey matter volume and white matter integrity in old age: The Whitehall II MRI study

The allostatic load index quantifies the cumulative multisystem physiological response to chronic everyday stress, and includes cardiovascular, metabolic and inflammatory measures. Despite its central role in the stress response, research of the effect of allostatic load on the ageing brain has been limited. We investigated the relation of mid-life allostatic load index and multifactorial predictors of stroke (Framingham stroke risk) and diabetes (metabolic syndrome) with voxelwise structural grey and white matter brain integrity measures in the ageing Whitehall II cohort (N = 349, mean age = 69.6 (SD 5.2) years, N (male) = 281 (80.5%), mean follow-up before scan = 21.4 (SD 0.82) years). Higher levels of all three markers were significantly associated with lower grey matter density. Only higher Framingham stroke risk was significantly associated with lower white matter integrity (low fractional anisotropy and high mean diffusivity). Our findings provide some empirical support for the concept of allostatic load, linking the effect of everyday stress on the body with features of the ageing human brain.

The cross-sectional associations between objectively measured sedentary time and cardiometabolic health markers in adults - a systematic review with meta-analysis component

Sedentary time is viewed as an independent risk factor for adverse cardiometabolic health (CMH). No systematic review and meta-analysis on the cross-sectional associations between objectively measured sedentary time and CMH markers has been conducted. PubMed, Scopus and Web of Science Core Collection were searched for papers that examined the cross-sectional association between objectively measured sedentary time and CMH markers in adults. Forty-six papers met the inclusion criteria. The included papers had a combined sample size of 70,576 and an age range of 18-87 years. To examine the effect of increased levels of sedentary time on CMH markers, data on effect sizes and moderators were extracted, where possible. By pooling the unadjusted data from the included papers, increased sedentary time was shown to have a significant detrimental association with fasting glucose (Δ = 0.12, 95% confidence interval [CI]: 0.02, 0.23), fasting insulin (Δ = 0.19, 95% CI: 0.06, 0.32), triglycerides (Δ = 0.25, 95% CI: 0.14, 0.37), high-density lipoprotein cholesterol (Δ = -0.20, 95% CI: -0.28, -0.13) and waist circumference (Δ = 0.25, 95% CI: 0.15, 0.35). How sedentary time was quantified and the device used to measure sedentary time significantly influence the size of the effect reported. Future interventions focused on both decreasing sedentary time and increasing physical activity may be the most effective strategy to improve CMH.

Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries

BACKGROUND

Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.

METHODS

Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.

RESULTS

The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83-2.55], 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37).

CONCLUSION

Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

Correlates of pericardial adipose tissue volume using multidetector CT scanning in cardiac patients in China

BACKGROUND

Pericardial adipose tissue (PAT) is an emerging cardiovascular risk factor, yet much less is understood about PAT volume in Chinese adults, especially in relation to physical activity. The study explores associations between demographic and clinical variables and PAT volume, using multidetector computed tomography (MDCT) scanning in China. We also examined the relationship between PAT volume and coronary artery disease (CAD).

METHODS

An observational, correlational study design was used. Chinese (n=163) attended a study visit and underwent MDCT scanning between September 2014 and December 2015.

RESULTS

Participants were 48.5% male and had a mean age of 60.6 (SD 9.4) years. PAT volume was higher (p=0.001) in males than in females. PAT volume was correlated with age (r=0.388, p=0.001), systolic blood pressure (r=0.205, p=0.009), body mass index (r=0.466, p=0.001), high-density cholesterol (r=-0.282, p=0.001), low-density cholesterol (r=0.177, p=0.024), and triglycerides (r=0.248, p=0.001). Both moderate intensity physical activity energy consumption (r=-0.363, p=0.001) and total physical activity (r=-0.290, p=0.001) had inverse relationships with PAT volume. Total sedentary energy consumption was positively related to PAT volume (r=0.266, p=0.001). Multiple regression revealed that age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume (R²=0.465). The relationship between PAT volume and CAD was found to be significant in the adjusted models.

CONCLUSIONS

Age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume, and PAT volume itself is a predictor of CAD.

Sedentary time assessed by actigraphy and mortality: The Rotterdam Study

Research suggests that sedentary behavior is a risk factor for mortality. However, most studies rely on questionnaires, which are prone to reporting error. We examined the association between sedentary time assessed by actigraphy and mortality among 1839 participants, aged 45-98years, from the prospective population-based Rotterdam Study, enrolled between 2004 and 2007. Participants wore an actigraph around the wrist for seven days. Sedentary time was evaluated continuously, per 1h/day increase, and categorically in three groups (<8, 8-11, ≥11h/day). The lowest category was used as reference. Mortality risks were examined using Cox proportional hazard models, adjusted for confounders and biological risk factors. We examined the association between sedentary behavior and mortality over and beyond other activity measures (including physical activity (PA) and activities of daily living (ADL)) in a final model. During 11years of follow-up (median: 7.5years, interquartile range: 6.6-8.3years), 212 participants (11.5%) died. In the multivariable model, the hazard ratio (HR) and 95% confidence interval (95% CI) per 1 more hour/day sedentary time was 1.09 (1.00, 1.18). The HR (95% CI) after adjustment for PA and ADL was 1.04 (0.96, 1.13). Participants sedentary for ≥11h/day had a higher mortality risk (HR: 1.80, 95% CI: 1.14, 2.84) than those sedentary <8h/day, in the multivariable model. After adjusting for PA and ADL, this association was clearly attenuated (HR: 1.50, 95% CI: 0.93, 2.41). In conclusion, our study suggests that sedentary behavior is a risk factor for mortality. Further investigation is needed to examine whether this association is distinct from the effect of other measures of activity.

Improving physical fitness and health status perception in community-dwelling older adults through a structured program for physical activity promotion in the city of Naples, Italy: A randomized controlled trial

AIM

To evaluate the efficacy and feasibility of a physical activity promotion intervention in community-dwelling older adults based on a free program of exercise adapted for older adults aged ≥60 years managed by trainees from the Movement Sciences degree course.

METHODS

A total of 160 adults aged 60-82 years were randomly allocated into the intervention and control group. The exercise program consisted of 1-h sessions carried out twice a week for a year. Control participants received recommendations about an active lifestyle from their physicians. Senior Fitness Tests and the 12-item Short Form Health Survey were used to assess six functional fitness domains of participants and perception of their health status, respectively. Body mass index was also evaluated.

RESULTS

A total of 62 participants completed the exercise path. At the end of the intervention, they showed a significant body mass index decrease (from 27.9 ± 1.6 to 25.1 ± 1.8 kg/m² , P < 0.01), and a significant improvement in functional domains, mainly aerobic fitness (+33.9%, P < 0.01) and agility (+24.2%, P < 0.01), and in good health status perception (+38.7%, P < 0.05). Similar variations were not observed in the control group (P > 0.05). A high acceptance of the intervention was registered among participants (>88.7%); staff competence and gratuitousness were the most appreciated features (>85.5%).

CONCLUSIONS

The structured program represented a useful opportunity to promote physical activity among participants, and it was effective in improving their physical fitness and health status perception. Similar interventions are required to sensitize the whole older population, and experts in Movement Sciences might represent a key figure in this context. Geriatr Gerontol Int 2017; 17: 1421-1428.

Utilization and Harmonization of Adult Accelerometry Data: Review and Expert Consensus

PURPOSE

This study aimed to describe the scope of accelerometry data collected internationally in adults and to obtain a consensus from measurement experts regarding the optimal strategies to harmonize international accelerometry data.

METHODS

In March 2014, a comprehensive review was undertaken to identify studies that collected accelerometry data in adults (sample size, n ≥ 400). In addition, 20 physical activity experts were invited to participate in a two-phase Delphi process to obtain consensus on the following: unique research opportunities available with such data, additional data required to address these opportunities, strategies for enabling comparisons between studies/countries, requirements for implementing/progressing such strategies, and value of a global repository of accelerometry data.

RESULTS

The review identified accelerometry data from more than 275,000 adults from 76 studies across 36 countries. Consensus was achieved after two rounds of the Delphi process; 18 experts participated in one or both rounds. The key opportunities highlighted were the ability for cross-country/cross-population comparisons and the analytic options available with the larger heterogeneity and greater statistical power. Basic sociodemographic and anthropometric data were considered a prerequisite for this. Disclosure of monitor specifications and protocols for data collection and processing were deemed essential to enable comparison and data harmonization. There was strong consensus that standardization of data collection, processing, and analytical procedures was needed. To implement these strategies, communication and consensus among researchers, development of an online infrastructure, and methodological comparison work were required. There was consensus that a global accelerometry data repository would be beneficial and worthwhile.

CONCLUSIONS

This foundational resource can lead to implementation of key priority areas and identification of future directions in physical activity epidemiology, population monitoring, and burden of disease estimates.

Associations of Sedentary Time with Fat Distribution in a High-Risk Population

PURPOSE

The effect of sedentary behavior on regional fat deposition, independent of physical activity, remains equivocal. We examined the cross-sectional associations between objectively measured sedentary time and markers of regional fat distribution (heart, liver, visceral, subcutaneous, and total body fat) in a population at a high risk of type 2 diabetes mellitus (T2DM).

METHODS

Participants were recruited from primary care to two diabetes prevention programs. Sedentary time (<25 counts per 15 s) was measured using ActiGraph GT3X accelerometers. Heart, liver, visceral, subcutaneous, and total body fat were quantified using magnetic resonance images. Fat volumes were calculated by multiplying the cross-sectional areas of the fat-containing pixels by the slice thickness. The liver fat percentage was measured using a representative region of interest created in the right lobe of the liver, avoiding the main portal veins. Linear regression models examined the association of sedentary time with markers of regional fat deposition.

RESULTS

Sixty-six participants (age, 47.9 ± 16.2 yr; male, 50.0%) were included. After adjustment for several covariates, including glycemia, whole-body fat, and moderate-to-vigorous physical activity, each 30 min of sedentary time was associated with 15.7 cm higher heart fat (P = 0.008), 1.2% higher liver fat (P = 0.026), and 183.7 cm higher visceral fat (P = 0.039).

CONCLUSIONS

This study provides new evidence suggesting that objectively measured sedentary behavior may have an independent association with heart, liver, and visceral fat in individuals at a high risk of T2DM.

Associations among sedentary and active behaviours, body fat and appetite dysregulation: investigating the myth of physical inactivity and obesity

BACKGROUND

There is considerable disagreement about the association between free-living physical activity (PA) and sedentary behaviour and obesity. Moreover studies frequently do not include measures that could mediate between PA and adiposity. The present study used a validated instrument for continuous tracking of sedentary and active behaviours as part of habitual daily living, together with measures of energy expenditure, body composition and appetite dysregulation. This cross-sectional study tested the relationship between inactivity and obesity.

METHODS

71 participants (81.7% women) aged 37.4 years (±14) with a body mass index of 29.9 kg/m² (±5.2) were continuously monitored for 6-7 days to track free-living PA (light 1.5-3 metabolic equivalents (METs), moderate 3-6 METs and vigorous >6 METs) and sedentary behaviour (<1.5 METs) with the SenseWear Armband. Additional measures included body composition, waist circumference, cardiovascular fitness, total and resting energy expenditure, and various health markers. Appetite control was assessed by validated eating behaviour questionnaires.

RESULTS

Sedentary behaviour (11.06±1.72 h/day) was positively correlated with fat mass (r=0.50, p<0.001) and waist circumference (r=-0.65, p<0.001). Moderate-to-vigorous PA was negatively associated with fat mass (r=-0.72, p<0.001) and remained significantly correlated with adiposity after controlling for sedentary behaviour. Activity energy expenditure was positively associated with the level of PA and negatively associated with fat mass. Disinhibition and binge eating behaviours were positively associated with fat mass (r=0.58 and 0.47, respectively, p<0.001).

CONCLUSIONS

This study demonstrated clear associations among objective measures of PA (and sedentary behaviour), energy expenditure, adiposity and appetite control. The data indicate strong links between physical inactivity and obesity. This relationship is likely to be bidirectional.

Does duration of physical activity bouts matter for adiposity and metabolic syndrome? A cross-sectional study of older British men

Background

Older adults have low physical activity(PA) and high sedentary behaviour(SB) levels. We investigate how total volume and specific patterns of moderate to vigorous PA(MVPA), light PA(LPA) and SB are related to adiposity and metabolic syndrome (MS). Then, with reference to physical activity guidelines which encourage MVPA in bouts > =10 min and avoiding “long” sedentary bouts, we investigate whether accumulating PA and SB in bouts of different defined durations are differently associated with these outcomes.

Methods

Cross-sectional study of men (71–91 years) recruited in UK primary care centres. Nurses made physical measures (weight, height, bio-impedance, blood pressure) and took fasting blood samples. 1528/3137 (49 %) surviving men had ≥3 valid days (≥600 min) accelerometer data. 450 men with pre-existing chronic disease were excluded. 1009/1078 (93.6 %) had complete covariate data.

Results

Men (n = 1009, mean age 78.5(SD 4.7) years) spent 612(SD 83), 202(SD 64) and 42(SD 33) minutes in SB, LIPA and MVPA respectively. Each additional 30 min/day of SB and MVPA were associated with 0.32 (95 % CI 0.23, 0.40)Kg/m² higher Body Mass Index (BMI) and −0.72(−0.93, −0.51) lower BMI Kg/m² respectively. Patterns for waist circumference (WC), fat mass index (FMI), fasting insulin and MS were similar. MVPA in bouts lasting <10 min or ≥10 min duration were not associated differently with outcomes. In models adjusted for total MVPA, each minute accumulated in SB bouts lasting 1–15 min was associated with lower BMI −0.012 kg/m², WC −0.029 cm, and OR 0.989 for MS (all p < 0.05), and coefficients for LPA bouts 1–9 min were very similar in separate models adjusted for total MVPA. Minutes accumulated in SB bouts 1–15 min and LPA bouts 1–9 min were correlated, r = 0.62.

Conclusions

Objectively measured MVPA, LPA and SB were all associated with lower adiposity and metabolic risk. The beneficial associations of LPA are encouraging for older adults for whom initiating MVPA and maintaining bouts lasting ≥10 min may be particularly challenging. Findings that short bouts of LPA (1–9 min) and SB (1–15 min), but that all MVPA, not just MVPA accumulated in bouts ≥10 min were associated with lower adiposity and better metabolic health could help refine older adult PA guidelines.

Effects of substituting sedentary time with physical activity on metabolic risk

Supplemental digital content is available in the text.

Purpose

The detrimental effects of sedentary time on health may act by replacing time spent in physical activities. The aim of this study was to examine cross-sectional associations between objectively assessed sedentary and physical activity domains and cardiometabolic risk factors using a novel isotemporal substitution paradigm.

Methods

Participants were 445 healthy men and women (mean age, 66 ± 6 yr), without history or objective signs of cardiovascular disease, drawn from the Whitehall II epidemiological cohort. Physical activity was objectively measured using accelerometers (ActiGraph GT3X) worn around the waist during waking hours for 4–7 consecutive days. We examined the effects of replacing sedentary time with light activity or moderate-to-vigorous physical activity (MVPA) on a range of risk factors (HDL cholesterol, triglycerides, HbA1c, and body mass index) using an isotemporal substitution paradigm.

Results

In partition models, where the time in each of the intensity categories was held constant, only MVPA remained associated with risk factors. In isotemporal substitution models that held total (wear) time constant, replacing 10-min sedentary time with an equal amount of MVPA was associated with favorable effects in all risk factors, including HbA1c (B = −0.023; 95% confidence interval (CI), −0.043 to −0.002), BMI (B = −0.39; 95% CI, −0.54 to −0.24), HDL cholesterol (B = 0.037; 95% CI, 0.021–0.054), and triglycerides (B = −0.035; 95% CI, −0.061 to −0.009).

Conclusions

The associations between sedentary behavior and cardiometabolic risk may be dependent on the types of activities that are displaced by sedentary time.

Self-reported and objectively measured physical activity in adults with systemic lupus erythematosus

OBJECTIVE

Most estimates of physical activity (PA) patterns in systemic lupus erythematosus (SLE) are based on subjective self-report measures prone to error. The aims of this study were to obtain objective measurements of PA using an accelerometer and estimates of energy expenditure based on the self-reported International Physical Activity Questionnaire (IPAQ), and to describe their relationship.

METHODS

The Activity in Lupus To Energize and Renew study, a cross-sectional study of PA, included 129 persons with SLE. Accelerometer measures >7 days included total daily activity counts and minutes of moderate-vigorous PA (MVPA). Each person completed the IPAQ via telephone interview. Spearman's correlations (r) and 95% confidence intervals (95% CIs) assessed associations between accelerometer and IPAQ.

RESULTS

Daily PA means and SDs from accelerometer measures were 502,910 ± 118,755 for total daily activity counts and 40 ± 30 minutes for MVPA. The median (interquartile range) MET minutes/day for IPAQ intensities were: 400 (159-693) for total; 83 (26-184) for walking; and 231 (77-514) for MVPA, and domains were: 0 (0-73) for work; 28 (0-85) for active transportation; 77 (26-231) for domestic and garden; and 57 (0-213) for leisure. Associations between accelerometer measures and IPAQ were 1) total daily count versus IPAQ total: r = 0.21 (95% CI 0.03, 0.37) and 2) MVPA versus IPAQ moderate-vigorous: r = 0.16 (95% CI - 230.02, 0.33).

CONCLUSION

Accelerometer measures and IPAQ energy expenditure estimates were moderately correlated. IPAQ provided descriptive PA data, whereas accelerometers captured all daily activities, which can help assess guideline attainment. The choice of IPAQ versus accelerometer measure should include considering the purpose for which PA is measured.

Pericoronary adipose tissue: a novel therapeutic target in obesity-related coronary atherosclerosis

Inflammation plays a crucial role in the development and destabilization of atherosclerotic plaques in coronary vessels. Adipose tissue is considered to act in paracrine manner, which modulates a number of physiological and pathophysiological processes. Perivascular adipose tissue has developed specific properties that distinguish it from the fat in other locations. Interestingly, its activity depends on several metabolic conditions associated with insulin resistance and weight gain. Particularly in obesity perivascular fat seems to change its character from a protective to a detrimental one. The present review analyzes literature in terms of the pathophysiology of atherosclerosis, with particular emphasis on inflammatory processes. Additionally, the authors summarize data about confirmed paracrine activity of visceral adipose tissue and especially about pericoronary fat influence on the vascular wall. The contribution of adiponectin, leptin and resistin is addressed. Experimental and clinical data supporting the thesis of outside-to-inside signaling in the pericoronary milieu are further outlined. Clinical implications of epicardial and pericoronary adipose tissue activity are also evaluated. The role of pericoronary adipose tissue in obesity-related atherosclerosis is highlighted. In conclusion, the authors discuss potential therapeutical implications of these novel phenomena, including adipokine imbalance in pericoronary adipose tissue in the setting of obesity, the influence of lifestyle and diet modification, pharmaceutical interventions and the growing role of microRNAs in adipogenesis, insulin resistance and obesity. Key teaching points: • adipose tissue as a source of inflammatory mediators • changes in the vascular wall as a result of outside-to-inside signaling • anatomy, physiology, and clinical implications of epicardial and pericoronary adipose tissue activity • adipokines and their role in obesity-related atherosclerosis • therapeutic perspectives and future directions.

The association between objectively measured sitting and standing with body composition: a pilot study using MRI

OBJECTIVE

To investigate the association between objectively measured sitting and standing, using a postural allocation technique, with MRI-assessed body composition.

DESIGN

The present study was a cross-sectional pilot study.

SETTING

Participants were examined at one centre located in London, UK.

PARTICIPANTS

Normal weight Caucasian women (30.9±6.1 years; body mass index (BMI), 22.9±3.4 kg/m(2)) with desk-bound occupations were recruited to minimise variability in body composition outcomes. A convenience sample of 12 women was recruited in January 2014 from University College London.

OUTCOME MEASURES

For each participant a number of body composition variables were attained from a single whole-body MRI session. Main outcome variables included: total and liver adiposity, visceral/subcutaneous fat ratio and BMI. Main exposure variables included: average sitting time, standing:sitting ratio and step count. Pearson correlations were carried out to examine associations between different activity categories and body composition variables.

RESULTS

There were significant correlations between average daily sitting and liver adiposity and visceral/subcutaneous abdominal fat ratio (r=0.66 and 0.64, respectively); standing:sitting ratio was moderately correlated with liver adiposity and visceral/subcutaneous abdominal fat ratio (r=-0.53 and -0.45); average daily step count was moderately correlated with liver adiposity, total adiposity and visceral/subcutaneous abdominal fat ratio (r=-0.45, -0.46 and -0.51, respectively).

CONCLUSIONS

This pilot study has provided preliminary evidence of relationships between objectively measured sitting and standing and precise measures of body composition.

Sedentary behavior and health outcomes among older adults: a systematic review

Background

In the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this sedentary behavior on the health of this population has not yet been reviewed. We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age.

Methods

We searched the Medline, Embase, Web of Science, SPORTDiscus, PsycINFO, CINAHL, LILLACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study.

Results

We included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health, renal cancer cells, and falls remain insufficient to draw conclusions.

Conclusion

This systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

The impact of obesity and exercise on cognitive aging

Obesity is a major concern in the aging population and degrades health, motor functions and cognition in older adults. The effects of obesity are pervasive and challenging to health-care systems, making this a widespread and critically important public health dilemma. In this review, we examine the relationship between obesity, cognitive aging, and related dysfunctions. Potential neural mechanisms underlying such relationship are described. We propose that cost-effective exercises can be employed to cope with obesity and cognitive declines in older adults. Finally, we discuss implications and future research directions.

Physical activity patterns over 10 years in relation to body mass index and waist circumference: the Whitehall II cohort study

OBJECTIVE

Physical activity patterns over 10-years in relation to changes in body mass index (BMI) and waist circumference (WC) were examined.

DESIGN AND METHODS

Participants (4,880, mean age 49.3 years at baseline) from the Whitehall II cohort study were included. Self-reported physical activity and anthropometric data were collected at baseline (1991) and twice during follow-up (1997 and 2002).

RESULTS

At baseline, meeting established guidelines for physical activity, particularly through vigorous activity, was associated with lower WC (multivariable adjusted B compared to not meeting the guidelines -2.08 cm, 95% CI, -1.39, -0.75) and BMI (-0.34 kg/m(2) , -0.10, -0.59). Based on repeat data, "high adherence" to the guidelines compared to "rare adherence" over follow-up was associated with lower BMI (adjusted difference, -0.43 kg/m(2) , 95% CI, -0.79, -0.08) and WC (-2.50 cm, 95% CI, -3.46, -1.54) at follow-up. Compared to participants that remained stable between 1997 and 2002 (change of <2.5 h/week), those that reported an increase in moderate-vigorous physical activity of at least 2.5 h/week displayed lower BMI (-0.40 kg/m(2) , 95% CI, -0.71, -0.08) and WC (-1.10 cm, 95% CI, -1.95, -0.75).

CONCLUSION

Regular physical activity, confirmed by repeated assessments, is associated with relatively favorable levels of adiposity markers after 10 years follow-up.

Physical activity levels and torso orientations of hospitalized patients at risk of developing a pressure injury: an observational study

Pressure injury guidelines recommend regular repositioning yet patients' mobility and repositioning patterns are unknown. An observational study using activity monitors was undertaken to describe the 24 h activity patterns of 84 hospitalized patients at risk of developing a pressure injury. The vast majority of participants' time was spent in the sedentary activity range (94% ± 3%) followed by the light range (5% ± 4 %). Patients changed their posture a median of 94 (interquartile range 48) time in the 24-h period (range 11-154), or ≈ 3.8 times per hour. Although a main focus for pressure injury prevention has been on repositioning, this study shows that patients with restricted mobility are actually moving quite often. Therefore, it might be appropriate to focus more attention on other pressure injury prevention strategies such as adequate nutrition, appropriate support surfaces and good skin care.

Sedentary behavior and physical activity are independently related to functional fitness in older adults

The last decades of life have been traditionally viewed as a time of inevitable disease and frailty. Sedentary living and physical activity may influence capacity to perform activities that are needed to maintain physical independence in daily living. A total of 117 males and 195 females, aged 65-103years, were assessed for physical activity and sedentary time with accelerometers and for functional fitness with the Senior Fitness Test battery. Based on the individual scores for each fitness item, a Z-score was created. Associations between functional fitness with sedentary time and moderate-to-vigorous physical activity (MVPA) were analyzed. A negative association was found between the composite Z-score for functional fitness and the sedentary time, even adjusting for MVPA and other confounders. On the other hand, MVPA was positively associated with the composite Z-score for functional fitness, independently of the sedentary time. In conclusion elderly who spend more time in physical activity or less time in sedentary behaviors exhibit improved functional fitness and other confounders. The results reinforce the importance of promoting both the reduction of sedentary behaviors and the increase of MVPA in this age group, as it may interfere at older ages in order to preserve functional fitness and performance of daily functioning tasks.