Cardiorespiratory fitness in 16 025 adults aged 18-91 years and associations with physical activity and sitting time

Relative aerobic load of walking in people with multiple sclerosis

OBJECTIVE

To examine the energy demand of walking relative to aerobic capacity in people with multiple sclerosis.

DESIGN

Cross-sectional cohort study.

PATIENTS

A total of 45 people with multiple sclerosis (32 females), median disease duration 15 years (interquartile range (IQR) 9; 20), median Expanded Disability Status Scale 4 (min-max range: 2.0; 6.0).

METHODS

Aerobic capacity, derived from a cardiopulmonary exercise test and gas exchange measurements, assessed during a 6-min overground walk test at comfortable speed, were analysed. The relative aerobic load of walking was determined as the energy demand of walking relative to oxygen uptake at peak and at the first ventilatory threshold. Healthy reference data were used for clinical inference.

RESULTS

People with multiple sclerosis walk at a mean relative aerobic load of 60.0% (standard deviation 12.8%) relative to peak aerobic capacity, and 89.1% (standard deviation 19.9%) relative to the first ventilatory threshold. Fourteen participants walked above the first ventilatory threshold (31%). Peak aerobic capacity was reduced in 45% of participants, and energy demands were increased in 52% of participants.

CONCLUSION

People with multiple sclerosis walk at a relative aerobic load close to their first ventilatory threshold. A high relative aerobic load can guide clinicians to improve aerobic capacity or reduce the energy demands of walking.

Cardiorespiratory fitness (V̇O2peak) across the adult lifespan in persons with multiple sclerosis and matched healthy controls

OBJECTIVES

Cardiorespiratory fitness (measured as peak oxygen uptake; V̇O2peak) is a well-established health predictor in the general population and in persons with multiple sclerosis (pwMS). We aimed to investigate differences in V̇O2peak between age groups and the prevalence of V̇O2peak impairments across the adult lifespan in pwMS compared to age- and sex-matched healthy controls (HC).

DESIGN

Cross-sectional study.

METHODS

Data from 469 pwMS (EDSS range 1.0-7.0), who carried out graded cardiopulmonary exercise testing during their rehabilitation stay at the Valens clinic from 07/2010 to 10/2022, were retrospectively analyzed. Data from 21,063 HC were extracted from previously published studies containing normative reference values.

RESULTS

With advanced age (i.e., across age groups), a continuous deterioration of V̇O2peak was observed in both pwMS and HC. Within all age groups, V̇O2peak was reduced in pwMS compared to HC with deficits ranging from 29 % to 40 % for females (p < .05), and from 30 % to 41 % for males (p < .05). However, no age ∗ group interaction was observed in neither males (p = .626) nor females (p = .557). With V̇O2peak impairments defined as values below the 5th percentile of HC, a high prevalence was observed in pwMS, with values ranging from 48 % to 100 % across age groups.

CONCLUSIONS

The present data provide evidence for a parallel deterioration of V̇O2peak in pwMS and matched controls with advancing age, coinciding with a high prevalence of impairments in V̇O2peak already present in young adulthood in pwMS. Understanding the extent of impairments as well as the age trajectories of cardiorespiratory fitness in pwMS is crucial for designing optimal rehabilitative and preventive interventions.

Complexity and pitfalls in maximal exercise testing for persons with multiple sclerosis

BACKGROUND AND PURPOSE

Valid measurements of cardiorespiratory fitness in persons with multiple sclerosis (pwMS) are essential during inpatient rehabilitation for a precise evaluation of the current health status, for defining appropriate exercise intensities, and for evaluation of exercise intervention studies. We aim (i) to examine the proportion of pwMS who attain the American College of Sports Medicine (ACSM) criteria for maximal effort during graded cardiopulmonary exercise testing (CPET) and (ii) to provide insight into participant characteristics that limit maximal exercise performance.

METHODS

This cross-sectional study comprises a retrospective examination of ACSM criteria for maximal effort during graded CPET of n = 380 inpatient pwMS (mean age = 48 ± 11 years, 66% female). Chi-squared or Fisher's exact tests were conducted to compare differences in the distribution of criteria achieved. Participants' characteristics were examined as potential predictors using binary logistic regression.

RESULTS

Only 60% of the overall sample attained a respiratory exchange ratio ≥ 1.10. With regard to the definition applied, only 24% or 40% of the participants achieved an oxygen consumption plateau, and 17% or 50% attained the heart rate criterion. Forty-six percent met at least two of three criteria. Disability status, gender, disease course, and body mass index were associated with the attainment of maximal effort.

CONCLUSIONS

Our findings suggest that a relevant proportion of inpatient pwMS do not attain common criteria utilized to verify maximal oxygen consumption. Identified predictors for criteria attainment can be used to create models to predict cardiorespiratory fitness and to optimize CPET protocols in restrictive groups of pwMS.

Resting heart rate is a population-level biomarker of cardiorespiratory fitness: The Fenland Study

INTRODUCTION

Few large studies have evaluated the relationship between resting heart rate (RHR) and cardiorespiratory fitness. Here we examine cross-sectional and longitudinal relationships between RHR and fitness, explore factors that influence these relationships, and demonstrate the utility of RHR for remote population monitoring.

METHODS

In cross-sectional analyses (The UK Fenland Study: 5,722 women, 5,143 men, aged 29-65y), we measured RHR (beats per min, bpm) while seated, supine, and during sleep. Fitness was estimated as maximal oxygen consumption (ml⋅min-1⋅kg-1) from an exercise test. Associations between RHR and fitness were evaluated while adjusting for age, sex, adiposity, and physical activity. In longitudinal analyses (6,589 participant subsample), we re-assessed RHR and fitness after a median of 6 years and evaluated the association between within-person change in RHR and fitness. During the coronavirus disease-2019 pandemic, we used a smartphone application to remotely and serially measure RHR (1,914 participant subsample, August 2020 to April 2021) and examined differences in RHR dynamics by pre-pandemic fitness level.

RESULTS

Mean RHR while seated, supine, and during sleep was 67, 64, and 57 bpm. Age-adjusted associations (beta coefficients) between RHR and fitness were -0.26, -0.29, and -0.21 ml⋅kg-1⋅beat-1 in women and -0.27, -0.31, and -0.19 ml⋅kg-1⋅beat-1 in men. Adjustment for adiposity and physical activity attenuated the RHR-to-fitness relationship by 10% and 50%, respectively. Longitudinally, a 1-bpm increase in supine RHR was associated with a 0.23 ml⋅min-1⋅kg-1 decrease in fitness. During the pandemic, RHR increased in those with low pre-pandemic fitness but was stable in others.

CONCLUSIONS

RHR is a valid population-level biomarker of cardiorespiratory fitness. Physical activity and adiposity attenuate the relationship between RHR and fitness.

Effects of reducing sedentary behaviour duration by increasing physical activity, on cognitive function, brain function and structure across the lifespan: a systematic review protocol

INTRODUCTION

Greater engagement in sedentary behaviours has been related to poorer cognitive functions in epidemiological research. However, the effects of reducing sedentary behaviour duration on cognitive function, brain function, and structure remain poorly understood. This systematic review aims to synthesise the evidence on the effects of reducing sedentary behaviour duration by increasing time spent in physical activity on cognitive function, brain structure and function in apparently healthy children, adolescents and adults.

METHODS AND ANALYSIS

The protocol follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search will be conducted (search dates: August-September 2022) across six databases: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (via EBSCO Host), PsycINFO (via ProQuest), SPORTDiscus and Web of Science (Science and Social Science Citation Index). The inclusion criteria are as follows: randomised and non-randomised experimental studies as defined by the Cochrane Handbook, published in English, in peer-reviewed journals, and as theses or dissertations. References of included papers will be screened for additional studies. Acute and chronic interventions targeting children (≥ 4 years), adolescents, younger adults (≥ 18-40 years), middle-aged (40-64 years) and older adults (65+ years) will be eligible. Methodological quality will be assessed with the Effective Public Health Practice Project quality assessment tool for quantitative studies. Qualitative synthesis will be stratified by intervention type (acute vs chronic), intervention content (reducing sedentary time or interrupting prolonged sitting) and outcome (cognitive, brain structure and function).

ETHICS AND DISSEMINATION

No primary data collection will be conducted as part of this systematic review. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.

PROSPERO REGISTRATION NUMBER

CRD42020200998.

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

Sedentary behaviour - put simply, too much sitting, as a distinct concept from too little exercise - is a novel determinant of cardiovascular risk. This definition provides a perspective that is complementary to the well-understood detrimental effects of physical inactivity. Sitting occupies the majority of the daily waking hours in most adults and has become even more pervasive owing to the COVID-19 pandemic. The potential for a broad cardiovascular health benefit exists through an integrated approach that involves 'sitting less and moving more'. In this Review, we first consider observational and experimental evidence on the adverse effects of prolonged, uninterrupted sitting and the evidence identifying the possible mechanisms underlying the associated risk. We summarize the results of randomized controlled trials demonstrating the feasibility of changing sedentary behaviour. We also highlight evidence on the deleterious synergies between sedentary behaviour and physical inactivity as the underpinnings of our case for addressing them jointly in mitigating cardiovascular risk. This integrated approach should not only reduce the specific risks of too much sitting but also have a positive effect on the total amount of physical activity, with the potential to more broadly benefit the health of individuals living with or at risk of developing cardiovascular disease.

Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ)

Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18-25, 26-44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.

The influence of age, sex and cardiorespiratory fitness on maximal fat oxidation rate

Fat oxidation decreases with age, yet no studies have previously investigated if aging affects the maximal fat oxidation rate (MFO) during exercise in men and women differently. We hypothesized that increased age would be associated with a decline in MFO and this would be more pronounced in women due to menopause, compared with men. In this cross-sectional study design, 435 (247/188, male/female) subjects of varying ages performed a DXA scan, a submaximal graded exercise test and a maximal oxygen uptake test, to measure MFO and cardiorespiratory fitness (CRF) by indirect calorimetry. Subjects were stratified into 12 groups according to sex (male/female), age (<45, 45-55 and >55 years), CRF (below average and above average). Women aged <45 years had a higher MFO relative to fat free mass (FFM) (mg/min/kg) compared with men, regardless of CRF. However, there were no differences in MFO (mg/min/kg FFM) between men and women, in the groups aged between 45-55 and >55 years. In summary, we found that women aged <45 years display a higher MFO (mg/min/kg FFM) compared with men and that this sexual divergence is abolished after the age of 45 years. Novelty: Maximal fat oxidation rate is higher in young women compared with men. This sex-related difference is attenuated after the age of 45 years. Cardiorespiratory fitness does not influence this sex-related difference.

Inspiratory Muscle Strength and Cardiorespiratory Fitness Association With Health-Related Quality of Life in Healthy Older Adults

The main purpose of this study was to explore similarities and differences in the association between two capabilities affecting the cardiorespiratory system (overall and multifactorial cardiorespiratory fitness and inspiratory muscle strength) and the health-related quality of life (HRQoL), in a group of active healthy seniors. Sixty-five individuals (age, 73.01 ± 5.27 years; 53 women) who participated regularly in a multicomponent training program completed the EuroQol 5D-5L questionnaire, the 6-min walking test (6MWT), and the maximum inspiratory pressure test (MIP). Non-parametric correlations (Spearman's rho) were conducted to analyze the association between HRQoL indices (EQindex and EQvas), MIP, and 6MWT, considering both, the whole sample and men and women separately. Furthermore, partial correlation was made by controlling age and sex. We found a moderate association between HRQoL and cardiorespiratory fitness (EQvas: r = 0.324, p = 0.009; EQindex: r = 0.312, p = 0.011). Considering sex, relationship EQvas-6MWT decrease to small (r = 0.275; p = 0.028) whereas EQindex-6MWT remained moderated (r = 0.425; p = 0.000). When we considered women and men separately, the association between HRQoL and 6MWT appeared only in women, while the observed strong trend (p = 0.051) toward a large and positive association between EQindex and MIP, mediated by the covariate age, appeared only in men. Conversely to the cardiorespiratory fitness, MIP is not a limiting factor of HRQoL in healthy active elderly. Moreover, MIP and HRQoL should be included in the assessment of exercise interventions because they provide different information about the cardiorespiratory system deterioration. Similarly, EQvas and EQindex confirm to be complementary in the assessment of HRQoL. Furthermore, like aging process is different for men and women, the association between MIP and cardiorespiratory fitness with HRQoL may behave differently, so keeping on research these associations could help to improve training programs for this population.

Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis

Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one's life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.

The physiological benefits of sitting less and moving more: Opportunities for future research

Sedentary behavior (SB) and physical activity (PA) are important risk factors of cardiovascular disease morbidity and mortality. In addition to increasing the amount of moderate-to-vigorous PA (MVPA), the current PA guidelines recommend that adults should reduce SB, or any waking activity performed while sitting, reclining, or lying, with low energy expenditure. While mounting evidence has emphasized the benefits of increasing MVPA, little has focused on the effect of SB on health. Therefore, this review discusses the pathophysiological effects of SB and the potential physiological benefits of reducing/breaking up SB at the levels below the current guidelines for PA. Such knowledge is important, given that the majority of the United States population performs insufficient or no MVPA and is at high risk of being negatively impacted by SB. Interventions targeting sedentary time, such as breaking up SB by standing and moving, may be safe, feasible, and applicable to execute daily for a wide range of the population. This review also discusses the importance of monitoring SB in the era of the coronavirus disease 2019 (COVID-19) pandemic and the clinical implications of sitting less and moving more.

Health-Related Fitness in Adults From Eight European Countries-An Analysis Based on Data From the European Fitness Badge

BACKGROUND

There are conflicting reports about the fitness status of European adults, partly due to the lack of a standardized fitness test battery used across Europe. The European Fitness Badge (EFB) was developed in 2017 as an online-based tool to assess the health-related fitness of persons aged ≥ 18 years residing in European countries. We examined the demographic characteristics and fitness status of persons who completed the EFB between June 2017 and May 2019.

METHODS

We conducted a multinational study in eight European countries. Participants completed the EFB which includes 11 validated motor tests to measure endurance, strength, coordination, and flexibility performance, under the supervision of an EFB instructor in different settings (e.g., sports club sessions, public events). Two different test batteries [test profiles (TPs)] are available to distinguish between less active (TP1) and active individuals (TP2). We calculated descriptive statistics and conducted analyses of variance to examine sample characteristics and a potential impact of sex, age, body mass index (BMI), physical activity, and posture on fitness as assessed by the EFB.

RESULTS

The sample included 6,019 adults (68.7% females; mean age 52.7 years; age range 18-89 years). Participants who completed TP1 were older (TP1: 61.4 years; TP2: 44.2 years; p = 0.00), reported a lower level of physical activity (TP1: 3.8; TP2: 4.0; p = 0.00), had a higher BMI (TP1: 25.7; TP2: 24.3; p = 0.00) and a higher frequency of postural abnormalities (TP1: 43%; TP2: 33%; p = 0.00) than TP2 participants. Among 3,034 participants who completed TP2, males had higher performance in endurance, strength, and overall fitness, whereas females performed better in coordination and flexibility tests. In addition, younger age, lower BMI, and higher level of physical activity engagement were associated with better EFB test performance.

CONCLUSION

The EFB can be used to assess the health-related fitness status of individuals aged ≥ 18 years. Our results show that TP1 and TP2 were completed by persons from the respective target groups (i.e., less active vs. active), and also confirm findings from previous studies on potential determinants of fitness such as sex or age.

Socioeconomic status relates to exercise habits and cardiorespiratory fitness among workers in the Tokyo area

OBJECTIVES

This survey aims to investigate consciousness regarding habitual exercise among workers in urban areas and to analyze the associations of workers' socioeconomic status with their habitual exercise and cardiorespiratory fitness (CRF).

METHODS

Ten thousand participants, who worked in the Tokyo area of Japan, were recruited for the questionnaire-based survey. The questionnaire elicited participant's characteristics, socioeconomic status (eg, employment status and annual income), habitual exercise status, and consciousness regarding exercising. After the data-cleaning procedure, 9406 participants were selected for analyses. CRF was estimated by a validated equation model.

RESULTS

Some (32.9%) participants had an exercise habit, and 93% recognized that exercise is good for health. Of the nonexercise habit group (n = 6308), 73% wanted to develop an exercise habit, and "spare time (40%)" and "financial capability (16%)" were the two most necessary conditions for habituating exercise. As socioeconomic statuses increased, the odds ratios (ORs) for engaging in habitual exercise increased among full-time (1.22) versus part-time (reference) employees and those having high (1.76) versus low (reference) incomes, whereas the ORs for low CRF risk decreased among full-time (0.78) versus part-time (reference) employees and those having high (0.53) versus low (reference) incomes.

CONCLUSIONS

Although most workers recognized the benefits of exercise, many were unable to develop exercise habits and believed that they could develop exercise habits if they had the time and financial capabilities. The survey suggests that workers with a higher socioeconomic status more likely to obtain favorable physical fitness, indicating a health disparity among workers in urban areas.

Device-Based Measures of Sedentary Time and Physical Activity Are Associated With Physical Fitness and Body Fat Content

Introduction/Purpose: Physical activity and sedentary time may associate with physical fitness and body composition. Yet, there exists some observational studies that have investigated the associations of device-based measures of sedentary time and physical activity (PA) with cardiorespiratory fitness (CRF) and body composition but associations with muscular fitness (MF) are less studied.

Methods: Objective sedentary time and physical activity was measured by a hip worn accelerometer from 415 young adult men (age: mean 26, standard deviation 7 years). Cardiorespiratory fitness (VO₂max) (CRF) was determined using a graded cycle ergometer test until exhaustion. Maximal force of lower extremities was measured isometrically and lower body power was assessed using standing long jump (MF). Body composition was determined with bioimpedance method. Single and compositional approach was used in regression analysis.

Results: Mean sedentary time was 707 (standard deviation 133) minutes per day (77 ± 8% of the wear time). Volumes of all PA intensities were positively associated with CRF and associations showed linearly increasing magnitudes with higher intensities in single regression models adjusted for age and smoking (p < 0.001). Similarly, PA intensities were positively associated with lower body MF, however, with weaker associations (p < 0.005). After further adjustment for resistance training, the associations remained significant. The associations of the relative distribution of time within sedentary behavior (SB), light intensity PA (LPA) and moderate-to-vigorous PA (MVPA) behaviors as a whole with using compositional analysis further revealed that within the composition MVPA and SB were positively associated with CRF and MF (p < 0.001), while LPA was not. In addition, within the composition, accumulated PA bouts lasting more than 3 min were consistently associated with CRF and MF, and with all body composition variables (p < 0.001), while sedentary time was associated with body fat percentage (p < 0.001).

Conclusion: Promoting physical activity and reducing sedentary time may have positive influence on physical fitness and body fat content, and thereby may offer positive health effects. Physical activity of higher intensities may offer greater benefits.

Can we walk away from cardiovascular disease risk or do we have to 'huff and puff'? A cross-sectional compositional accelerometer data analysis among adults and older adults in the Copenhagen City Heart Study

Background

It is unclear whether walking can decrease cardiovascular disease (CVD) risk or if high intensity physical activity (HIPA) is needed, and whether the association is modified by age. We investigated how sedentary behaviour, walking, and HIPA, were associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) among adults and older adults in a general population sample using compositional data analysis. Specifically, the measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) HIPA.

Methods

Cross-sectional data from the fifth examination of the Copenhagen City Heart Study was used. Using the software Acti4, we estimated daily time spent in physical behaviours from accelerometer data worn 24 h/day for 7 days (i.e., right frontal thigh and iliac crest; median wear time: 6 days, 23.8 h/day). SBP, WC, and LDL-C were measured during a physical examination. Inclusion criteria were ≥ 5 days with ≥16 h of accelerometer recordings per day, and no use of antihypertensives, diuretics or cholesterol lowering medicine. The 24-h physical behaviour composition consisted of sedentary behaviour, standing, moving, walking, HIPA (i.e., sum of climbing stairs, running, cycling, and rowing), and time in bed. We used fitted values from linear regression models to predict the difference in outcome given the investigated time reallocations relative to the group-specific mean composition.

Results

Among 1053 eligible participants, we found an interaction between the physical behaviour composition and age. Age-stratified analyses (i.e., </≥65 years; 773 adults, 280 older adults) indicated that less sedentary behaviour and more walking was associated with lower SBP among older adults only. For less sedentary behaviour and more HIPA, the results i) indicated an association with a lower SBP irrespective of age, ii) showed an association with a smaller WC among adults, and iii) showed an association with a lower LDL-C in both age groups.

Conclusions

Less sedentary behaviour and more walking seems to be associated with lower CVD risk among older adults, while HIPA types are associated with lower risk among adults. Therefore, to reduce CVD risk, the modifying effect of age should be considered in future physical activity-promoting initiatives.

Workers' physical activity data contribute to estimating maximal oxygen consumption: a questionnaire study to concurrently assess workers' sedentary behavior and cardiorespiratory fitness

Background

Sedentary behavior (SB) and cardiorespiratory fitness (CRF) are important issues in occupational health. Developing a questionnaire to concurrently assess workers’ SB and CRF could fundamentally improve epidemiological research. The Worker’s Living Activity-time Questionnaire (WLAQ) was developed previously to assess workers’ sitting time. WLAQ can be modified to evaluate workers’ CRF if additional physical activity (PA) data such as PA frequency, duration, and intensity are collected.

Methods

A total of 198 working adults (93 women and 105 men; age, 30–60 years) completed anthropometric measurements, a treadmill exercise test for measuring maximal oxygen consumption (VO_2max), and modified WLAQ (m-WLAQ, which included questions about PA data additional to the original questions). Multiple regression analyses were performed to develop prediction equations for VO_2max. The generated models were cross-validated using the predicted residual error sum of squares method. Among the participants, the data of 97 participants who completed m-WLAQ twice after a 1-week interval were used to calculate intraclass correlation coefficient (ICC) for the test–retest reliability analyses.

Results

Age (r = − 0.29), sex (r = 0.48), body mass index (BMI, r = − 0.20), total sitting time (r = − 0.15), and PA score (total points for PA data, r = 0.47) were significantly correlated with VO_2max. The models that included age, sex, and BMI accounted for 43% of the variance in measured VO_2max [standard error of the estimate (SEE) = 5.04 ml·kg^− 1·min^− 1]. These percentages increased to 59% when the PA score was included in the models (SEE = 4.29 ml·kg^− 1·min^− 1). Cross-validation analyses demonstrated good stability of the VO_2max prediction models, while systematic underestimation and overestimation of VO_2max were observed in individuals with high and low fitness, respectively. The ICC of the PA score was 0.87 (0.82–0.91), indicating excellent reliability.

Conclusions

The PA score obtained using m-WLAQ, rather than sitting time, correlated well with measured VO_2max. The equation model that included the PA score as well as age, sex, and BMI had a favorable validity for estimating VO_2max. Thus, m-WLAQ can be a useful questionnaire to concurrently assess workers’ SB and CRF, which makes it a reasonable resource for future epidemiological surveys on occupational health.

Reference Values for Cardiorespiratory Fitness in Healthy Koreans

We investigated reference values for cardiorespiratory fitness (CRF) for healthy Koreans and Koreans with coronary heart disease (CHD) and used them to identify inter-ethnic differences in CRF, differences over time in CRF, and differences in CRF between the healthy population and patients with CHD. The study population for healthy Koreans was derived from the database of KISS FitS (Korea Institute of Sports Science Fitness Standards) between 2014 and 2015. The study population for Koreans with CHD was derived from the database of the Korea University Guro Hospital Cardiac Rehabilitation Registry between June 2015 and December 2018. In healthy Koreans, there was a significant difference between sex and age groups for VO₂ max. The VO₂ max of healthy Koreans differed from that of Westerners in age-related reference values. Our results were not significantly different from those of the Korean population in the past, except for a small decline in the young population. There seemed to be a clear inter-ethnic difference in CRF. We could also identify signs of small change in CRF in younger age groups. Therefore, CRF should be assessed according to ethnic or national standards, and it will be necessary to establish a reference for each nation or ethnicity with periodic updates.

Criterion validity of the Ekblom-Bak and the Åstrand submaximal test in an elderly population

Purpose

The aim of this study was to validate the submaximal Ekblom-Bak test (EB-test) and the Åstrand test (Å-test) for an elderly population.

Methods

Participants (n = 104), aged 65–75 years, completed a submaximal aerobic test on a cycle ergometer followed by an individually adjusted indirect calorimetry VO₂max test on a treadmill. The HR from the submaximal test was used to estimate VO₂max using both the EB-test and Å-test equations.

Results

The correlation between measured and estimated VO₂max using the EB method and Å method in women was r = 0.64 and r = 0.58, respectively and in men r = 0.44 and r = 0.44, respectively. In women, the mean difference between estimated and measured VO₂max was − 0.02 L min⁻¹ (95% CI − 0.08 to 0.04) for the EB method and − 0.12 L min⁻¹ (95% CI − 0.22 to − 0.02) for the Å method. Corresponding values for men were 0.05 L min⁻¹ (95% CI − 0.04 to 0.14) and − 0.28 L min⁻¹ (95% CI − 0.42 to − 0.14), respectively. However, the EB method was found to overestimate VO₂max in men with low fitness and the Å method was found to underestimate VO₂max in both women and men. For women, the coefficient of variance was 11.1%, when using the EB method and 19.8% when using the Å method. Corresponding values for men were 11.6% and 18.9%, respectively.

Conclusion

The submaximal EB-test is valid for estimating VO₂max in elderly women, but not in all elderly men. The Å-test is not valid for estimating VO₂max in the elderly.

Electronic supplementary material

The online version of this article (10.1007/s00421-019-04275-7) contains supplementary material, which is available to authorized users.

Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults

The aim was to investigate sex- and age-specific associations between cardiorespiratory fitness, all-cause and cause-specific mortality, and cardiovascular disease (CVD) morbidity. 266.109 participants (47% women, 18-74 years) free from CVD, participating in occupational health service screenings in 1995-2015 were included. CRF was assessed as estimated maximal oxygen consumption (estVO₂max) using a submaximal cycle test. Incident cases of first-time CVD event and death from any cause were ascertained through national registers. There were 4244 CVD events and 2750 cases of all-cause mortality during mean 7.6 years follow-up. Male gender, higher age and lower estVO₂max were associated with higher all-cause mortality and CVD morbidity incidence rates. Risk reductions with increasing estVO₂max were present in all age-groups of men and women. No obvious levelling off in risk was identified in the total cohort. However, women and older age-groups showed no further reduction in higher aggregated estVO₂max levels. CVD specific mortality was more associated with estVO₂max compared to tumor specific mortality. The risk for all-cause mortality and CVD morbidity decreased by 2.3% and 2.6% per increase in 1 ml·min^-1·kg^-1 with no significant sex-differences but more pronounced in the three lower estVO₂max categories for all-cause mortality (9.1%, 3.8% and 3.3%, respectively). High compared to lower levels of estVO₂max was not related to a significantly elevated mortality or morbidity. In this large cohort study, CVD morbidity and all-cause mortality were inversely related to estVO₂max in both men and women of all age-groups. Increasing cardiorespiratory fitness is a clear public health priority.

Physical Activity After Breast Cancer Surgery: Does Depression Make Exercise Feel More Effortful than It Actually Is?

BACKGROUND

Prior to treatment, breast cancer patients are less physically fit compared to peers; during cancer treatment, their fitness typically declines. Depressive symptoms are associated with reduced activity up to 5 years post-treatment, but research has not identified mechanisms linking depression and lower activity. The current study assessed relationships among breast cancer patients' depression and perceived exertion during exercise as well as heart rate, an objective indicator of exertion.

METHODS

Participants were 106 breast cancer patients, stages I-IIIA, who completed surgery but had not started adjuvant treatment. Heart rate and self-rated exertion, measured using the Borg Scale of Perceived Exertion, were assessed every 2 min during a graded exercise test. Depression was assessed using the CES-D and a structured clinical interview.

RESULTS

Compared to women below the CES-D clinical cutoff, women with significant depressive symptoms reported steeper increases in exertion during the exercise test (p = .010) but had similar heart rates (p = .224) compared to women below the cutoff. Major depression history was unrelated to perceived exertion (ps > .224) and heart rate (ps > .200) during exercise.

CONCLUSIONS

Women with currently elevated depressive symptoms experienced exercise as more difficult compared to women below the CES-D cutoff, but these self-perceptions did not reflect actual heart rate differences. Depression may make exercise feel more demanding, which could ultimately decrease patients' likelihood of engaging in regular exercise. Results support the use of depression screening tools following breast cancer surgery to identify and intervene on individuals at risk for decreased physical activity during survivorship.

Is Sitting Time Related with Physical Fitness in Spanishelderly Population? The EXERNET Multicenter Study

BACKGROUND

Older adults spend most of their waking hours performing sedentary activities. The influence of these lifestyle patterns on the physical fitness (PF) levels of this population has not yet been sufficiently investigated.

OBJECTIVE

The aim of the study was to examine whether sedentary behavior (SB) (h•d-1sitting) is associated with PF, and specifically to analyze whether sitting >4 h•d-1 is associated with higher risk of having lower levels of fitness in seniors.

DESIGN

EXERNET multi-center study.

PARTICIPANTS AND SETTINGS

A representative sample of 3136 non-institutionalized elderly (aged 72.2±5.3 years), from 6 Regions of Spain were included in the study.

MEASUREMENTS

PF was assessed using 8 different tests from the EXERNET battery. Lifestyle patterns were collected using a validated questionnaire. ANOVA was used to compare the groups according to the hours of sitting. Binary logistic regression was used to calculate the association between the SB and low levels of fitness.

RESULTS

For both genders, those who spent sitting >4 h•d-1 had lower levels of balance, agility, walking speed and aerobic endurance (p<0.001). Sedentary men also had less strength of lower extremities (p<0.05), whereas, sedentary women were less flexible in the lower extremities (p<0.001). More than 4 h•d-1 sitting was associated, in men, to higher odds for having low strength (lower extremities), agility, flexibility (lower extremities) and aerobic endurance (p<0.05); and in women, to higher risk of low balance, strength (lower and upper extremities), flexibility (lower extremities), agility, walking speed and aerobic endurance (p<0.05).

CONCLUSIONS

Seniors that sit >4 h•d-1 have lower levels of fitness and this behavior is related with an increased risk of having low levels of PF in this population.

Insomnia and cardiorespiratory fitness in a middle-aged population: the SCAPIS pilot study

BACKGROUND

The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64 years.

METHODS

Subjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n = 603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VO₂max). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score ≥ 10 was used to define insomnia.

RESULTS

Insomnia was identified in 31.8% of the population. The VO₂max was significantly lower in insomnia subjects compared with the non-insomnia group (31.2 ± 6.3 vs. 32.4 ± 6.5 ml* kg^-1 *min^-1, p = 0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VO₂max was found in men, but not in women (β = - 1.15 [95% CI - 2.23-- 0.06] and - 0.09 [- 1.09-0.92], p = 0.038 and 0.866, respectively).

CONCLUSIONS

We found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.

Muscle Strength and Aerobic Capacity in Patients with CIDP One Year after Participation in an Exercise Trial

BACKGROUND

We have previously shown that patients with chronic inflammatory demyelinating polyneuropathy (CIDP) improve muscle strength and aerobic capacity after resistance and aerobic exercise.

OBJECTIVE

The purpose of this study was to determine if muscle strength and aerobic capacity are preserved one year after discontinuation of regular exercise.

METHODS

All patients in the previous exercise study were eligible for a one-year follow-up with measurement of combined isokinetic muscle strength (cIKS) by dynamometry and maximal oxygen consumption velocity (VO2-max). Data are presented as median (ranges).

RESULTS

Ten of 17 patients accepted to participate in the follow-up study. Following the exercise study six patients discontinued exercise and at one-year follow-up cIKS had decreased by -13.0 % (-25.8 to -2.9) (p = 0.03) and VO2-max by -16.6 % (-18.8 to -12.6) (p = 0.06). Four patients continued exercise (three with aerobic training and one with resistance training) and at one-year follow-up cIKS and VO2-max were preserved compared to the end of the exercise study (11.6 % (-8.9 to 32.1) (p = 0.88) and -8.4 % (-34.5 to -2.2) (p = 0.13), respectively).

CONCLUSIONS

Continuation of aerobic and resistance exercise may preserve gains in muscle strength and aerobic capacity in patients with CIDP.

Can socioeconomic health differences be explained by physical activity at work and during leisure time? Rationale and protocol of the active worker individual participant meta-analysis

INTRODUCTION

Socioeconomic health differences have often been described, but remain insufficiently understood. Recent evidence suggests that workers who are high (compared with low) physically active at work are less healthy. Moreover, workers who are highly physically active at work are predominantly physically inactive during leisure time. These observations suggest that workers with a lower socioeconomic status may be exposed to negative health consequences of occupational physical activity and may only benefit to a limited extent from health benefits of leisure-time physical activity. Physical activity may therefore be an important driver of socioeconomic health differences. We describe the rationale and protocol of the active worker study, an individual participant data meta-analysis aimed at exploring socioeconomic health differences by differential doses of physical activity at work and leisure time.

METHODS AND ANALYSIS

Using database and scoping searches (we searched in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews from database inception to 14 September 2017), we have identified 49 published and unpublished prospective studies in which the association of occupational and leisure-time physical activity with cardiovascular or all-cause mortality was assessed. Principal investigators of these studies will be invited to participate in the active worker consortium, after which data will be retrieved. After data merging and harmonising, we will perform multilevel survival analysis assessing the combined association of occupational and leisure-time physical activity with mortality. We will also test the mediating effect of physical activity on the association of socioeconomic status and mortality (ie, socioeconomic health differences).

DISCUSSION

The Medical Ethical Committee of the VU University Medical Center has declared, according to Dutch legislation, that the 'Dutch Medical Research Involving Human Subjects Act' does not apply to the current study. As such, no ethics approval is required. We intent to publish outcomes of the active worker Study in scientific peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42018085228.

Effect of a respiratory muscle training program on lung function, respiratory muscle strength and resting oxygen consumption in sedentary young people

Introduction: Physical inactivity is a risk factor for developing noncommnunicable diseases, as well as respiratory and cardiovascular disorders. To counter this, different types of interventions have been proposed, including respiratory muscle training (RMT).Objective: To determine the effect of a respiratory muscle training program on respiratory muscle strength, lung function and resting oxygen consumption in sedentary subjects.Materials and methods: Pretest-posttest experimental study conducted in sedentary students. Lifestyle and the level of physical activity was determined using the International Physical Activity Questionnaire (IPAQ) and the FANTASTIC questionnaire, while respiratory muscle strength was established by means of expiratory and inspiratory pressure using a Dwyer Series 477 meter, and lung function and oxygen consumption was determined by spirometry and indirect calorimetry whit Vmax Encore 29C® calorimeter. Respiratory muscle training was performed for eight weeks with Threshold IMT system. R software, version 3.1.2, was used for statistical analysis.Results: Clinically and statistically significant improvements were found in maximal inspiratory pressure (MIP) (pre: 81.23±22.00/post: 96.44±24.54 cmH2O; p<0.001); maximal expiratory pressure (MEP) (pre: 94.84±21.63/post: 107.39±29.15 cmH2O; p<0.05); pulmonary function FEV1 [(pre: 3.33±0.88/post: 3.54±0.90L) (p<0.05)]; and FEV1/FVC ratio [(pre: 87.78±7.67/post: 93.20±6.02% (p<0.01)].Conclusion: The respiratory muscle training protocol implemented for eight weeks using the Threshold IMT system improved strength and FEV1. There were no significant changes in oxygen consumption.

Physical Activity and Sitting Time Are Specifically Associated With Multiple Chronic Diseases and Medicine Intake in Brazilian Older Adults

The purpose of the study was to clarify the independent association between sedentary behavior and physical activity with multiple chronic diseases and medicine intake in older individuals. Sedentary behavior and physical activity were measured by questionnaires. Diseases and medication use were self-reported. Poisson's regression was adopted for main analysis, through crude and adjusted prevalence ratio and confidence interval of 95%. For men, sedentary time >4 hr/day presented a 76% higher prevalence of ≥2 chronic diseases, while physical inactivity increases the likelihood of using ≥2 medicines in 95%. For women, sedentary behavior >4 hr/day presented an 82% and 43% greater prevalence for ≥2 chronic diseases and the intake of ≥2 medicines, respectively. Sedentary behavior represents an independent associated factor of multiple chronic diseases in older men and women. In addition, inactivity for men and sedentarism for women are associated with the amount of medicine intake.

Sedentary Behavior, Physical Activity, and Fitness-The Maastricht Study

PURPOSE

This cross-sectional study examined the mutual independent associations of sedentary behavior, lower intensity physical activity (LPA) and higher intensity physical activity (HPA) (an approximation of moderate to vigorous physical activity with cardiorespiratory fitness (CRF).

METHODS

Two thousand twenty-four participants were included from The Maastricht Study (mean ± SD age, 59.7 ± 8.1 yr; 49.6% men). With the activPAL3 activity monitor, we assessed sedentary time (ST), sedentary pattern variables (number of sedentary breaks, average sedentary bout duration, and number of prolonged sedentary bouts [≥30 min]), LPA, and HPA. CRF was calculated as maximum power output per kilogram body mass (Wmax·kg) estimated from a submaximal cycle ergometer test. Linear regression analyses and isotemporal substitution analyses were used to examine associations of ST, sedentary pattern variables, and HPA with CRF. Analyses were stratified by sex.

RESULTS

One hour of ST per day was associated with a lower Wmax·kg: Bmen = -0.03 (95% confidence interval [CI], -0.05 to -0.01) and Bwomen = -0.02 (95% CI, -0.04 to 0.00), independent of HPA. No statistically significant associations between sedentary patterns variables and CRF were observed. LPA was associated with a higher Wmax·kg: Bmen = 0.12 (95% CI, 0.07-0.17) and Bwomen = 0.12 (95% CI, 0.07-0.18). HPA was associated with a higher Wmax·kg: Bmen = 0.48 (95% CI, 0.38-0.58) and Bwomen = 0.27 (95% CI, 0.18-0.36). Replacing ST with LPA (Bmen, 0.08; 95% CI, 0.03-0.14; Bwomen, 0.10; 95% CI, 0.05-0.16) or with HPA (Bmen, 0.49; 95% CI, 0.39-0.59; Bwomen = 0.28; 95% CI, 0.19-0.36), but not with standing was associated with higher CRF.

CONCLUSIONS

Modest associations between sedentary behavior and CRF were observed. Replacing ST with LPA was associated with higher CRF, which could be of particular importance for individuals who cannot engage in HPA. Nonetheless, replacing ST with HPA was associated with greatest estimated change in CRF.

Exercise more or sit less? A randomized trial assessing the feasibility of two advice-based interventions in obese inactive adults

OBJECTIVES

The risk of metabolic and cardiovascular disease may be reduced by a healthy pattern of daily physical activity. We investigated the feasibility and preliminary effectiveness of advice-based interventions aiming at either increasing moderate-to-vigorous intensity physical activity (MVPA) or reducing sedentary time (ST) in obese volunteers.

DESIGN

Randomized non-blinded two-armed trial.

METHOD

Inactive, obese adults were randomly assigned to reduce sedentary behavior (SitLess) (n=30) or increase MVPA (ExMore) (n=29) for 4 weeks. Participants wore ActivPAL (AP) and ActiGraph (AG) devices for 7 consecutive days at baseline and during the final week of the intervention period. Cardiometabolic risk factors (waist circumference, BMI, percent body fat, blood pressure, VO₂max and blood markers) were measured at baseline and at follow-up. Trial was set in Midtjylland Denmark from 2012 to 2014.

RESULTS

The interventions were completed by 77% (SitLess) and 69% (ExMore) of the participants. The SitLess group reduced sedentary time by 53min/day (95% CI 10; 96; P<0.05) while ExMore increased MVPA by 16min/day (95% CI 5; 27; P<0.05). SitLess and ExMore both improved VO₂max by 8% and 11%, respectively (P<0.05). None of the other measured cardiometabolic risk factors changed over the 4 weeks of intervention.

CONCLUSIONS

This trial showed that completion of 4-week, advice-based interventions led to reduced ST or increased MVPA in obese adults. Furthermore, both interventions led to small significant increases in VO₂max. Studies of longer duration are needed to determine if these behavioral changes can be maintained, and to quantify possible longterm effects of reduced ST or increased MVPA on cardiometabolic risk factors.

High prevalence of poor fitness among Danish adults, especially among those with high cardiovascular mortality risk

Background

: Poor cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular and all-cause mortality. Yet, our knowledge about the prevalence of poor CRF is limited. We investigated the prevalence of poor CRF among middle-aged Danish adults from a community-based health promotion program, including identification of a subgroup with high cardiovascular mortality risk. This cross-sectional study included 2,253 middle-aged adults, who completed a preventive health check including CRF testing. CRF (ml O 2 /min/kg) was assessed using the Astrand-Ryhming cycle ergometer test. High 10-year cardiovascular mortality risk as defined in the Danish 2016 guidelines was assessed using questionnaires, health examinations, and prescription data from the Danish National Prescription Registry. The prevalence of poor CRF was 51.7% (95% confidence interval [CI] 48.7-54.7) among men and 31.3% (95% CI 28.7-34.1) among women. A total of 216 (19.4%) men and 220 (19.3%) women were identified with a high 10-year cardiovascular mortality risk. Among these, 65.0% of men (95% CI 58.2-71.3) and 44.1% of women (95% CI 37.4-50.9) had poor CRF. Half of men and one third of women participating in a community-based health promotion program were identified with poor CRF. Among high-risk individuals, two thirds of men and almost every second woman had a poor CRF. Our results emphasise the need for effective public health strategies and interventions to increase CRF in the general population and among high-risk individuals in particular in order to improve public health and reduce mortality.

A lifestyle intervention among elderly men on active surveillance for non-aggressive prostate cancer: a randomised feasibility study with whole-grain rye and exercise

BACKGROUND

The prognosis for men with non-aggressive prostate cancer is good, and several studies have investigated the impact of lifestyle changes including physical activity and diet on the prognosis. Despite positive results in animal studies and a few human interventions with whole-grain rye on markers of prostate cancer progression, the feasibility of trials investigating such dietary changes in combination with physical activity remains largely unstudied. The primary aim was to investigate the feasibility of an intervention with high whole-grain rye intake and vigorous physical activity for 6 months in men diagnosed with prostate cancer.

METHODS

In total, 26 men (53-72 years) recently diagnosed with non-aggressive prostate cancer and on active surveillance, were enrolled in 2011-2012 and randomly assigned to an intervention or a control group. The intervention included 170 g/day of whole-grain rye and 3 × 45 minutes/week of vigorous physical activity. The duration of the intervention was 6 months and end of follow-up 12 months after baseline. Clinic visits were scheduled at baseline and 3, 6 and 12 months after baseline. Compliance with the intervention was evaluated by diaries, food frequency questionnaires, biomarkers, and heart rate monitor data. The effect of the intervention was evaluated by linear multiple regression analysis.

RESULTS

In the intervention group, the mean daily intake of whole-grain rye measured from diaries was 146 g (SD: 19) for the first 3 months and 125 g (SD: 40) for the last 3 months of the intervention. The median level (5th and 95th percentiles) of vigorous physical activity was 91 (17, 193) min/week for the first 3 months and 66 (13, 259) min/week for the last 3 months. No recordings of physical activity were done for the control group. Aerobic fitness (VO2 peak) increased in the intervention group compared to the control group after the intervention. No effects were found on other cardio-metabolic outcomes or prostate cancer progression.

CONCLUSIONS

The lifestyle intervention appeared feasible for 6 months among Danish men and the results are encouraging for conducting full-scale studies, where the impact of whole-grain rye and vigorous physical activity on prostate cancer progression and metabolic parameters can be evaluated.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01300104 . Registered on 18 February 2011.

Validity of the revised Ekblom Bak cycle ergometer test in adults

Purpose

To further develop the Ekblom Bak-test prediction equation for estimation of VO₂max from submaximal cycle ergometry.

Methods

The model group (117 men and 100 women, aged 48.3 ± 15.7 and 46.1 ± 16.8 years, VO₂max 46.6 ± 11.1 and 40.4 ± 9.6 mL kg⁻¹ min⁻¹, respectively) and the cross-validation group (60 men and 55 women, aged 40.6 ± 17.1 and 41.6 ± 16.7 years, VO₂max 49.0 ± 12.1 and 43.2 ± 8.9 mL min⁻¹ kg⁻¹, respectively) performed 4 min of cycling on a standard work rate (30 W) directly followed by 4 min on a higher work rate. Heart rate (HR) at each work rate was recorded. Thereafter, participants completed a graded maximal treadmill test for direct measurement of oxygen uptake. The new prediction equation was cross-validated and accuracy compared with the original Ekblom Bak equation as well as by the Åstrand test method.

Results

The final sex-specific regression models included age, change in HR per-unit change in power (ΔHR/ΔPO), the difference in work rates (ΔPO), and HR at standard work rate as independent variables. The adjusted R² for the final models were 0.86 in men and 0.83 in women. The coefficient of variation (CV) was 8.7 % and SEE 0.28 L min⁻¹. The corresponding CV and SEE values for the EB-test₂₀₁₂ and the Åstrand tests were 10.9 and 18.1 % and 0.35 and 0.48 L min⁻¹, respectively.

Conclusion

The new EB-test prediction equation provides an easy administered and valid estimation of VO₂max for a wide variety of ages (20–86 years) and fitness levels (19–76 mL kg⁻¹ min⁻¹).

Reflections on Physical Activity and Health: What Should We Recommend?

The health benefits of regular physical activity are irrefutable; virtually everyone can benefit from being active. The evidence is overwhelming with risk reductions of at least 20%-30% for more than 25 chronic medical conditions and premature mortality. Even higher risk reductions (ie, ≥ 50%) are observed when objective measures of physical fitness are taken. International physical activity guidelines generally recommend 150 minutes per week of moderate- to vigorous-intensity physical activity. A critical review of the literature indicates that half of this volume of physical activity might lead to marked health benefits. There is compelling evidence to support health promotion strategies that emphasize that health benefits can be accrued at a lower volume and/or intensity of physical activity. Public health policies are needed that reduce the barriers to physical activity participation such that everyone can reap the benefits of physical activity. It is also important to highlight that sedentary time (particularly sitting time) carries independent health risks. The simple message of "move more and sit less" likely is more understandable by contemporary society and is formed on the basis of a strong body of evidence. For practitioners who work directly with clients, it is recommended that an individualized prescription (dosage) that takes into consideration the unique characteristics and needs of the client is provided. Physical activity or exercise promotion should not be done in isolation; it should be part of an integrated approach to enhance healthy lifestyle behaviours.