Using different physical activity measurements in eight European countries. Results of the European Physical Activity Surveillance System (EUPASS) time series survey

Normative values in healthy adults for the 6-minute and 2-minute walk tests in Belgium and Vietnam: implications for clinical practice

OBJECTIVE

To establish reference values for the 6-minute walk test (6MWT) and 2-minute walk test (2MWT) distances, to investigate the correlation between these 2 tests, and to establish prediction equations for these distances in healthy populations of Belgium and Vietnam.

DESIGN

Cross-sectional study.

SUBJECTS AND METHODS

The 6MWT and 2MWT were administered to a convenience sample of 239 Belgian and 303 Vietnamese participants between the ages of 18 and 80 years.

RESULTS

The mean (standard deviation; SD) 2MWT distances were 215 (32.8) m for Belgian participants and 156 (25.5) m for Vietnamese participants. The mean (SD) 6MWT distances were 625 (90.7) m for Belgian participants and 449 (70.4) m for Vietnamese participants. The Pearson correlation coefficient between the 2 tests was 0.901 (p < 0.001) for Belgian participants and 0.871 (p < 0.001) for Vietnamese participants. Age and sex were the 2 most important predictors of walking distance, followed by body mass index for Belgium and height for Vietnam. The adjusted R² ranged from 0.31 to 0.49 across 4 predictive equations.

CONCLUSION

These results can be used to determine the presence of walking performance deficits and to guide future studies. The 2MWT is suggested as a useful and convenient alternative to the 6MWT for assessing walking performance in clinical practice.

Predictive Role of Physical Activity and Health-Related Quality of Life in Police Officers' Work Assessment

Police officers (POs) frequently encounter high stress and burnout risks in their demanding professional environment. This study delves into the relationship between physical activity (PA), health-related quality of life (HRQoL), and job performance among POs. A cross-sectional survey was conducted involving 1175 POs, with 691 providing complete responses. The survey included questions on biosocial and professional characteristics; the International Physical Activity Questionnaire-short form; the Short Form Health Survey version 2.0; and a qualitative job performance evaluation. The key findings highlight that vigorous PA significantly enhances job performance. About 46.2% of POs engage in vigorous PA, with a notable 73.7% participating in some form of PA weekly. This study also found that age and gender considerably impact the HRQoL, especially in mental health aspects like vitality and social functioning. Vigorous PA is linked to higher job performance ratings, especially when practised consistently. In conclusion, this research underscores the importance of vigorous PA in improving job performance among POs. We suggest that institutions prioritise facilitating environments that encourage regular PA, recognising its substantial benefits in both professional effectiveness and the overall health of POs. This study contributes to understanding the critical role of physical fitness in enhancing the occupational well-being of law enforcement personnel.

Translation to German and linguistic validation of the Rapid Assessment of Physical Activity (RAPA) questionnaire

PURPOSE

To produce a culturally adapted translation of the Rapid Assessment of Physical Activity (RAPA) questionnaire for German speaking Austrians and to conduct a linguistic validation of the new language version.

METHODS

The original English RAPA questionnaire was translated into German for Austria and underwent an independent forward and back translation, followed by cognitive debriefing interviews with older adults aged 55 to 78 years with and without health conditions (n = 13), for linguistic validation.

RESULTS

Several distinct choices were made in the translation of the RAPA questionnaire to German, including the use of colloquial terms for 'physical activity' and 'intensity'; and the decision to keep to the original examples and images of different physical activities for illustrating the intensity levels (light, moderate, vigorous) of physical activity. In cognitive debriefing, interviewees commented that some example activities for the respective intensity levels could - depending on the individual - also represent a higher or lower intensity level; and that the wording of RAPA items 4 and 5, which describe the category 'under-active regular' aerobic activity, was difficult to understand. Both issues were addressed and resolved through minor iterative modifications made during the cognitive debriefing process.

CONCLUSIONS

A new version of the RAPA questionnaire in German for Austria has been produced by forward and back translation and linguistic validation. The questionnaire may now undergo psychometric evaluation.

Genetic Determinants of Leisure-Time Physical Activity in the Hungarian General and Roma Populations

Leisure-time physical activity (LTPA) is one of the modifiable lifestyle factors that play an important role in the prevention of non-communicable (especially cardiovascular) diseases. Certain genetic factors predisposing to LTPA have been previously described, but their effects and applicability on different ethnicities are unknown. Our present study aims to investigate the genetic background of LTPA using seven single nucleotide polymorphisms (SNPs) in a sample of 330 individuals from the Hungarian general (HG) and 314 from the Roma population. The LTPA in general and three intensity categories of it (vigorous, moderate, and walking) were examined as binary outcome variables. Allele frequencies were determined, individual correlations of SNPs to LTPA, in general, were determined, and an optimized polygenetic score (oPGS) was created. Our results showed that the allele frequencies of four SNPs differed significantly between the two study groups. The C allele of rs10887741 showed a significant positive correlation with LTPA in general (OR = 1.48, 95% CI: 1.12-1.97; p = 0.006). Three SNPs (rs10887741, rs6022999, and rs7023003) were identified by the process of PGS optimization, whose cumulative effect shows a strong significant positive association with LTPA in general (OR = 1.40, 95% CI: 1.16-1.70; p < 0.001). The oPGS showed a significantly lower value in the Roma population compared with the HG population (oPGS_Roma: 2.19 ± SD: 0.99 vs. oPGS_HG: 2.70 ± SD: 1.06; p < 0.001). In conclusion, the coexistence of genetic factors that encourage leisure-time physical activity shows a more unfavorable picture among Roma, which may indirectly contribute to their poor health status.

Prevalence and associated factors of physical inactivity among adult diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Physical inactivity has been viewed as an emerging public health problem in developing countries including Ethiopia. Diabetes mellitus (DM) is a group metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, function, or both. Its prevalence increases with changing lifestyles including physical inactivity across the globe. However, there is limited research, and not yet received attention in Ethiopia. This study aimed to assess the prevalence and associated factors of physical inactivity among adult diabetic patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. An institutional-based cross-sectional study design was conducted among 308 participants from February to June 2018 at Felege Hiwot Referral Hospital. A face-to-face interview was conducted using a structured questionnaire by trained data collectors. Participants were selected through a systematic random sampling technique. Physical inactivity was assessed by the international physical activity questionnaire (IPAQ). Collected data were entered in Epi info version 7 and transferred to SPSS version 20 for analysis. A summary of descriptive statistics and multiple binary logistic regression analyses were computed to identify associated factors of physical inactivity among adult diabetic patients. P < 0.05 with 95% CI was considered statistically significant. The overall prevalence of physical inactivity among diabetic patients was 30.5% ( 95% CI: 22.8-33.5%). Gender (AOR = 1.5, 95% CI: 1.1, 3.62), Old age (AOR = 18.17, 95% CI: 22.7, 61.9) Residence (AOR = 4.24, 95% CI: 1,12,16.028), Low self-efficacy (AOR = 20.59, 95% CI: 10.598, 41.608), Poor attitude (AOR = 2.75, 95%CI: 1.44,5.28), and Lack of social support (AOR = 4.22, 95% CI: 1.28,4.07) were found significantly predictor factors of physical inactivity. The prevalence of physical inactivity in this study was high. Being female, old age, dwelling in an urban, having low efficacy, poor attitude, and lack of social support was greater risk factors for being physically inactive. Diabetic education should focus on engagement in physical activity by overcoming barriers to performing physical activity. Government and health professionals should emphasize that evidence-based physical activity important to change their attitudes and require reaching a consensus on social support by their families.

Risk factors for bleeding in people living with hemophilia A and B treated with regular prophylaxis: A systematic review of the literature

BACKGROUND

Knowledge about the risk for bleeding in patients with hemophilia (PWH) would be relevant for patients, stakeholders, and policy makers.

OBJECTIVES

To perform a systematic review of the literature on risk assessment models (RAMs) and risk factors for bleeding in PWH on regular prophylaxis.

METHODS

We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception through August 2019. In duplicate, reviewers screened the articles for inclusion, extracted data, and assessed the risk for bias using the Quality in Prognostic Studies (QUIPS) tool. A qualitative synthesis of the results was not performed due to high heterogeneity in risk factors, outcomes definition and measurement, and statistical analysis of the results.

RESULTS

From 1843 search results, 10 studies met the inclusion criteria. No RAM for the risk for bleeding in PWH was found. Most studies included only PWH A or both PWH A and B and were conducted in North America or Europe. Only one study had a low risk for bias in all the domains. Eight categories of risk factors were identified. The risk for bleeding was increased when factor levels were lower and in people with a significant history of bleeding or who engaged in physical activities involving contact.

CONCLUSIONS

Our findings suggest that plasma factor levels, history of bleeds, and physical activity should be considered for the derivation analysis when building a RAM for bleeding in PWH, and the role of other risk factors, including antithrombotic treatment and obesity, should be explored.

Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature

Background

Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of acceptability and accuracy.

Objective

The aim of this study is to perform a systematic review of the literature to assess the accuracy and acceptability (willingness to use the device for the task it is designed to support) of wrist-wearable activity trackers.

Methods

We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and SPORTDiscus for studies measuring physical activity in the general population using wrist-wearable activity trackers. We screened articles for inclusion and, for the included studies, reported data on the studies’ setting and population, outcome measured, and risk of bias.

Results

A total of 65 articles were included in our review. Accuracy was assessed for 14 different outcomes, which can be classified in the following categories: count of specific activities (including step counts), time spent being active, intensity of physical activity (including energy expenditure), heart rate, distance, and speed. Substantial clinical heterogeneity did not allow us to perform a meta-analysis of the results. The outcomes assessed most frequently were step counts, heart rate, and energy expenditure. For step counts, the Fitbit Charge (or the Fitbit Charge HR) had a mean absolute percentage error (MAPE) <25% across 20 studies. For heart rate, the Apple Watch had a MAPE <10% in 2 studies. For energy expenditure, the MAPE was >30% for all the brands, showing poor accuracy across devices. Acceptability was most frequently measured through data availability and wearing time. Data availability was ≥75% for the Fitbit Charge HR, Fitbit Flex 2, and Garmin Vivofit. The wearing time was 89% for both the GENEActiv and Nike FuelBand.

Conclusions

The Fitbit Charge and Fitbit Charge HR were consistently shown to have a good accuracy for step counts and the Apple Watch for measuring heart rate. None of the tested devices proved to be accurate in measuring energy expenditure. Efforts should be made to reduce the heterogeneity among studies.

Validity and Reliability of International Physical Activity Questionnaires for Adults across EU Countries: Systematic Review and Meta Analysis

This review and meta-analysis (PROSPERO registration number: CRD42020138845) critically evaluates test-retest reliability, concurrent validity and criterion validity of different physical activity (PA) levels of three most commonly used international PA questionnaires (PAQs) in official language versions of European Union (EU): International Physical Activity Questionnaire (IPAQ-SF), Global Physical Activity Questionnaire (GPAQ), and European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ). In total, 1749 abstracts were screened, 287 full-text articles were identified as relevant to the study objectives, and 20 studies were included. The studies' results and quality were evaluated using the Quality Assessment of Physical Activity Questionnaires checklist. Results indicate that only ten EU countries validated official language versions of selected PAQs. A meta-analysis revealed that assessment of moderate-to-vigorous PA (MVPA) is the most relevant PA level outcome, since no publication bias in any of measurement properties was detected while test-retest reliability was moderately high (r_w = 0.74), moderate for the criterion (r_w = 0.41) and moderately-high for concurrent validity (r_w = 0.72). Reporting of methods and results of the studies was poor, with an overall moderate risk of bias with a total score of 0.43. In conclusion, where only self-reporting of PA is feasible, assessment of MVPA with selected PAQs in EU adult populations is recommended.

On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial

Background

Non-specific neck pain and headache are major economic and individual burden in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of prevalent and incident neck pain and headache in office workers.

Methods/design

This study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18–65 years from two Swiss organisations in the Cantons of Zurich and Aargau, working more than 25 h a week in predominantly sedentary office work and without serious health conditions of the neck. One hundred twenty voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes are neck disability and pain (measured by the Neck Disability Index, and muscle strength and endurance measures), headache (measured by the short-form headache impact test), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), adherence to intervention, and additional measures (e.g. care-seeking). Measurements will take place at baseline, 4 months, 8 months, and 12 months after commencement. Data will be analysed on an intention to treat basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models.

Discussion

To the authors’ knowledge, this study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, prevalent and incident neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers.

Trial registration

ClinicalTrials.gov, NCT04169646. Registered 15 November 2019 - Retrospectively registered.

Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis

Obesity is one of the most important risk factors of knee osteoarthritis (KOA), but its impact on clinical and functional consequences is less clear. The main objective of this cross-sectional study was to describe the relation between body mass index (BMI) and clinical expression of KOA. Participants with BMI ≥ 25 kg/m² and KOA completed anonymous self-administered questionnaires. They were classified according to BMI in three groups: overweight (BMI 25-30 kg/m²), stage I obesity (BMI 30-35 kg/m²) and stage II/III obesity (BMI ≥ 35 kg/m²). The groups were compared in terms of pain, physical disability, level of physical activity (PA) and fears and beliefs concerning KOA. Among the 391 individuals included, 57.0% were overweight, 28.4% had stage I obesity and 14.6% had stage II/III obesity. Mean pain score on a 10-point visual analog scale was 4.3 (SD 2.4), 5.0 (SD 2.6) and 5.2 (SD 2.3) with overweight, stage I and stage II/III obesity, respectively (p = 0.0367). The mean WOMAC function score (out of 100) was 36.2 (SD 20.1), 39.5 (SD 21.4) and 45.6 (SD 18.4), respectively (p = 0.0409). The Knee Osteoarthritis Fears and Beliefs Questionnaire total score (KOFBEQ), daily activity score and physician score significantly differed among BMI groups (p = 0.0204, p = 0.0389 and p = 0.0413, respectively), and the PA level significantly differed (p = 0.0219). We found a dose-response relation between BMI and the clinical consequences of KOA. Strategies to treat KOA should differ by obesity severity. High PA level was associated with low BMI and contributes to preventing the clinical consequences of KOA.

Adults with familial hypercholesterolaemia have healthier dietary and lifestyle habits compared with their non-affected relatives: the SAFEHEART study

Objective

Healthy lifestyle habits are the cornerstone in the management of familial hypercholesterolaemia (FH). Nevertheless, dietary studies on FH-affected populations are scarce. The present study analyses dietary habits, adherence to a Mediterranean diet pattern and physical activity in an adult population with FH and compares them with their non-affected relatives.

Design

Cross-sectional study.

Setting

Data came from SAFEHEART, a nationwide study in Spain.

Participants

Individuals (n 3714) aged ≥18 years with a genetic diagnosis of FH (n2736) and their non-affected relatives (n 978). Food consumption was evaluated using a validated FFQ.

Results

Total energy intake was lower in FH patients v. non-affected relatives (P<0·005). Percentage of energy from fats was also lower in the FH population (35 % in men, 36 % in women) v. those non-affected (38 % in both sexes, P<0·005), due to the lower consumption of saturated fats (12·1 % in FH patients, 13·2 % in non-affected, P<0·005). Consumption of sugars was lower in FH patients v. non-affected relatives (P<0·05). Consumption of vegetables, fish and skimmed milk was higher in the FH population (P<0·005). Patients with FH showed greater adherence to a Mediterranean diet pattern v. non-affected relatives (P<0·005). Active smoking was lower and moderate physical activity was higher in people with FH, especially women (P<0·005).

Conclusions

Adult patients with FH report healthier lifestyles than their non-affected family members. They eat a healthier diet, perform more physical activity and smoke less. However, this patient group’s consumption of saturated fats and sugars still exceeds guidelines.

Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women

ABSTRACT

Sanda B, Vistad I, Haakstad LAH, Berntsen S, Sagedal LR, Lohne-Seiler H, Torstveit MK. Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women.

BACKGROUND

The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy.

METHOD

Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart (n = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) (n = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3-6, >6 and >3 Metabolic Equivalents (METs), respectively.

RESULTS

Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were-84 ± 402 min/week for MPA,-85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were-197 ± 326 min/week for MPA,-205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%.

CONCLUSION

IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.

Association of socioeconomic, school-related and family factors and physical activity and sedentary behaviour among adolescents: multilevel analysis of the PRALIMAP trial inclusion data

BACKGROUND

Social differences among adolescents in physical activity and sedentary behaviour have been identified but are not well explained. The current study aimed to identify socioeconomic, family and school-related associated factors with physical activity and sedentary behaviour among high-school adolescents.

METHODS

This was a cross-sectional analysis of T0 physical activity and sedentary behaviour of 2523 students 14 - 18 years old recruited for the PRALIMAP trial from 24 French state-run high schools. Data were collected by self-administered questionnaire at the start of grade 10. Adolescents completed the International Physical Activity Questionnaire for physical activity and sedentary behaviour and an ad hoc questionnaire for active commuting and sport participation. Statistical analyses involved linear and logistic regressions.

RESULTS

Socioeconomic, family or school variables were associated with levels of physical activity and sedentary behaviour for both boys and girls, but no factor, except perceived parental physical activity level, was associated with total energy expenditure (total physical activity) for either gender. Adolescents with privileged and less privileged socioeconomic status reported the same total amount of energy expenditure.

CONCLUSIONS

Total physical activity score alone is not sufficient to assess the physical activity of adolescents. These findings may have implications for better understanding of social inequalities in this context and recommendations to prevent overweight.

TRIAL REGISTRATION

This trial is registered at ClinicalTrials.gov ( NCT00814554 ). The date of registration: 23 December 2008. Registration was not required at the time of the start of PRALIMAP for public health and prevention programmes and trials.

The relation of trait and state mindfulness with satisfaction and physical activity: A cross-sectional study in 305 Dutch participants

Previous research has shown that satisfaction mediates the relationship of state mindfulness (i.e. during physical activity) with physical activity. This study aimed to replicate this finding and to explore the role of trait mindfulness with a cross-sectional design. In all, 305 participants completed measures on trait and state mindfulness, satisfaction with physical activity, and physical activity. Mediation analyses were used. Satisfaction mediated the effect of state mindfulness on physical activity. Trait mindfulness related to physical activity via an indirect path, namely through two consecutive mediators, first state mindfulness and then satisfaction. Our results suggest that to enhance satisfaction, both state and trait mindfulness should be considered.

Physical activity in patients with type 2 diabetes and hypertension--insights into motivations and barriers from the MOBILE study

Background

Although physical activity (PA) is key in the management of type 2 diabetes (T2DM) and hypertension, it is difficult to implement in practice.

Methods

Cross-sectional, observational study. Participating physicians were asked to recruit two active and four inactive patients, screened with the Ricci-Gagnon (RG) self-questionnaire (active if score ≥16). Patients subsequently completed the International Physical Activity Questionnaire. The objective was to assess the achievement of individualized glycated hemoglobin and blood pressure goals (<140/90 mmHg) in the active vs inactive cohort, to explore the correlates for meeting both targets by multivariate analysis, and to examine the barriers and motivations to engage in PA.

Results

About 1,766 patients were analyzed. Active (n=628) vs inactive (n=1,138) patients were more often male, younger, less obese, had shorter durations of diabetes, fewer complications and other health issues, such as osteoarticular disorders (P<0.001 for all). Their diabetes and hypertension control was better and obtained despite a lower treatment burden. The biggest difference in PA between the active vs inactive patients was the percentage who declared engaging in regular leisure-type PA (97.9% vs 9.6%), also reflected in the percentage with vigorous activities in International Physical Activity Questionnaire (59.5% vs 9.6%). Target control was achieved by 33% of active and 19% of inactive patients (P<0.001). Active patients, those with fewer barriers to PA, with lower treatment burden, and with an active physician, were more likely to reach targets. The physician’s role emerged in the motivations (reassurance on health issues, training on hypoglycemia risk, and prescription/monitoring of the PA by the physician). A negative self-image was the highest ranked barrier for the inactive patients, followed by lack of support and medical concerns.

Conclusion

Physicians should consider PA prescription as seriously as any drug prescription, and take into account motivations and barriers to PA to tailor advice to patients’ specific needs and reduce their perceived constraints.

A randomized controlled trial evaluating the effectiveness of a web-based, computer-tailored self-management intervention for people with or at risk for COPD

Introduction

COPD is a leading cause of morbidity and mortality. Self-management interventions are considered important in order to limit the progression of the disease. Computer-tailored interventions could be an effective tool to facilitate self-management.

Methods

This randomized controlled trial tested the effectiveness of a web-based, computer-tailored COPD self-management intervention on physical activity and smoking behavior. Participants were recruited from an online panel and through primary care practices. Those at risk for or diagnosed with COPD, between 40 and 70 years of age, proficient in Dutch, with access to the Internet, and with basic computer skills (n=1,325), were randomly assigned to either the intervention group (n=662) or control group (n=663). The intervention group received the web-based self-management application, while the control group received no intervention. Participants were not blinded to group assignment. After 6 months, the effect of the intervention was assessed for the primary outcomes, smoking cessation and physical activity, by self-reported 7-day point prevalence abstinence and the International Physical Activity Questionnaire – Short Form.

Results

Of the 1,325 participants, 1,071 (80.8%) completed the 6-month follow-up questionnaire. No significant treatment effect was found on either outcome. The application however, was used by only 36% of the participants in the experimental group.

Conclusion

A possible explanation for the nonsignificant effect on the primary outcomes, smoking cessation and physical activity, could be the low exposure to the application as engagement with the program has been shown to be crucial for the effectiveness of computer-tailored interventions. (Netherlands Trial Registry number: NTR3421.)

Adherence to physical activity recommendations and its associated factors: an interregional population-based study

Background

Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity recommendations among populations and identified the demographic, socioeco-nomic, behavioural and health-related factors associated with good compliance.

Design and methods

Cross-sectional interregional NESCaV survey of 3133 subjects compared three populations, Luxembourg, Lorraine (France) and Wallonia (Belgium), by using the International Physical Activity Questionnaire. Age and gender prevalence rates of physical activity were standardized to the European population.

Results

The likelihood to meet the recommendations was higher in Luxembourg, after adjustment for age, gender, education, employment, weight status, morbidity score, health perception and level of importance attributed to the practice of physical activity (P<0.0001). The odds for meeting the recommendations were significantly higher among those with secondary than tertiary education. Compared to good self-health perception, subjects with poor or fair self-perceived health were less likely to meet the recommendations; this also applied to those attributing little or enough importance to physical activity compared with great importance.

Conclusions

Region, education, self-perceived health and perception of importance of physical activity were emerged as independent determinants of meeting the recommendations. Awareness of the positive health effects of physical activity might thus be crucial for motivating the people to become more active. Further research is needed to explore potential region-specific factors which might explain the difference in population behaviours with respect to physical activity.

Mindfulness and satisfaction in physical activity: A cross-sectional study in the Dutch population

Both satisfaction and mindfulness relate to sustained physical activity. This study explored their relationship. We conducted a cross-sectional study with 398 Dutch participants who completed measures on trait mindfulness, mindfulness and satisfaction with physical activity, physical activity habits, and physical activity. We performed mediation and moderated mediation. Satisfaction mediated the effect of mindfulness on physical activity. Mindfulness was related to physical activity only when one's habit was weak. The relation of mindfulness with satisfaction was stronger for weak compared to strong habit. Understanding the relationship between mindfulness and satisfaction can contribute to the development of interventions to sustain physical activity.

High levels of physical inactivity amongst dental professionals: a questionnaire based cross sectional study

INTRODUCTION

A Dentist plays an important role in providing health education (General and Oral) to the community. Questions arise regarding their own health, which in turn affects their patients' counselling for leading a healthy and a physically active life.

AIM

To measure and compare the amount of physical activity present amongst dental professionals with the general population of Greater Noida.

MATERIALS AND METHODS

The International Physical Activity Questionnaire (IPAQ) was used to measure physical activity and statistical significance was calculated using SPSS version 21.0. Statistical significance was kept as p <.05.

RESULTS

Compared to the general population, Dentists were more obese and reported increased levels of low physical activity. Dentists had an increased and significant transportation and leisure time activity (p= .03 and .01) whereas, the general population had a higher level of vigorous activity(p = <.01). The MET hour/week for dentists and general population was 33.72 and 36.24 respectively, which was quite low as compared to European population.

CONCLUSION

The results indicate that dentists report a lower level of physical activity as compared to the general population of Greater Noida. However, on a global scale, the physical inactiveness of dentists and general population alike could pose a serious health hazard and if kept unchecked, shall increase the global burden of chronic disease.

Associations of blood pressure with common factors among left-behind farmers in rural China: a cross-sectional study using quantile regression analysis

The whole range of blood pressure (BP) has important implications. Yet, published studies focus primarily on hypertension and hypotension, the two extremes of BP continuum. This study aims at exploring quantile-specific associations of BP with common factors. The study used cross-sectional survey, collected information about gender, age, education, body mass index (BMI), alcohol intake, diet risk behavior, life event index, physical activity, fasting capillary glucose (FCG), and systolic/diastolic blood pressure (SBP/DBP) and pulse pressure (PP) from farmers living in 18 villages from rural Anhui, China, and performed descriptive and multivariate and quantile regression (QR) analysis of associations of SBP, DBP, or PP with the 9 factors surveyed. A total of 4040 (86.3%) eligible farmers completed the survey. Average hypertension prevalence rate and SBP, DBP, and PP values estimated 43.20 ± 0.50% and 141.37 ± 21.98, 87.76 ± 12.23, and 53.63 ± 15.72 mm Hg, respectively. Multivariate regression analysis revealed that all the 9 factors were significantly (P < 0.05) associated with one or more of SBP, DBP, and PP. QR coefficients of SBP, DBP, or PP with different factors demonstrated divergent patterns and age, BMI, FCG, and life event index showed substantial trends along the quantile axis. Hypertension prevalence rate was high among the farmers. QR modeling provided more detailed view on associations of SBP, DBP, or PP with different factors and uncovered apparent quantile-related patterns for part of the factors. Both the population group studied and the trends in QR coefficients identified merit specific attention.

Physical activity at home, at leisure, during transportation and at work in French adults with type 2 diabetes: the ENTRED physical activity study

AIM

Our study assessed the distribution of physical activity during various typical tasks of daily life in adults with type 2 diabetes (T2D), a population typified by low physical activity.

METHODS

We investigated the duration and intensity of physical activity in four domains (work, leisure, transportation and domestic), and how individual determinants might influence the repartition. The long-form International Physical Activity Questionnaire (IPAQ) was administered to participants from the échantillon national témoin représentatif des personnes diabétiques (ENTRED), a study of French adults with T2D (n=724, 65% men, age 62±10y, BMI 29±5kg.m(-2), HbA1c 7.1±1.1%), and the associations between sociodemographic/clinical characteristics and categories of physical activity intensity (low, moderate or high) were examined by logistic regression.

RESULTS

The median total physical activity was 2079 [Q1=893, Q3=3915]MET-min·week(-1). The main contributors to total physical activity were domestic chores, followed by leisure-time activities and transportation (median: 630, 347 and 198MET-min·week(-1), respectively). Absence of cardiovascular complications (OR=1.87, 95% CI=1.01-3.47), age<65y (OR=2.28, 95% CI=1.30-4.01) and better self-perceived health (OR=2.12, 95% CI=1.18-3.83) were associated with more physical activity. In all patient subgroups (defined by category of physical activity intensity or stratified by determinants of physical activity level), domestic chores were always the main contributor to total physical activity (P<0.0001).

CONCLUSION

Domestic chores are the predominant routine whereby adults with T2D engage in physical activity. This emphasizes the vast potential for promoting voluntary leisure-time physical activity in this population.

An evaluation of energy expenditure estimation by three activity monitors

A comparative evaluation of the ability of activity monitors to predict energy expenditure (EE) is necessary to aid in the investigation of the effect of EE on health. The purpose of this study was to validate and compare the RT3, the SWA and the IDEEA at measuring EE in adults and children. Twenty-six adults and 22 children completed a resting metabolic rate (RMR) test and performed four treadmill activities at 3 km.h(-1), 6 km.h(-1), 6 km.h(-1) at a 10% incline, 9 km.h(-1). EE was assessed throughout the protocol by the RT3, the SWA and the IDEEA. Indirect calorimetry (IC) was used as a criterion measure of EE against which each monitor was compared. Mean bias was assessed by subtracting EE from IC from EE from each monitor for each activity. Limit of agreement plots were used to assess the agreement between each monitor and IC. Limits of agreement for resting EE were narrowest for the RT3 for adults and children. Although the IDEEA displayed the smallest mean bias between measures at 3 km.h(-1), 6 km.h(-1) and 9 km.h(-1) in adults and children, the SWA agreed closest with IC at 6 km.h(-1), 6 km.h(-1) at a 10% incline and 9 km.h(-1). Limits of agreement were closest for the SWA at 9 km.h(-1) in adults representing 42% of the overall mean EE. Although the RT3 provided the best estimate of resting EE in adults and children, the SWA provided the most accurate estimate of EE across a range of physical activity intensities.

Physical activity in students of the Medical University of Silesia in Poland

BACKGROUND

Medical students and other health care professionals have substantial knowledge of the benefits of regular physical activity. Furthermore, as they have an ethical obligation to prescribe suitable exercises, they can influence their patients' attitude toward physical activity and can become role models for their patients. Physical therapists, who are primary care practitioners, have great potential for promoting physical activity; however, their role is still underestimated by patients and health care professionals.

OBJECTIVE

The objectives of this study were to evaluate physical activity level in students of the Medical University of Silesia in Poland and to focus on the role of physical therapist students in promoting physical activity.

DESIGN

This was a cross-sectional study.

METHODS

The final analysis included 300 students from the schools of physical therapy, midwifery, nursing, pharmacy, cosmetology, and medicine at the Medical University of Silesia. The short form of the International Physical Activity Questionnaire (IPAQ) was used to evaluate physical activity level.

RESULTS

Physical therapist students demonstrated the highest level of physical activity, with 46% demonstrating a high level of physical activity, 54% a moderate level of physical activity, and none a low level of physical activity. The largest group of students with a low level of physical activity comprised students from the school of medicine (26%).

LIMITATIONS

The number of respondents was relatively small. The main study limitations included its cross-sectional nature and the possibility of self-report biases. Further research is warranted to expand the study nationally and determine which factors influence physical activity.

CONCLUSIONS

There was a large group of medical students who, despite being aware of benefits of physical activity, did not meet the recommended level of physical activity. Physical therapist students are well trained and qualified to promote healthy habits and encourage individuals to undertake regular physical activity.

DRD2 C313T and DRD4 48-bp VNTR polymorphisms and physical activity of healthy men in Lower Silesia, Poland (HALS study)

BACKGROUND

Both animal and human studies have proved that the dopaminergic system of the brain controls many aspects of behavior, e.g. motivation, addiction, motor movement, locomotion. It has been hypothesized that dopamine signalling may regulate spontaneous physical activity as well.

AIM

Literature data suggests that an intact function of dopamine receptors (DRD2-DRD4) inhibits physical activity. This study searched for associations between a propensity to be active (or sedentary) and genetic variants of DRD2 and DRD4.

SUBJECTS AND METHODS

Invitations to participate in the study were sent to 900 randomly selected, adult men living in Lower Silesia, Poland. Genotyping of DRD2 C313T and DRD4 48-bp VNTR polymorphisms of enrolled subjects (371 (DRD2 C313T) and 397 (DRD4 48-bp VNTR)) was performed. Level of physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ).

RESULTS

No associations were found between level of physical activity (low, moderate, high) and the two polymorphisms: DRD2 C313T (p = 0.49) and DRD4 48-bp VNTR (p = 0.31). Studied subjects did not differ as to the number of hours spent sitting either.

CONCLUSION

The results exclude the presence of significant relationships between polymorphic variants of the dopamine receptors genes and the level of physical activity in men.

Declared and real physical activity in patients with type 2 diabetes mellitus as assessed by the International Physical Activity Questionnaire and Caltrac accelerometer monitor: a potential tool for physical activity assessment in patients with type 2 diabetes mellitus

AIMS

The aims of this study were to assess and compare declared and real volume of physical activity (PA), and to evaluate correlations of these measurements with glycemic control (HbA1c) and body mass index (BMI), in patients with type 2 diabetes mellitus (T2DM).

MATERIAL AND METHODS

A group of 31 (16 women and 15 men) type 2 diabetic patients treated with insulin monotherapy, from (mean age=54 ± 3.6 years, BMI=29.7 ± 4.8 kg/m(2), T2DM treatment=9 ± 8 years, HbA1c 7 ± 1%) and not professionally active (unemployed or retired) was recruited. An assessment of energy cost (EC) of their weekly PA using International Physical Activity Questionnaire (IPAQ), and an accelerometer assessment was performed.

RESULTS

Total energy expenditure of the declared weekly PA, calculated from the IPAQ (DPA) was 2513 ± 1349 METmin/week, and 2428 ± 1348, for male and female participants, respectively (p > 0.05). EC of the real PA (RPA), registered with the accelerometer was 4552 ± 2028 kcal/week, and 4032 ± 2288 kcal/week, for males, and females, respectively. Patients who demonstrated a high DPA, based on their IPAQ score, showed a significantly higher RPA, as registered by the accelerometer (p < 0.05). HbA1c and BMI did not correlate with their PA measurements.

CONCLUSIONS

Our findings indicate that the IPAQ may serve as a potential tool for physical activity assessment with no further requirement for more sophisticated methods. Our results suggest that habitual physical activity has no impact on glycemic control and BMI in type 2 diabetic patients. However, further studies on a larger population are needed to explore these issues.

[How to identify physical inactivity in primary care: validation of the Catalan and Spanish versions of 2 short questionnaires]

OBJECTIVE

The Brief Physical Activity Assessment Tool (BPAAT) and the General Practice Physical Activity Questionnaire (GPPAQ) are valid and reliable assessment tools to identify "inactive" patients in primary care. No similar tools exist for the Spanish population. The study aimed to evaluate the reliability and validity of the Catalan and Spanish versions (CBPAAT-CGPPAQ; CBPAAT-EGPPAQ) of such tools.

DESIGN

Validation study of the linguistic and cultural adaptation of two questionnaires into Catalan/Spanish.

SETTING

Centres of Primary Care.

PARTICIPANTS

The load for administering the questionnaires was evaluated by 7 general practitioners and 44 patients. Construct validity and reliability was assessed in 105 patients (58 years old±20; 37% men) without any contraindication for physical activity (PA).

MAIN VARIABLES

After carrying out the translation and back-translation, construct validity was assessed against the International Physical Activity Questionnaire (IPAQ short form). Reliability was assessed administering the questionnaires again within 14 to 28 days.

RESULTS

The validity of the CBPAAT-EBPAAT showed a moderate percentage agreement, correctly classifying over 80% and 83% of the "inactive" cases. Reliability was also good, correctly classifying over 86% and 88% of the cases. The validity of the CGPPAQ-EGPPAQ showed a moderate percentage agreement, correctly classifying over 70% and 60% of the "inactive" cases. Reliability was good, correctly classifying over 82% and 72% of the cases.

CONCLUSIONS

The CBPAAT-CGPPAQ and EBPAAT-EGPPAQ are valid instruments to identify "inactive" patients that should receive advice on PA.

Salzburg Skiing for the Elderly Study: changes in cardiovascular risk factors through skiing in the elderly

Numerous studies have shown that treatment of the modifiable cardiovascular risk factors (CVRF) results in a decreased risk to suffer from stroke or myocardial infarction. Despite the fact that exercise training is a potent treatment choice for CVRF, this is the first randomized study to assess the effects of alpine skiing on CVRF in elderly skiers. Subjects (n=42) were randomized into an intervention group (IG; n=22; 12 males/10 females; age: 66.6 ± 2.1 years) completing 12 weeks of guided skiing or a control group (CG; n=20; 10 males/10 females; age: 67.3 ± 4.4 years). CVRF were assessed before and after the intervention period. No cardiovascular event occurred within a total of 795.1 h of skiing. A significant increase in exercise capacity in IG (ΔVO(2 max) : +2.0 mL/kg/min, P=0.005) but not in CG (ΔVO(2 max) : -0.1 mL/kg/min, P=0.858; IG vs CG: P=0.008) as well as a decrease in body fat mass [IG: -2.3%, P<0.0001; CG: ± 0.0%, P=0.866; IG vs CG: P<0.0001] was achieved. Blood pressure, blood lipids, heart rate and everyday physical activity remained essentially unchanged. Alpine skiing in the elderly is safe with respect to cardiovascular events, and improves some, but not all CVRF.

Validity of the International Physical Activity Questionnaire and the Singapore Prospective Study Program physical activity questionnaire in a multiethnic urban Asian population

BACKGROUND

Physical activity patterns of a population remain mostly assessed by the questionnaires. However, few physical activity questionnaires have been validated in Asian populations. We previously utilized a combination of different questionnaires to assess leisure time, transportation, occupational and household physical activity in the Singapore Prospective Study Program (SP2). The International Physical Activity Questionnaire (IPAQ) has been developed for a similar purpose. In this study, we compared estimates from these two questionnaires with an objective measure of physical activity in a multi-ethnic Asian population.

METHODS

Physical activity was measured in 152 Chinese, Malay and Asian Indian adults using an accelerometer over five consecutive days, including a weekend. Participants completed both the physical activity questionnaire in SP2 (SP2PAQ) and IPAQ long form. 43 subjects underwent a second set of measurements on average 6 months later to assess reproducibility of the questionnaires and the accelerometer measurements. Spearman correlations were used to evaluate validity and reproducibility and correlations for validity were corrected for within-person variation of accelerometer measurements. Agreement between the questionnaires and the accelerometer measurements was also evaluated using Bland Altman plots.

RESULTS

The corrected correlation with accelerometer estimates of energy expenditure from physical activity was better for the SP2PAQ (vigorous activity: r = 0.73; moderate activity: r = 0.27) than for the IPAQ (vigorous activity: r = 0.31; moderate activity: r = 0.15). For moderate activity, the corrected correlation between SP2PAQ and the accelerometer was higher for Chinese (r = 0.38) and Malays (r = 0.57) than for Indians (r = -0.09). Both questionnaires overestimated energy expenditure from physical activity to a greater extent at higher levels of physical activity than at lower levels of physical activity. The reproducibility for moderate activity (accelerometer: r = 0.68; IPAQ: r = 0.58; SP2PAQ: r = 0.55) and vigorous activity (accelerometer: 0.52; IPAQ: r = 0.38; SP2PAQ: r = 0.75) was moderate to high for all instruments.

CONCLUSION

The agreement between IPAQ and accelerometer measurements of energy expenditure from physical activity was poor in our Asian study population. The SP2PAQ showed good validity and reproducibility for vigorous activity, but performed less well for moderate activity particularly in Indians. Further effort is needed to develop questionnaires that better capture moderate activity in Asian populations.

Measurement of adults' sedentary time in population-based studies

Sedentary time (too much sitting) increasingly is being recognized as a distinct health risk behavior. This paper reviews the reliability and validity of self-reported and device-based sedentary time measures and provides recommendations for their use in population-based studies. The focus is on instruments that have been used in free-living, population-based research in adults. Data from the 2003-2006 National Health and Nutrition Examination Survey are utilized to compare the descriptive epidemiology of sedentary time that arises from the use of different sedentary time measures. A key recommendation from this review is that, wherever possible, population-based monitoring of sedentary time should incorporate both self-reported measures (to capture important domain- and behavior-specific sedentary time information) and device-based measures (to measure both total sedentary time and patterns of sedentary time accumulation).

Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART)

Aim

Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART.

Methods and Results

A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe.

Conclusion

Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.

Measuring physical activity during pregnancy

BACKGROUND

Currently, little is known about physical activity patterns in pregnancy with prior estimates predominantly based on subjective assessment measures that are prone to error. Given the increasing obesity rates and the importance of physical activity in pregnancy, we evaluated the relationship and agreement between subjective and objective physical activity assessment tools to inform researchers and clinicians on optimal assessment of physical activity in pregnancy.

METHODS

48 pregnant women between 26-28 weeks gestation were recruited. The Yamax pedometer and Actigraph accelerometer were worn for 5-7 days under free living conditions and thereafter the International Physical Activity Questionnaire (IPAQ) was completed. IPAQ and pedometer estimates of activity were compared to the more robust and accurate accelerometer data.

RESULTS

Of 48 women recruited, 30 women completed the study (mean age: 33.6 ± 4.7 years; mean BMI: 31.2 ± 5.1 kg/m(2)) and 18 were excluded (failure to wear [n = 8] and incomplete data [n = 10]). The accelerometer and pedometer correlated significantly on estimation of daily steps (ρ = 0.69, p < 0.01) and had good absolute agreement with low systematic error (mean difference: 505 ± 1498 steps/day). Accelerometer and IPAQ estimates of total, light and moderate Metabolic Equivalent minutes/day (MET min(-1) day(-1)) were not significantly correlated and there was poor absolute agreement. Relative to the accelerometer, the IPAQ under predicted daily total METs (105.76 ± 259.13 min(-1) day(-1)) and light METs (255.55 ± 128.41 min(-1) day(-1)) and over predicted moderate METs (-112.25 ± 166.41 min(-1) day(-1)).

CONCLUSION

Compared with the accelerometer, the pedometer appears to provide a reliable estimate of physical activity in pregnancy, whereas the subjective IPAQ measure performed less accurately in this setting. Future research measuring activity in pregnancy should optimally encompass objective measures of physical activity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry Number: ACTRN12608000233325. Registered 7/5/2008.

Melanocortin-4 receptor gene polymorphism and the level of physical activity in men (HALS Study)

Melanocortin plays an important role in the energy balance in humans. Actions of melanocortin are exerted through activation of five receptors among which the melanocortin-4 receptor (MC4R) is especially abundant within the central nervous system (CNS). It has been proved that genetic variations of the MC4R gene are associated with the energy intake. Recent data has suggested that MC4R gene polymorphism might influence physical activity/energy expenditure as well. Our aim was to search for associations between MC4R polymorphisms and the level of physical activity. We genotyped MC4R in a population-based cohort of 311 men. The level of physical activity was determined with use of the International Physical Activity Questionnaire. We have found that physical effort expressed as log METs-min/week (corrected for age, BMI and educational status) was 6.61 in men declaring low, 7.56-moderate and 8.96-high level of physical activity. We have not found any associations between the C-2745T MC4R polymorphism and the level of physical activity (P = 0.53). There were no interactions between the level of physical activity and the C-2745T polymorphisms either (P = 0.47). We conclude that the C-2745T genetic polymorphism of the MC4R gene does not influence the level of physical activity in healthy, adult men.

Commuting and health in Cambridge: a study of a 'natural experiment' in the provision of new transport infrastructure

BACKGROUND

Modifying transport infrastructure to support active travel (walking and cycling) could help to increase population levels of physical activity. However, there is limited evidence for the effects of interventions in this field, and to the best of our knowledge no study has convincingly demonstrated an increase in physical activity directly attributable to this type of intervention. We have therefore taken the opportunity presented by a 'natural experiment' in Cambridgeshire, UK to establish a quasi-experimental study of the effects of a major transport infrastructural intervention on travel behaviour, physical activity and related wider health impacts.

DESIGN AND METHODS

The Commuting and Health in Cambridge study comprises three main elements: a cohort study of adults who travel to work in Cambridge, using repeated postal questionnaires and basic objective measurement of physical activity using accelerometers; in-depth quantitative studies of physical activity energy expenditure, travel and movement patterns and estimated carbon emissions using household travel diaries, combined heart rate and movement sensors and global positioning system (GPS) receivers; and a longitudinal qualitative interview study to elucidate participants' attitudes, experiences and practices and to understand how environmental and social factors interact to influence travel behaviour, for whom and in what circumstances. The impacts of a specific intervention - the opening of the Cambridgeshire Guided Busway - and of other changes in the physical environment will be examined using a controlled quasi-experimental design within the overall cohort dataset.

DISCUSSION

Addressing the unresolved research and policy questions in this area is not straightforward. The challenges include those of effectively combining different disciplinary perspectives on the research problems, developing common methodological ground in measurement and evaluation, implementing robust quantitative measurement of travel and physical activity behaviour in an unpredictable 'natural experiment' setting, defining exposure to the intervention, defining controls, and conceptualising an appropriate longitudinal analytical strategy.

Self-reported physical activity in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

OBJECTIVE

To describe self-reported physical activity (PA) patterns in the various domains (school, home, transport, leisure time) and intensity categories (walking, moderate PA, vigorous PA) in European adolescents. Furthermore, self-reported PA patterns were evaluated in relation to gender, age category, weight status category and socio-economic status (SES).

DESIGN

Cross-sectional study.

SETTING

Ten European cities.

SUBJECTS

In total, 3051 adolescents (47·6 % boys, mean age 14·8 (sd 1·2) years) completed an adolescent-adapted version of the validated International Physical Activity Questionnaire.

RESULTS

The total sample reported most PA during leisure time (485 min/week) and least PA at home (140 min/week). Boys reported significantly more school-based PA (P < 0·001), leisure-time PA (P = 0·003), vigorous PA (P < 0·001) and total PA (P = 0·002) than girls, while girls reported more home-based PA (P < 0·001) and walking (P = 0·002) than boys. Self-reported PA at school (P < 0·001), moderate PA (P < 0·001), vigorous PA (P < 0·001) and total PA (P < 0·001) were significantly higher in younger age groups than in older groups. Groups based on weight status differed significantly only in leisure-time PA (P = 0·004) and total PA (P = 0·003), while groups based on SES differed in all PA domains and intensities except transport-related PA and total PA.

CONCLUSIONS

The total sample of adolescents reported different scores for the different PA domains and intensity categories. Furthermore, patterns were different according the adolescents' gender, age, weight status and SES.

Sociodemographic factors associated with physical activity in Mexican adults

OBJECTIVE

To estimate the physical activity level among Mexican adults and to establish the sociodemographic variables that may be linked to active lifestyles.

DESIGN

Data from a cross-sectional survey were analysed. Physical activity was assessed using the short version of the International Physical Activity Questionnaire. The independent variables were sex, age, socio-economic status and size of town. Ordinal regression models were fitted to assess the association of physical activity levels with sociodemographic factors.

SETTING

Fieldwork was conducted from November 2002 through April 2003; the non-response rate was 3.1%.

SUBJECTS

Data from a national representative sample (n 38,746) of Mexican adults aged >18 years old were analysed.

RESULTS

Almost 60% of the population was classified into the high physical activity level. Women were less active than men in rural areas; in urban areas, the opposite trend was observed. In women, higher socio-economic status was associated with less physical activity, while among men there were no differences. People from rural and urban areas had a higher probability of engaging in physical activity than those from cities. In urban localities and cities, respondents of low socio-economic status had a lower probability of engaging in physical activity.

CONCLUSIONS

Using a validated instrument to measure physical activity, we found that the prevalence of active lifestyle among Mexican adults was high. The socio-economic and gender inequalities are different according to size of town (i.e. an effect modifier), which must be considered in the design of policies and programmes to promote physical activity.

Estimating physical activity energy expenditure, sedentary time, and physical activity intensity by self-report in adults

BACKGROUND

Few questionnaires that assess usual physical activity have been reported to be valid for all different subdimensions of physical activity.

OBJECTIVE

The objective was to assess the validity and reliability of the Recent Physical Activity Questionnaire (RPAQ), which assesses usual physical activity (PA) in 4 domains (work, travel, recreation, and domestic life).

DESIGN

Total energy expenditure (TEE) was measured for 14 d by using the doubly labeled water technique combined with a measure of resting metabolic rate to yield PA energy expenditure (PAEE) in 25 men and 25 women. Simultaneously, intensity of activity was measured by using combined heart rate and movement sensing for 11 d. Repeatability of the RPAQ was assessed in an independent sample of 71 women and 60 men aged 31-57 y.

RESULTS

Estimated TEE and PAEE were significantly associated with criterion measures (TEE: r = 0.67; PAEE: r = 0.39) with mean (+/-SD) biases of -3452 +/- 2025 kJ/d and -13 +/- 24 kJ d(-1) kg(-1). The correlation between self-reported and measured time spent was significant for vigorous PA (r = 0.70) and marginally insignificant for sedentary time (r = 0.27, P = 0.06). The mean biases were relatively small for sedentary time and vigorous PA: 0.7 +/- 2.8 h/d and -12 +/- 24 min/d, respectively. The intraclass correlation coefficient for repeatability of total PAEE (kJ/d) was 0.76 (P < 0.0001).

CONCLUSION

The RPAQ is the first questionnaire with demonstrated validity for ranking individuals according to their time spent at vigorous-intensity activity and overall energy expenditure.

What predicts obesity in patients with rheumatoid arthritis? An investigation of the interactions between lifestyle and inflammation

OBJECTIVE

To assess whether physical activity, diet or inflammation is a more important determinant of body mass index (BMI) and body fat (BF) in patients with rheumatoid arthritis (RA).

METHODS

A total of 150 RA patients (102 female) were assessed for BMI and BF. Their habitual physical activity was assessed with the international physical activity questionnaire (IPAQ) and their energy intake with a 3-day food diary. Pro-inflammatory cytokines (interleukins, IL-1 and IL-6, and tumor necrosis factor-alpha), erythrocyte sedimentation rate, C-reactive protein, disease activity score-28 and physical function (Health Assessment Questionnaire-HAQ) were also measured.

RESULTS

BMI correlated inversely with IPAQ (r=-0.511, P=0.000) and positively with energy intake (r=0.331, P=0.016) and HAQ (r=0.133, P=0.042). BF correlated inversely with IPAQ (r=-0.575, P=0.000) and positively with HAQ (r=0.201, P=0.037). Normal weight patients were more physically active compared with those who were either overweight (P=0.006) or obese (P=0.000). Underweight patients consumed significantly fewer calories compared with other patients (P<0.05 in all cases). Cytokines or HAQ did not differ between weight groups. IPAQ was the sole predictor of obesity, whereas energy intake was the sole predictor of underweight.

CONCLUSIONS

Inflammation does not seem to influence BMI and BF in RA. As in the general population, high levels of habitual physical activity associate with low BMI and BF in RA. Energy intake is a major determinant of being underweight in those who consume fewer calories. Further research is needed to investigate the suitability of exercise and diet modalities, and their effects on the body composition of RA patients.

Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries

Background

Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases (NCDs) such as stroke and heart disease. In high income countries, studies have measured the population level of physical activity, but comparable data are lacking from most low and middle-income countries.

Objective

To assess the level of physical inactivity and its associated factors in selected rural sites in five Asian countries.

Methods

The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network in Bangladesh, India, Indonesia, Thailand, and Vietnam. Using the methodology from the WHO STEPwise approach to Surveillance (STEPS), about 2,000 men and women aged 25–64 years were selected randomly from each HDSS sampling frame. Physical activity at work and during leisure time, and on travel to and from places, was measured using the Global Physical Activity Questionnaire version 2 (GPAQ2). The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week, and was used to determine the level of physical activity. Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity.

Results

The prevalence of physical inactivity ranged from 13% in Chililab HDSS in Vietnam to 58% in Filabavi HDSS in Vietnam. The majority of men were physically active, except in the two sites in Vietnam. Most of the respondents walked or cycled for at least 10 minutes to get from place to place, with some exceptions in the HDSSs in Indonesia and Thailand. The majority of respondents, both men and women, were inactive during their leisure time. Women, older age, and high level of education were significantly associated with physical inactivity.

Conclusion

This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive. The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity. Considering the importance of physical activity in improving health and preventing chronic NCDs, efforts need to be made to promote physical activity particularly among women, older people, and high education groups in these settings.