Clinical use of physical activity measures

OPTORER: A Dynamic Routing and Touring Service for Indoors and Outdoor Tours

This paper introduces a new routing and touring service both for outdoor and indoor places of touristic and cultural interest designed to be used in the wider area of Attica, Greece. This service is the result of the work performed in OPTORER (OPTORER: OPtimal rouTing and explOration of touRistic and cultural arEas of interest within Attica given personalized adaptive preferences, promoted underlying purpose, and interactive experience), project, and it aspires to offer a range of innovative and thematic routes to several specified points of interest in the selected area of Attica, encouraging the combination of indoor and outdoor routes in a single tour. The aim is to optimize the user experience while promoting specific, user-centric features, with safety and social welfare being a priority for every designed tour, resulting in enhancing the touristic experience in the area. Using a common smartphone device, as well as common wearable devices (i.e., smartwatches), the OPTORER service will provide an end-to-end solution by developing the algorithms and end-user applications, together with an orchestration platform responsible for managing, operating, and executing the service that produces and presents to the end user results derived from solving dynamically complex optimization problems.

Considerations for Maximizing the Exercise "Drug" to Combat Insulin Resistance: Role of Nutrition, Sleep, and Alcohol

Insulin resistance is a key etiological factor in promoting not only type 2 diabetes mellitus but also cardiovascular disease (CVD). Exercise is a first-line therapy for combating chronic disease by improving insulin action through, in part, reducing hepatic glucose production and lipolysis as well as increasing skeletal muscle glucose uptake and vasodilation. Just like a pharmaceutical agent, exercise can be viewed as a "drug" such that identifying an optimal prescription requires a determination of mode, intensity, and timing as well as consideration of how much exercise is done relative to sitting for prolonged periods (e.g., desk job at work). Furthermore, proximal nutrition (nutrient timing, carbohydrate intake, etc.), sleep (or lack thereof), as well as alcohol consumption are likely important considerations for enhancing adaptations to exercise. Thus, identifying the maximal exercise "drug" for reducing insulin resistance will require a multi-health behavior approach to optimize type 2 diabetes and CVD care.

Physical Activity in Parents of Young African American Children: The Application of Social Cognitive Theory

Background:

Social cognitive theory (SCT) proposes that personal and environmental factors influence behavior bidirectionally. Research examining the personal and environmental factors of physical activity (PA) among African Americans (AAs) framed by SCT is scarce.

Purpose:

The purpose of this article is to enhance knowledge of SCT as a foundation for health promotion and PA research, in general, and among AAs. Findings from a previous study provide exemplars for key factors and relationships in SCT.

Implications for Research and Practice:

The SCT serves as a good framework for researchers studying health promotion and PA in generalamong AA parents.

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.

A Review of Current Literature on Vital Sign Assessment of Physical Activity in Primary Care

PURPOSE

To conduct an integrated review of the performance and implementation of two physical activity (PA) assessment tools, the exercise vital sign (EVS) and the physical activity vital sign (PAVS), in U.S. primary care practice.

DESIGN

An integrative review following Whittemore and Knafl's methodology.

METHODS

Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched. Search terms were "exercise vital sign" OR "physical activity vital sign" AND "primary care". Additional inclusion criteria were studies conducted in the United States, published in English, in primary care, between 2010 and 2016.

RESULTS

Nine studies met inclusion criteria. Five studies reported validity data of the EVS tool, while four studies reported data from the PAVS tool. Compared with the accelerometer, the EVS tool overestimated moderate-vigorous PA, while the PAVS tool demonstrated moderate agreement in identifying those not meeting national PA guidelines. The EVS tool was successfully implemented in large, integrated practices utilizing electronic health record systems. PA documentation increased compared to non-EVS practices. The predictive ability of the PAVS tool for clinical outcomes was shown. Studies of PA assessment tool use in children were not found.

CONCLUSIONS

Preliminary evidence on the validity of both the EVS and PAVS tools support cautious use of each as a screening tool in primary care. There were no data on reliability, with limited data on tool use in diverse populations or settings. Data in children, older adults, and diverse population subgroups were lacking.

CLINICAL RELEVANCE

Two brief exercise vital signs tools have each shown some initial validity for use by primary care clinicians as measures to identify patients not meeting PA guidelines.

The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review

BACKGROUND

Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients.

OBJECTIVES

To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Colorectal cancer survivors aged 18 years and over.

TYPES OF INTERVENTIONS

Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy.

TYPES OF STUDIES

Pre- and post-observational and experimental studies.

OUTCOMES

Physical activity, ability to perform activities of daily living (functional status) and QoL.

SEARCH STRATEGY

CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015.

METHODOLOGICAL QUALITY

All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.

DATA EXTRACTION

Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software.

DATA SYNTHESIS

The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form.

RESULTS

A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies.

CONCLUSION

In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment.

IMPLICATIONS FOR PRACTICE

The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors.

IMPLICATIONS FOR RESEARCH

The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.

A multilevel approach to examining time-specific effects in accelerometer-assessed physical activity

OBJECTIVES

Popular methods for analyzing accelerometer data often use a single physical activity outcome variable such as average-weekly or total physical activity. These approaches limit the types of research questions that can be answered and fail to utilize the detailed, time-specific information available from accelerometers. This study proposes the use of multilevel modeling, which tested intervention effects at specific time periods.

DESIGN

The motivating example was the Active by Choice Today trial. Simulations were used to test whether the application of time-specific hypotheses about when physical activity intervention treatment effects were expected to occur (e.g., after-school hours) increased power to detect effects compared to traditional methods.

METHODS

Six simulation conditions were tested: (1) no treatment effects (to test the type 1 error rate), (2) time-specific effects, but no traditionally-tested effects, (3) traditionally-tested effects, but no time-specific effects, and (4) combinations of traditional and time-specific effects in 3 proportions.

RESULTS

Results showed the proposed multilevel approach demonstrated appropriate type 1 error rates and increased power to detect treatment effects during hypothesized times by 31-38 percentage points compared to traditional approaches. This was consistent across varying proportions of traditional versus time-specific effects, and there was no loss of power using the multilevel approach when only traditional effects were present.

CONCLUSIONS

The current study showed potential advantages of testing time-specific hypotheses about intervention effects using a multilevel time-specific approach. This approach may show intervention effects when traditional approaches do not. Future research should explore the application of this additional analytic tool for accelerometer physical activity estimates.

Physical activity prescriptions in healthy populations: resources for Canadian nurse practitioners

Canadian nurse practitioners' use of physical activity prescriptions is examined. Nurse practitioners use unstructured counseling techniques; have more opportunities with older adults; experience barriers; and want more education. Barriers are lack of time, lack of knowledge, and patient disinterest. Canadian resources are suggested to support physical activity prescriptions.

An evaluation of questionnaires assessing physical activity levels in youth populations

The aim of this study was to revise and organize according to recall time based criteria, questionnaires created and validated to assess the level of physical activity in children and adolescents, with the intention of enabling their proper understanding and subsequent use by nurses and health care professionals. In order to determine the questionnaires' quality, their degree of reliability and validity was the main feature to be taken into account. Thirty-eight papers were retrieved and analyzed, 31 of which were aimed at designing and validating a questionnaire intended for physical activity (PA) level assessment in youth populations (four to 19 year olds). The most widely used questionnaires were those whose recall time spans from one to seven days. In general, all questionnaires were characterized by the use of pen-and-paper format and scarce utilization of new technologies. Based upon validity and reliability criteria, in order to assess PA level in children and adolescents, nurses should use the "Children's Leisure Activities Study Survey" and the "Flemish Physical Activity Computer Questionnaire", respectively. There is a need for the validation of these tools in other languages and cultures.

Physical activity classification using the GENEA wrist-worn accelerometer

INTRODUCTION

Most accelerometer-based activity monitors are worn on the waist or lower back for assessment of habitual physical activity. Output is in arbitrary counts that can be classified by activity intensity according to published thresholds. The purpose of this study was to develop methods to classify physical activities into walking, running, household, or sedentary activities based on raw acceleration data from the GENEA (Gravity Estimator of Normal Everyday Activity) and compare classification accuracy from a wrist-worn GENEA with a waist-worn GENEA.

METHODS

Sixty participants (age = 49.4 ± 6.5 yr, body mass index = 24.6 ± 3.4 kg·m⁻²) completed an ordered series of 10-12 semistructured activities in the laboratory and outdoor environment. Throughout, three GENEA accelerometers were worn: one at the waist, one on the left wrist, and one on the right wrist. Acceleration data were collected at 80 Hz. Features obtained from both fast Fourier transform and wavelet decomposition were extracted, and machine learning algorithms were used to classify four types of daily activities including sedentary, household, walking, and running activities.

RESULTS

The computational results demonstrated that the algorithm we developed can accurately classify certain types of daily activities, with high overall classification accuracy for both waist-worn GENEA (0.99) and wrist-worn GENEA (right wrist = 0.97, left wrist = 0.96).

CONCLUSIONS

We have successfully developed algorithms suitable for use with wrist-worn accelerometers for detecting certain types of physical activities; the performance is comparable to waist-worn accelerometers for assessment of physical activity.

Physical Activity and Health Beliefs among Saudi Women

Background. Physical activity (PA) is associated with health benefits and disease prevention and is often prescribed in managing many health conditions. Understanding the cultural influences is relevant in order to effectively promote PA. The objective of this study was to assess the level of PA among Saudi women, measured by daily step count, and the association between PA and health beliefs. Methods. A total of 161 eligible participants were asked to complete two questionnaires to assess health beliefs: Health Locus of Control (HLC) and Self-Efficacy Assessment Scale. Each participant was given a pedometer and a diary to record their daily PA for two weeks. Results. One hundred and five participants completed the two weeks pedometer data (mean age 26.3 ± 7.1 years, BMI 25 ± 4.2 kg/m²). The average pedometer score over two weeks was 5114 ± 2213 steps. Step count had strong correlation with self-efficacy (r_s = 0.75), mild correlation with internal HLC (r_s = 0.42), and mild negative correlation with external HLC (r_s = −0.35). Conclusion. The study demonstrates high level of inactivity among Saudi females in reference to the international recommendation for minimum activity. The data also reveal an association between PA and health beliefs. Ultimately, such information can be used to design gender- and culture-sensitive interventions that could enhance adherence to PA.

Reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip osteoarthritis

Background

Physical activity (PA) is beneficial in reducing pain and improving function in lower limb osteoarthritis (OA), and is recommended as a first line treatment. Self-administered questionnaires are used to assess PA, but knowledge about reliability and validity of these PA questionnaires are limited, in particular for patients with OA. The purpose of this study was to evaluate the reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip OA.

Methods

Forty patients with hip OA (20 men and 20 women, mean age 61.3 ± 10 years) were included. For test-retest reliability PASE was administered twice with a mean time between tests of 9 ± 4 days. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for the total score and for the particular items assessing different PA intensity levels. In addition a Bland-Altman analysis for the total PASE score was performed. Construct validity was evaluated by comparing the PASE results with the Actigraph GT1M accelerometer and the International Physical Activity Questionnaire (IPAQ), using the Spearman rank correlation coefficient.

Results

ICC for the total PASE score was 0.78, with relatively large error of measurement; SEM = 31 and MDC = 87. ICC for the intensity items was 0.20 for moderate PA intensity, 0.46 for light PA intensity and to 0.68 for vigorous PA intensity. The Spearman rank correlation coefficient between the Actigraph GT1M total counts per minute and the total PASE score was 0.30 (p = 0.089), and ranging from 0.20-0.38 for the different PA intensity categories. The Spearman rank correlation between IPAQ and PASE was 0.61 (p = 0.001) for the total scores.

Conclusions

In patients with hip OA the test-retest reliability of the total PASE score was moderate, with acceptable ICC, but with large measurement errors. The construct validity of the PASE was poor when compared to the Actigraph GT1M accelerometer. Test-retest reliability and construct validity revealed that the PASE was unable to assess PA intensity levels. PASE is not recommended as a valid tool to examine PA level for patients with hip OA.

The relationship between ambulatory step activity, self-reported physical functioning and standardised timed walking in patients with haematological malignancies

PURPOSE

This cross-sectional study investigated the degree of association between the results of ambulatory step activity monitoring (SAM), self-reported physical functioning (SRPF) and the 6-minute standardised walking test (6-MWT) in cancer patients with haematological malignancies.

METHOD

Assessments of ambulatory SAM, SRPF and 6-MWT were assessed in 102 patients up to 122 days (mean 78  ±  35) after haematopoietic stem cell transplantation (HSCT). To determine the association between measures of walking, the Pearson product moment correlation coefficient (r) including the 95%CI and the r(2) were calculated. Simple linear regression analyses were performed to estimate the ambulatory step activity from SRPF and the 6-MWT.

RESULTS

The average age was 47 years (± 12) and body mass index 23.4 (± 4). The correlations were low between ambulatory SAM outputs and SRPF (ranging from -0.32 to 0.34, p < 0.01), and very low between SAM outputs and 6-MWT, (ranging from 0.21 to 0.24). The correlation between SRPF and the 6-MWT was low (0.33, p < 0.01). The correlation between SRPF and the 6-MWT was low (0.33, p < 0.01). The 95%CIs were quite narrow around r. The shared variance (r(2)) between the SAM and SPPF ranged between 4% and 11% and the shared variance between the SAM and 6-MWT ranged between 0.5% and 18%. Linear regression yielded weak relationships and large standard errors of estimate between the SAM, SRPF and 6-MWT.

CONCLUSIONS

SRPF and the 6-MWT do not reflect daily walking activity. In clinical use (e.g. to evaluate the effects of a rehabilitation program), ambulatory step activity outputs can be considered an additional outcome to assess day-to-day walking activity in patients with haematological cancer after HSCT.

[Prevalence of overweight and obesity in adults in an urban health area]

OBJECTIVE

To estimate prevalence of overweight and obesity in adults and to identify those individuals at high cardiovascular risk (subjects with type 2 diabetes or hypertension) in whom a nurse intervention might be beneficial in terms of life-style changes and reduction in body weight.

METHOD

A cross-sectional study on 2270 adults (18-80 years-old) from an urban Primary Health Care Centre. Medical history, social and demographic data, physical examination and blood tests were collected.

RESULTS

The mean body mass index was 26.9±5.1kg/m(2) and was found to be higher in men. Thirty-eight percent of subjects were overweight and 22% were obese. Although the prevalence of obesity was identical in both sexes, women had higher prevalences of type ii and iii obesity than men, but overweight was more frequent in men. Among those older than fifty years-old, 84% were overweight or obese. One-hundred and fifty-six (7%) subjects had type 2 diabetes and 707 (31%) had hypertension, and 111 (5%) subjects with both diabetes and hypertension. BMI was higher (P<0.001) in patients who suffered from, hypertension (29.7±5.2), diabetes (28.5±4.6), and diabetes and hypertension (31.4±5.3), than in those who did not suffer from these diseases (25.4±4.3).

CONCLUSIONS

Obesity and overweight is highly prevalent in the population studied and is higher in patients with diabetes and hypertension.

The effects of a 30-month dietary intervention on bone mineral density: The Postmenopausal Health Study

Low dietary Ca intake and vitamin D insufficiency have been implicated as part of the aetiology leading to osteoporosis. The aim of the present study was to examine the effects of a 30-month dietary intervention that combined supplementation of dairy products fortified with Ca and vitamin D3 and lifestyle and nutrition counselling sessions on bone mineral density (BMD) of postmenopausal women. Sixty-six postmenopausal women (aged 55–65 years) were randomised into a dietary group (DG; n 35), receiving daily and for the first 12 months 1200 mg Ca and 7·5 μg vitamin D3, while for the next 18 months of intervention 1200 mg Ca and 22·5 μg vitamin D3 through fortified dairy products, and a control group (CG; n 31) receiving neither counselling nor dairy products. The DG was found to have more favourable changes in arms (P < 0·001), total spine (P = 0·001) and total body BMD (P < 0·001) compared with the CG. Furthermore, a significant increase was observed for the DG in lumbar spine BMD (0·056; 95 % CI 0·009, 0·103), which was not found to differentiate significantly compared with the change observed in the CG (P = 0·075). In conclusion, the present study showed that intakes of vitamin D of about 22·5 μg/d and of Ca close to the recommended level of 1200 mg from fortified dairy foods for 30 months, with compliance ensured by lifestyle and nutrition counselling sessions, can induce favourable changes in arms, total spine and total body BMD of postmenopausal women.