Sit less and move more for cardiovascular health: emerging insights and opportunities

Prolonged sitting time and all-cause mortality: the mediating and predictive role of kidney function markers

OBJECTIVE

To investigate the association between daily sitting time and all-cause mortality, with a focus on the mediating effect and predictive value of the makers relating to kidney.

METHODS

The cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020. The makers relating to kidney were assessed through estimated glomerular filtration rate (eGFR), urine albumin creatinine ratio (UACR), and other relevant markers.

RESULTS

A total of 9,707 adults were included in the analysis. There was a significant increase in the levels of blood urea nitrogen (BUN), creatinine, uric acid, osmolality, and UACR with extended daily sitting time, while eGFR significantly decreased. Notably, individuals sitting ≥ 8 h per day exhibited a 67% higher risk of all-cause mortality (HR = 1.67, 95% CI: 1.43-1.94). A nonlinear (L-shaped) relationship was observed between eGFR (p < 0.001) or UACR (p < 0.001) and all-cause mortality. Mediation analysis revealed that eGFR accounted for 20.98% of the association between sitting time and mortality (p < 0.01). An addition of eGFR or UACR would increase the AUC from 0.585 to 0.762 and 0.656, respectively(p < 0.001). The main mortality caused by daily sitting time included chronic lower respiratory diseases, diabetes mellitus, cerebrovascular diseases and heart diseases.

CONCLUSIONS

Prolonged daily sitting time is significantly associated with an increased risk of all-cause mortality, potentially mediated by impaired kidney function. Incorporating kidney function markers such as eGFR and UACR enhances the predictive value for mortality risk assessment in sedentary populations.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Physical health correlates of co-occurring chronic pain and PTSD Among U.S. Veterans: Results from a nationally representative study

Co-occurring chronic pain and posttraumatic stress disorder (PTSD) affects between 4%-8% of the U.S. veteran population. A large body of research has documented the psychosocial burden of the co-occurrence, but fewer studies have examined physical health conditions and functioning. The current study aimed to address this gap by examining physical health conditions and functioning of co-occurring chronic pain and PTSD. Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4,069 (age=62.2 years) U.S. veterans in 2019-2020. The sample was predominantly male (N = 3,564; 90.2%) and non-Hispanic White (N = 3,318; 78.0%). PTSD diagnoses were determined using the PTSD Checklist for DSM-5 and chronic pain and other physical health conditions using self-report and validated measures. Logistic regression analyses revealed that veterans with co-occurring chronic pain and PTSD were generally more likely to have a physical health condition (ORs 2.79-9.53) or a cognitive disorder (OR=16.55) relative to controls (ORs 2.79-9.53). ANCOVA analyses revealed that relative to veterans with chronic pain or PTSD only, those with both chronic pain and PTSD had worse physical functioning across several domains (ds=0.32-1.13). Results underscore the importance of approaching co-occurring chronic pain and PTSD using a whole person approach to care that targets both physical and mental health concerns.

Comparison of energy metabolism and muscular activity between sitting on a stability ball and office chairs: A pilot study

Stability balls (SB) are commonly used as substitutes for office chairs (OC) due to their potential benefits in preventing musculoskeletal issues. However, limited research has explored the specific impact of SB usage on energy expenditure (EE). This study investigated the effects of using various chairs, including SB, on energy metabolism, muscle activity, and subjective sensations during seated rest. Sixteen adults alternated randomly between four chair types, sitting on each for 10 min: OC with a backrest (OCcont), OC without a backrest, OC designed to promote proper posture, and SB. Expired gas and surface electromyogram (EMG) data were recorded. The integrated EMG (iEMG) was analyzed for two abdominal, two back, and two lower limb muscles. Oxygen consumption was significantly higher while sitting on SB (mean ± standard deviation, 13 ± 21 % net increase) compared to OCcont. The combined iEMG for all six muscles showed a notable increase while sitting on SB (54.9 ± 45.6 % net increase) versus OCcont, with rectus femoris activation being particularly prominent. These findings indicate that substituting a standard OC with an SB during office work induces small but significant physiological changes, potentially aiding in obesity and metabolic disorder prevention.

Maintenance effects of a multilevel workplace intervention to reduce sedentary time: twenty-four-month follow-up of the group randomized clinical trial 'Stand and Move at Work'

BACKGROUND

The long-term impact of multilevel workplace sedentary behavior interventions has not been established beyond 12-months. We conducted a 2-arm group randomized trial examining the 24-month efficacy of a multilevel workplace intervention with sit-stand workstations (SSW) relative to the same multilevel intervention with delayed SSW implementation until 12-months.

METHODS

Worksites (N = 24 worksites, N = 630 employees) were randomized to participate in Stand and Move at Work and received: (a) STAND + , a 12-month multilevel behavioral intervention targeting reductions in sedentary time and increases in light physical activity (LPA) with SSW delivery during the 12-months or (b) MOVE + , the same multilevel intervention, however with SSW delivery at the end of the 12-month primary assessment period. We present maintenance endpoints (24-month follow-up) of objectively measured sedentary behavior variables as well as cardiometabolic biomarkers of the total sample and an at-risk exploratory dysglycemic (prediabetes or diabetes) subgroup per study arm.

RESULTS

All worksites (N = 24; from academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) were retained and participated in 24-month follow-up data collection. A total of 464 participants (248 STAND + , 216 MOVE + ; 19 ± 6 per worksite; 45.8 ± 10.6 years of age, 73% female) completed the 24-month assessment. At 24 months, the adjusted within-arm difference in sitting was -37.3 (CI:-51.9, -22.7) min per 8 h workday for STAND + and -23.4 (-39.7, -7.0) min per 8 h workday for MOVE + . Findings at 12-months were reproduced at 24-months, in which the majority of reductions in sitting translated to increasing standing with minimal change in LPA. There were no significant changes in cardiometabolic risk within the total sample, while there were some significant changes in triglycerides and blood pressure for the dysglycemic participants.

CONCLUSIONS

Multilevel workplace interventions incorporating SSWs have the potential to sustain reductions in workplace sedentary time through 24-months. Further, delayed introduction of SSWs following a 12-month multilevel workplace intervention seem to produce similar sitting time reductions relative to immediate introduction. SSWs are a robust environmental stimulus within multilevel interventions targeting workplace sedentary behavior. A larger sample size is needed to detect concomitant impact on cardiometabolic health.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02566317. Registered on 2 October 2015, the first participant enrolled 11 January 2016. https://clinicaltrials.gov/ct2/show/NCT02566317 . See Consort checklist.

A Practical Cardiovascular Health Assessment for Manual Wheelchair Users During the 6-Minute Push Test

Traditional VO2max testing methods are often impractical for manual wheelchair users, as they rely on lower-body exercise protocols, require specialized equipment, and trained personnel. The 6-Minute Push Test (6MPT) is a widely used cardiovascular assessment that may provide a feasible alternative for estimating aerobic capacity in this population. This study aimed to develop a predictive model for VO2max using physiological variables recorded during the 6MPT. Twenty-eight participants (14 novice and 14 expert manual wheelchair users) completed the test while wearing a VO2 mask and heart rate monitor. Spearman correlation analysis showed that distance covered during the 6MPT significantly correlated with VO2max (r = 0.685, p < 0.001). A stepwise linear regression identified two predictive models: one using distance alone (R2 = 0.416, p < 0.001) and another incorporating both distance and maximum heart rate (R2 = 0.561, p < 0.001). These models offer practical estimations of VO2max, eliminating separate protocols. Our findings suggest that the 6MPT can serve as a simple, cost-effective alternative to laboratory-based VO2 testing, facilitating routine cardiovascular fitness assessments for manual wheelchair users in clinical and community settings. Future research should focus on validating these models in a larger, more diverse cohort to enhance their generalizability.

Metabolic Factors Mediate the Causal Effect of Physical Activity and Sedentary Behavior on Stroke and Its Subtypes: Evidence from Mendelian Randomization Study

In observational studies, physical activity and sedentary behavior are associated with the risk of stroke (overall and stroke subtypes). However, whether it is causal relevance remains to be established. Given that exercise habits can be an intervention towards preventing strokes, we assessed the causality of behavioral habits with stroke and its subtypes using Mendelian randomization (MR) approaches. Stroke was analyzed as all-cause ischemic stroke (IS), three IS subtypes including large artery stroke, small vessel stroke and cardioembolic stroke, and intracerebral hemorrhage (ICH). Univariable MR analyses revealed an association between genetically predicted leisure screen time and higher overall IS risk (odds ratio (OR), 1.12; 95% confidence interval (CI), 1.06 to 1.19; P = 1.65 × 10-4). A protective association was also reported between genetically linked moderate-to-vigorous intensity physical activity and the risk of small vessel stroke (OR, 0.52; 95% CI, 0.32 to 0.84; P = 0.008). Further reverse analyses found no causal effect of IS on leisure screen time and small vessel stroke on moderate-to-vigorous intensity physical activity. We also studied the mediating role of metabolic traits including obesity, blood lipids, blood glucose, and blood pressure via two-step MR. It was found in mediation analysis that BMI partly mediated the causal relationship between leisure screen time and all-cause IS; the mediated proportion was 26.1% (95% CI: 18.1 to 35.0%). We found evidence that a sedentary lifestyle is associated with a higher risk of overall IS, and BMI plays a mediating role in the causal pathway. Our findings provide genetic evidence for the point that active lifestyles may be an effective prevention strategy for IS.

Association of Daily Physical Activity With Motivation in Prefrail and Frail Older Adults Living in Retirement Communities

Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time. External motivation was negatively associated with the square root of daily step count (β = -4.57; p < .001) and square root of daily stepping time (β = -0.49; p < .001). Older adults living in retirement communities demonstrated low levels of daily activity, with a negative association between external motivation and daily activity. Strategies are needed to make an active lifestyle supportive and enticing for older adults in these communities.

Workplace physical activity, sitting time, and menopause symptoms

OBJECTIVE

Increasing numbers of women are in employment during the menopause; however, menopause symptoms can negatively impact capacity to work. Aspects of the work environment, such as the amount of time spent in physical activity (PA) and sitting, may influence symptoms, yet this is unexplored. This study aimed to explore relationships between workplace PA and sitting, and menopause symptom severity.

METHODS

Using a cross-sectional study design, 264 perimenopausal or postmenopausal women were recruited to complete an online questionnaire assessing their self-reported workplace PA and sitting time, and their menopause symptom severity (menopause quality of life, hot flash interference, symptom severity). Multiple linear regression analyses examined the associations between menopause symptom severity and the time spent in PA (standing, walking, and physically demanding tasks) and sitting during work hours. Binomial logistical regression was used to assess if menopause symptom severity predicts whether women meet workplace activity guidelines.

RESULTS

No significant associations were observed between the time spent in PA or sitting while at work and menopause symptom severity ( P > 0.05). Menopause symptom severity did not significantly predict whether women met workplace activity guidelines ( P > 0.05).

CONCLUSIONS

In a cohort of perimenopausal and postmenopausal women, self-reported time spent in PA and sitting while at work is not associated with menopause symptom severity. Further research is needed using device-based methods to assess PA and sitting time, to explore in more detail the influence of the time spent in these behaviors while at work on menopause symptoms.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

BACKGROUND

Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

METHODS

A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

RESULTS

The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

CONCLUSION

The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

Current and historic patterns of chronic disease burden are associated with physical activity and sedentary behavior in older adults: an observational study

BACKGROUND

Cross-sectional studies suggest that chronic disease burden in older adults is associated with lower activity. However, preceding life-course patterns of morbidity accumulation may also influence current activity and have not been well characterized. Using a well-described sample of older adults, we estimated associations between current chronic disease burden and accelerometer-measured moderate-to-vigorous intensity movement measures, light-intensity movement measures, and sedentary behavior measures. Additionally, we examined historic morbidity patterns among those with current multimorbidity to provide additional understanding of these later life associations between current multimorbidity and activity.

METHODS

Analyses included N = 886 older adult study participants who wore activPAL and Actigraph accelerometers. We calculated Charlson Comorbidity Index (CCI; range 0-29) scores for participants at the time of device wear and estimated the association between current chronic disease burden (CCIcurrent) and each accelerometer-based activity metric using linear regression. Additionally, for participants categorized as having multimorbidity at time of device wear (CCIcurrent = 2+), we calculated CCI scores from age 55 through age at device wear. We plotted these to illustrate historic patterns of morbidity accumulation, and we compared activity metrics between participants with observed distal vs. recent onset of multimorbidity.

RESULTS

A unit increment in CCIcurrent was associated with higher mean sitting bout duration (0.5 min, CI: [0.0,1.0], p = 0.039) and with both lower average daily step counts (-319 steps, CI: [-431,-208], p < 0.001) and lower average daily minutes of moderate-to-vigorous physical activity (MVPA; -3.8 min, CI: [-5.2,-2.4], p < 0.001). No associations were seen with standing, light-intensity physical activity, or other sitting measures. Among older adults with multimorbidity at time of device-wear, results suggested some evidence that participants whose apparent onset was more distal engaged in less MVPA (-12.1, CI: [-21.0, -3.2], p = 0.008) and had fewer daily steps (-1000, CI: [-1745, -254], p = 0.009) than participants whose apparent onset was more recent.

CONCLUSIONS

Current chronic disease burden was associated with moderate-to-vigorous intensity movement measures and some patterns of prolonged sitting. Current multimorbidity is characterized by a preceding pattern of accumulation over the life-course. Attention to both current and historic trajectory of multimorbidity is important in investigations of MVPA and health.

Sedentary behavior and physical activity on exercise capacity in adult patients with congenital heart disease

Background

Reduced exercise capacity is associated with a poor prognosis in adult patients with congenital heart disease (CHD). Reducing sedentary behavior (SB) and increasing physical activity (PA) could be potential strategies that may contribute to enhanced fitness and prevention of acquired cardiovascular disease in adult patients with CHD. The present study aimed to examine the association of SB and PA with exercise capacity in adult patients with CHD.

Methods

Ninety-six adult patients with CHD (age: 18-74 years) underwent measurements of peak oxygen uptake (VO2), % predicted peak VO2, and time spent in SB, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Three regression models (single-activity, partition, and isotemporal substitution) were used to examine the associations of the time spent in SB, LPA, and MVPA with peak VO2 and % predicted peak VO2.

Results

In the single-activity and partition models, time spent in MVPA was consistently associated with peak VO2 and % predicted peak VO2. The isotemporal substitution model indicated that replacing 10-min of SB with the same duration of MVPA was associated with a higher peak VO2 (by 0.454 mL/min/kg [0.100 mL/min/kg, 0.807 mL/min/kg]) and % predicted peak VO2 (by 1.810 % [0.594 %, 3.026 %]).

Conclusion

These findings suggest that reducing SB time and increasing PA time are associated with improved exercise capacity in adult patients with CHD.

Low-intensity activity breaks combined with alternate day interval training mitigate cardiovascular effects of sedentary behavior

This study aimed to determine whether interrupting prolonged sitting with brief bouts of light-intensity activity (ISIT), undertaking structured high-intensity interval training (HIIT), or the combination of both interventions would elicit greater cardiometabolic benefits. Seventeen healthy adults (22-50 yr) were recruited to undertake three 2-wk interventions in a random order: 1) HIIT (6 HIIT sessions + <5,000 steps following the session and on the next day), 2) ISIT (2.5-min light-intensity walking every hour for 12 h/day on weekdays), and 3) HIIT + ISIT. Participants underwent a 6-day lead-in phase prior to each condition (days 1-3: normal activity, days 4-6 sedentary: <5,000 steps/day). Pre- and postassessments included glycemic control (2-h postprandial glucose), endothelial function via flow-mediated dilation (FMD), cardiorespiratory fitness, and body composition. Changes in primary and secondary outcomes were assessed via repeated measures ANOVA. Eleven participants completed all conditions (8 female, 33 ± 5 yr, 23 ± 4 kg/m2, habitual activity 7,156 ± 2,272 steps/day). FMD significantly improved following HIIT + ISIT when compared with ISIT (+1.04 ± 1.20%, P = 0.02), but there were no differences when ISIT was directly compared with HIIT. Cardiorespiratory fitness improved significantly following HIIT + ISIT when compared with ISIT (+1.88 ± 2.03 mL/kg/min, P = 0.01), but there were no differences when ISIT alone was compared with HIIT. There were no significant differences between groups for outcomes related to glucose control or body composition. HIIT + ISIT elicits greater improvements in cardiovascular outcomes when compared with ISIT but not HIIT. The benefits of structured exercise, such as HIIT, may go beyond those achieved by limiting sedentary behavior alone.NEW & NOTEWORTHY Although the adverse health effects of sedentary behavior are well-recognized, effective strategies for interrupting such behavior remain unclear. This study demonstrates that combining light-intensity activity breaks throughout the day with structured high-intensity exercise every other day can mitigate some of the cardiovascular consequences associated with prolonged sedentary periods in healthy young adults. Furthermore, our findings also suggest that merely incorporating regular breaks of light-intensity activity may not suffice. These results underscore the importance of regular exercise for cardiovascular health amid sedentary lifestyles.

Associations Between Clinical Inflammatory Risk Markers, Body Composition, Heart Rate Variability, and Accelerometer-Assessed Physical Activity in University Students with Overweight and Obesity

This cross-sectional study aimed to identify associations between clinical inflammatory risk markers, body composition, heart rate variability (HRV), and self-reported and objectively assessed physical activity (PA) in university students with overweight and obesity. Seventeen participants (eight females) completed a screening visit following a randomized controlled four-arm crossover trial period with 8 h of uninterrupted prolonged sitting, alternate sitting and standing, continuous standing, and continuous slow walking, respectively. Clinical inflammatory risk markers were obtained from venous blood samples, and PA was assessed using the International Physical Activity Questionnaire (IPAQ-SF) and ActiGraph wGT3X-BT accelerometers. HRV was recorded over 24 h using the Faros 180 Holter electrocardiogram (ECG). White blood cell (WBC) counts were significantly correlated with fat mass (FM; p = 0.03) and visceral adipose tissue (VAT; p = 0.04) and inversely correlated with moderate PA (p = 0.02). Light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA) were correlated with HRV parameters (p = 0.02), and LIPA was inversely correlated with interleukin-6 (p = 0.003) and c-reactive protein (p = 0.04) during different trial conditions. In university students with overweight and obesity, higher values of FM were negatively correlated with WBC count, and integrating LIPA and MVPA in the students' daily life strengthened their sympathetic-parasympathetic regulation and positively mediated anti-inflammatory mechanisms.

Joint association of antioxidant intakes from diet and supplements and sedentary behavior with all-cause and cardiovascular disease mortality among US adults

BACKGROUND

Imbalanced dietary patterns, sedentary behavior, and other unhealthy lifestyle behaviors are among the potentially modifiable risk factors most consistently linked to all-cause and cardiovascular disease (CVD) mortality. This study aimed to investigate the joint association of antioxidant intakes from diet and supplements and sedentary behavior with all-cause and CVD mortality.

METHODS

This retrospective cohort study included 16,019 adults from National Health and Nutrition Examination Survey (NHANES) 2007-2014. All-cause and CVD mortality was ascertained by linkage to National Death Index records through 31 December 2019. Participants were divided into four lifestyle patterns based on their intake of six antioxidants from dietary intakes and supplements and their self-reported sedentary behavior: low-antioxidant diet and prolonged sedentary behavior, low-antioxidant diet and nonprolonged sedentary behavior, high-antioxidant diet and prolonged sedentary behavior, high-antioxidant diet and nonprolonged sedentary behavior. Multivariable Cox proportional hazards models were utilized to evaluate the associations of antioxidant diet and sedentary behavior with regards to all-cause and CVD mortality.

RESULTS

Over an average follow-up of 8.5 years, a total of 1,894 overall deaths and 482 CVD deaths were reported. Compared with the low-antioxidant diet and prolonged sedentary behavior group, participants in the high-antioxidant diet and nonprolonged sedentary behavior group had a significantly lower risk of all-cause (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.50-0.72) and CVD (0.51; 0.34-0.77) mortality. Similarly, individuals following a low-antioxidant diet and engaging in nonprolonged sedentary behavior also had a reduced risk of all-cause (0.63; 0.52-0.75) and CVD (0.54; 0.38-0.76) mortality. On the other hand, there was no significant reduction in all-cause mortality among individuals in the high-antioxidant diet and prolonged sedentary behavior group (0.83; 0.68-1.03), as well as CVD mortality (0.87; 0.62-1.21). Subgroup and sensitivity analyses yielded results that were consistent with the overall analysis.

CONCLUSIONS

Participants with both high-antioxidant diet and nonprolonged sedentary behavior had the lowest all-cause and CVD mortality. Additionally, nonprolonged sedentary behavior can help counteract the harms of low-antioxidant diet, whereas a high-antioxidant diet fails to offset the deleterious effect of prolonged sedentary behavior.

Healthy Behavior for Preventing Cognitive Disability in Older Persons

Sufficient levels of physical activity are fundamental for preventing cardiovascular disease, dementia, and ultimately disability in older persons, yet this protective factor is nullified when excessive hours are spent in continuous sitting. Balancing physical activity and sedentary behavior is crucial for influencing metabolic parameters and vascular patterns, both central and peripheral, thereby reducing the risk of cardiovascular diseases, vascular dementia, and cognitive impairment. The primary goal of geriatric medicine is to improve quality of life and prevent disability by promptly identifying frail older individuals, thus mitigating both cognitive and motor impairments. Achieving this objective requires not only the optimization of pharmacological treatments but also the active promotion of a healthy lifestyle. In this context, investigating preclinical stages of disability, such as Motoric Cognitive Risk (MCR) Syndrome, which integrates physical and cognitive components of decline, becomes essential. However, despite robust evidence supporting these interventions, greater efforts are needed from the geriatric medical community to bridge the gap between scientific recommendations and everyday clinical practice. Integrating these guidelines into routine care is pivotal for delivering personalized interventions that address both physical inactivity and prolonged sedentary behavior. More research should aim to strengthen this balance, providing clearer, actionable strategies for clinicians to implement, thereby fostering the formation of evidence-based public health guidelines on physical activity specifically tailored for older persons.

Accelerometer-Measured Sedentary Behavior and Risk of Future Cardiovascular Disease

BACKGROUND

Beyond serving as a marker for insufficient physical activity, sedentary behavior may directly affect future cardiovascular (CV) disease risk.

OBJECTIVES

This study sought to examine associations between accelerometer-measured sedentary behavior with risk of specific CV outcomes, including potential relations with moderate to vigorous physical activity (MVPA).

METHODS

Among participants of the UK Biobank prospective cohort study, we fit Cox models adjusted for demographic and lifestyle factors to assess associations between accelerometer-measured daily sedentary time with incident atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF), and CV mortality. We assessed the potential effect of MVPA on associations between sedentary time and CV disease by including MVPA as an adjustment variable, as well as performing subgroup analyses stratified at the guideline-recommended MVPA threshold (ie, ≥150 min/wk). We then performed compositional analyses to estimate the effects of reallocating sedentary time to other activities.

RESULTS

Among 89,530 individuals (age 62 ± 8 years, 56.4% women) undergoing 1 week of accelerometry, median sedentary time was 9.4 h/d (Q1-Q3: 8.2-10.6). In multivariable models, using the second quartile (8.2-9.4 h/d) as a referent, sedentary time in the top quartile (>10.6 h/d) was associated with greater risks of HF (HR: 1.45; 95% CI: 1.28-1.65) and CV mortality (HR: 1.62; 95% CI: 1.34-1.96), with an inflection of risk at 10.6 h/d. Higher sedentary time was also associated with greater risks of incident AF (HR: 1.11; 95% CI: 1.01-1.21) and MI (HR: 1.15; 95% CI: 1.00-1.32), with an approximately linear relation. Associations with HF and CV mortality persisted among individuals meeting guideline-recommended MVPA levels. Among individuals with >10.6 h/d of sedentary time, reallocating sedentary behavior to other activities substantially reduced the excess CV risk conferred by sedentary behavior (eg, 30-minute decrease in sedentary time for HF: HR: 0.93; 95% CI: 0.90-0.96), even among individuals meeting guideline-recommended MVPA (HR: 0.93; 95% CI: 0.87-0.99).

CONCLUSIONS

Sedentary behavior is broadly associated with future adverse CV outcomes, with particularly prominent effects on HF and CV mortality, where risk inflected at approximately 10.6 h/d. Although guideline-adherent MVPA partially mitigates excess risk, optimizing sedentary behavior appears to be important even among physically active individuals.

Socioeconomic Status and Patterns of Physical Activity and Sedentary Behavior: A Cross-Sectional Analysis of the J-SHINE

BACKGROUND

This study aimed to examine the association between socioeconomic status (SES) and optimal movement behaviors including sufficient moderate-to-vigorous physical activity (PA), regular leisure-time PA, and less sedentary behavior.

METHODS

We used data from the Japanese Study on Stratification, Health, Income, and Neighborhood conducted in 2012. Activity patterns and SES were measured using International Physical Activity Questionnaire Short-Version and other self-administered questionnaires. Activity pattern outcomes assessed were sufficient total volume of moderate-to-vigorous PA (≥150 min/wk), regular leisure-time PA (≥1 d/wk), less sedentary time (≤4 h/d), and optimal movement behaviors (meeting all criteria). SES variables were equivalized annual income, educational attainment, and occupation. Logistic regression analysis adjusted for confounders.

RESULTS

We included 731 men and 852 women. Lower income levels were associated with less leisure-time PA among men and women (men, odds ratio [OR]: 0.60 and 0.65 for Q2 and Q1 [lowest], respectively; women, OR: 0.53 and 0.56 for Q2 and Q1 [lowest]). Lower SES groups associated with less sedentary time (men, OR: 1.82 for blue-collar; women, OR: 1.44 for Q1 income level, 1.61 and 1.53 for junior college, technical school, and high school/junior high school, respectively; 1.89 for unemployed). SES was not significantly associated with optimal movement behavior in both sexes (in men, OR for those with high school or junior high school education vs those with university or graduate school education = 0.81 [0.43-1.53]).

CONCLUSION

Activity patterns varied by SES, with lower income associated with less leisure-time PA and white-collar workers associated with more prevalent sedentary behavior among both sexes.

Effect of Interrupting Prolonged Sitting with Frequent Activity Breaks on Postprandial Glycemia and Insulin Sensitivity in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy: A Randomized Crossover Pilot Trial

Objective: This study examined acute effects of interrupting prolonged sitting with short activity breaks on postprandial glucose/insulin responses and estimations of insulin sensitivity in adults with type 1 diabetes (T1D). Method: In a randomized crossover trial, eight adults (age = 46 ± 14 years [mean ± SD], body mass index [BMI] = 27.2 ± 3.8 kg/m2) receiving continuous subcutaneous insulin infusion (CSII) therapy completed two 6-h conditions as follows: uninterrupted sitting (SIT) and sitting interrupted with 3-min bouts of simple resistance activities (SRAs) every 30 min. Basal and bolus insulin were standardized across conditions except in cases of hypoglycemia. Postprandial responses were assessed using incremental area-under-the-curve (iAUC) and total AUC (tAUC) from half-hourly venous sampling. Meal-based insulin sensitivity determined from glucose sensor and insulin pump (SiSP) was assessed from flash continuous glucose monitor and insulin pump data. Outcomes were analyzed using mixed models adjusted for sex, BMI, treatment order, and preprandial values. Results: Glucose iAUC did not differ by condition (SIT: 19.8 ± 3.0 [estimated marginal means ± standard error] vs. SRA: 14.4 ± 3.0 mmol.6 h.L-1; P = 0.086). Despite CSII being standardized between conditions, insulin iAUC was higher in SRA compared to SIT (137.1 ± 22.7 vs. 170.9 ± 22.7 mU.6 h.L-1; P < 0.001). This resulted in a lower glucose response relative to the change in plasma insulin in SRA (tAUCglu/tAUCins: 0.32 ± 0.02 vs. 0.40 ± 0.02 mmol.mU-1; P = 0.03). SiSP was also higher at dinner following the SRA condition, with no between-condition differences at breakfast or lunch. Conclusion: Regularly interrupting prolonged sitting in T1D may increase plasma insulin and improve insulin sensitivity when meals and CSII are standardized. Future studies should explore underlying mechanistic determinants and the applicability of findings to those on multiple daily injections. Trial Registration: Australian and New Zealand Clinical Trial Registry Identifier-ACTRN12618000126213 (www.anzctr.org.au).

Behavioural patterns of university students during the COVID-19 pandemic: A cross-sectional study of the effects of active transportation, uninterrupted sitting time, and screen use on physical activity and sitting time

Background

The closure of universities due to the coronavirus disease 2019 (COVID-19) pandemic significantly affected students' behaviours, particularly regarding physical activity, sitting time, and screen use. This study aimed to determine the effect of active transportation duration, uninterrupted sitting time, and screen time to study on physical activity and sitting time during the confinement.

Methods

This was a cross-sectional study based on data collected via an online questionnaire for university students during the second confinement in France (between October and December 2020). The questionnaire assessed physical activity and sedentary behaviour, and contained questions about modes of transport, and perception of uninterrupted sitting time and screen time to study prior to confinement and during confinement. Participants (N=2873) completed the International Physical Activity Questionnaire (IPAQ) in an average time of around 15 minutes, after providing digital informed consent. Multiple regression models assessed how time duration of active transportation, uninterrupted sitting time, and screen time studying increased or reduced confinement effects on physical activity and sitting time.

Results

The regression models showed that physical activity decreased during confinement for students who engaged in more prolonged periods of active transportation prior to confinement. Moreover, the perception of long, uninterrupted sitting time and high screen time prior to confinement significantly increased sitting time during confinement. Students who adopted the most active transport time prior to confinement were the least likely to increase their screen time during confinement.

Conclusions

Confinement reduced physical activity levels and increased sitting time, mainly among students who adopted active transport and accumulated longer uninterrupted sitting time prior to confinement. Students who combined-long periods of uninterrupted sitting time with high screen use could be a riskier profile for health. Analysis of physical activity time and sitting position should include its accumulation patterns.

Metabolome Alterations Associated with Three-Month Sitting-Time Reduction Among Sedentary Postmenopausal Latinas with Cardiometabolic Disease Risk

Background: Incidence of cardiometabolic disease among U.S. Hispanics/Latinos is higher than in non-Hispanic Whites. Prolonged sitting duration is prevalent in older adults, and compounded with menopause, greatly increases cardiometabolic risk in postmenopausal women. Metabolomic analyses of interventions to reduce sitting are lacking and mechanistic understanding of health-promoting behavior change in postmenopausal Latinas is needed. Methods: To address this knowledge gap, an exploratory analysis investigated the plasma metabolome impact of a 12-week increased standing intervention among sedentary postmenopausal Latinas with overweight or obesity. From a parent-randomized controlled trial, a subset of Best Responders (n = 43) was selected using parameters of highest mean change in sitting bout duration and total sitting time; baseline variable-Matched Controls (n = 43) were selected using random forest modeling. Targeted LC-MS/MS analysis of archived baseline and 12-week plasma samples was conducted. Metabolite change was determined using a covariate-controlled general linear model and multivariate testing was performed. A false discovery rate correction was applied to all analyses. Results: Best Responders significantly changed time sitting (-110.0 ± 11.0 min; -21%), standing (104.6 ± 10.1 min; 40%), and sitting in bouts >30 min (-102.3 ± 13.9 min; -35%) compared to Matched Controls (7.1 ± 9.8 min, -7.8 ± 9.0 min, and -4.6 ± 12.7 min, respectively; all p < 0.001). Twelve-week metabolite change was significantly different between the two groups for 24 metabolites (FDR < 0.05). These were primarily related to amino acid metabolism, improved blood flow, and ATP production. Enzyme enrichment analysis predicted significant changes regulating glutamate, histidine, phenylalanine, and mitochondrial short-chain fatty acid catabolism. Pathway analysis showed significant intervention effects on glutamate metabolism and phenylalanine, tyrosine, and tryptophan biosynthesis, potentially indicating reduced cardiometabolic disease risk. Conclusions: Replacing nearly two hours of daily sitting time with standing and reduced prolonged sitting bouts significantly improved metabolomic profiles associated with cardiometabolic risk among postmenopausal Latinas.

Effects of blood flow restriction training on cardiometabolic health and body composition in adults with overweight and obesity: a meta-analysis

Objective

This meta-analysis aims to evaluate the effects of blood flow restriction (BFR) training on cardiometabolic health and body composition in adults with overweight and obesity.

Method

Following PRISMA guidelines, a systematic search of PubMed (MEDLINE), EMBASE, Web of Science, Cochrane, and Scopus databases was conducted on 15 March 2024. Pooled effects for each outcome were summarized using Hedge's g (g) through meta-analysis-based random effects models, and subgroup analyses were used to explore moderators.

Results

A total of 11 studies with 242 participants (Age:32.6 ± 3.6, BMI:27.2 ± 3.5) were included. Regarding cardiometabolic health, BFR training significantly reduced systolic blood pressure (g = 0.62 [0.08, 1.16], p = 0.02), while no significant differences were observed in maximal oxygen uptake (g = 0.48 [-0.21, 1.17], p = 0.17) or diastolic blood pressure (g = 0.31 [-0.22, 0.84], p = 0.25). Regarding body composition, BFR training significantly reduced body fat percentage (g = 0.30 [0.01, 0.58]; p = 0.04), while no significant differences (p > 0.05) were observed in body weight (g = 0.14 [-0.14, 0.42]), body mass index (g = 0.08 [-0.21, 0.38]), waist circumference (g = 0.13 [-0.28, 0.53]), or waist-to-hip ratio (g = 0.48 [-0.19, 1.15]). Subgroup analysis revealed no significant difference in improving systolic blood pressure (g = 0.57 [-0.10, 1.24] vs. g = 0.70 [-0.18, 1.59]) and body fat percentage (g = 0.20 [-0.20, 0.61] vs. g = 0.45 [-0.05, 0.95]) between BFR resistance training and BFR aerobic training. In all selected studies, the overall risk of bias was categorized as "some concern". The certainty of evidence for the BFR outcomes was low.

Conclusion

BFR training shows promise in improving cardiometabolic health and body composition, indicating that it may serve as a beneficial, individualized exercise prescription for improving cardiovascular disease risk and fat loss in adults with excess body weight and obesity.

Systematic Review Registration

https://archive.org/details/osf-registrations-uv6jx-v1.

Exercise intensity of virtual reality exergaming modulates the responses to executive function and affective response in sedentary young adults: A randomized, controlled crossover feasibility study

Virtual reality (VR) exergaming is a novel strategy to encourage physical activity and boost emotional well-being. However, its effects on executive function (EF) are not fully understood. This study assessed the immediate and retention effects of immersive VR exergaming, at varying exercise intensities, on EF and affect among sedentary college students. Thirty participants (mean age = 22.2 ± 2.5 years; 18 females) underwent 15-minute sessions of moderate-intensity (MI), high-intensity (HI), and active-control intensity (AC) VR exergaming in a counterbalanced order. EF was evaluated using the Flanker, Task-switching, and N-back tasks before, immediately after, and 30 min post-intervention. Emotional valence and arousal were measured by the Feeling Scale and Felt Arousal Scale, respectively. The inverse efficiency score (IES) results indicated that inhibitory control was higher following both MI and HI exergaming compared to AC (p < 0.05), with improvements sustained for 30 minutes HI VR exergaming showed the greatest improvement (p = 0.048). Both HI and MI also exhibited higher working memory capacity than AC (p < 0.05), with HI performing better (p = 0.039). No significant differences in task-switching performance were observed among the groups (p > 0.05). Emotional valence and arousal were significantly elevated immediately after and sustained for 30 minutes following MI and HI exergaming (p < 0.05). This study demonstrates the cognitive and affective benefits of MI and HI VR exergaming in young adults, with HI VR exergaming showing longer-lasting improvements. These findings suggest that immersive VR exergaming can enhance both physical and cognitive health, potentially improving academic performance and daily functionality in collegiate populations.

Sitting time at work and cardiovascular disease risk-a longitudinal analysis of the Study on Mental Health at Work (S-MGA)

PURPOSE

This study analyzed longitudinal data to examine whether occupational sitting time is associated with increases in body mass index (BMI) and five-year cardiovascular disease (CVD) risk.

METHODS

We included 2,000 employed men and women (aged 31-60) from the German Study on Mental Health at Work (S-MGA) for a BMI analysis and 1,635 participants free of CVD at baseline (2011/2012) for a CVD analysis. Occupational sitting time was categorized into five groups (< 5, 5 to < 15, 15 to < 25, 25 to < 35, and ≥ 35 h per week). BMI change was measured from baseline (2011/2012) to follow-up (2017). Incident CVD included hypertension, heart disease, myocardial infarction, and stroke (all self-reported). Multiple linear regression examined the association between sitting time and BMI change, while modified Poisson regression analyzed CVD incidence, adjusting for age, sex, occupation, shift work, leisure activity, and smoking by sex. Covariates were self-reported.

RESULTS

Over five years, the average BMI change was 0.49 (SD 1.9). We found no association between baseline occupational sitting time and BMI changes, with consistent results in sensitivity analyses. During this period, 245 participants developed cardiovascular disease. There was no increased risk of CVD among those with more sitting time compared to less. No differences in risk were found between women and men.

CONCLUSION

There was no association between occupational sitting time and five-year changes in BMI or incident CVD.

Correlation and predictive value of novel anthropometric indicators with adult sarcopenia and sarcopenia obesity

The present study leverages the comprehensive data from the National Health and Nutrition Examination Survey (NHANES) to examine the Influencing factors of sarcopenia (SA) and sarcopenic obesity (SO). The investigation is designed to a non-invasive, cost-effective, and convenient method that is applicable to the adult population, enabling the accurate and simultaneous detection of risks associated with SA and SO. Furthermore, this research will evaluate the critical values of effective anthropometric indicators, providing early warning for risk management in self-health care and offering valuable insights for subsequent research and clinical practice. The data pertaining to NHANES participants were meticulously selected from the databases of six cycles, spanning from 2001 to 2004 and 2011 to 2018. Utilizing the diagnostic criteria established by the American Foundation for the National Institutes of Health (FNIH), anthropometric measurement data were extracted to construct composite indices. These indices were then cross-referenced with diagnostic assessments from dual-energy X-ray absorptiometry and bioelectrical impedance analysis to examine the correlations between various metrics and the incidence of diseases. R software (version 4.3.3) was used for analysis, and the primary analytical methods employed included logistic regression, restricted cubic splines (RCS), and the Receiver Operating Characteristic (ROC) curve analysis (AUC). Sarcopenia and sarcopenic obesity are commonly observed in individuals within the middle-aged and elderly demographics. The prevalence of these conditions is higher among middle-aged men of a given age when contrasted with women at the age of 40. All anthropometric indexes demonstrated a positive correlation with the onset of SA and SO, with the association with waist-to-height ratio (WHtR) showcasing a heightened strength subsequent to the adjustment for all covariates. The predictive models of all ROC curves performed commendably, particularly with the body roundness index and WHtR forecasting models exhibiting superior performance, the area under the AUC curve is 0.87 (95 CI% 0.85, 0.88) and 0.86 (95 CI% 0.85, 0.88), respectively. The RCS curve delineated a distinctive J-shaped distribution for each physical index in concurrence with SA and SO, signifying an optimal value at which the incidence of these conditions is minimal; conversely, deviations from this optimal value entailed an escalated risk of disease. Diverse anthropometric index metrics bear a strong correlation with adult onset of sarcopenia and sarcopenic obesity, each displaying commendable predictive capability. Notably, the body roundness index and waist-to-height ratio may harbor heightened potential as indicative anthropometric indexes. Furthermore, the dose-effect relationship analysis inferred that the lowest disease risk is manifested among individuals with specific index profiles, thereby advocating for autonomous health monitoring to promote physical activity and bolster nutrient intake, thus mitigating the risk of sarcopenia and sarcopenic obesity.

Interventions for reducing sedentary behaviour in patients with coronary heart disease: a systematic review and meta-analysis protocol

INTRODUCTION

Sedentary behaviour is associated with numerous adverse health outcomes in patients with cardiovascular disease, independent of physical activity. Related interventions have improved sedentary behaviour in patients with coronary heart disease (CHD). However, their effectiveness has remained inconclusive. This systematic review and meta-analysis aim to comprehensively examine the efficacy of interventions for patients with CHD, thereby contributing to future implementation decisions to improve sedentary behaviour.

METHODS AND ANALYSIS

This protocol follows the guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Searches will be conducted in English and Chinese electronic databases from inception to 31 December 2024. All published randomised controlled trials and quasi-experimental studies that report on reducing sedentary behaviour in patients with CHD will be included. Two authors will independently conduct study selection, data extraction and quality assessment. Study quality will be assessed using validated tools appropriate for each study design. The overall meta-analyses for sedentary behaviour outcomes will be performed if the outcome data are sufficient and provide similar effect measures and subgroup analyses based on demographic characteristics, intervention duration, intervention types, intervention content and measurement tools. We will conduct a qualitative synthesis for studies that could not be quantitatively synthesised.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review as no human participants will be involved. The results will be disseminated through a peer-reviewed journal publication or academic conference.

PROSPERO REGISTRATION NUMBER

CRD42023466985.

The Relationship Between Daily Activity Level, Posture Distribution, Stepping Patterns, and Cadence in the BCS70 Cohort

This study investigated the relationship between stepping-defined daily activity levels, time spent in different postures, and the patterns and intensities of stepping behaviour. Using a thigh-mounted triaxial accelerometer, physical activity data from 3547 participants with seven days of valid data were analysed. We classified days based on step count and quantified posture and stepping behaviour, distinguishing between indoor, community, and recreation stepping. The results indicated significant differences in time spent in upright (2.5 to 8.9 h, p < 0.05), lying (8.0 to 9.1 h, p < 0.05), and sedentary (7.0 to 13.0 h, p < 0.05) postures across activity levels. At higher daily activity levels (10,000-15,000 steps), individuals tended to spend approximately equal time in each posture (8 h lying, 8 h sitting, and 8 h upright). The study found that at lower stepping-defined activity levels, step volumes were driven primarily by indoor stepping, while at higher activity levels, outdoor and recreation stepping were larger contributors. Additionally, stepping classified as indoor had significantly slower cadences compared to outdoor stepping. These findings suggest that the composition and intensity of stepping behaviours vary significantly with daily activity volumes, providing insights that could enhance public health messaging and interventions aimed at promoting physical activity.

Association of sedentary behaviour with gout and the interaction effect of hyperuricemia: a cross-sectional study from 2007 to 2018

BACKGROUND

The increasing prevalence of sedentary lifestyles has raised concerns about its health impacts. This study sought to explore the association between sedentary behaviour and gout, a condition historically linked with affluent lifestyles but now increasingly prevalent in the general population.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey database, this cross-sectional study analysed 34,526 participants from 2007 to 2018. The study focused on identifying any potential relationships between sedentary behaviour and the incidence of gout while adjusting for various confounders.

RESULTS

The study found a significant increase in the prevalence of gout from 2017 to 2018 and identified a reversed L-shaped relationship between sedentary behaviour and gout (OR = 1.03; 95% CI 1.00, 1.06; P = 0.0198), especially among individuals without hyperuricemia. Body Mass Index (BMI) may act as a key mediator in the relationship between sedentary behaviour and gout. In those with hyperuricemia, more than 12 h per day of sedentary behaviour substantially increased the prevalence of gout.

CONCLUSION

Prolonged sedentary behaviour emerged as an independent risk factor for gout. This association was particularly pronounced in individuals without hyperuricemia, suggesting the need for lifestyle modifications in this group. However, further research using prospective cohort studies is necessary to establish causality.

A Physical Activity and Sitting Time Balance Index and All-Cause Mortality Risk

INTRODUCTION

Achieving a healthier balance of more time spent in physical activity (PA) and less time in sedentary behavior is now widely advocated for achieving multiple health benefits. This study introduces a Physical Activity and Sitting Time Balance Index (PASTBI), a potential risk identification tool addressing the interplay between PA and sedentary behavior; and aims to explore its association with the risk of all-cause mortality in Australian adults.

METHODS

This prospective cohort study analyzed the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) data on 5,836 Australian adults. The PASTBI was calculated by dividing the total duration of PA (minutes/day) by the duration of sitting time (ST) (hours/day), both self-reported at baseline (2004-2005). The PASTBI was expressed in quartiles ranging from Q1 - low PA/high ST to Q4 - high PA/low ST. The association between PASTBI and all-cause mortality was explored (in 2022) using the Cox proportional hazards regression models adjusted for socio-demographics, lifestyle factors, waist circumference, and the number of comorbidities.

RESULTS

During 78,406 person-years of follow-up (median follow-up of 14.3 years), there were 885 deaths (15%). In the fully adjusted model, compared to those in the highest PASTBI category (Quartile 4 - high PA/low ST), participants from the lowest PASTBI category (Quartile 1 - low PA/high ST) were at a higher risk of all-cause mortality [HR (95% CI) = 1.47 (1.21-1.79)].

CONCLUSIONS

A less favorable balance of time spent in PA and ST (as characterized by a parsimonious PASTBI index approach) was associated with a higher risk of all-cause mortality.

Exercise Mediates Noncoding RNAs in Cardiovascular Diseases: Pathophysiological Roles and Clinical Application

Exercise-based cardiac rehabilitation is effective in improving cardiovascular disease risk factor management, cardiopulmonary function, and quality of life. However, the precise mechanisms underlying exercise-induced cardioprotection remain elusive. Recent studies have shed light on the beneficial functions of noncoding RNAs in either exercise or illness models, but only a limited number of noncoding RNAs have been studied in both contexts. Hence, the present study aimed to elucidate the pathophysiological implications and molecular mechanisms underlying the association among exercise, noncoding RNAs, and cardiovascular diseases. Additionally, the present study analysed the most effective and personalized exercise prescription, serving as a valuable reference for guiding the clinical implementation of cardiac rehabilitation in patients with cardiovascular diseases.

Sitting less and moving more: the impact of physical activity on mortality in the population of Spain

BACKGROUND

Sitting time (ST) constitutes a significant aspect of sedentary behavior, and its worldwide escalation raises concerns regarding public health. International guidelines recommend limiting sedentary time and replacing it with physical activity (PA) to reduce the risk of diseases and mortality. This study examines the impact of replacing ST with PA on all-cause, cardiovascular disease (CVD), and cancer mortality in a representative cohort of the population of Spain.

METHODS

We included 30 955 participants aged 15-69 years from two National Health Surveys performed in 2011 and 2017. Data were linked to mortality records as of December 2022. Data on ST, light PA (LPA), and moderate-vigorous PA (MVPA) were collected as part of the International Physical Activity Questionnaire at baseline. Isotemporal substitution analysis from Poisson regression models was used to estimate the relative risk ratio (RR) of replacing ST with LPA or MVPA.

RESULTS

During a median follow-up of 5.7 years, 957 deaths were reported. The replacement of 1 h per week of ST with 1 h per week of MVPA was significantly associated with a lower risk of all-cause (3.3%), CVD (6.7%), and cancer mortality (3.1%). Similarly, replacing 1 h per week of ST with 1 h per week of LPA was significantly associated with a lower risk of all-cause (1.6%) and cancer mortality (2.1%). Finally, substituting 1 h per week of LPA with 1 h per week of MVPA was significantly associated with a 7.6% lower risk of CVD mortality.

CONCLUSIONS

Substituting one hour per week of ST with an equivalent amount of PA was associated with a lower risk of all-cause, CVD, and cancer mortality.

Focusing on Sedentary Behavior in Comprehensive Cardiac Rehabilitation

In recent years, the adverse effects of prolonged sedentary behavior in daily life, so-called 'sitting too much', on health have been pointed out. Sedentary behavior is defined as 'all waking behavior in which the energy expenditure in a sitting, semi-recumbent, or recumbent position is 1.5 metabolic equivalents or less'. Even if a person engages in the level of physical activity recommended in the guidelines, sitting for too long at other times may increase the risk of developing various diseases and death. For patients with cardiovascular disease, a comprehensive cardiac rehabilitation program that systematically includes not only medical treatment but also exercise therapy, patient education, and disease management is extremely important. Also, differences in sedentary behavior during the acute and recovery phases are known to affect physical function and activities of daily living at the time of hospital discharge. Here, we discuss cardiac rehabilitation that addresses sedentary behavior and review the previous related research.

Dose-Response Independent and Joint Associations of Physical Activity and Sedentary Behavior With Mortality Risk in 40 156 Australian Adults With Coronary Heart Disease

BACKGROUND

Little is known about the relationship between physical activity (PA) and sedentary behavior (SB) with death in people with coronary heart disease. The aim was to examine the independent and joint associations of PA and SB with death.

METHODS AND RESULTS

This is a prospective cohort study including Australian participants aged ≥45 years with self-reported coronary heart disease (2006-2020). Self-reported PA (min/wk) and SB (h/d) were the exposures. Cardiac and all-cause death were the main outcomes. The cohort included 40 156 participants (mean age, 70.3 (SD, 10.3) years; 15 278 women [38%]). During a median follow-up of 11.1 (interquartile range, 6.2-14.4) years, 2497 cardiac and 12 240 all-cause deaths were recorded. Compared with no PA, a 20% to 30% lower risk of cardiac and all-cause death was associated with any level of PA. Walking and moderate to vigorous PA at 150 to 300 min/wk was associated with a 43% to 44% lower risk of cardiac death and 35% to 40% lower risk of all-cause death. Compared with ≥10.5 h/d of SB, participants who were sedentary for 7 to 10.4 h/d experienced an ≈25% reduced associated risk of cardiac and all-cause death. A 56% associated reduction in all-cause mortality risk was found if SB was limited to <3.4 h/d. If participants completed >150 min/wk moderate to vigorous PA and spent <7 h/d in SB, the associated risk of cardiac and all-cause death was reduced by ≈70%.

CONCLUSIONS

All people with coronary heart disease should be encouraged to meet the PA guidelines and limit SB to <7 h/d, noting any increase in physical activity and decrease in SB is better than none to prevent premature death.

Characteristics of physical activity and sedentary behavior in patients undergoing outpatient cardiac rehabilitation

Cardiac rehabilitation is crucial for the secondary prevention of cardiovascular disease, the leading cause of death worldwide. In Japan, as hospitalization periods have been shortened due to advances in medical technology and government policies, outpatient rehabilitation focused on lifestyle and physical activity (PA) is becoming increasingly important as hospital stays shorten. This study was aimed to identify patient characteristics that define the different types of PA and sedentary behaviors, and patient factors in 92 Japanese outpatients by using accelerometers. The patients were found to spend considerable time being sedentary (663.7 ± 118.1 min/day) and very little time engaging in moderate-to-vigorous PA (MVPA, 25.6 (10.6-43.4) min/day). Regression analysis revealed that the daily duration of sedentary behavior was 64 min longer in men than in women (β = 64.2, 95% CI[12.9, 115], p = 0.015); furthermore, men engaged in 22% less light PA (β = -0.245, 95% CI[-0.388, -0.102], p = 0.001). Additionally, MVPA increased by 43% for every 1 metabolic equivalent (MET) task increase in the anaerobic threshold (AT) (β = 0.367, 95% CI[0.035, 0.698], p = 0.031) but decreased by 3% per year of age(β = -0.035, 95% CI[-0.056, -0.015], p < 0.001). The study also found that body mass index (BMI) was negatively correlated with walking time (β = -0.039, 95% CI[-0.075, -0.003], p = 0.036), while AT was positively correlated with MVPA (β = 0.367, 95% CI[0.035, 0.698], p = 0.031) but negatively correlated with time above the AT (β = -2.06, 95% CI[-2.53, -1.59], p < 0.001). These results emphasize the importance of customizing rehabilitation programs according to sex, age, BMI, and AT differences. Furthermore, monitoring home activities and providing individualized prescriptions may enhance the effectiveness of rehabilitation programs.

Effects of Breaking Up Sitting on Gut Hormone Responses and Subsequent Compensatory Behaviors in Physically Inactive Adults

INTRODUCTION

The effects of breaking up sitting on gut hormone responses and free-living energy compensatory behaviors are still unclear in people of Asian ethnicity.

METHODS

Twenty-six Asians including 13 lean individuals (Lean) and 13 individuals with centrally overweight/obesity (OW), aged between 20 and 45 yr, completed a randomized crossover study with either 5.5-h uninterrupted sitting (SIT) or 5.5-h sitting with 2-min walking at 6.4 km·h -1 every 20 min (ACTIVE) in the laboratory. Blood samples were collected at regular time points to examine postprandial glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and glucose-dependent insulinotropic polypeptide (GIP) concentrations. Free-living physical activity and energy intake were recorded using wearable devices and weighed food diaries outside the laboratory until midnight. Paired t -tests were conducted to compare responses between trials.

RESULTS

Postprandial GLP-1 and PYY incremental area under the curve values were higher in the ACTIVE trial versus SIT in both Lean and OW groups (all, P < 0.05), but there was no difference in GIP in either group (both, P > 0.05). There were no differences in free-living physical activity (volume and intensity) or energy intake (total and macronutrients) between trials in either group (all, P > 0.05), resulting in greater total physical activity over the 24-h monitoring period in ACTIVE trial versus SIT trial (both, P < 0.05).

CONCLUSIONS

Breaking up sitting increases postprandial GLP-1 and PYY concentrations in Asians, but does not induce subsequent behavioral compensation, resulting in greater 24-h physical activity levels and lower relative energy intake, in inactive individuals irrespective of bodyweight status.

Association of sedentary behavior and physical activity with occurrence of signs and symptoms in participants of a cardiac rehabilitation program

Sedentary behavior (SB) is associated with health impairments, while physical activity (PA) has been a protective factor. It is unclear whether SB and PA are associated with occurrence of signs and/or symptoms (SS) during cardiac rehabilitation program (CRP) exercise sessions. The objective was to evaluate the association between SB and PA with occurrence of SS. Was included 48 patients from a CRP program (64.7 ± 10.4 years-old). Daily time and % of time of SB and weekly time in moderate-to-vigorous-intensity [MVPA], % of MVPA time, steps/day, and steps/minute were accelerometer-measured. Patients were followed-up during 24 CRP sessions, for accompaniment of SS. Age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, obesity) were covariates. Log-transformed values of SB, MVPA and steps/day were also analyzed. As results, 43.7% (n = 21) of participants presented occurrence of signs, 62.5% (n = 30) presented occurrence of symptoms, and 81.2% (n = 39) present occurrence of SS. In fully adjusted model, % of time in MVPA (β: -0.449,p = 0.045) and steps/minute (β: -0.244,p = 0.026) were inversely associated with occurrence of symptoms. No association was observed between SB and PA and occurrence of signs. The occurrence of symptoms and SS among CRP participants was directly associated with SB and inversely associated with variables of PA.

Detection of sedentary time and bouts using consumer-grade wrist-worn devices: a hidden semi-Markov model

BACKGROUND

Wrist-worn data from commercially available devices has potential to characterize sedentary time for research and for clinical and public health applications. We propose a model that utilizes heart rate in addition to step count data to estimate the proportion of time spent being sedentary and the usual length of sedentary bouts.

METHODS

We developed and trained two Hidden semi-Markov models, STEPHEN (STEP and Heart ENcoder) and STEPCODE (STEP enCODEr; a steps-only based model) using consumer-grade Fitbit device data from participants under free living conditions, and validated model performance using two external datasets. We used the median absolute percentage error (MDAPE) to measure the accuracy of the proposed models against research-grade activPAL device data as the referent. Bland-Altman plots summarized the individual-level agreement with activPAL.

RESULTS

In OPTIMISE cohort, STEPHEN's estimates of the proportion of time spent sedentary had significantly (p < 0.001) better accuracy (MDAPE [IQR] = 0.15 [0.06-0.25] vs. 0.23 [0.13-0.53)]) and agreement (Bias Mean [SD]=-0.03[0.11] vs. 0.14 [0.11]) than the proprietary software, estimated the usual sedentary bout duration more accurately (MDAPE[IQR] = 0.11[0.06-0.26] vs. 0.42[0.32-0.48]), and had better agreement (Bias Mean [SD] = 3.91[5.67] minutes vs. -11.93[5.07] minutes). With the ALLO-Active dataset, STEPHEN and STEPCODE did not improve the estimation of proportion of time spent sedentary, but STEPHEN estimated usual sedentary bout duration more accurately than the proprietary software (MDAPE[IQR] = 0.19[0.03-0.25] vs. 0.36[0.15-0.48]) and had smaller bias (Bias Mean[SD] = 0.70[8.89] minutes vs. -11.35[9.17] minutes).

CONCLUSIONS

STEPHEN can characterize the proportion of time spent being sedentary and usual sedentary bout length. The methodology is available as an open access R package available from https://github.com/limfuxing/stephen/ . The package includes trained models, but users have the flexibility to train their own models.

Assessing and Enhancing Movement Quality Using Wearables and Consumer Technologies: Thematic Analysis of Expert Perspectives

BACKGROUND

Improvements in movement quality (ie, how well an individual moves) facilitate increases in movement quantity, subsequently improving general health and quality of life. Wearable technology offers a convenient, affordable means of measuring and assessing movement quality for the general population, while technology more broadly can provide constructive feedback through various modalities. Considering the perspectives of professionals involved in the development and implementation of technology helps translate user needs into effective strategies for the optimal application of consumer technologies to enhance movement quality.

OBJECTIVE

This study aimed to obtain the opinions of wearable technology experts regarding the use of wearable devices to measure movement quality and provide feedback. A secondary objective was to determine potential strategies for integrating preferred assessment and feedback characteristics into a technology-based movement quality intervention for the general, recreationally active population.

METHODS

Semistructured interviews were conducted with 12 participants (age: mean 42, SD 9 years; 5 males) between August and September 2022 using a predetermined interview schedule. Participants were categorized based on their professional roles: commercial (n=4) and research and development (R&D; n=8). All participants had experience in the development or application of wearable technology for sports, exercise, and wellness. The verbatim interview transcripts were analyzed using reflexive thematic analysis in QSR NVivo (release 1.7), resulting in the identification of overarching themes and subthemes.

RESULTS

Three main themes were generated as follows: (1) "Grab and Go," (2) "Adjust and Adapt," and (3) "Visualize and Feedback." Participants emphasized the importance of convenience to enhance user engagement when using wearables to collect movement data. However, it was suggested that users would tolerate minor inconveniences if the benefits were perceived as valuable. Simple, easily interpretable feedback was recommended to accommodate diverse audiences and aid understanding of their movement quality, while avoiding excessive detail was advised to prevent overload, which could deter users. Adaptability was endorsed to accommodate progressions in user movement quality, and customizable systems were advocated to offer variety, thereby increasing user interest and engagement. The findings indicate that visual feedback representative of the user (ie, an avatar) should be used, supplemented with concise text or audible instructions to form a comprehensive, multimodal feedback system.

CONCLUSIONS

The study provides insights from wearable technology experts on the use of consumer technologies for enhancing movement quality. The findings recommend the prioritization of user convenience and simplistic, multimodal feedback centered around visualizations, and an adaptable system suitable for a diverse audience. Emphasizing individualized feedback and user-centric design, this study provides valuable findings around the use of wearables and other consumer technologies to enhance movement quality among the general population. These findings, in conjunction with those of future research into user perspectives, should be applied in practical settings to evaluate their effectiveness in enhancing movement quality.

Composite activity type and stride-specific energy expenditure estimation model for thigh-worn accelerometry

BACKGROUND

Accurately measuring energy expenditure during physical activity outside of the laboratory is challenging, especially on a large scale. Thigh-worn accelerometers have gained popularity due to the possibility to accurately detect physical activity types. The use of machine learning techniques for activity classification and energy expenditure prediction may improve accuracy over current methods. Here, we developed a novel composite energy expenditure estimation model by combining an activity classification model with a stride specific energy expenditure model for walking, running, and cycling.

METHODS

We first trained a supervised deep learning activity classification model using pooled data from available adult accelerometer datasets. The composite energy expenditure model was then developed and validated using additional data based on a sample of 69 healthy adult participants (49% female; age = 25.2 ± 5.8 years) who completed a standardised activity protocol with indirect calorimetry as the reference measure.

RESULTS

The activity classification model showed an overall accuracy of 99.7% across all five activity types during validation. The composite model for estimating energy expenditure achieved a mean absolute percentage error of 10.9%. For running, walking, and cycling, the composite model achieved a mean absolute percentage error of 6.6%, 7.9% and 16.1%, respectively.

CONCLUSIONS

The integration of thigh-worn accelerometers with machine learning models provides a highly accurate method for classifying physical activity types and estimating energy expenditure. Our novel composite model approach improves the accuracy of energy expenditure measurements and supports better monitoring and assessment methods in non-laboratory settings.

Effects of light-intensity physical activity on cardiometabolic parameters in young adults with overweight and obesity: The SED-ACT randomized controlled crossover trial

AIMS

To investigate how a change in body position with light-intensity physical activity (PA) 'snacks' (LIPAS, alternate sitting and standing, walking or standing continuously) compared with uninterrupted prolonged sitting affects glucose metabolism and heart rate variability (HRV) parameters in young adults with overweight and obesity.

MATERIALS AND METHODS

We conducted a four-arm randomized controlled crossover trial. The following conditions were tested during an 8-h simulated workday: uninterrupted prolonged sitting (SIT), alternate sitting and standing (SIT-STAND; 2.5 h total), continuous standing (STAND), and continuous walking (1.0 mph; WALK). The primary outcome was to investigate how a change in body position (alternate sitting and standing, walking or standing continuously) compared with uninterrupted sitting affects mean 8-h glucose metabolism. Secondary outcomes included the effects on 2-h postprandial glucose concentrations, as well as on 8-h/24-h heart rate and HRV parameters, in the respective study arms. Capillary blood samples were drawn from an hyperemised earlobe in the fasted state and once every hour during each trial intervention by puncturing the earlobe with a lancet and collecting 20 μL of blood (Biosen S-Line Lab+; EKF diagnostics, Barleben, Germany). HRV was assessed for 24 h including the 8-h intervention phase, and a home phase by means of a Holter electrocardiogram. All participants received the same standardized non-relativised breakfast and lunch during the four trial visits.

RESULTS

Seventeen individuals (eight women, mean age 23.4 ± 3.3 years, body mass index 29.7 ± 3.8 kg/m2, glycated haemoglobin level 34.8 ± 3.1 mmol/mol [5.4 ± 0.3%], body fat 31.8 ± 8.2%) completed all four trial arms. Compared with SIT (89.4 ± 6.8 mg/dL), 8-h mean glucose was lower in all other conditions (p < 0.05) and this was statistically significant compared with WALK (86.3 ± 5.2 mg/dL; p = 0.034). Two-hour postprandial glucose after breakfast was approximately 7% lower for WALK compared with SIT (p = 0.002). Furthermore, significant time × condition effects on HRV parameters favouring light-intensity walking were observed (p < 0.001).

CONCLUSIONS

Replacement and interruption of prolonged sitting with light-intensity walking showed a significant blood glucose-lowering effect and improved HRV during an 8-h work environment in young adults with overweight and obesity.

Can step count be used to identify older adults with high sedentary time and low moderate-to-vigorous physical activity?

INTRODUCTION

Combined high sedentary time (ST) and low moderate-to-vigorous physical activity (MVPA) has been associated with adverse cardiovascular events. However, accurately assessing ST and MVPA in older adults is challenging in clinical practice.

PURPOSE

To investigate whether step count can identify older adults with unhealthier movement behavior (high ST/low MVPA) and poorer cardiometabolic profile.

METHODS

Cross-sectional study (n = 258; 66 ± 5 years). Step count, ST, and MVPA were assessed by hip accelerometry during 7 days. The cardiometabolic profile was assessed using a continuous metabolic syndrome score (cMetS), including blood pressure, HDL-cholesterol, triglycerides, fasting glucose, and waist circumference. Receiving operating curve analysis was used to test the performance of step count in identifying older adults with unhealthier movement behavior (highest tertile of ST/lowest tertile of MVPA). Healthier movement behavior was defined as lowest tertile of ST/highest tertile of MVPA, with neutral representing the remaining combinations of ST/MVPA.

RESULTS

A total of 40 participants (15.5%) were identified with unhealthier movement behavior (ST ≥ 11.4 h/day and MVPA ≤ 10 min/day). They spent ~73% and 0.4% of waking hours in ST and MVPA, respectively. Step count identified those with unhealthier movement behavior (area under the curve 0.892, 0.850-0.934; cutoff: ≤5263 steps/day; sensitivity/specificity: 83%/81%). This group showed a higher cMetS compared with neutral (β = .25, p = .028) and healthier movement behavior groups (β = .41, p = .008).

CONCLUSION

Daily step count appears to be a practical, simple metric for identifying community-dwelling older adults with concomitant high ST and low MVPA, indicative of unhealthier movement behavior, who have a poorer cardiometabolic profile.

Effects of Interrupting Prolonged Sitting with Light-Intensity Physical Activity on Inflammatory and Cardiometabolic Risk Markers in Young Adults with Overweight and Obesity: Secondary Outcome Analyses of the SED-ACT Randomized Controlled Crossover Trial

Sedentary behavior (SB) is an essential risk factor for obesity, cardiovascular disease, and type 2 diabetes. Though certain levels of physical activity (PA) may attenuate the detrimental effects of SB, the inflammatory and cardiometabolic responses involved are still not fully understood. The focus of this secondary outcome analysis was to describe how light-intensity PA snacks (LIPASs, alternate sitting and standing, walking or standing continuously) compared with uninterrupted prolonged sitting affect inflammatory and cardiometabolic risk markers. Seventeen young adults with overweight and obesity participated in this study (eight females, 23.4 ± 3.3 years, body mass index (BMI) 29.7 ± 3.8 kg/m2, glycated hemoglobin A1C (HbA1c) 5.4 ± 0.3%, body fat 31.8 ± 8.2%). Participants were randomly assigned to the following conditions which were tested during an 8 h simulated workday: uninterrupted prolonged sitting (SIT), alternate sitting and standing (SIT-STAND, 2.5 h total standing time), continuous standing (STAND), and continuous walking (1.6 km/h; WALK). Each condition also included a standardized non-relativized breakfast and lunch. Venous blood samples were obtained in a fasted state at baseline (T0), 1 h after lunch (T1) and 8 h after baseline (T2). Inflammatory and cardiometabolic risk markers included interleukin-6 (IL-6), c-reactive protein (CRP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), visceral fat area (VFA), triglyceride-glucose (TyG) index, two lipid ratio measures, TG/HDL-C and TC/HDL-C, albumin, amylase (pancreatic), total protein, uric acid, and urea. We found significant changes in a broad range of certain inflammatory and cardiometabolic risk markers during the intervention phase for IL-6 (p = 0.014), TG (p = 0.012), TC (p = 0.017), HDL-C (p = 0.020), LDL-C (p = 0.021), albumin (p = 0.003), total protein (p = 0.021), and uric acid (p = 0.040) in favor of light-intensity walking compared with uninterrupted prolonged sitting, alternate sitting and standing, and continuous standing. We found no significant changes in CRP (p = 0.529), creatinine (p = 0.199), TyG (p = 0.331), and the lipid ratios TG/HDL-C (p = 0.793) and TC/HDL-C (p = 0.221) in response to the PA snack. During a simulated 8 h work environment replacement and interruption of prolonged sitting with light-intensity walking, significant positive effects on certain inflammatory and cardiometabolic risk markers were found in young adults with overweight and obesity.

Association between daily sitting time and kidney stones based on the National Health and Nutrition Examination Survey (NHANES) 2007-2016: a cross-sectional study

BACKGROUND

Kidney stones are among the most common urological conditions affecting ~9% of the world population. Although some unhealthy diets and unhealthy lifestyles are reportedly risk factors for kidney stone, the association between daily sitting time and kidney stone has not been explored.

MATERIALS AND METHODS

This large-scale, cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) database 2007-2016. Kidney stone history and daily sitting time were retrieved from the questionnaire and 24 hour (h) recall interviews. Logistic regression and subgroup analysis were conducted to investigate the association. The analysis was further stratified by vigorous recreational activity.

RESULTS

A total of 19 188 participants aged ≥20 years with complete information were included in this study. The overall prevalence of kidney stone was 9.6%. Among participants without vigorous recreational activity, a trend towards an increasing prevalence of kidney stone was observed with increased daily sitting time. However, the trend was not observed in individuals who participated in vigorous recreational activity, as they experienced a decreased risk of kidney stone despite having a daily sitting time of 6-8 h (crude model OR=0.659, 95% CI: 0.457-0.950, P =0.028), indicating that vigorous recreational activity may partially attenuate the detrimental effect of prolonged sitting time.

CONCLUSION

Our study revealed an increasing trend of prevalence of kidney stone with increased daily sitting time among the population not performing vigorous recreational activity despite the difference was nonsignificant. Vigorous recreational activity may modify the association between daily sitting time and kidney stone. More prospective cohort studies are warranted to further examine this association.

A 7-Month Multidisciplinary Healthy Lifestyle Intervention Effectively Improved Cardiometabolic Risk Profile of Firefighters

OBJECTIVE

We investigated the effect of a 7-month healthy lifestyle intervention on cardiometabolic risk factors (CMRF) among male career military firefighters (FFs).

METHODS

Forty-nine FFs participated in a 7-month workplace multiddisciplinary healthy lifestyle intervention designed to reduce CMRF through exercise, diet, and improved sleep. Medical assessments, accelerometry, and surveys at the beginning and end determined program effectiveness.

RESULTS

At the end of the intervention period, there was a significant improvement in measures of body composition and blood glucose. The prevalence of hypertension also decreased significantly ( P < 0.01). The 57% of participants who fully adhered to the program had significantly greater improvements across multiple CMRF. Participants increased their physical activity and improved their diet following the intervention.

CONCLUSIONS

This healthy lifestyle intervention was effective in changing behavior and lowering cardiometabolic risk among FFs.

Thigh-worn accelerometry: a comparative study of two no-code classification methods for identifying physical activity types

BACKGROUND

The more accurate we can assess human physical behaviour in free-living conditions the better we can understand its relationship with health and wellbeing. Thigh-worn accelerometry can be used to identify basic activity types as well as different postures with high accuracy. User-friendly software without the need for specialized programming may support the adoption of this method. This study aims to evaluate the classification accuracy of two novel no-code classification methods, namely SENS motion and ActiPASS.

METHODS

A sample of 38 healthy adults (30.8 ± 9.6 years; 53% female) wore the SENS motion accelerometer (12.5 Hz; ±4 g) on their thigh during various physical activities. Participants completed standardized activities with varying intensities in the laboratory. Activities included walking, running, cycling, sitting, standing, and lying down. Subsequently, participants performed unrestricted free-living activities outside of the laboratory while being video-recorded with a chest-mounted camera. Videos were annotated using a predefined labelling scheme and annotations served as a reference for the free-living condition. Classification output from the SENS motion software and ActiPASS software was compared to reference labels.

RESULTS

A total of 63.6 h of activity data were analysed. We observed a high level of agreement between the two classification algorithms and their respective references in both conditions. In the free-living condition, Cohen's kappa coefficients were 0.86 for SENS and 0.92 for ActiPASS. The mean balanced accuracy ranged from 0.81 (cycling) to 0.99 (running) for SENS and from 0.92 (walking) to 0.99 (sedentary) for ActiPASS across all activity types.

CONCLUSIONS

The study shows that two available no-code classification methods can be used to accurately identify basic physical activity types and postures. Our results highlight the accuracy of both methods based on relatively low sampling frequency data. The classification methods showed differences in performance, with lower sensitivity observed in free-living cycling (SENS) and slow treadmill walking (ActiPASS). Both methods use different sets of activity classes with varying definitions, which may explain the observed differences. Our results support the use of the SENS motion system and both no-code classification methods.

Joint association of sedentary time and physical activity with abnormal heart rate recovery in young and middle-aged adults

BACKGROUND

Abnormal heart rate recovery (HRR), representing cardiac autonomic dysfunction, is an important predictor of cardiovascular disease. Prolonged sedentary time (ST) is associated with a slower HRR. However, it is not clear how much moderate-to-vigorous physical activity (MVPA) is required to mitigate the adverse effects of sedentary behavior on HRR in young and middle-aged adults. This study aimed to examine the joint association of ST and MVPA with abnormal HRR in this population.

METHODS

A cross-sectional analysis was conducted on 1253 participants (aged 20-50 years, 67.8% male) from an observational study assessing cardiopulmonary fitness in Fujian Province, China. HRR measured via cardiopulmonary exercise tests on a treadmill was calculated as the difference between heart rate at peak exercise and 2 min after exercise. When the HRR was ≤ 42 beats·minute-1 within this time, it was considered abnormal. ST and MVPA were assessed by the IPAQ-LF. Individuals were classified as having a low sedentary time (LST [< 6 h·day-1]) or high sedentary time (HST [≥ 6 h·day-1]) and according to their MVPA level (low MVPA [0-149 min·week-1], medium MVPA [150-299 min·week-1], high MVPA [≥ 300 min·week-1]). Finally, six ST-MVPA groups were derived. Associations between ST-MVPA groups with abnormal HRR incidence were examined using logistic regression models.

RESULTS

53.1% of the young and middle-aged adults had less than 300 min of MVPA per week. In model 2, adjusted for possible confounders (e.g. age, sex, current smoking status, current alcohol consumption, sleep status, body mass index), HST was associated with higher odds of an abnormal HRR compared to LST (odds ratio (OR) = 1.473, 95% confidence interval (CI) = 1.172-1.852). Compared with the reference group (HST and low MVPA), the HST and high MVPA groups have a lower chance of abnormal HRR (OR, 95% CI = 0.553, 0.385-0.795). Compared with individuals with HST and low MVPA, regardless of whether MVPA is low, medium, or high, the odds of abnormal HRR in individuals with LST is significantly reduced (OR, 95% CI = 0.515, 0.308-0.857 for LST and low MVPA; OR, 95% CI = 0.558, 0.345-0.902 for LST and medium MVPA; OR, 95% CI = 0.476, 0.326-0.668 for LST and high MVPA).

CONCLUSION

Higher amounts of MVPA appears to mitigate the increased odds of an abnormal HRR associated with HST for healthy young and middle-aged adults.

Wearable Sensors for Cardiovascular Assessment of Manual Wheelchair Users

The cardiovascular health of manual wheelchair users impacts their quality of life and function. A commonly used method to assess cardiovascular fitness and functional independence of manual wheelchair users is the 6-Minute Push Test. While it is a simple, no-cost, easy-to-implement test, it provides minimal data and can be subject to errors in counting laps, measuring distance, and reporting data. This study introduces the utilization of inertial measurement units and a wristwatch heart rate monitor to address those errors and gather more comprehensive physiological and movement data from the 6-Minute Push Test. Five manual wheelchair users performed the test while wearing a wristwatch and one inertial sensor on their dominant wrist while another sensor was mounted on their wheelchair. Observer-obtained distance was reported, and distance traveled, speed, propulsion cycles, and heart rate were calculated from the recorded sensor data. The results demonstrate that observer error is common and inertial data is more reliable in providing objective data for distance traveled. Furthermore, using inertial measurement units and heart rate monitors can improve the quantification of the cardiovascular fitness assessment and provide valuable insights for clinicians to help them with health evaluations, personalized interventions, and rehabilitation programs for wheelchair users. Future testing is needed on a larger population to explore the robustness of the method. Moreover, future integration with a phone application could allow for the method to be more accessible to everyone.

Inertial Measurement Unit and Heart Rate Monitoring to Assess Cardiovascular Fitness of Manual Wheelchair Users during the Six-Minute Push Test

Manual wheelchair users (MWUs) are prone to a sedentary life that can negatively affect their physical and cardiovascular health, making regular assessment important to identify appropriate interventions and lifestyle modifications. One mean of assessing MWUs' physical health is the 6 min push test (6MPT), where the user propels themselves as far as they can in six minutes. However, reliance on observer input introduces subjectivity, while limited quantitative data inhibit comprehensive assessment. Incorporating sensors into the 6MPT can address these limitations. Here, ten MWUs performed the 6MPT with additional sensors: two inertial measurement units (IMUs)-one on the wheelchair and one on the wrist together with a heart rate wristwatch. The conventional measurements of distance and laps were recorded by the observer, and the IMU data were used to calculate laps, distance, speed, and cadence. The results demonstrated that the IMU can provide the metrics of the traditional 6MPT with strong significant correlations between calculated laps and observer lap counts (r = 0.947, p < 0.001) and distances (r = 0.970, p < 0.001). Moreover, heart rate during the final minute was significantly correlated with calculated distance (r = 0.762, p = 0.017). Enhanced 6MPT assessment can provide objective, quantitative, and comprehensive data for clinicians to effectively inform interventions in rehabilitation.

Charting the cascade of physical activities: implications for reducing sitting time and obesity in children

OBJECTIVE

Traditional intensity-based physical activity measures and variable-centered statistics may not fully capture the complex associations between sitting time, physical activity, and obesity indices. This study investigates the associations between device-measured sitting, standing and different modes of physical activity (i.e., slow walking, brisk-walking, cycling and high-intensity activity) and measured body mass index (BMI) in children using person-based latent profile analyses and Partial Least Squared-structural equation modeling (PLS-SEM).

METHODS

A total of 344 children (11.5 ± 0.81 years, boys n = 139) wore a triaxial accelerometer (Fibion®) on their thigh for eight days, and their weight and height were measured at school. Latent profile analysis formed profiles including BMI, total sitting time, and physical activities, and their associations were further studied with PLS-SEM.

RESULTS

The latent profile analysis indicates that high levels of physical activity always coincide with low sitting time. Both normal weight and overweight/obesity can coexist with low physical activity and prolonged sitting. The PLS-SEM results highlight a cascade-like sequence in the relationship between various types of physical activity, sitting time, and BMI. This sequence begins with light-intensity activities, such as standing, progresses to higher-intensity activities, and ultimately through reduced sitting time (sample mean= -0.01; effect size = 0.0001; p = 0.02), mediates a decline in BMI (sample mean= -0.06; effect size = 0.0036; p = 0.01). The most positive effects on sitting time and BMI occur when this pattern is adhered to consistently, suggesting that omitting steps could negatively impact the associations.

CONCLUSION

These findings suggest that persuading children to increase physical activity incrementally, starting from low-intensity activities such as standing and slow walking to activity types with higher intensities, possibly influence BMI by mediating reduced sitting time. This approach is particularly inclusive for overweight and obese children, taking into account the potential challenges they may encounter when performing activity types with high intensity. These cross-sectional associations need to be verified with longitudinal and experimental designs.