Evaluation of methods to assess physical activity in free-living conditions

Association between physical activity and quality of life in Japanese adults aged 85 to 89 years: a cross-sectional study

BACKGROUND

Associations between physical activity (PA) and quality of life (QOL) have usually been studied in people in their 60s and 70s, however little is known about these associations in older age groups. We aimed to examine the association between PA and QOL in Japanese adults aged 85-89 years and investigate the types of exercises/sports in this population.

METHODS

This cross-sectional study (n = 914) used baseline data from the Kawasaki Aging and Well-being Project (KAWP), a longitudinal cohort study of older adults aged 85-89 years. Health-related QOL and psychological well-being were assessed using the EuroQoL 5D-5L (EQ-5D-5L) and the WHO Five Well-Being Index (WHO-5), respectively. PA was objectively and subjectively measured using a triaxial accelerometer and modified Zutphen Physical Activity Questionnaire, respectively. Associations were analyzed using multivariable regression analysis.

RESULTS

Higher PA was significantly associated with a higher EQ-5D-5L index score (coefficient, 0.004; 95%CI [0.001, 0.008], standardized coefficient, 0.142). In contrast, no association was observed between PA and the WHO-5 total score (coefficient, 0.103; 95%CI [-0.066, 0.271], standardized coefficient, 0.068). Calisthenics were the most commonly performed sports or exercises (27.4% of male and 47.6% of female participants). The subgroup of participants with > median PA had a longer walking duration than their counterparts, and the following sports/exercises were more frequently performed in addition to calisthenics; resistance training and others among male participants: stretching/yoga among female participants.

CONCLUSIONS

Our findings suggest that PA is associated with a better health-related QOL. However, no association was observed between PA and psychological well-being in this population. We found that calisthenics were the most commonly performed and that more physically active older adults performed several types of exercises/sports in addition to calisthenics and walking for longer durations. Since few studies have investigated the types of exercises/sports in this age group, these findings would be helpful for interventions to maintain PA and QOL in this age group.

TRIAL REGISTRATION

UMIN000026053.

Pasos Hacia La Salud II: A Superiority RCT Utilizing Technology to Promote Physical Activity in Latinas

INTRODUCTION

Latinas face an increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA.

STUDY DESIGN

The researchers conducted a superiority randomized controlled trial (data collected 2018-2022, analyzed 2023).

SETTING/PARTICIPANTS

Participants were 195 Spanish-speaking Latinas ages 18-65 in the Providence, RI area.

INTERVENTION

The original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features.

MAIN OUTCOME MEASURES

Total weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months.

RESULTS

Participants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs 70.18 [9.99]) and accelerometer-measured (66.21 [18.26] vs 60.27 [16.00]) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 [23.35] vs 81.44 [1.82]) and accelerometer-measured (63.76 [15.12] vs 54.86 [14.59]) MVPA at 24 months. Baseline PA moderated the intervention effect.

CONCLUSIONS

This study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance.

TRIAL REGISTRATION

This study is registered at www.

CLINICALTRIAL

gov (NCT03491592).

Six-Month Outcomes of a Theory- and Technology-Enhanced Physical Activity Intervention for Latina Women (Pasos Hacia La Salud II): Randomized Controlled Trial

BACKGROUND

More than half (55%) of Latina women do not meet aerobic physical activity (PA) guidelines, and frequently cite time, childcare, and transportation as barriers to PA. In addition to linguistic adaptations for this population, successful PA interventions for Latina women addressed these barriers through remote intervention delivery approaches (eg, mail, phone, or web delivery).

OBJECTIVE

We aimed to evaluate 6-month outcomes of a randomized trial comparing a Spanish-language, individually tailored, web-delivered PA intervention (original) to an enhanced version with text messages and additional features (enhanced). Further, we evaluated if increases in PA at 6 months were moderated by baseline activity status.

METHODS

In total, 195 Latina women aged 18-65 years participated in a trial comparing the efficacy of the enhanced versus original interventions at initiating PA behavior change. We examined minutes per week of accelerometer-measured PA in the enhanced versus original arms, and the proportion of each arm meeting aerobic PA guidelines (150 min/wk at 6 mo). For moderator analyses, participants were classified as inactive (0 min/wk) or low active (1-90 min/wk) at baseline, measured via the 7 Day Physical Activity Recall interview.

RESULTS

PA increased from 19.7 (SD 47.9) minutes per week at baseline to 46.9 (SD 66.2) minutes per week at 6 months in the enhanced arm versus 20.6 (SD 42.7) minutes per week to 42.9 (SD 78.2) minutes per week in the original arm (P=.78). Overall, 30% (31/103) of the enhanced group met aerobic PA guidelines at 6 months, compared to 21% (19/92) of the original group (odds ratio [OR] 1.75, 95% CI 0.87-3.55). Baseline PA (inactive vs low active) moderated treatment effects on PA. For inactive participants, there were no group differences at 6 months (b=7.1; SE 22.8; P=.75), while low-active participants increased more in enhanced than original (b=72.5; SE 27.9; P=.01). For low-active participants, 45% (46/103) of the enhanced group met PA guidelines at 6 months, versus 20% (18/92) of the original arm (OR 3.29, 95% CI 1.05-11.31). For inactive participants, there were no group differences (25/103, 24% vs n=19/92, 21% for enhanced vs original, respectively; OR 1.28, 95% CI 0.54-3.06).

CONCLUSIONS

Intervention effects were conditional on baseline PA. For low-active Latina women, the enhanced intervention was more effective at increasing PA. Additional tailored intervention enhancements may be necessary to increase PA for inactive Latina women.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03491592; https://www.clinicaltrials.gov/study/NCT03491592.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-022-06575-4.

Body image and physical activity in Latinas

Women with negative body image engage in less physical activity. The purpose of this study is to examine the relationship between body image and physical activity in Latinas participating in a lifestyle program. Participants (age 43.8 ± 10.1 years and BMI 30.4 ± 5.2 kg/m2) were enrolled in a 12-month culturally and linguistically adapted, individually tailored, intervention focused on increasing moderate-to-vigorous intensity physical activity (MVPA). Longitudinal assessments were conducted on body image dissatisfaction (BID) using the Figure Rating Scale, MVPA using the 7-day PAR interview, and objectively measured body weight. Pre-intervention BID did not significantly predict MVPA change. Participants experienced considerable reduction in BID. Greater MVPA engagement and weight loss were independently related to BID reduction. Acculturation did not moderate these relationships. Body image improved in Latinas participating in a cognitive and behavioral physical activity intervention regardless of weight loss and acculturation level.

Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity

BACKGROUND

Older people with hip fracture are often medically frail, and many do not regain their walking ability and level of physical activity. The aim of this study was to examine the relationship between pre-fracture recalled mobility, fear of falling, physical activity, walking habits and walking speed one year after hip fracture.

METHODS

The study had a longitudinal design. Measurements were performed 3-5 days postoperatively (baseline) and at one year after the hip fracture. The measurements at baseline were all subjective outcome measures recalled from pre-fracture: The New Mobility Scale (NMS), the 'Walking Habits' questionnaire, The University of California, Los Angeles (UCLA) Activity Scale, Fear of Falling International (FES-I) and demographic variables. At one year 4-meter walking speed, which was a part of the Short Physical Performance Battery (SPPB) was assessed.

RESULTS

At baseline 207 participants were included and 151 were assessed after one year. Their age was mean (SD) 82.7 (8.3) years (range 65-99 years). Those with the fastest walking speed at one year had a pre-fracture habit of regular walks with a duration of ≥ 30 min and/or a frequency of regular walks of 5-7 days a week. Age (p =.020), number of comorbidities (p <.001), recalled NMS (p <.001), and recalled UCLA Activity Scale (p =.007) were identified as predictors of walking speed at one year. The total model explained 54% of the variance in walking speed.

CONCLUSIONS

Duration and frequency of regular walks before the hip fracture play a role in walking speed recovery one year following the fracture. Subjective outcome measures of mobility and physical activity, recalled from pre-fracture can predict walking speed at one year. They are gentle on the old and medically frail patients in the acute phase after hip fracture, as well as clinically less time consuming.

The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men

BACKGROUND

Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men.

OBJECTIVE

This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis.

METHODS

We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message-based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months.

RESULTS

The 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety.

CONCLUSIONS

The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/23690.

Low Energy Availability and Increased Risk of Relative Energy Deficiency in Sport (RED-S) During a 3767-km Thru-Hike on the Pacific Crest Trail: A Case Study

Long-distance "thru-hiking" has extraordinary physical demands and has become increasingly popular. This report describes a man (55 y) who thru-hiked the Pacific Crest Trail in 2021 and was at risk of developing the relative energy deficiency in sport (RED-S) syndrome. Hiking distance was 3767 km over 128 d. Eighty-eight days (69%) were full days of hiking, covering 38±8 km/d (mean±SD) in 7.9±1.6 h/d. Exercise energy expenditure above rest (heart rate vs indirect calorimetry regression method) was 2834±1518 kcal/d, total energy expenditure was 5702±1323 kcal/d, and energy intake was 4141 kcal/d. Body mass decreased by 9%, and fat mass (dual-energy X-ray absorptiometry) decreased by 46%. Energy availability (energy intake minus exercise energy expenditure) was 19.3 kcal/d/kg fat-free mass, indicating low energy availability (defined as <30 kcal/d/kg). Dual-energy X-ray absorptiometry-measured spine bone mineral density (BMD) decreased by 8.6%, with little to no decrease in total hip (-1.0%) and femoral neck (-1.5%) BMD. Total cholesterol, low-density lipoprotein cholesterol, and triglycerides increased by 24, 39, and 57%, respectively. Within 8 mo after the hike, BMD and serum lipids nearly or fully returned to baseline. No changes in high-density lipoprotein cholesterol, glycemia, or blood pressure were observed. According to guidelines, these observations are consistent with a moderate risk of RED-S, and a medical evaluation and treatment plan are advisable in order to avoid clinical manifestations (eg, stress fractures, anemia, psychological disturbances). To minimize RED-S risk, it may be prudent for thru-hikers to optimize energy availability by moderating daily hiking distances and/or increasing food intake.

Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies

OBJECTIVES

To examine whether moderate-to-vigorous physical activity (MVPA) modifies the association between sedentary time and mortality and vice versa, and estimate the joint associations of MVPA and sedentary time on mortality risk.

METHODS

This study involved individual participant data analysis of four prospective cohort studies (Norway, Sweden, USA, baseline: 2003-2016, 11 989 participants ≥50 years, 50.5% women) with hip-accelerometry-measured physical activity and sedentary time. Associations were examined using restricted cubic splines and fractional polynomials in Cox regressions adjusted for sex, education, body mass index, smoking, alcohol, study cohort, cardiovascular disease, cancer, and/or diabetes, accelerometry wear time and age.

RESULTS

6.7% (n=805) died during follow-up (median 5.2 years, IQR 4.2 years). More than 12 daily sedentary hours (reference 8 hours) was associated with mortality risk only among those accumulating <22 min of MVPA per day (HR 1.38, 95% CI 1.10 to 1.74). Higher MVPA levels were associated with lower mortality risk irrespective of sedentary time, for example, HR for 10 versus 0 daily min of MVPA was 0.85 (95% CI 0.74 to 0.96) in those accumulating <10.5 daily sedentary hours and 0.65 (95% CI 0.53 to 0.79) in those accumulating ≥10.5 daily sedentary hours. Joint association analyses confirmed that higher MVPA was superior to lower sedentary time in lowering mortality risk, for example, 10 versus 0 daily min of MVPA was associated with 28-55% lower mortality risk across the sedentary time spectrum (lowest risk, 10 daily sedentary hours: HR 0.45, 95% CI 0.31 to 0.65).

CONCLUSIONS

Sedentary time was associated with higher mortality risk but only in individuals accumulating less than 22 min of MVPA per day. Higher MVPA levels were associated with lower mortality risk irrespective of the amount of sedentary time.

Does work-related and commuting physical activity predict changes in physical activity and sedentary behavior during the transition to retirement? GPS and accelerometer study

We examined how GPS and accelerometer measured work-related and commuting physical activity contribute to changes in physical activity and sedentary behavior during the retirement transition in the Finnish Retirement and Aging study (n = 118). Lower work-related activity was associated with a decrease in sedentary time and an increase in light physical activity during retirement. Conversely, higher work-related activity was associated with an increase in sedentary time and a decrease in light physical activity, except among those active workers who also were active commuters. Thus, both work-related and commuting physical activity predict changes in physical activity and sedentary behavior when retiring.

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

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

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

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

Pasos Hacia La Salud II: study protocol for a randomized controlled trial of a theory- and technology-enhanced physical activity intervention for Latina women, compared to the original intervention

Background

Latinas are at increased risk for many lifestyle-related chronic diseases and are one of the least physically active populations in the US Innovative strategies are needed to help Latinas achieve the health benefits associated with physical activity (PA). This manuscript describes the study protocol of the Pasos Hacia La Salud II Study, which builds upon our previous research to test an enhanced individually-tailored, text-message and website-delivered, Spanish-language intervention (enhanced intervention), in comparison to the original web-based Pasos Hacia La Salud Intervention (original intervention).

Methods

Sedentary Latinas between the ages of 18–65 will be recruited and will complete an orientation and baseline assessments. Participants will be subsequently randomized to the original intervention, or the Enhanced Intervention, which has greater targeting of theoretical constructs such as self-efficacy, enjoyment, and social support, and which uses text messages and more dynamic and refined website features to encourage increased website use. Using a linear mixed effects regression model, we will simultaneously estimate the intervention effects on mean accelerometer-measured hours/week of moderate-to-vigorous PA (MVPA) at 6, 12, 18, and 24 months, with a subject-specific intercept (intent-to-treat sample). Change in self-reported MVPA, measured via the 7-day Physical Activity Recall, will be assessed as a secondary outcome using a similar model. We will investigate potential mediators of the intervention effect using a multiple mediation approach, and potential moderators by evaluating potential interactions. As an exploratory outcome, we will study the differences (among both study arms) in cost, in US dollars, per minute increases in weekly mean MVPA.

Discussion

The original Pasos PA intervention showed efficacy in helping Latinas increase PA; we expect the Enhanced Intervention to help a larger proportion of participants to increase and maintain their PA long term. This web- and text-based enhanced intervention could have great reach and dissemination potential, which could be capitalized on in the future to help to advance health equity. Adaptations made in response to the COVID-19 pandemic are also described in this manuscript.

Trial registration

Clinical Trial Number: NCT03491592. First posted April 9, 2018.

Personalised Accelerometer Cut-point Prediction for Older Adults' Movement Behaviours using a Machine Learning approach

BACKGROUND AND OBJECTIVES

Body-worn accelerometers are the most popular method for objectively assessing physical activity in older adults. Many studies have developed generic accelerometer cut-points for defining activity intensity in metabolic equivalents for older adults. However, methodological diversity in current studies has led to a great deal of variation in the resulting cut-points, even when using data from the same accelerometer. In addition, the generic cut-point approach assumes that 'one size fits all' which is rarely the case in real life. This study proposes a machine learning method for personalising activity intensity cut-points for older adults.

METHODS

Firstly, raw accelerometry data was collected from 33 older adults who performed set activities whilst wearing two accelerometer devices: GENEActive (wrist worn) and ActiGraph (hip worn). ROC analysis was applied to generate personalised cut-point for each data sample based on a device. Four cut-points have been considered: Sensitivity optimised Sedentary Behaviour; Specificity optimised Moderate to Vigorous Physical Activity; Youden optimised Sedentary Behaviour; and Youden optimised Moderate to Vigorous Physical Activity. Then, an additive regression algorithm trained on biodata features, that concern the individual characteristics of participants, was used to predict the cut-points. As the model output is a numeric cut-point value (and not discrete), evaluation was based on two error metrics, Mean Absolute Error and Root Mean Square Error. Standard Error of estimation was also calculated to measure the accuracy of prediction (goodness of fit) and this was used for performance comparison between our approach and the state-of-the-art. Hold-out and 10-Fold cross validation methods were used for performance validation and comparison.

RESULTS

The results show that our personalised approach performed consistently better than the state-of-the-art with 10-Fold cross validation on all four cut-points considered for both devices. For the ActiGraph device, the Standard Error of estimation from our approach was lower by 0.33 (Youden optimised Sedentary Behaviour), 9.50 (Sensitivity optimised Sedentary Behaviour), 0.64 (Youden optimised Moderate to Vigorous Physical Activity) and 22.11 (Specificity optimised Moderate to Vigorous Physical Activity). Likewise, the Standard Error of estimation from our approach was lower for the GENEActiv device by 2.29 (Youden optimised Sedentary Behaviour), 41.65 (Sensitivity optimised Sedentary Behaviour), 4.31 (Youden optimised Moderate to Vigorous Physical Activity) and 347.15 (Specificity optimised Moderate to Vigorous Physical Activity).

CONCLUSIONS

personalised cut-point can be predicted without prior knowledge of accelerometry data. The results are very promising especially when we consider that our method predicts cut-points without prior knowledge of accelerometry data, unlike the state-of-the-art. More data is required to expand the scope of the experiments presented in this paper.

Physical activity outcomes from a randomized trial of a theory- and technology-enhanced intervention for Latinas: the Seamos Activas II study

Latina women report disproportionately high and increasing prevalence of chronic health conditions (obesity, diabetes) related to low physical activity levels. Efforts to date at addressing high rates of physical inactivity in this at-risk population have shown modest success. The original Seamos Saludables (sample size N = 266) was a culturally and linguistically adapted, print-based physical activity intervention that showed significant increases in moderate to vigorous physical activity (MVPA) from baseline to 6 months. However, only 11% of intervention participants reached the national PA guidelines of ≥ 150 min/week of aerobic MVPA. The current study tests the original Seamos Saludables intervention (Original Intervention) against an enhanced iteration Seamos Activas II (Enhanced Intervention). Study aims and intervention refinements focus on increasing the percentage of Latinas meeting national aerobic PA guidelines. For the current study (Seamos Activas II), a randomized controlled trial with (N = 199 participants) of two PA interventions (original intervention, N = 102; vs. enhanced intervention, N = 97) was conducted. Intervention refinements involved further targeting key constructs of the Social Cognitive Theory and incorporating text-message-based strategies for self-monitoring, in response to participant feedback for greater interactivity and accountability. PA assessments were conducted at baseline and 6 months. The sample was predominantly Mexican American (89%) with average age of 43.8 years (SD = 10.11) and mean BMI at baseline was 30.6 (SD = 7.56). There were significant within group increases in MVPA from baseline to 6 months (p < .05) in both Original and Enhanced Intervention arms. However, quantile regression models did not indicate significant differences in 6-month outcomes between conditions controlling for baseline, p = 0.73. There were significant differences between conditions with respect to meeting national guidelines for aerobic MVPA at 6 months, with 57% of Enhanced Intervention participants meeting guidelines compared to 44% of Original Intervention participants, OR = 1.66, 95% CI: 1.09 -2.89. Models suggest trends favoring the enhanced condition for improvements in biomarkers over 6 months. Findings indicate that the intervention enhancements likely helped more Latinas achieve nationally recommended, health enhancing PA levels than the original intervention and showed promise for improving physiological response to exercise.Trial Registration ClinicalTrials.Gov; NCT02630953. Registered 14 December 2015. https://clinicaltrials.gov/ct2/show/NCT02630953 .

Do different cognitive domains mediate the association between moderate-to-vigorous physical activity and adolescents' off-task behaviour in the classroom?

Background

Accumulating evidence suggests that adolescents’ moderate‐to‐vigorous physical activity (MVPA) is associated with less off‐task behaviour in the classroom. However, the contribution of cognitive functions to this relation still remains unclear. Executive function and aspects of social cognition, which appear to be correlated with MVPA, have been found to determine academic behaviours.

Aim

This study examines the direct association between MVPA and off‐task behaviour as well as mediations by different cognitive domains.

Sample

Forty‐six‐male and 67‐female adolescents aged 13.0 ± 1.3 years were recruited from local schools.

Methods

Participants recalled their MVPA. Using video cameras, their classroom behaviours were recorded and a 6‐min period was rated for off‐task behaviour. Additionally, participants completed a modified Flanker task, which assessed both inhibitory control and cognitive flexibility, a Sternberg paradigm, which assessed working memory, and an Emotion Recognition task.

Results

Path‐analyses revealed that higher MVPA was associated with less off‐task behaviour. Inhibitory control accounted for a partial mediation of this association. The mediating role of inhibitory control was most pronounced for the relation between MVPA and off‐task behaviours related to noise.

Conclusion

These findings provide a first indication that curricular and extracurricular physical activities targeting specific improvements in inhibitory control may promise transfer effects to classroom behaviours.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29245.

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

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

Congruence and trajectories of device-measured and self-reported physical activity during therapy for early breast cancer

Purpose

This study examines congruence between self-reported and device-measured physical activity data in women with early breast cancer and compares trajectories under different treatments.

Methods

Women with non-metastatic breast cancer were recruited before primary therapy. In four weeks distributed over six months after treatment start, patients reported time spent on work, transport, chores and sports via diary and wore Garmin^® vivofit 3 accelerometers to assess steps taken. Associations between these measures and agreement regarding guideline adherence were tested with Spearman’s Correlation Coefficient and Weighted Kappa statistic. Effects of time and treatment were evaluated using mixed analyses of variance.

Results

Ninety-nine participants (median age = 50) were treated with adjuvant (N= 23), neoadjuvant (N= 21) or without chemotherapy (N= 55). Coherence between self-report and device data was strong (r = 0.566). Agreement about reaching recommendations was only “fair” (kappa coefficient = 0.321 and 0.249, resp.). Neither treatment or week nor their interaction had effects on step counts (all p > 0.05). Self-reported activity time was lower for patients with chemotherapy than for those without (adjuvant: ∆ = 69min, p= 0.006, neoadjuvant: ∆ = 45min, p= 0.038) and lower in week 18 than in week 3 (∆ = 43min, p= 0.010).

Conclusion

Results show that consumer-grade activity monitors and self-reports correlate but show different perspectives on physical activity in breast cancer patients. In general, patients perceive some decline regardless of primary treatment regimen. Those affected should be offered assistance to gain the benefits of activity. Accelerometers may help professionals to identify these individuals and patients to verify appraisal of their activity levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10549-021-06195-7.

A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial

Background

Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men.

Objective

To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables.

Methods

Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization.

Results

This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing.

Conclusions

We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial.

Trial Registration

Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570

International Registered Report Identifier (IRRID)

DERR1-10.2196/23690

Reliability of ActiGraph GT3X+ placement location in the estimation of energy expenditure during moderate and high-intensity physical activities in young and older adults

WHO defines physical activity (PA) as any bodily movement produced by skeletal muscles that requires energy expenditure (EE). The purpose of this study was to compare the EE estimations by ActiGraph GT3X+ with a gold standard measurement, the portable gas analyser in a set of 3 different PAs. This cross-sectional study involved 56 participants, age range (years, [min, max]: young people [20, 33], older adults [65, 83]). Participants completed a single session of three experimental PAs including biking, treadmill walking, and treadmill running. Each participant wore five GT3X+ triaxial accelerometers and a portable gas analyser used as the gold standard measurement. The GT3X+ were placed on the wrists, the waist (centred at the pelvis), and the ankles. ActiGraph GT3X+ and MetaMax3B records were investigated through intraclass correlation coefficient. Magnitude of measurement error was estimated using Effect Size. The GT3X+ wrist and GT3X+ waist underestimated EE regardless of the PA type. The GT3X+ ankles strongly overestimated EE during biking (mean bias = 489 ± 392%) and walking (mean bias = 106 ± 58%), while it underestimated EE during running (mean bias = -47 ± 27%). The ActiGraph GT3X+ does not provide accurate EE estimates across a range of placement locations during moderate and high-intensity PA.

Psychosocial mediators of physical activity change in a web-based intervention for Latinas

Objective: To determine whether psychosocial constructs targeted in an online physical activity intervention for Latinas mediated changes in moderate-to-vigorous physical activity (MVPA). Method: Data were taken from a randomized trial of a web-based MVPA intervention for Latina women age 18-65 (N = 205) based on social cognitive theory and the transtheoretical model. Baseline and 6-month measures included minutes/week of MVPA (ActiGraph GT3X + accelerometers and 7-Day Physical Activity Recall Interview) and theorized mediators (self-efficacy, behavioral processes, cognitive processes, social support, enjoyment). A multiple mediation model adjusting for baseline MVPA was fit using a products of coefficients method, simultaneously testing all hypothesized mediators. Results: MVPA increased more in the intervention group than controls by 50 min/week (self-report) and 31 min/week (accelerometers). For the self-reported MVPA model, there was an intervention effect (a-path coefficient) on self-efficacy (b = 0.43, p < .01), cognitive processes (b = 0.64, p < .01), behavioral processes (b = 0.54, p < .01), and enjoyment (b = 9.91, p = .01). Changes in self-efficacy (b = 24.54, p = .03), social support from friends (b = 2.36, p = .04), and enjoyment (a = 0.74, p = .08) were associated with changes in MVPA (b-path coefficient). However, only changes in self-efficacy (b = 10.49, 95% CI [2.46, 24.54]) and enjoyment (b = 7.30, 95% CI [0.92, 21.78]) mediated the intervention effect on MVPA (ab-path coefficient). For the accelerometer-measured MVPA model, intervention effects were significant for self-efficacy (b = 0.48, p < .01), cognitive processes (b = 0.62, p < .01), and behavioral processes (b = 0.61, p < .01), yet only self-efficacy was associated with changes in MVPA (b = 4.43, p = .03), and mediated intervention effects on MVPA (b = 12.15, 95% CI [11.25, 16.34]). Conclusions: Future MVPA interventions with Latinas should target self-efficacy and enjoyment to maximize efficacy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income

BACKGROUND

Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched.

METHODS

We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status.

RESULTS

After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (OR_adj) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% OR_adj = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample.

CONCLUSION

Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.

Randomized Trial of a Physical Activity Intervention for Latino Men: Activo

INTRODUCTION

Latino men experience disproportionately high rates of diseases related to low physical activity, yet they are poorly represented in physical activity intervention trials. Efforts to promote physical activity in Latina women show promising results, yet such interventions are yet to be extended to Latino men. This study tested a computer expert system‒tailored, text messaging-supported physical activity intervention for underactive Spanish-speaking Latino men compared with a control group matched for contact time. Potential predictors of intervention success were also explored.

STUDY DESIGN

Randomized trial. Participants were randomized to receive a Tailored Physical Activity Intervention (Intervention) or a Wellness Control (Control). Data were collected in 2015-2017 and analyzed in 2018-2019.

SETTING/PARTICIPANTS

Insufficiently active Latino men (n=46).

INTERVENTION

Intervention participants received a baseline counseling session and then, individually tailored print materials and text messages on a tapered schedule for 6 months. Control participants received printed wellness materials and text messages on the same schedule.

MAIN OUTCOME MEASURES

Primary outcome was a change in weekly moderate to vigorous physical activity from baseline to 6 months measured by accelerometers. Self-reported moderate to vigorous physical activity measured by the 7-day Physical Activity Recall Interview was a secondary outcome.

RESULTS

For Intervention participants, median accelerometer-measured moderate to vigorous physical activity increased from 10.0 minutes/week at baseline to 57.5 minutes/week at 6 months, whereas for Control participants, it increased from 21.0 minutes/week at baseline to 23.0 minutes/week at 6 months (p<0.05). Similar results were found for self-reported moderate to vigorous physical activity. At 6 months, 47% of Intervention participants met national guidelines of 150 minutes/week versus 25% of Control participants (p=0.15, not significant).

CONCLUSIONS

Findings suggest that an individually tailored intervention can successfully increase moderate to vigorous physical activity in underactive Latino men. Such technology-supported interventions have the potential for broad dissemination.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02512419.

Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study

INTRODUCTION

Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention.

METHODS/DESIGN

The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings.

RESULTS

Participants (N = 199) are Latinas 18-65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change.

CONCLUSION

Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.

Objective measurement of sedentary time and physical activity in people with rheumatoid arthritis: protocol for an accelerometer and activPALTM validation study

BACKGROUND

The accurate measurement of sedentary time and physical activity in Rheumatoid Arthritis (RA) is critical to identify important health consequences and determinants of these behaviours in this patient group. However, objective methods have not been well-validated for measurement of sedentary time and physical activity in RA.

AIMS

Specific objectives are to: 1) validate the ActiGraph GT3X+ accelerometer and activPAL3μTM against indirect calorimetry and direct observation respectively, and define RA-specific accelerometer cut-points, for measurement of sedentary time and physical activity in RA; 2) validate the RA-specific sedentary time accelerometer cut-points against the activPAL3μTM; 3) compare sedentary time and physical activity estimates in RA, using RA-specific vs. widely-used non-RA accelerometer cut-points.

METHODS

Objective 1: People with RA will wear an ActiGraph GT3X+, activPAL3μTM, heart rate monitor and indirect calorimeter, whilst being video-recorded undertaking 11 activities representative of sedentary behaviour, and light and moderate intensity physical activity. Objectives 2 and 3: People with RA will wear an ActiGraph GT3X+ and activPAL3μTM for 7 days to measure free-living sedentary time and physical activity.

DISCUSSION

This will be the first study to define RA-specific accelerometer cut-points, and represents the first validation of the ActiGraph accelerometer and activPALTM, for measurement of sedentary time and physical activity in RA. Findings will inform future RA studies employing these devices, ensuring more valid assessment of sedentary time and physical activity in this patient group.

Comparison of Conventional and Individualized 1-MET Values for Expressing Maximum Aerobic Metabolic Rate and Habitual Activity Related Energy Expenditure

The maximum aerobic metabolic rate can be expressed in multiple metabolically equivalent tasks (MET), i.e., METmax. The purpose was to quantify the error when the conventional (3.5 mL∙kg⁻¹∙min⁻¹) compared to an individualized 1-MET-value is used for calculating METmax and estimating activity energy expenditure (AEE) in endurance-trained athletes (END) and active healthy controls (CON). The resting metabolic rate (RMR, indirect calorimetry) and aerobic metabolic capacity (spiroergometry) were assessed in 52 END (46% male, 27.9 ± 5.7 years) and 53 CON (45% male, 27.3 ± 4.6 years). METmax was calculated as the ratio of VO₂max over VO₂ during RMR (METmax_ind), and VO₂max over the conventional 1-MET-value (METmax_fix). AEE was estimated by multiplying published MET values with the individual and conventional 1-MET-values. Dependent t-tests were used to compare the different modes for calculating METmax and AEE (α = 0.05). In women and men CON, men END METmax_fix was significantly higher than METmax_ind (p < 0.01), whereas, in women END, no difference was found (p > 0.05). The conventional 1-MET-value significantly underestimated AEE in men and women CON, and men END (p < 0.05), but not in women END (p > 0.05). The conventional 1-MET-value appears inappropriate for determining the aerobic metabolic capacity and AEE in active and endurance-trained persons.

Calibration of activity-related energy expenditure in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVES

Usual physical activity (PA) is a complex exposure and typical instruments to measure aspects of PA are subject to measurement error, from systematic biases and biological variability. This error can lead to biased estimates of associations between PA and health outcomes. We developed a calibrated physical activity measure that adjusts for measurement error in both self-reported and accelerometry measures of PA in adults from the US Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a community-based cohort study.

DESIGN

Total energy expenditure (TEE) from doubly labeled water and resting energy expenditure (REE) from indirect calorimetry were measured in 445 men and women aged 18-74years in 2010-2012, as part of the HCHS/SOL Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS). Measurements were repeated in a subset (N=98) 6months later.

METHOD

Calibration equations for usual activity-related energy expenditure (AEE=0.90×TEE-REE) were developed by regressing this objective biomarker on self-reported PA and sedentary behavior, Actical accelerometer PA, and other subject characteristics.

RESULTS

Age, weight and height explained a significant amount of variation in AEE. Actical PA and wear-time were important predictors of AEE; whereas, self-reported PA was not independently associated with AEE. The final calibration equation explained fifty percent of variation in AEE.

CONCLUSIONS

The developed calibration equations can be used to obtain error-corrected associations between PA and health outcomes in HCHS/SOL. Our study represents a unique opportunity to understand the measurement characteristics of PA instruments in an under-studied Hispanic/Latino cohort.

Understanding the Nature of Measurement Error When Estimating Energy Expenditure and Physical Activity via Physical Activity Recall

Background: The National Health and Nutrition Examination Survey physical activity questionnaire (PAQ) is used to estimate activity energy expenditure (AEE) and moderate to vigorous physical activity (MVPA). Bias and variance in estimates of AEE and MVPA from the PAQ have not been described, nor the impact of measurement error when utilizing the PAQ to predict biomarkers and categorize individuals.Methods: The PAQ was administered to 385 adults to estimate AEE (AEE:PAQ) and MVPA (MVPA:PAQ), while simultaneously measuring AEE with doubly labeled water (DLW; AEE:DLW) and MVPA with an accelerometer (MVPA:A).Results: Although AEE:PAQ [3.4 (2.2) MJ·d−1] was not significantly different from AEE:DLW [3.6 (1.6) MJ·d−1;P > .14], MVPA:PAQ [36.2 (24.4) min·d−1] was significantly higher than MVPA:A [8.0 (10.4) min·d−1;P < .0001]. AEE:PAQ regressed on AEE:DLW and MVPA:PAQ regressed on MVPA:A yielded not only significant positive relationships but also large residual variances. The relationships between AEE and MVPA, and 10 of the 12 biomarkers were underestimated by the PAQ. When compared with accelerometers, the PAQ overestimated the number of participants who met the Physical Activity Guidelines for Americans.Conclusions: Group-level bias in AEE:PAQ was small, but large for MVPA:PAQ. Poor within-participant estimates of AEE:PAQ and MVPA:PAQ lead to attenuated relationships with biomarkers and misclassifications of participants who met or who did not meet the Physical Activity Guidelines for Americans.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study

BACKGROUND

Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low-cost dissemination.

OBJECTIVE

This study aimed to assess the feasibility, acceptability, and potential efficacy of a Web-based physical activity intervention for Latina adolescents in a single-arm pilot trial.

METHODS

A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers.

RESULTS

Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90%, 19/21) returned. Adherence and engagement with materials were low, but 72% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies.

CONCLUSIONS

Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective.

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

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

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

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

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

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

Physical Activity Assessment with the ActiGraph GT3X and Doubly Labeled Water

PURPOSE

To compare the degree to which four accelerometer metrics-total activity counts per day (TAC per day), steps per day (steps per day), physical activity energy expenditure (PAEE) (kcal·kg·d), and moderate- to vigorous-intensity physical activity (MVPA) (min·d)-were correlated with PAEE measured by doubly labeled water (DLW). Additionally, accelerometer metrics based on vertical axis counts and triaxial counts were compared.

METHODS

This analysis included 684 women and 611 men age 43 to 83 yr. Participants wore the Actigraph GT3X on the hip for 7 d twice during the study and the average of the two measurements was used. Each participant also completed one DLW measurement, with a subset having a repeat. PAEE was estimated by subtracting resting metabolic rate and the thermic effect of food from total daily energy expenditure estimated by DLW. Partial Spearman correlations were used to estimate associations between PAEE and each accelerometer metric.

RESULTS

Correlations between the accelerometer metrics and DLW-determined PAEE were higher for triaxial counts than vertical axis counts. After adjusting for weight, age, accelerometer wear time, and fat free mass, the correlation between TAC per day based on triaxial counts and DLW-determined PAEE was 0.44 in women and 0.41 in men. Correlations for steps per day and accelerometer-estimated PAEE with DLW-determined PAEE were similar. After adjustment for within-person variation in DLW-determined PAEE, the correlations for TAC per day increased to 0.61 and 0.49, respectively. Correlations between MVPA and DLW-determined PAEE were lower, particularly for modified bouts of ≥10 min.

CONCLUSIONS

Accelerometer measures that represent total activity volume, including TAC per day, steps per day, and PAEE, were more highly correlated with DLW-determined PAEE than MVPA using traditional thresholds and should be considered by researchers seeking to reduce accelerometer data to a single metric.

Replacing Sedentary Time with Physical Activity in Relation to Mortality

INTRODUCTION

Data evaluating mortality benefit from replacing sedentary time with physical activity are sparse. We explored reallocating time spent in sedentary behavior to physical activity of different intensities in relation to mortality risk.

METHODS

Women and men age 50-85 yr from the National Health and Nutrition Examination Survey 2003-2004 and 2005-2006 cycles with follow-up through December 31, 2011, were included. Sedentary time and physical activity were assessed using an ActiGraph accelerometer. Isotemporal substitution models were used to estimate the effect of replacing one activity behavior with another activity behavior for the same amount of time while holding total accelerometer wear time constant.

RESULTS

During a mean follow-up of 6.35 yr, 697 deaths from any cause occurred. Replacing 30 min of sedentary time with an equal amount of light activity was associated with 14% reduced risk of mortality (multivariable-adjusted hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.83-0.90). Replacement of sedentary time with moderate to vigorous activity was related to 50% mortality risk reduction (HR, 0.50; 95% CI, 0.31-0.80). We also noted a 42% reduced risk of mortality when light physical activity was replaced by moderate to vigorous activity (HR, 0.58; 95% CI, 0.36-0.93).

CONCLUSION

Replacing sedentary time with an equal amount of physical activity may protect against preterm mortality. Replacement of light physical activity with moderate to vigorous activity is also associated with protection from premature mortality.

The rationale, design, and methods of a randomized, controlled trial to evaluate the effectiveness of collaborative telecare in preserving function among patients with late stage cancer and hematologic conditions

Disablement affects over 40% of patients with advanced stage cancer, devastates their quality of life (QoL), and increases their healthcare costs. Proactively treating the causes of disablement; physical impairments, pain, and immobility, can prolong functional independence, improve QoL and, potentially, reduce utilization. However rehabilitation service delivery models are reactive in nature and focus on catastrophic rather than incipient disability. A validated collaborative approach, the Three Component Model (TCM), optimizes important clinical outcomes and may provide an ideal framework to overcome barriers to proactively integrating rehabilitation into cancer care. A novel expansion of the TCM that targets disablement by engaging local physical therapists to address physical impairments and immobility, the TCM-Rehabilitation Services (TCM-RS), benefits and is well received by patients. However, its effectiveness has not been rigorously assessed. The 3-arm randomized COllaborative Care to Preserve PErformance in Cancer (COPE) Trial compared: 1) enhanced usual care, 2) rehabilitation services targeting physical impairments and immobility via the TCM-RS, and 3) TCM-RS plus conventional TCM pain management TCM-RS+Pain. Of the 516 participants, those randomized to arms 2 and 3 underwent an initial 4-week intervention period and were then followed for 6months with remote monitoring and monthly telephone calls. The trial's primary outcome, functional status, and secondary outcomes were assessed at baseline, 3, and 6months. Utilization was abstracted from clinical records. By estimating the effectiveness and cost-utility implications of the TCM-RS and TCM-RS+Pain, COPE will inform future delivery research, practice and policy in the means to reduce disablement in chronically diseased populations.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis

Background

Latinas report particularly low levels of physical activity and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinas and the scalability of Web-based programs.

Objective

To examine the costs and cost-effectiveness of a Web-based, Spanish-language physical activity intervention for Latinas compared to a wellness contact control.

Methods

Healthy adult Latina women (N=205) were recruited from the community and randomly assigned to receive a Spanish-language, Web-based, individually tailored physical activity intervention (intervention group) or were given access to a website with content on wellness topics other than physical activity (control group). Physical activity was measured using the 7-Day Physical Activity Recall interview and ActiGraph accelerometers at baseline, 6 months (ie, postintervention), and 12 months (ie, maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (ie, wages, benefits, and overhead), materials, hardware, website hosting, and routine website maintenance.

Results

At 6 months, the costs of running the intervention and control groups were US $17 and US $8 per person per month, respectively. These costs fell to US $12 and US $6 per person per month at 12 months, respectively. Linear interpolation showed that intervention participants increased their physical activity by 1362 total minutes at 6 months (523 minutes by accelerometer) compared to 715 minutes for control participants (186 minutes by accelerometer). At 6 months, each minute increase in physical activity for the intervention group cost US $0.08 (US $0.20 by accelerometer) compared to US $0.07 for control participants (US $0.26 by accelerometer). Incremental cost-per-minute increases associated with the intervention were US $0.08 at 6 months and US $0.04 at 12 months (US $0.16 and US $0.08 by accelerometer, respectively). Sensitivity analyses showed variations in staffing costs or intervention effectiveness yielded only modest changes in incremental costs.

Conclusions

While the Web-based physical activity intervention was more expensive than the wellness control, both were quite low cost compared to face-to-face or mail-delivered interventions. Cost-effectiveness ranged markedly based on physical activity measure and was similar between the two conditions. Overall, the Web-based intervention was effective and low cost, suggesting a promising channel for increasing physical activity on a large scale in this at-risk population.

ClinicalTrial

Clinicaltrials.gov NCT01834287; https://clinicaltrials.gov/ct2/show/NCT01834287 (Archived by WebCite at http://www.webcitation.org/6nyjX9Jrh)

Lies, Damned Lies, and Survey Self-Reports? Identity as a Cause of Measurement Bias

Explanations of error in survey self-reports have focused on social desirability: that respondents answer questions about normative behavior to appear prosocial to interviewers. However, this paradigm fails to explain why bias occurs even in self-administered modes like mail and web surveys. We offer an alternative explanation rooted in identity theory that focuses on measurement directiveness as a cause of bias. After completing questions about physical exercise on a web survey, respondents completed a text message-based reporting procedure, sending updates on their major activities for five days. Random assignment was then made to one of two conditions: instructions mentioned the focus of the study, physical exercise, or not. Survey responses, text updates, and records from recreation facilities were compared. Direct measures generated bias-overreporting in survey measures and reactivity in the directive text condition-but the nondirective text condition generated unbiased measures. Findings are discussed in terms of identity.

Validation of the self-report EXERNET questionnaire for measuring physical activity and sedentary behavior in elderly

This study aims to examine the validity and reliability of the Elderly EXERNET Physical Activity Questionnaire (EEPAQ) in a sample of Spanish elderly population. A sample of 73 elderly successfully completed the EEPAQ and wore an accelerometer over 7 consecutive days. Test-retest reliability of the EEPAQ was assessed by having the participants answer the EEPAQ twice within 14 days. Criterion validity was assessed for the questionnaire against the accelerometer, as the gold standard. Results indicated that EEPAQ had adequate reliability measured by Intraclass correlation coefficient (ICC) (walking ICC=0.88; sitting ICC=0.68; household activities ICC=0.97), and good validity against the accelerometer. Walking had a significant (p<0.05) correlation with countsmin^-1 (r=0.56) and moderate to vigorous physical activity (MVPA) (r=0.51), as well as a negative significant (p<0.01) correlation with sedentary minutes (r=-0.33). Sitting time was positively correlated (r=0.57; p<0.01) with sedentary time and negatively correlated with the countsmin^-1 and MVPA. EEPAQ seems to be a valid and reliable tool to measure physical activity (PA) in a population of elderly living in Spain.

Development and validation of a very brief questionnaire measure of physical activity in adults with coronary heart disease

Background

The aim of this study was to validate the Total Activity Measure, a brief questionnaire, to measure physical activity in an older adult population with heart disease.

Methods

Two versions of the Total Activity Measure were administered twice, 7 days apart. The Total Activity Measure 1 asked respondents for the frequency and average duration of bouts of physical activity at three different intensity levels per week, whereas the Total Activity Measure 2 asked respondents for the total time spent in activity at each activity level per week. Questionnaire accuracy was studied in 62 men and 15 women aged 47-84 years, by repeatability and comparison of both administrations of the Total Activity Measure 1 and Total Activity Measure 2 with 7-day RT3 accelerometer data.

Results

Seventy-three adults (58 men, 15 women) were used for all statistical analyses. Intraclass correlation coefficients for the Total Activity Measure 1 and Total Activity Measure 2 total activity scores (metabolic equivalent per minute) were r = 0.73 (95% confidence intervals, 0.56-0.83) and r = 0.82 (95% confidence intervals, 0.71-0.88), respectively. Correlations between the Total Activity Measure 1 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were significant, r = 0.26 at time 1 and r = 0.27 at time 2 for moderate intensity activities. Correlations between the Total Activity Measure 2 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were also significant, r = 0.38 at time 1 and r = 0.36 at time 2, r = 0.31 at time 2 for strenuous intensity activities and r = 0.29 at time 1 and r = 0.25 at time 2 for moderate intensity activities. Participants overestimated the amount of physical activity on both questionnaires as compared with the RT3 accelerometer.

Conclusions

The Total Activity Measure 2 was reasonably accurate in assessing total and moderate intensity activity over a 7-day period and demonstrated good test-retest reliability. The Total Activity Measure 1 was less accurate. The Total Activity Measure 2 is a suitable measure of total or moderate intensity physical activity for surveys and audits in an adult cardiac population. Eur J Cardiovasc Prev Rehabil 14:615-623 © 2007 The European Society of Cardiology

Pasos Hacia La Salud: a randomized controlled trial of an internet-delivered physical activity intervention for Latinas

Background

Internet access has grown markedly in Latinos during the past decade. However, there have been no Internet-based physical activity interventions designed for Latinos, despite large disparities in lifestyle-related conditions, such as obesity and diabetes, particularly in Latina women. The current study tested the efficacy of a 6-month culturally adapted, individually tailored, Spanish-language Internet-based physical activity intervention.

Methods

Inactive Latinas (N = 205) were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. Participants in both groups received emails on a tapered schedule over 6 months to alert them to new content on the website. The primary outcome was minutes/week of moderate to vigorous physical activity (MVPA) at 6 months as measured by the 7-Day Physical Activity Recall; activity was also measured by accelerometers. Data were collected between 2011 and 2014 and analyzed in 2015 at the University of California, San Diego.

Results

Increases in minutes/week of MVPA were significantly greater in the Intervention Group compared to the Control Group (mean difference = 50.00, SE = 9.5, p < 0.01). Increases in objectively measured MVPA were also significantly larger in the Intervention Group (mean differences = 31.0, SE = 10.7, p < .01). The Intervention Group was also significantly more likely to meet national physical activity guidelines at 6 months (OR = 3.12, 95 % CI 1.46–6.66, p < .05).

Conclusion

Findings from the current study suggest that this Internet-delivered individually tailored intervention successfully increased MVPA in Latinas compared to a Wellness Contact Control Internet Group.

Trial registration

NCT01834287.

Critical evaluation of food intake and energy balance in young modern pentathlon athletes: a cross-sectional study

BACKGROUND

Modern pentathlon comprises five sports: fencing, swimming, equestrian jumping, and a combined event of pistol shooting and running. Despite the expected high energy demand of this sport, there are few studies that provide support for the nutritional recommendations for pentathletes. The purpose of the present study was to evaluate young modern pentathlon athletes with respect to body composition, biochemical profile, and consumption of food and supplements.

METHODS

Fifty-six young modern pentathletes aged 13.5 ± 2.4 years participated in the study: 22 adolescent girls and 34 adolescent boys, weight 55.8 ± 13.3 kg, height 1.6 ± 0.1 m, and body fat 21.1 ± 3.1 %. Food consumption was analyzed through a 24-h recall method and food-frequency questionnaire. Assessment of body composition was carried out by checking anthropometric measures (body mass, height, and skinfolds) and using protocols according to participants' age and sexual maturity.

RESULTS

Male participants consumed less energy than the general recommendations for athletes from the American Dietetic Association (2749 ± 1024 kcal vs. 3113 ± 704 kcal, p < 0.01), whereas female participants consumed more energy than those recommendations (2558 ± 808 kcal vs. 2213 ± 4734 kcal, p < 0.01). Neither young men nor young women followed the carbohydrate intake recommendations for athletes (6.3 ± 2.5 g/kg/day and 6.6 ± 2.2 g/kg/day, respectively). Lipid and protein intakes corresponded to recommendations for both sexes; however, insufficient intakes of calcium, fruits, and vegetables were seen, as well as frequent consumption of baked goods and sugared soft drinks.

CONCLUSIONS

Adolescent modern pentathlon athletes presented inadequate eating habits with respect to consumption of carbohydrates and energy. Many participants had insufficient intake of micronutrients, especially calcium. However, future research is needed that is aimed at elucidating the real nutritional demands for good physical performance in this sport and the impact of inadequate eating habits on performance, especially among young athletes who are in the growth-stage years and are exposed to intense physical exercise routines.

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

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

Prediction of activity-related energy expenditure using accelerometer-derived physical activity under free-living conditions: a systematic review

BACKGROUND/OBJECTIVES

Activity-related energy expenditure (AEE) might be an important factor in the etiology of chronic diseases. However, measurement of free-living AEE is usually not feasible in large-scale epidemiological studies but instead has traditionally been estimated based on self-reported physical activity. Recently, accelerometry has been proposed for objective assessment of physical activity, but it is unclear to what extent this methods explains the variance in AEE.

SUBJECTS/METHODS

We conducted a systematic review searching MEDLINE database (until 2014) on studies that estimated AEE based on accelerometry-assessed physical activity in adults under free-living conditions (using doubly labeled water method). Extracted study characteristics were sample size, accelerometer (type (uniaxial, triaxial), metrics (for example, activity counts, steps, acceleration), recording period, body position, wear time), explained variance of AEE (R(2)) and number of additional predictors. The relation of univariate and multivariate R(2) with study characteristics was analyzed using nonparametric tests.

RESULTS

Nineteen articles were identified. Examination of various accelerometers or subpopulations in one article was treated separately, resulting in 28 studies. Sample sizes ranged from 10 to 149. In most studies the accelerometer was triaxial, worn at the trunk, during waking hours and reported activity counts as output metric. Recording periods ranged from 5 to 15 days. The variance of AEE explained by accelerometer-assessed physical activity ranged from 4 to 80% (median crude R(2)=26%). Sample size was inversely related to the explained variance. Inclusion of 1 to 3 other predictors in addition to accelerometer output significantly increased the explained variance to a range of 12.5-86% (median total R(2)=41%). The increase did not depend on the number of added predictors.

CONCLUSIONS

We conclude that there is large heterogeneity across studies in the explained variance of AEE when estimated based on accelerometry. Thus, data on predicted AEE based on accelerometry-assessed physical activity need to be interpreted cautiously.

Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control

BACKGROUND

Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas.

METHODS

Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs.

RESULTS

At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months.

CONCLUSIONS

While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population.

TRIAL REGISTRATION

NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.

Estimation of Free-Living Energy Expenditure by Heart Rate and Movement Sensing: A Doubly-Labelled Water Study

Background

Accurate assessment of energy expenditure (EE) is important for the study of energy balance and metabolic disorders. Combined heart rate (HR) and acceleration (ACC) sensing may increase precision of physical activity EE (PAEE) which is the most variable component of total EE (TEE).

Objective

To evaluate estimates of EE using ACC and HR data with or without individual calibration against doubly-labelled water (DLW) estimates of EE.

Design

23 women and 23 men (22–55 yrs, 48–104 kg, 8–46%body fat) underwent 45-min resting EE (REE) measurement and completed a 20-min treadmill test, an 8-min step test, and a 3-min walk test for individual calibration. ACC and HR were monitored and TEE measured over 14 days using DLW. Diet-induced thermogenesis (DIT) was calculated from food-frequency questionnaire. PAEE (TEE ÷ REE ÷ DIT) and TEE were compared to estimates from ACC and HR using bias, root mean square error (RMSE), and correlation statistics.

Results

Mean(SD) measured PAEE and TEE were 66(25) kJ·day^-1·kg^-1, and 12(2.6) MJ·day^-1, respectively. Estimated PAEE from ACC was 54(15) kJ·day^-1·kg^-1 (p<0.001), with RMSE 24 kJ·day^-1·kg^-1 and correlation r = 0.52. PAEE estimated from HR and ACC+HR with treadmill calibration were 67(42) and 69(25) kJ·day^-1·kg^-1 (bias non-significant), with RMSE 34 and 20 kJ·day^-1·kg^-1 and correlations r = 0.58 and r = 0.67, respectively. Similar results were obtained with step-calibrated and walk-calibrated models, whereas non-calibrated models were less precise (RMSE: 37 and 24 kJ·day^-1·kg^-1, r = 0.40 and r = 0.55). TEE models also had high validity, with biases <5%, and correlations r = 0.71 (ACC), r = 0.66–0.76 (HR), and r = 0.76–0.83 (ACC+HR).

Conclusions

Both accelerometry and heart rate may be used to estimate EE in adult European men and women, with improved precision if combined and if heart rate is individually calibrated.

Using interactive Internet technology to promote physical activity in Latinas: Rationale, design, and baseline findings of Pasos Hacia La Salud

Internet-based interventions show promise as an effective channel for promoting physical activity. However, a paucity of research has been conducted among underserved groups despite recent increases in Internet access and physical activity-related health disparities in these communities. Thus, the current randomized controlled trial will test the efficacy of an individually tailored, Internet-based physical activity intervention for Latinas. This program was culturally and linguistically adapted for the target population through extensive formative research. Two hundred eighteen sedentary Latinas were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. The Physical Activity Internet Intervention, based on Social Cognitive Theory and the Transtheoretical Model, utilizes a website with features including self-monitoring, goal setting, discussion forum, links to online resources, individually tailored and motivation-matched physical activity feedback reports, and exercise tip sheets. Participants receive regular emails over the first 6months with a tapered dose during the second 6months (maintenance phase) to alert them to new content on the website. The main outcome is differences in minutes/week of moderate to vigorous physical activity at six months as measured by the 7-Day Physical Activity Recall and accelerometer data. High reach, low cost, culturally relevant Internet-based interventions that encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.

Measurement error of self-reported physical activity levels in New York City: assessment and correction

Because it is difficult to objectively measure population-level physical activity levels, self-reported measures have been used as a surveillance tool. However, little is known about their validity in populations living in dense urban areas. We aimed to assess the validity of self-reported physical activity data against accelerometer-based measurements among adults living in New York City and to apply a practical tool to adjust for measurement error in complex sample data using a regression calibration method. We used 2 components of data: 1) dual-frame random digit dialing telephone survey data from 3,806 adults in 2010-2011 and 2) accelerometer data from a subsample of 679 survey participants. Self-reported physical activity levels were measured using a version of the Global Physical Activity Questionnaire, whereas data on weekly moderate-equivalent minutes of activity were collected using accelerometers. Two self-reported health measures (obesity and diabetes) were included as outcomes. Participants with higher accelerometer values were more likely to underreport the actual levels. (Accelerometer values were considered to be the reference values.) After correcting for measurement errors, we found that associations between outcomes and physical activity levels were substantially deattenuated. Despite difficulties in accurately monitoring physical activity levels in dense urban areas using self-reported data, our findings show the importance of performing a well-designed validation study because it allows for understanding and correcting measurement errors.