Sedentary Behavior, Exercise, and Cardiovascular Health

Multidimensional Risk Factors for Heart Failure in Hispanic Adults: Findings from the All of Us Research Program

Heart failure (HF) is a leading cause of morbidity and mortality in the United States affecting approximately 6.7 million adults. In Hispanic adults, HF is underdiagnosed, leading to an incomplete characterization of the HF risk profiles in this population. Thus, the objective of the study was to investigate the multidimension HF risk factors among Hispanic adults. This cross-sectional study analyzed observational data collected from Hispanic adult participants in the All of Us Research Program. Sociodemographic, lifestyle, environmental, stress, and health care access and utilization data were retrieved from the survey domain. Past medical history was retrieved from the electronic health record domain. Using SAS, logistic regression was performed to identify multidimension risk factors for HF in Hispanic adults. The study subjects consisted of 5,281 Hispanic adults with 72.5% females and 27.5% males. The prevalence of HF was 3.6% (188/5,281). Males had a higher prevalence of HF than females (5.7% vs 2.7%). After adjusting for potential confounders with logistic regression, age (OR = 1.03, 95% CI [1.01, 1.04], p <0.0001), hypertension (OR = 5.75, 95% CI [3.23, 10.24], p <0.0001), heart attack (OR = 11.31, 95% CI [7.71, 16.58], p <0.0001), type 2 diabetes mellitus (OR = 1.45, 95% CI [1.02, 2.06], p = 0.0383), and obesity (OR = 2.32, 95% CI [1.60, 3.36], p <0.0001) were significant risk factors for HF. In conclusion, multidimension risk factors for HF among Hispanic adults were explored in this study. More research is needed to compare these risk factors to other non-Hispanic populations.

Cross-sectional study of lipoprotein(a) and the severity of coronary artery disease, cerebrovascular disease, and peripheral vascular disease in a group of South Asian patients

Background

Atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), remain the leading cause of death globally. South Asians exhibit a higher incidence of cardiovascular diseases than other ethnicities, attributed to a range of genetic, environmental, and lifestyle factors. Lipoprotein(a) [Lp(a)] with a unique apolipoprotein(a) component, has emerged as a marker of atherosclerosis and ASCVD risk, with evidence to promote arterial plaque formation and thrombogenesis.

Objective

The aim of this study was to explore the associations between Lp(a) levels and the severity of CAD, CVD, and PVD in a group of South Asian patients.

Methods

Following ethical approval, 60 consecutive patients who underwent coronary angiography for any indication were reviewed. There were 51 eligible participants who were evaluated for Lp(a) level, Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, and severity of CVD and PVD. The SYNTAX-I score was calculated using two-observer consensus on coronary angiograms. Assessment of CVD was by ultrasound/Doppler, and PVD by estimating ankle-brachial index using Doppler. The multisite arterial disease score 2 (MADS2) and SYNTAX score tertiles were used to group the patients. Statistical analysis was performed using the SPSS software.

Results and discussion

In this group, we identified a statistically significant difference with higher Lp(a) levels being associated with more severe coronary disease (SYNTAX tertile 2,3). Despite a numerical trend, statistical significance was not confirmed for Lp(a) levels in relation to MADS2-CVD or MADS2-PVD scores. A larger study may be required to assess these aspects.

Body Mass Index Predicts Function in Individuals With Plantar Fasciopathy: A Longitudinal Observational Study

CONTEXT

Plantar fasciopathy (PF) is a common, self-limiting condition with notable economic impact and multifactorial origins. Clinical tests help clinicians to identify specific dysfunction and limitations influencing PF's clinical course. This study aims to investigate whether body mass index (BMI) influences the performance of clinical tests and clinical presentation of individuals with PF and to determine whether BMI and clinical tests predict the clinical course of PF over a 3-month follow-up period.

DESIGN

This study is a longitudinal observational study. Participants were grouped, according to the median BMI, into low and high BMI.

SETTING

Healthcare centers and physiotherapy clinics.

PARTICIPANTS

Fifty-two individuals with PF participated in this study.

MAIN OUTCOME MEASURES

Baseline: Ankle dorsiflexion range of motion and navicular drop, heel-rise, and step-down tests were administered. Pain intensity and function were measured at baseline and at 3-month follow-up.

RESULTS

Low BMI group showed better function (mean difference = 11.8; 95% CI, 1.9 to 21.6) and lower pain intensity (mean difference = -1.5; 95% CI, -2.6 to -0.3) than the high BMI group. In the multivariable regression model, higher BMI predicted lower function (beta coefficient = -1.20; 95% CI, -2.3 to -0.3).

CONCLUSIONS

In individuals with PF, BMI levels influenced PF clinical presentation. The high BMI group showed more severe pain and lower function. Higher BMI was found to be a poor prognostic factor for function in individuals with PF.

The prevention and management of chronic kidney disease among patients with metabolic syndrome

Treatment of patients with chronic kidney disease (CKD) requires implementation of prevention and management strategies that reduce the risk of kidney failure and CKD-associated cardiovascular risk. Metabolic syndrome is characterized by obesity, high blood pressure, dyslipidemia, and hyperglycemia, and it is common among patients with CKD. Large-scale randomized trials have led to significant advances in the management of CKD, with 5 pharmacotherapies now proven to be nephroprotective and/or cardioprotective in certain types of patients. Renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors slow kidney disease progression and reduce heart failure complications for most patients with CKD. In addition, statin-based regimens reduce low-density lipoprotein cholesterol and lower the risk of atherosclerotic disease (with no clinically meaningful effect on kidney outcomes). For patients with type 2 diabetes and albuminuric CKD, the nonsteroidal mineralocorticoid receptor antagonist finerenone and the glucagon-like peptide-1 receptor agonist semaglutide also confer cardiorenal benefits, with semaglutide additionally effective at reducing weight. Together, these randomized data strongly suggest that metabolic syndrome mediates some of the cardiorenal risk observed in CKD. Considered separately, the trials help elucidate which components of metabolic syndrome influence the pathophysiology of kidney disease progression and which separately modify risk of atherosclerotic and nonatherosclerotic cardiovascular outcomes. As we predict complementary and different mechanisms of nephroprotection and cardioprotection for these different interventions, it seems logical that they should be deployed together to maximize benefits. Even when combined, however, these therapies are not a cure, so further trials remain important to reduce the residual cardiorenal risks associated with CKD.

Influence of Plant-Based Diet on the Cardiovascular System: A Narrative Review

A plant-based diet (PBD) includes multiple dietary patterns such as vegetarianism, veganism, lacto-ovo-vegetarianism, etc. A well-balanced PBD has positive effects on body mass index, hyperlipidemia, and type 2 diabetes, and it is associated with decreased risk of cardiovascular diseases. Due to its high fiber content, which lowers levels of low-density lipoprotein cholesterol, high antioxidant content, which prevents capillary wall damage; the presence of polyunsaturated fatty acids, which have an anti-inflammatory effect, improvement in glucose homeostasis through improved insulin sensitivity, and impact on the gut microbiota, it has been proven to be beneficial for the heart. Despite their possible benefits, PBDs can be low in essential nutrients such as vitamin B12, zinc, vitamin D, iodine, and amino acids. This review aims to analyze the influence of PBDs on the cardiovascular system and associated disease progression.

Relationship between trait mindfulness and physical activity among emerging adults: The mediating roles of exercise-related cognitive errors and trait self-control

OBJECTIVE

Exercise-related cognitive errors (ECEs) is a significant factor that can negatively influence physical activity (PA) engagement among emerging adults, whereas mindfulness interventions may be beneficial for promoting PA. Against this background, we investigated the potential association between trait mindfulness and PA levels among emerging adults and determined whether trait self-control and ECEs serve as mediators.

METHOD

328 Chinese participants (61.3 % female, mean age = 20.65, SD = 2.21) completed a series of questionnaires, including demographics, the Five Dimension Mindfulness Questionnaire short form (FFMQ-SF), the Exercise Cognitive Bias Questionnaire (E-CEQ), the Brief Self Control Scale (BSCS), and the short form of the International Physical Activity Questionnaire (IPAQ-SF). A structural equation model was used to investigate the potential relationships between trait mindfulness and PA levels, considering trait self-control and ECEs as mediators.

RESULTS

Trait self-control (Indirect 1; B = 0.09, 95%CI: 0.04, 0.16) and ECEs (Indirect 3; B = 0.02, 95%CI: 0.00, 0.04) mediates the relationship between trait mindfulness and PA levels, respectively, when considered as independent mediators. In addition, also in a dual-mediation model ECEs and trait self-control (Indirect 2; B = 0.02, 95%CI [0.00, 0.06]) mediate the relationship between trait mindfulness and PA.

CONCLUSIONS

This study provides evidence that trait self-control and ECEs are mediators of the relationship between trait mindfulness and PA levels, providing a new direction for further research aiming to reduce ECEs and improve PA levels among emerging adults.

Short sleep duration and daytime outdoor activities effects on adolescents mental health: A stress susceptibility-recovery model analysis

BACKGROUND

Mental health disorders are a growing public health challenge globally. This study aimed to utilize the Stress Susceptibility-Recovery Model to identify the relationship between sleep duration, daytime outdoor activities, and major mental health outcomes among adolescents.

METHODS

Data from the Yunnan Students' Common Disease Survey was analyzed. Multi-factorial logistic regression assessed the impact of each variable on mental health, while subgroup analyses and interaction tests examined the stability of the association between sleep duration, daytime outdoor activity, and mental health. Mendelian Randomization analysis assessed causal effects.

RESULTS

The analysis included 204,158 participants aged 12-18 from 953 surveillance schools. After adjusting for covariates, the prevalence of depressive mood increased from 18.81 % (12-13 years) to 24.89 % (16-18 years); Females had a higher prevalence than males (1:1.36). Senior high school students (26.04 %) had a significantly higher rate than junior high school (21.41 %), and vocational high school students (18.42 %). Students with <2 h of daytime outdoor activity had a higher prevalence of depressive mood (24.40 %) compared to those with 2 or more hours of daytime outdoor activity (19.96 % for 2 h and 19.70 % for 3 or more hours). Short sleep duration mediated the association between reduced daytime outdoor activity and increased depressive mood or affective disorders risk, supporting the Stress Susceptibility-recovery Model.

CONCLUSIONS

Seep duration and daytime outdoor activity were key determinants of emotional well-being, considering aging and gender disparities.

LIMITATIONS

Potential sampling bias due to differences in baseline characteristics between participants with and without missing data.

Impact of resistance and high-intensity interval training on body composition, physical function, and temporal dynamics of adaptation in older women with impaired cardiometabolic health: a randomized clinical trial

PURPOSE

Physical inactivity is associated with reduced physical fitness (PF) in older women with impaired cardiometabolic health. Although exercise has been shown to improve PF, interindividual variability in response and adaptation changes over time remain unclear. This study evaluated the effects of eight weeks of resistance training (RT) and high-intensity interval training (HIIT) on body composition, isometric strength, and the 6-minute walk test (6MWT) in older women with impaired cardiometabolic health. Additionally, the study explored the reduction of non-responders (NRs) and adaptation changes over time.

METHODS

This randomized clinical trial involved 36 older women (64 ± 8.4 years; BMI: 31.8 ± 5.5) with impaired cardiometabolic health, divided into RT-G (n = 12; 62 ± 7 years; BMI: 32.2 ± 4.1), HIIT-G (n = 12; 66 ± 10 years; BMI: 31.2 ± 4.1), and CG (n = 12; 64 ± 9 years; BMI: 31.8 ± 6) groups. RT-G performed elastic band exercises, and HIIT-G performed cycle ergometer intervals. BMI, body fat, lean mass, isometric strength, and 6MWT were measured at baseline and at four and eight weeks. The Student's t-test was applied for normally distributed variables and the Mann-Whitney U test for non-normal variables. Intra- and inter-group differences were analyzed using a two-way repeated measures ANOVA, considering group, time, and their interaction. Post-hoc comparisons were conducted using the Bonferroni test. Individual responses (IR) were calculated using the equation proposed by Hopkins: SDIR = √(SDExp2 - SDCon2). The prevalence of responders (Rs) and non-responders (NRs) was expressed as a percentage, and percentage changes from baseline to weeks four and eight were used to evaluate adaptations dynamics.

RESULTS

By week eight, isometric strength in RT-G significantly improved from 21.3 ± 4.4 to 24.37 ± 3.99 kg (p = 0.027; 95% CI: 1.8, 4.3 kg; Cohen's d = 0.731) and 6MWT distance in HIIT-G increased from 441.0 ± 48.9 to 480.0 ± 53.0 m. (p = 0.002; 95% CI: 22, 55 m; Cohen's d = 0.757). Both protocols reduced NRs for body fat, lean mass, and 6MWT. Responders showed greater adaptations in the first four weeks, stabilizing by week eight.

CONCLUSION

RT and HIIT improved PF in older women with impaired cardiometabolic health, reducing NRs in terms of body composition and 6MWT over eight weeks, with similar adaptation changes over time among the responders. These findings highlight the importance of individualized exercise interventions to maximize health benefits.

TRIAL REGISTRATION

This study was part of a trial registered at ClinicalTrials.gov (ID: NCT06201273). Date: 22/12/2023.

Impact of 10 Weeks of Yoga Intervention on Mental Health and Overall Well-Being Among Medical Students: GSY Study

BACKGROUND

the purpose of this study was to explore the effect of 10 weeks of yoga intervention on the mental health outcomes (stress, anxiety, and depression), quality of life, emotional regulation, and quality of sleep of medical students.

METHOD

In the current experimental study, 220 medical students, with a mean age of 21.36 ± 2.20 years, participated in a 10-week yoga intervention at the University of Pécs. Data were collected before and after the intervention using the validated questionnaires DASS-21, WHOQOL-BREF, PSQI, and DERS. The distribution of data was checked using the Kolmogorov-Smirnov test. A paired sample T-test was used to compare the mean of the continuous variable. Stepwise linear regression was used to assess the association between mental health outcomes and quality-of-life variables.

RESULTS

The present study shows a significant reduction in (p < 0.001), depression (p < 0.001), and anxiety (p < 0.001) for participants, and overall quality of life (p < 0.001), quality of sleep (p < 0.001), and emotional regulation (p < 0.001) significantly improved after the intervention. The stepwise linear regression shows a strong association between higher levels of anxiety (β = 0.608, R2 = 0.366) and depression (β = 0.608, R2 = 0.392), with higher stress levels and improvement in environmental conditions being associated with a decrease in stress levels (β = -0.392, R2 = 0.087).

CONCLUSIONS

the current study shows that yoga significantly improved the mental health and well-being of medical students, improving quality of life, quality of sleep, and emotional regulation.

REGISTERED CLINICAL TRIAL

NCT06661603.

Active futures: combating youth sedentary lifestyles in Pakistan through smart use of fragmented time

Sedentary behavior among adolescents is a growing concern globally, including in Pakistan, due to its association with negative physical and psychological health outcomes. Fragmented time agility training has arisen as a prospective solution to tackle these challenges. The proposed work evaluates the impact of a structured six-week agility training protocol on sedentary behavior, mood, and stress among adolescents aged 12-18 in Pakistan. A total of 100 participants (50 intervention, 50 control) were recruited from three schools in Islamabad, with equal representation of males and females. Participants were randomly assigned to an intervention group that completed daily 30-min agility training sessions (including high-knee running, lateral shuffles, and cone drills, five days a week) or a control group that maintained their usual routines. Sedentary behavior (sitting and screen time), mood [Profile of Mood States (POMS)], and stress levels [Perceived Stress Scale (PSS)] were assessed at baseline and post-intervention. Differences between groups were analyzed using independent t-tests. At post-intervention, significant between-group differences were observed. The intervention group showed reductions in sitting time (6-4 h/day, p < 0.001) and screen time (4-2.5 h/day, p < 0.001) equated to the control group. Mood improvements were noted with decreased tension and fatigue and increased vigor (p < 0.01 for all). Stress levels in the intervention group decreased significantly from 31 to 24 (p < 0.001), though no notable alterations were detected in the control group. Concise, systematically organized agility-oriented training significantly diminishes sedentary behavior while concurrently improving psychological well-being in adolescent populations. This adaptable and economically feasible intervention provides critical insights for public health initiatives focused on mitigating sedentary lifestyles and addressing mental health issues among young individuals, especially in contexts with limited resources.

Handgrip strength and menopause are associated with cardiovascular risk in women with obesity: a cross-sectional study

BACKGROUND

While physical performance is closely linked to cardiovascular health, further research is essential to elucidate the association of physical tests in the early screening for cardiovascular risk (CVR), underscoring the potential for these assessments to enhance preventive healthcare strategies.

OBJECTIVES

To investigate the association between the Handgrip Strength (HGS) test and CVR in women with obesity, as well as to evaluate the predictive value of the HGS test as a CVR screening tool in this population.

METHODS

Fifty-five eligible women with obesity, aged 40 to 65 years, were studied. The Framingham Global Risk Score was used to classify participants into low-risk and moderate/high-risk groups. Dual X-ray Absorptiometry was used to assess body composition. Additionally, clinical and biochemical parameters, along with HGS, were evaluated. Data were analyzed using the logistic regression analysis, and the positive and negative predictive values were calculated; accuracy was defined through the ROC curve and the Youden index. Statistical significance was set at 5%.

RESULTS

The prevalence of the moderate/high CVR was 49%. The menopause [0.14 (0.03-0.52), p = 0.003] and handgrip strength [0.90 (0.82-0.99), p = 0.046] were associated with cardiovascular risk, independent of the clinical and biochemical parameters. The optimal cutoff points for screening CVR were ≤ 37.8 kg for HGS [AUC = 0.73 (0.59-0.84), p = 0.003].

CONCLUSION

HGS and menopause are significantly associated with CVR in women with obesity, highlighting the importance of considering physical evaluation in early clinical screening for CVR. The simple measure of HGS emerged as a promising tool for cardiovascular prevention in this population.

A Pilot 24-Week 'Bulk and Cut' Dietary Protocol Combined with Resistance Training Is Feasible and Improves Body Composition and TNF-α Concentrations in Untrained Adult Males

Background/Objectives: This study piloted a 24-week bodybuilding program combining resistance training (RT) with a dietary bulk-and-cut protocol in middle-aged adult males. Methods: Seven untrained males (33 ± 3.0 years; BMI = 35.0 ± 4.6 kg/m2; body fat = 36 ± 5%) completed a 24-week intervention combining RT with a dietary protocol consisting of 12-week cycles of caloric bulking (0-12 weeks) and cutting (12-24 weeks). The participant retention rate was 64%, while compliance with training was 96.7%, and adherence to dietary cycles was over 93%. To assess the preliminary efficacy of the intervention, venous blood samples and measurements of body composition (BodPod), muscle strength, and VO2max (cycle ergometer) were collected at baseline (week 0) and following the bulking (week 12) and cutting (week 24) cycles. Circulating lipids (triglycerides, total, low-density, and high-density cholesterol), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured in serum. Results: The training led to significant increases in muscle strength, especially in the deadlift (+46%, p < 0.001) and squat (+65%, p < 0.001). Improvements in body composition were characterized by an increase in fat-free mass and a decrease in body fat percentage over the 24-week intervention (+3% and -6%, respectively, p < 0.05). Lipids, CRP, IL-6, and IL-10 did not change significantly, but there was a notable reduction in TNF-α (time effect p = 0.05, pη2 = 0.39), with 15% lower concentrations at week 24 compared to baseline, indicating reduced inflammation. Conclusions: Overall, the pilot intervention achieved high compliance and adherence rates, leading to improvements in body composition and lower resting TNF-α concentrations in a group of middle-aged males with obesity.

Purine Metabolism Pathway Influence on Running Capacity in Rats

Background: The natural differences in running capacities among rats remain poorly understood, and the mechanisms driving these differences need further investigation. Methods: Twenty male Sprague-Dawley (SD) rats were selected. High and low running capacity rats were identified using Treadmill Exhaustion Tests. Peripheral blood was collected for serum isolation, followed by a metabolomics analysis using LC-MS/MS. Data were preprocessed, and a principal component analysis (PCA) and a partial least squares-discriminant analysis (PLS-DA) were applied to identify metabolic profile differences. Significant metabolites were screened, and a pathway enrichment analysis was conducted using the KEGG database to determine key metabolic pathways. Forty SD rats (equal male and female) were randomly divided into an inosine triphosphate (ITP) group (24.29 mg/kg.bw daily) and a control group. Running capacity was assessed after one week of continuous treatment. Results: Three independent measurements showed consistent differences in running capacity. A total of 519 differential metabolites were identified, with 255 up-regulated and 264 down-regulated. The KEGG pathway analysis revealed a significant enrichment of the Purine Metabolism pathway (ITP-ATP) in the high running capacity group (p < 0.05). The ITP-treated group exhibited a significantly higher running capacity than the controls (p < 0.05), confirming the efficacy of dietary ITP supplementation. Conclusions: The running capacity of rats is influenced by the ITP-ATP pathway, and exogenous ITP administration through dietary intervention significantly improves running ability.

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

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

Individual and socio-psychological characteristics as predictors of physical activity among men living with overweight and obesity taking part in the Aussie Fans in Training weight management behaviour change programme

Background

Sufficient physical activity (PA) is important to reduce the risk of men developing chronic diseases and to improve mental health. The effectiveness of PA programmes can vary, however, among men. Individual and socio-psychological characteristics may affect the level of men's PA before starting a behaviour change programme as well as changes in PA during the programme.

Aims

The primary objective of this study was to examine the role of individual and socio-psychological characteristics in predicting men's (a) accelerometer-assessed PA (step count and moderate to vigorous PA [MVPA]) upon presentation to a behaviour change programme and (b) changes in PA (step count and MVPA) during a behaviour change programme.

Methods

A total of 109 men (mean age = 45.5 years, SD = 7.8 years, mean body mass index = 34.5 kg/m2, SD = 5.1 kg/m2) who participated in the Australian Fans in Training 3-month PA and dietary behaviour change programme in 2018 participated in this study. Before and after completing the 12-week programme, men completed assessments including individual (age, weight) and socio-psychological (psychological needs support, psychological needs satisfaction, positive affect and negative affect) characteristics. We used regression analysis to examine the relationship between these variables and PA.

Results

At baseline, men's weight (β = -.36, p < .001) and positive affect (β = .29, p < .01) were significant predictors of step count. At baseline, men's weight (β = -.21, p < .05) and negative affect (β = .23, p < .05) were significant predictors of MVPA, though the overall model did not display statistical significance. The overall regression models did not significantly predict changes in either step count or MVPA pre- to post-programme.

Conclusion

The influence of weight and positive and negative affect in predicting PA outcomes suggests that tailoring men's health behaviour change interventions to individual circumstances and needs could enhance their effectiveness for some men.

Cardiometabolic disease risk in relation to objectively measured physical activity, sedentary behaviour in South African adults with knee and hip osteoarthritis

PURPOSE

This study aimed to investigate the relationship between cardiometabolic disease risk and time spent in device-measured activity behaviours in a cohort of people with advanced osteoarthritis (OA) awaiting joint replacement surgery.

MATERIALS AND METHODS

Cardiometabolic risk biomarkers were assessed in people with OA (n = 96; hip n = 38, knee n = 58; mean (SD) age = 64.3 (9.8) years; 71% female). Physical activity (PA) and sedentary behaviour (SB) were measured by accelerometer over seven days (24 h/day).

RESULTS

There were similar patterns of PA and SB between the hip and knee OA participants except for total number of steps (hip = 3365 (2926) vs knee 4344 (2836) steps/day; p = 0.018) and total stepping time (hip = 50.8 (38.2) vs knee = 67.2 (38.5) min/day; p = 0.005). Each additional cardiometabolic risk factor accumulated was associated with a 26.3 min/day increase in sedentary behaviour (p = 0.032; 95% CI: 2.3, 50.2), a 26.3 min/day decrease in upright time (p = 0.032; -50.2, -2.3) and a 23.6 min/day decrease in standing time (p = 0.032; -45.1, -2.1).

CONCLUSIONS

In people with hip or knee OA, increased cardiometabolic disease risk was associated with more sitting and less upright and standing time. Findings support targeting reductions in sedentary behaviour for improvements in cardiometabolic health in people with osteoarthritis. IMPLICATIONS FOR REHABILITATIONKnee and hip osteoarthritis is a condition which is associated with an increased risk of cardiometabolic disease but also due to the low levels of physical activity and high levels of sedentary behaviour.Offsetting sedentary behaviour with light physical activity offers a feasible interventional target to reduce the risk of cardiometabolic disease in people with hip and knee osteoarthritis.

Trends and inequalities in physical fitness and nutritional status among 0.72 million Chinese adults aged 20-59 years: an analysis of five successive national surveillance surveys, 2000-2020

Background

Few comprehensive studies have assessed the long-term trends in physical fitness and nutritional status among Chinese adults, along with the socioeconomic inequalities. This study aimed to bridge this gap by examining the temporal changes and the evolution of socioeconomic disparities in physical fitness and nutritional status among Chinese adults aged 20-59, based on five successive national surveillance surveys.

Methods

We integrated data from five consecutive rounds of National Physical Fitness Surveillance (2000, 2005, 2010, 2014, and 2020) among Chinese adults aged 20-59 years. BMI was categorized into underweight (<18.5 kg/m2), overweight (24.0-27.9 kg/m2), and obesity (≥28.0 kg/m2). Central obesity was defined as a waist circumference ≥90 cm for males and ≥85 cm for females. A composite physical fitness indicator (PFI) was calculated by aggregating the Z-scores of all six components. Provinces were ranked by GDP per capita ($) and stratified into three socioeconomic strata from least (T1) to most developed (T3). Generalized additive models (GAMs), adjusted for age and sex, were employed to assess the associations between nutritional status, PFI, and both per capita GDP and urbanization levels.

Findings

A total of 716,790 Chinese adults aged 20-59 were included in the analysis. The PFI score declined from 0.71 in 2000 to -0.84 in 2020, with a particularly sharp annual decline between 2014 and 2020. The underweight prevalence declined from 5.54% in 2000 to 3.51% in 2020, while the prevalence of overweight, obesity, and central obesity increased to 35.84%, 15.05%, and 32.10% in 2020, respectively. After 2005, the urban-rural disparities in physical fitness narrowed, whereas the gap between most and least developed regions widened, with urban and high-SES regions consistently showing better fitness. The prevalence of overweight, obesity, and central obesity in urban and economically developed regions was higher than in less economically developed and rural regions in earlier years, but this pattern reversed over time. The underweight prevalence showed the opposite trend. With increasing GDP per capita, PFI initially rose before declining at higher levels, and it showed a positive correlation with urbanization. Overweight prevalence increased with GDP per capita but slowed at higher levels, while obesity and central obesity exhibited an N-shaped relationship with GDP per capita. Moreover, prevalence of overweight, obesity, and central obesity were positively correlated with urbanization.

Interpretation

During the first two decades of the 21st century, China experienced rapid economic growth accompanied by declining physical fitness and rising prevalence of overweight, obesity, and central obesity among adults aged 20-59 years. Inequalities in nutritional status between urban and rural areas and across socioeconomic strata reversed. Less developed and rural regions may face dual challenges of deteriorating physical fitness and the growing burden of overnutrition, which requires urgent attention. The complex interplay between socioeconomic development, urbanization, and physical health further emphasizes the need for health policies tailored to diverse socioeconomic contexts and subpopulations.

Funding

National Natural Science Foundation of China (72474005, 72122001) and the Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health (PKUWF-Y12).

Time reallocation to moderate-to-vigorous physical activity and its association with chronic kidney disease prevalence in Chinese adults with type 2 diabetes

AIMS

To examine the isotemporal substitution association of replacing moderate-to-vigorous physical activity (MVPA) with other behaviors on the prevalence of chronic kidney disease (CKD) among Chinese adults with type 2 diabetes mellitus (T2DM).

METHODS

This study included 5421 adults with T2DM from the National Metabolic Management Centre Ningbo Branch. Data on physical activity, sedentary behavior, and sleep were collected using a standardized questionnaire through face-to-face interviews. Isotemporal substitution models were employed to evaluate the associations of reallocating time from other behaviors to MVPA with the risk of CKD.

RESULTS

Substitution of 30 min per day of sleeping or sitting with MVPA was associated with a lower CKD prevalence (OR: 0.87 for sleep substitution; 0.90 for sitting substitution). Among individuals with inadequate MVPA levels (less than 150 min per week), the association of replacing 30 min of sleeping, sitting, or low-intensity physical activity with MVPA was particularly strong, cutting the risk of CKD by more than 60%. Stratified analysis among participants with inadequate MVPA revealed that the association of reallocating time to MVPA with lower CKD prevalence were predominantly observed among men, individuals with prolonged sleep duration (sleep duration more than 7.5 h per day), and those with better glycemic control (HbA1c levels below 7%).

CONCLUSIONS

This study revealed that replacing sleep or sedentary time with MVPA was associated with a lower prevalence of CKD among Chinese adults with T2DM, especially those with low MVPA. Incorporating MVPA into daily routines is potentially beneficial for improving renal health in people with T2DM.

A potential environmental paradox in India: Associations between air pollution precautions and sedentary behaviour among children and youth

The negative impact of ambient air pollution on movement behaviours in the global south is a significant concern. Yet, evidence about this complex relationship is limited. This study assessed how precautions taken to prevent ambient air pollution exposure are associated with sedentary behaviour among children and youth in India. Participants aged 5-17 years (N = 986) from 41 schools in 28 urban and rural areas across India completed online surveys to provide information on movement behaviours, including precautions taken to avoid exposure to air pollution, perception of built environment, and sedentary behaviour. Multivariate gamma regression models were developed, adjusting for sociodemographic variables with sedentary behaviour as the primary criterion variable. Apart from an overall sample model, six segregated models were built to understand age, gender, and geographical variations. Children and youth who reported taking precautions to prevent ambient air pollution exposure were associated with significantly higher daily minutes of sedentary behaviour in both the overall sample (β = 0.085, 95 % CI = 0.001, 0.169) and the 13 to 17 age group (β = 0.110, 95 % CI = 0.007, 0.227). However, being able to access outdoor physical activity facilities before or after school was associated with lower sedentary behaviour in the following models: overall, rural, 5 to 12 and 13 to 17 age groups, and boys and girls. To our knowledge, this is the first study to depict a potential paradoxical relationship between precautions taken to avoid exposure to ambient air pollution and higher sedentary behaviour among children and youth in India i.e., a health-preserving behaviour is perpetuating another chronic disease risk factor.

A reference equation for peak oxygen uptake for cycle ergometry in Chinese adult participants

Accurately quantifying cardiorespiratory fitness (CRF) through cardiopulmonary exercise testing (CPET) is increasingly important for improving risk assessment and guiding clinical decisions. However, research on V̇O2peak reference values and predictive equations for the Chinese population remains limited. This study aimed to establish a V̇O2peak predictive equation for Chinese adults. This study analyzed healthy participants who underwent CPET at Peking University Third Hospital (PUTH) from September 1, 2017, to September 1, 2023. Data from September 1, 2017, and August 31, 2021 were used as the derivation cohort, and September 1, 2021, to September 1, 2023 were utilized as an external validation cohort for temporal validation. The derivation cohort underwent backward multivariate regression analysis to generate the V̇O2peak prediction equation, which was compared with the widely-used Wasserman, FRIEND and Xiangya equations. The PUTH derivation cohort (N = 4531, mean age: 50.7 years, 18-88 years) and validation cohort (N = 4624, mean age: 46.1 years, 18-89 years) included 48.8 and 48.5% men, respectively. With increasing age, both men and women V̇O2peak exhibited a general decline. The predictive equation for V̇O2peak was established based on the derivation cohort: V̇O2peak (mL·min-1) =  -24364.9 - 621.3 × Sex (Women = 1, Men = 2) -10.7 × Age + 0.2 × Height2 (cm) + 6464.7 × Log(BMI) -24997.2 × Log(BSA) +12388.6 × Log(LBM) (adjusted R2 = 0.624, p < 0.001). It demonstrated higher consistency between measured and predicted results compared to Xiangya, Wasserman, and FRIEND equations. This study presents the PUTH equation, a new V̇O2peak prediction equation for Chinese adults. Compared to existing equations, the PUTH equation shows reduced bias and improved accuracy, providing a more reliable tool for assessing CRF and guiding clinical interventions in the Chinese population.

Exercise interventions for patients with heart failure: an evidence map

Background and aims

Although exercise performance is an essential tool for managing heart failure, there is still no consensus on whether exercise prescriptions can be universally applied to all types of heart failure patients. This study aimed to describe and evaluate the evidence on exercise interventions for patients with heart failure by creating an evidence map.

Methods

We searched PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database to identify systematic reviews and meta-analysis. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) to evaluate the quality of included systematic reviews and meta-analysis. Bubble charts were employed to visualize key characteristics like intervention effectiveness, literature quality, literature quantity, and heart failure types. Matrix bubble charts were used to show the distribution of outcome indicators, exercise methods, literature quantity, and heart failure types.

Results

A total of 113 systematic reviews/meta-analyses were included and over 80% of studies conclude that exercise is beneficial for heart failure patients. Three heart failure types involved varied due to different classification criteria used in the included literature. Eleven types of exercise interventions have been applied in patients with heart failure and mixed modality exercise is the exercise type with the highest attention. Existing researches focus more on the improvement of exercise capacity and cardiorespiratory function in heart failure patients. Most researchers tend to focus on conducting exercise intervention studies in HFrEF.

Conclusions

The evidence map provides a visual overview of the research volume and findings on exercise interventions for heart failure patients. Exercise interventions have significant advantages for heart failure patients, but there is room for improvement in study quality, heart failure classification, and outcome indicators. Future research should focus on designing more high-quality studies to provide more high-level evidence for this field.

Association between sedentary behavior, depressive symptoms, and the risk of all-cause and cause-specific mortality among U.S. cancer survivors

BACKGROUND

Sedentary behavior and depressive symptoms are commonly observed in cancer survivors. However, the combined impact of these factors on the mortality outcomes of cancer survivors remains unknown.

METHODS

Cancer survivors from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) were selected. Multivariate-adjusted Cox regression analyses were employed to examine the intendent and joint prognostic effects of sedentary behavior and depressive symptoms on the mortality outcomes of cancer survivors.

RESULTS

A total of 2,460 US adult cancer survivors (men = 1,143 and women = 1,317) were included. Severe sedentary behavior (≥ 8 h/day) was linked to higher all-cause [hazard ratio (HR) = 1.68, 95% confidence interval (CI): 1.36-2.09, p < 0.001] and noncancer mortality (HR = 1.80, 95% CI: 1.35-2.40, p < 0.001) in cancer survivors. Each additional hour of sedentary time increased the risk of all-cause (HR = 1.05, 95% CI: 1.02-1.08, p < 0.001) and noncancer mortality (HR = 1.07, 95% CI: 1.04-1.11, p < 0.001). Depressive symptoms (PHQ-9 ≥ 5) were also associated with higher all-cause (HR = 1.22, 95% CI: 1.01-1.48, p = 0.040) and noncancer mortality (HR = 1.27, 95% CI: 1.01-1.61, p = 0.045). In the joint analysis, cancer survivors with both depressive symptoms and severe sedentary behavior had the highest risk of all-cause mortality (HR = 2.06, 95% CI: 1.47-2.88, p < 0.001). Survivors with no depressive symptoms but severe sedentary behavior also had a higher risk (HR = 1.44, 95% CI: 1.10-1.88, p = 0.008). Additionally, the combination of depressive symptoms and severe sedentary behavior increased risks of cancer-specific (HR = 1.56, 95% CI: 1.04-2.34, p = 0.001), noncancer (HR = 1.86, 95% CI: 1.34-2.57, p < 0.001), and CMD-related mortality (HR = 1.74, 95% CI: 1.04-2.93, p = 0.037). In subgroup analysis, cancer survivors with endocrine-related and gastrointestinal cancers were more sensitive to these effects.

CONCLUSION

Our study highlighted the importance of considering both sedentary behavior and mental health in making effective long-term follow-up recommendations for cancer survivors.

The Relationship Between Motivation for Physical Activity, Physical Activity Level, and Body Mass Index for University Students

The object of the study was to identify the relationship between the motivation for physical activity, the physical activity index (PAI), and the body mass index (BMI) for a sample of university students, taking into consideration the gender difference. The study subjects were 813 (340 men and 473 women), and the age range of the participants varied between 18 and 25 years. The RM 4-FM (Motivation for Physical Activity and Exercise) and PAI online questionnaires were applied to measure the motivation and the physical activity level. The study's novelty focused on analyzing how intrinsic and extrinsic motivation interact and correlate BMI and physical activity levels (PAI). Regarding gender, we approached the identification of motivational differences and the level of physical activity of students from non-sports faculties to identify relevant aspects for promoting proactive behaviors. Results revealed significant gender differences: men had a higher PAI (53.48 ± 28.11) than women (36.67 ± 23.92, p < 0.01); BMI (23.25 vs. 21.69, p < 0.01). The Cohen's value of RAI of RM 4-FM, BMI, and PAI were > 0.5, indicating a large effect size. The analysis presents a unique perspective of the interactions between psychological factors, motivation, and physical characteristics, providing insight into developing strategies to improve and promote a proactive lifestyle.

Correlates of physical activity, sedentary time, and cardiovascular disease risk factors in autistic adults without intellectual disabilities

BACKGROUND

Emerging evidence indicates that autistic adults without intellectual disabilities (ID) are at elevated risk of developing cardiovascular disease (CVD).

AIMS

This cross-sectional survey study aimed to assess the prevalence of physiological and mental health risk factors for CVD and examine how physical activity (PA) and sedentary time (ST) relate to CVD risk in autistic adults without ID.

METHODS

An online self-report survey addressing PA, ST, and CVD risk factors was delivered to 229 autistic adults without ID aged 18-55 years. Participants were recruited via direct contact with autism advocacy organizations in the U.S. and autism support groups on social media. Binary logistic regression analyses were used to explain the impact of PA and ST on CVD risk factors.

RESULTS

Higher ST was significantly associated with increased odds for high blood pressure, stroke, and mental health risk factors (depression, anxiety, bipolar, and obsessive-compulsive disorder; all p < 0.05). No significant associations were found between PA and CVD risk factors.

CONCLUSIONS

Excessive ST in autistic adults without ID is associated with an increased risk for certain CVD factors, particularly those related to poor mental health. Health interventions should focus on breaking up prolonged sitting as a CVD prevention strategy in this population.

The Influence of Recreational Hiking on the Prevalence of Cardiovascular and Psychiatric Diseases Among Population of Republic of Serbia

Background: Hiking is a physical activity recommended for people of all ages. In an era of increased incidence of cardiovascular and psychiatric diseases, directing individuals to hiking can be very important from both public health and socioeconomic perspectives. Since the health status of recreational hikers and the general population in the Republic of Serbia has not been compared yet, our objectives are to compare the health-related characteristics of those two groups, including the prevalence of comorbidities, pharmacotherapy, and drug consumption. Methods: A descriptive epidemiological study was conducted. Research questions were asked via two specially prepared questionnaires distributed through the Google Forms platform. The means of the two groups were tested by a two-sample Student t-test for independent variables. Results: The sample consisted of 259 hikers and 292 people from the general population. A total of 199 hikers (76.8%) and 218 people from the general population group (74.7%) were declared as healthy. The statistically significant differences between the groups included age, sex, education level, and body mass index. In both groups, the majority of those with pre-existing medical conditions had at least one cardiovascular disease (23.5% of the hikers and 19.5% of the individuals in the general group). Pre-existing psychiatric diseases were noted in 6% of the hikers and in 12% of those in the general group. The average durations of the disease in the hiker and general population were 11.9 and 8.4 years, respectively (p < 0.05), whereas, there were no differences in drug consumption. Conclusions: This pilot study represents the comparison of the cardiovascular and mental health among hikers and the general population in the Republic of Serbia. Although psychiatric diseases were clearly less prevalent among hikers, the prevalence and burden of cardiovascular diseases must be interpreted with caution, due to big age difference between the respondents from both groups. However, our future studies will employ objective measurements and clinical parameters rather than self-reported surveys, so that the health benefits of hiking appear more clearly.

Combinations of physical activity, sedentary behavior and sleep and their associations with cardiovascular risk

BACKGROUND

Cardiovascular diseases (CVD) are the primary cause of global morbidity and mortality. Movement behaviors; physical activity (PA), sedentary behavior (SB) and sleep are essential for cardiovascular health, yet they are often studied separately.

OBJECTIVE

To investigate the association between the movement behaviors with cardiovascular risk (CVR) mediated by sleep quality.

METHODS

Population-based survey in two Brazilian municipalities, collected through face-to-face interview.PA practice was assessed using a question adapted from the study: Surveillance of risk and protective factors for chronic diseases by telephone survey (VIGITEL). Total daily SB time was measured in hours. The proportion of minutes of moderate to vigorous physical activity (MVPA) in relation to SB time was calculated and dichotomized into < 2.5 or ≥ 2.5 min of MVPA per hour of SB. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and CVR was estimated via the Framingham risk score (FRS), categorized as low risk (< 5%) or intermediate to high risk (≥ 5%).

RESULTS

The study involved 1,550 individuals, 46.3% aged 35-59 years and 50.7% female. Multivariate analysis, adjusted for confounders, indicated that individuals with ≥ 2.5 min of MVPA per hour of SB had a lower likelihood of intermediate to high CVR (odds ratio (OR): 0.60; 95%CI: 0.39-0.92), and 16.6% of this effect was mediated by sleep quality (OR: 0.65; 95%CI: 0.43-0.99). In the combined analysis, individuals with an MVPA per SB hour ratio and good sleep quality were less likely to have intermediate to high CVR (OR: 0.38; 95%CI: 0.21-0.69).

CONCLUSIONS

The combination of high MVPA, low SB and good sleep quality, was associated with a less CVR. These findings highlight the importance of integrated interventions addressing multiple movement behaviors to prevent and treat CVR.

Micro-gyms as a catalyst for healthy aging in university and healthcare settings: applications for the Semmelweis-EUniWell Workplace Health Promotion Model Program

Europe is experiencing a significant demographic shift, with aging populations posing economic and social challenges due to increased healthcare costs and a higher prevalence of age-related diseases. Hungary, in particular, faces these challenges acutely due to higher morbidity and mortality rates from a range of chronic age-related diseases and behavioral risk factors. Addressing these issues requires innovative approaches to promote healthy aging. Semmelweis University, the largest healthcare provider and leading health sciences university in the region, is developing a comprehensive healthy aging program. A critical pillar of this program is the Semmelweis-EUniWell Workplace Health Promotion Model Program, a pioneering initiative aimed at tackling unhealthy aging within Hungary's workforce by leveraging the workplace as a platform for health promotion. Central to this program's goal of combating sedentary lifestyles-a significant contributor to age-related health issues-is the innovative use of micro-gyms and motivational interviewing. Micro-gyms, with their compact size and accessibility, provide convenient exercise opportunities, while motivational interviewing fosters intrinsic motivation and personalized counseling to encourage sustained physical activity. Through concerted efforts and innovative approaches, including the implementation of micro-gyms, the Semmelweis-EUniWell Workplace Health Promotion Model Program aims to set a benchmark for workplace health promotion, fostering a healthier and more resilient aging population in Hungary. This program not only enhances the well-being of employees at Semmelweis University and its EUniWell partner institutions but also catalyzes broader transformations in workplace health promotion and healthy aging nationwide.

Sedentary behaviors negatively related to depressive symptoms in college students: The roles of type and duration of sedentary behaviors

OBJECTIVE

This study aimed to examine the associations of different types and duration with sedentary behaviors and depressive symptoms among college students.

METHODS

A cross-sectional study was conducted at a university in Shanghai, China, utilizing convenience sampling to recruit 3,190 participants (mean age 20.06 ± 1.23 years). Sedentary behaviors were self-reported using a structured questionnaire detailing the average daily time spent in different types of sedentary behaviors. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10). Linear regression models were conducted to analyze the associations between sedentary behaviors and depressive symptoms with adjustment for relevant covariates.

RESULTS

Recreational screen-based sedentary behaviors were significantly associated with higher depressive symptom scores on both weekdays (B = 0.523, 95 % CI= 0.409 to 0.637, p < 0.001) and weekends (B = 0.313, 95 % CI= 0.221 to 0.406, p < 0.001). Study-related sedentary behaviors showed no significant association on weekdays (p > 0.05), but were significantly associated with depressive symptoms on weekends (B = 0.084, 95 % CI= 0.017 to 0.151, p < 0.05). Other types of sedentary behaviors (e.g., commuting and eating) also showed a positive association with depression scores on both weekdays and weekends (p < 0.05). Longer durations of recreational screen-based and study-related sedentary behaviors were associated with higher depressive symptom scores (both p < 0.05).

CONCLUSION

The study suggests that the associations between sedentary behaviors and depressive symptoms vary by the type and context of sedentary behavior. Additionally, the duration of each sedentary behavior bout is a significant influencing factor.

The association between living environment and out-of-hospital cardiac arrest risk in adults: the perspective of daily-life contexts

BACKGROUND

Studying the spatial pattern of out-of-hospital cardiac arrest (OHCA) and its environmental impactors is crucial for both providing timely medical assistance and implementing preventative measures. Existing researches have mainly focused on natural and sociodemographic environments, usually at a macro- or meso-scale, while giving less attention to understanding the association between environment and OHCA risk from the perspective of daily-life contexts.

METHODS

In this study, we utilized 1843 eligible OHCA cases from core districts of Beijing in 2020 and employed modified Besag-York-Mollié (BYM2) Bayesian models to investigate the association between living environment (consisting of food environment, physical activity environment, healthcare environment and leisure environment) and adult OHCA risk, as well as its age disparities, at a 1 × 1 km2 cell resolution.

RESULTS

The results show that: (1) Fewer living environment factors are associated with the OHCA risk in the young/middle-aged group compared to the elderly group. (2) Unhealthy food destination like barbecue restaurants in living area is associated with increased OHCA risk in both age groups. (3) Facility inducing sedentary activity like chess rooms and healthcare facilities are associated with increased OHCA risk, but only among the elderly groups. (4) The decreased OHCA risk in the young/middle-aged group is related to public gathering places for socialization and relaxation in living area like coffee shops, while for the elder groups, decreased OHCA risk is associated with more green spaces in the living area.

CONCLUSIONS

The findings suggest that living environment may impact adult OHCA risk through shaping daily habits or providing access to health resources, with the underlying mechanism varying across different age groups. Future planning should fully consider and leverage the impact of living environment in order to effectively reduce OHCA risk.

Validity and reliability study of the Turkish version of the multidimensional outcome expectations for exercise scale (MOEES) in patients with cardiovascular diseases

Outcome expectations are a multidimensional construct encompassing physical, social, and self-evaluative components, significantly influencing adults' exercise behaviors. The study aimed to develop and validate a Turkish version of the 'Multidimensional Outcome Expectations for Exercise Scale' (MOEES) and assess its reliability in adults with cardiovascular disease (CVD). This cross-sectional validation included 150 participants. The MOEES was translated into Turkish, ensuring cultural and linguistic appropriateness, and reviewed by 15 healthcare professionals. Participants' demographic data were collected, and they completed the MOEES, International Physical Activity Questionnaire (IPAQ), and Tampa Scale for Kinesiophobia-Heart (TSK-H) twice, 15 days apart. The internal consistency of the MOEES was excellent, with a Cronbach's Alpha of 0.919. Test-retest reliability showed high intraclass correlation coefficients (ICC) for the physical (0.924), self-evaluative (0.921), and social (0.929) subscales. Confirmatory factor analysis (CFA) indicated an excellent fit (X2/df = 1.782, GFI = 0.908, AGFI = 0.856, CFI = 0.962, RMSEA = 0.072, NFI = 0.918, SRMR = 0.052). Strong correlations were found between MOEES sub-dimensions and IPAQ total and TSK-H scores (p < 0.01), confirming the scale's validity. The Turkish MOEES is a reliable tool for evaluating physical, social, and self-evaluative outcome expectations regarding exercise in CVD patients, making it suitable for clinical and research applications.

Investigation of Physical Activity Levels in the Population of Switzerland: Association With Lifestyle and Sociodemographic Factors

Objective

The aim of the present study was to investigate physical activity levels of the population of Switzerland and the association of lifestyle and sociodemographic factors with physical activity levels.

Methods

The association of physical activity with lifestyle and sociodemographic factors was analyzed by fitting ordinal logistic regression models, using the data of 2057 participants from the National Nutrition Survey menuCH.

Results

The physical activity level of the population of Switzerland was high: less than 10% of the participants are not physically active. Factors associated with lower physical activity levels, were the sociodemographic variables, middle age [age 30-44: odds ratio = 0.53 (95% confidence interval 0.37, 0.77) and age 45-59: 0.60 (0.41, 0.89)] and higher education [tertiary level: 0.50 (0.29, 0.86)] as well as the lifestyle factors higher body mass index [obesity: 0.64 (0.45, 0.90)] and poor self-reported health status [0.68 (0.50, 0.93)].

Conclusion

To improve the physical activity level of the population of Switzerland tailored public health strategies are required that address specific groups, such as individuals in the middle age group or obese individuals.

Physical activity, frailty, and kinesiophobia among older adult patients with coronary heart disease in China

BACKGROUND

Physical activity (PA) offers advantages in the secondary prevention of coronary heart disease (CHD). However, in older adults, frailty and kinesiophobia may exert negative influences on PA engagement.

OBJECTIVE

To investigate PA, frailty, and kinesiophobia among older adult patients with CHD in China.

METHODS

This cross-sectional study enrolled older adult patients with CHD in the cardiac outpatient care unit of the *** University. The International Physical Activity Questionnaire, the Frailty Phenotype Scale, and the Tampa Scale of Kinesiophobia were used to evaluate PA, frailty, and kinesiophobia, respectively.

RESULTS

A total of 239 participants (mean age: 72.0 ± 7.5 years, 148 males) were enrolled. The rates of frailty and pre-frailty were 20.5 % and 46.4 %, respectively. The mean kinesiophobia score was 43.13±5.48. The median metabolic equivalent of task of PA was 2784 MET-min/week, and 25.1 % of the patients did not reach the minimum recommended by AHA (150 mins/week). Spearman rank correlation analysis showed that PA was negatively correlated with frailty (r = -0.559, P < 0.001) and kinesiophobia (r = -0.463, P < 0.001). Multivariable logistic regression analysis showed that frailty [OR = 0.412, 95 % confidence interval (CI): 0.304-0.559, P < 0.001] and kinesiophobia (OR=0.936, 95 % CI: 0.879-0.997, P = 0.040) were independently associated with PA after adjustment for age, cardiovascular adverse events, comorbidities, Barthel index, and history of dizziness.

CONCLUSIONS

Older adult patients with CHD had low levels of PA. Frailty and kinesiophobia were independently associated with PA in older adult patients with CHD. Reversing frailty and reducing kinesiophobia in older adult patients with CHD may increase PA levels.

Sedentary behavior modified the association between depression and risk of all-cause deaths in hypertensive population

OBJECTIVE

The pathogenic mechanism of depression involves chronic inflammation, which can be affected by sedentary behavior. This study aimed to determine whether sedentary behavior modified the association between depression and risk of death in the hypertensive population.

METHODS

Data from the National Health and Nutrition Examination Survey (2007-2018) was analyzed. Depression was assessed through the Health Questionnaire-9, and sedentary behavior was evaluated using self-reported sitting hours in a day. Deaths were ascertained through the National Death Index until 31 December 2019. The interaction effect was evaluated through multivariable Cox regression analysis.

RESULTS

Eight thousand one hundred and twenty-four patients with hypertension were involved in the study. During a median follow-up of 7.3 years, we confirmed 1384 all-cause and 373 cardiovascular deaths. Separate analyses revealed that both depression and sitting for 6 h per day or more were correlated with increased risks of all-cause and cardiovascular deaths. Of note, we found that sitting time modified the link between depression and the risk of all-cause death (P for interaction: 0.02). Compared with the nondepression group, the depression group was correlated with an elevated risk of all-cause death among participants with sitting time of more than 6 h/day [hazard ratio 1.52, 95% confidence interval (CI) 1.22-1.91, P < 0.001], but not among participants with sitting time of less than 6 h/day (hazard ratio 0.95, 95% CI 0.65-1.39, P = 0.76).

CONCLUSION

Sedentary behavior modified the link between depression and the risk of all-cause death. Reducing sedentary time might attenuate the detrimental effects of depression on survival in the hypertensive population.

Associations of triglyceride glucose-body mass index and the combination of sedentary behavior and physical activity with risks of all-cause mortality and myocardial infarction: a cohort study from the UK biobank

BACKGROUND

Triglyceride glucose-body mass (TyG-BMI) index, sedentary behavior (SB) and physical activity (PA) are independently associated with all-cause mortality and myocardial infarction (MI). However, it remains unclear whether TyG-BMI index and the combination of SB and PA exhibit joint effects on all-cause mortality and MI.

METHODS

Among 502 356 participants from the UK Biobank, 297 761 eligible participants were selected. The Cox proportional hazards model and the restricted cubic spline regression model were used to assess the associations of TyG-BMI with all-cause mortality and MI. To conduct stratified analysis, participants were classified into four groups by SB (<6 h/d and ≥ 6 h/d) and moderate to vigorous physical activity (MVPA) (<150 min/wk and ≥ 150 min/wk). Additionally, the multiplicative interaction was assessed between TyG-BMI and SB & MVPA. Furthermore, to estimate their joint associations, participants were conjointly classified into twelve new groups by TyG-BMI (tertiles) and SB & MVPA (four groups).

RESULTS

During a median follow-up of 13.8 and 13.6 years, 21 335 deaths and 9 116 MI were observed, respectively. The dose-response relationship of TyG-BMI with all-cause mortality was U-shaped with a cut-off point at 225.09, whereas the relationship with MI was positive nonlinear with a cut-off point at 266.87. A synergistic effect on all-cause mortality was observed between TyG-BMI tertile 1 and ≥ 6 h/d SB & <150 min/wk MVPA (P for interaction < 0.001). When MVPA ≥ 150 min/wk combined with SB either <6 h/d or not, TyG-BMI tertile 2 showed no significant association with all-cause mortality risk, with HRs(95%CIs) of 0.98 (0.93-1.03) for <6 h/d SB and 1.00 (0.94-1.07) for ≥ 6 h/d SB. When one of the two healthy behaviors was present (i.e., either <6 h/d SB with <150 min/wk MVPA, or ≥ 150 min/wk MVPA with ≥ 6 h/d SB), its combination with TyG-BMI tertile 1 showed no significant association with MI risk, with HRs(95%CIs) of 1.07(0.95-1.20) and 1.09(0.94-1.25), respectively.

CONCLUSIONS

TyG-BMI index and the combination of SB and PA were independently and jointly associated with risks of all-cause mortality and MI. Our findings highlight the importance of improving insulin resistance to reduce all-cause mortality risk, particularly in individuals with long-term SB and insufficient PA, who are more susceptible to the adverse effects of TyG-BMI index. In long-term sedentary individuals, meeting PA guidelines (≥ 150 min/wk of MVPA) effectively mitigated risks of all-cause mortality and MI associated with TyG-BMI index.

Association between meeting the 24-hour movement guidelines and cardiometabolic syndrome in Korean adults

Twenty-four-hour movement guidelines are reported to correlate with a reduction in the risk of metabolic disease in all age groups. We explored the association between meeting 24-h Movement Guidelines and cardiometabolic syndrome in the general adult population using data from the Korea National Health and Nutrition Examination Survey (KNHANES). This population-based cross-sectional study used data from the KNHANES 2014-2017 and included 2151 adults. Physical activity and sedentary behavior were measured using a three-axis accelerometer. Sleep time was measured using a self-reported questionnaire. Compared with adherence to none of the three guidelines, the odds ratio (OR) for meeting two of the three guidelines were 0.66 (95% confidence interval 0.45-0.98), whereas the OR for meeting all three guidelines was 0.24 (95% CI 0.10-0.59). In the analysis of specific combinations, the group that met the physical activity and sleep time guidelines had a significantly lower risk of cardiometabolic syndrome (OR 0.45, 95% CI 0.21-0.90). Consequently, we suggest that adherence to two or more physical activity guidelines may reduce the risk of cardiometabolic syndrome in Korean adults. Furthermore, meeting all three guidelines is more closely associated with cardiometabolic health owing to their synergistic effects.

Physical Inactivity and Cardiovascular Health in Aging Populations: Epidemiological Evidence and Policy Implications from Riyadh, Saudi Arabia

BACKGROUND

Cardiovascular Diseases (CVDs) are the leading cause of morbidity and mortality globally, particularly among older adults. Physical inactivity, a modifiable risk factor, is strongly associated with the development and progression of CVD through its correlation with hypertension, diabetes, obesity, and hyperlipidemia. This study examines the association between physical inactivity and cardiovascular health among older adults in the Riyadh region, Saudi Arabia.

METHODS

A cross-sectional study was conducted on 168 participants aged 60 years and older attending a tertiary hospital in Riyadh. Data were collected using a structured questionnaire, the Physical Activity Scale for the Elderly (PASE), anthropometric measurements, and medical record reviews. Cardiovascular health indicators and risk factors were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression.

RESULTS

Participants with low physical activity levels had a higher prevalence of hypertension (78.2%), diabetes (64.4%), and obesity (51.3%) compared to those with high activity levels (41.8%, 28.7%, and 22.3%, respectively). Multivariate analysis showed that physical inactivity was significantly associated with an increased likelihood of CVD (adjusted OR: 1.98, p < 0.001), with hypertension and diabetes also being strong predictors.

CONCLUSIONS

Physical inactivity is strongly correlated with adverse cardiovascular outcomes in older adults. Interventions targeting increased physical activity are essential to reducing the CVD burden. Community-based programs and policy-driven initiatives tailored to the Riyadh region's specific environmental and cultural factors are crucial in promoting active lifestyles among aging populations.

Examination of factors associated with physical activity among medical students pre and post-COVID-19 in Serbia

The association of physical activity (PA) with the prevention and treatment of various diseases is well known. The issue of insufficient physical activity among university students has worsened due to the effects of the COVID-19 pandemic. The aim of this research is to examine the social, lifestyle, and health factors associated with moderate and high levels of PA in two cross-sectional studies conducted before and after COVID-19 involving 1,266 medical students from five universities in Serbia. Two cross-sectional studies were conducted on the population of fifth-year medical students from five different universities in Serbia before and after the COVID-19 pandemic (in 2019 and 2023). The research instrument was a questionnaire specially designed based on similar research. The mean energy expenditure in MET-minutes per week increased from 2,265.26 ± 1,930.67 in 2019 to 2,871.65 ± 2,301.99 in 2023 (p < 0.001). Multivariate logistic regression analysis with high PA as an outcome variable for the entire sample showed the association of high PA with the University of Kosovska Mitrovica and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2019 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2023 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. The average energy expenditure was significantly higher in 2023. Factors such as studying in Kosovska Mitrovica, scores on the Zung Anxiety Scale, alcohol consumption, binge drinking in the past month, and the number of meals consumed per day were associated with either moderate or high levels of PA or both.

Association between Life's essential 8 and mortality among individuals with hypertension

The "Life's Essential 8" (LE8) score is an assessment of cardiovascular health recently introduced by the American Heart Association. This study aimed to explore the correlation of the total LE8 score and its individual metrics with all-cause and cardiovascular disease (CVD) mortality in patients with hypertension. Data from 10,556 hypertension adults were retrieved from National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. After a median follow-up of 6.75 years, patients with high LE8 scores (≥ 75 points) showed significantly lower mortality rates from all causes and CVD (P < 0.001). Cox regression analysis indicated that high LE8 scores were associated with a 40% lower risk of all-cause [0.60(0.50-0.73)] and CVD mortality [0.60(0.43-0.83)] compared to low scores. As the total LE8 score increased linearly, the likelihood of all-cause and CVD mortality decreased, with a potential threshold at 60 points. Subgroup analyses revealed that diet, sleep, nicotine exposure, physical activity, and blood glucose control affected both types of mortality. The LE8 score was negatively correlated with the risks of all-cause and CVD mortality in hypertensive patients. Life interventions and management of physical indicators based on the LE8 score may be an effective way to improve mortality in hypertensive patients.

ENIGMA-shock: protocol for a study framEwork for aN InteGrated assessMent of cArdiac rehabilitation programmes in patients acutely managed for cardiogenic shock

INTRODUCTION

The treatment of patients with cardiogenic shock (CS) has been focused historically on single interventions (medical treatments, percutaneous and surgical interventions and, more recently, various temporary mechanical circulatory supports). However, none of these interventions has significantly changed the short-term prognosis of CS. Moreover, considerable interest in interventions applied in the acute setting has not been matched with comprehensive assessment of patients' long-term follow-up, not only for survival and rehospitalisation but also for quality of life and functional status, recovery from critical illness and its destructive sequelae, and a global evaluation of the overall sustainability of pathways of care. To fill this knowledge gap, the ENIGMA study will be conducted.

METHODS AND ANALYSIS

This is a prospective and retrospective multicentre registry conducted under the scientific coordination of the IRCCS Fondazione Don Gnocchi and funded by the Italian Ministry of Health (PNRR-MCNT2-2023-12377767). Data referring to 2000 patients included in the Altshock registry, the largest multicentre CS registry in Italy, will be analysed. A standardised protocol of high-intensity cardiac rehabilitation has been defined and will be followed by the involved institutions after the inclusion of the first 1000 patients. Where feasible, this new pathway will be implemented in every institution. All the patients enrolled will be evaluated according to the Long-Term Conditions Questionnaire, the Kansas City Cardiomyopathy Questionnaire and a questionnaire on the patient experience at 6-month follow-up, to evaluate real-life comparative effects on patient outcomes and experiences. In conclusion, a health technology assessment (HTA) analysis, grounded in the EUnetHTA Core Model, will be conducted to define the potential multidimensional benefits and effects with regard to the overall economic, organisational and social sustainability of the innovative dedicated pathway. Various data sources will be used to conduct the HTA: (1) literature evidence, to define the evidence-based comparative indicators considering both surgical approaches; (2) real-world anonymised data from the hospitals included in the study, to enable costing of the rehabilitative pathways; and (3) healthcare professionals' perceptions, defining the perceived added value of the innovative pathway versus the historical one, based on an evaluation scale ranging from -3 to +3.

ETHICS AND DISSEMINATION

The study was approved by the ethical committee (EC) of Lombardy Region (CET 44/24), on 28 May 2024, and is under evaluation by the EC of three other centres. The study protocol will be evaluated for ethics by 10 more centres in January 2025. Study results will be published in peer-reviewed publications and disseminated through conference presentations. The Associazione Nazionale Scompensati Cardiaci (AISC; 'National Association of Patients with Heart Failure'), the Progetto Vita initiative and the non-profit organisation 'Heart Helps Heart' have endorsed the project and will be involved in disseminating information about the project and its outcomes to the general public.

CLINICAL TRIAL REGISTRATION NUMBER

The ENIGMA-shock study has been registered at ClincialTrials.gov: NCT06572826.

Lower cardiorespiratory fitness is associated with an altered gut microbiome. The Study of Health in Pomerania (SHIP)

Sedentarism is characterized by low levels of physical activity, a risk factor for obesity and cardio-metabolic diseases. It can also adversely affect the composition and diversity of the gut microbiome which may result in harmful consequences for human health. While cardiorespiratory fitness (CRF) is inversely and independently associated with cardiovascular risk factors and diseases and all-cause mortality, the relationship between low CRF and the gut microbiome is not well known. A total of 3,616 individuals from two independent population-based cohorts of the Study of Health in Pomerania (SHIP-START and SHIP-TREND) performed standardized, symptom-limited cardiopulmonary exercise testing (CPET) and had faecal samples collected to determine gut microbiota profiles (16S rRNA gene sequencing). We analysed cross-sectional associations of CRF with the gut microbiome composition controlling for confounding factors. Lower CRF was associated with reduced microbial diversity, loss of beneficial short-chain fatty acid producing bacteria (i.e. Butyricoccus, Coprococcus, unclassified Ruminococcaceae or Lachnospiraceae) and an increase in opportunistic pathogens such as Escherichia/Shigella, or Citrobacter. Decreased cardiorespiratory performance was associated with a gut microbiota pattern that has been previously related to a proinflammatory state. These associations were independent of body weight or glycemic control.

Comparative Predictors of Mortality Risk in Contemporary Patients Referred for Stress Myocardial Perfusion Imaging

OBJECTIVE

To assess the relative predictors of mortality risk in a contemporary cohort of patients referred for stress single-photon emission computed tomography myocardial perfusion imaging in whom all relevant risk factors and cardiac-related comorbidities were evaluated at the time of cardiac stress testing.

METHODS

We evaluated 15,662 patients undergoing stress single-photon emission computed tomography myocardial perfusion imaging between 2008 and 2017. Patients were observed for a median of 6.7 years for all-cause mortality. Patients were assessed for their mode of stress testing (exercise vs pharmacologic testing), myocardial ischemia, coronary artery disease risk factors, and cardiac-related comorbidities, such as chronic kidney disease.

RESULTS

Age and pharmacologic stress testing, which was performed in 48.1% of our patients, were the most potent predictors of mortality. Moderate to severe myocardial ischemia, a traditional driver of mortality, was present in only 3.6% of patients. There was a stepwise increase in annualized mortality according to patients' number of risk factors (P < .001) or comorbidities (P < .001). After stratification of patients according to their mode of stress testing, this stepwise relationship of multimorbidity to mortality was noted only in pharmacologically tested patients. By contrast, the annualized mortality risk of patients undergoing treadmill exercise not only was low (<1%/year) but remained so even for patients with a high degree of multimorbidity.

CONCLUSION

Patients referred for cardiac stress testing manifest a stepwise increase in mortality risk with an increasing burden of coronary artery disease risk factors and concomitant comorbidities. However, this stepwise increase is not observed in patients who perform treadmill exercise at the time of cardiac stress testing.

Estimation of Cardiovascular Risk Using SCORE2, REGICOR and Vascular Age Scales in Spanish Healthcare Workers: A Retrospective Longitudinal Study

Background/Objectives: Cardiovascular diseases (CVD) are one of the major public health concerns worldwide due to their high morbidity and mortality rates. This situation has necessitated the development of tools to assess cardiovascular risk (CVR) in order to prevent the onset of CVD. The aim of this study is to assess how sociodemographic variables and health habits are associated with the values of CVR scales, such as REGICOR, SCORE2, and vascular age. Methodology: This is a descriptive and cross-sectional study involving 44,939 Spanish healthcare workers, where the association between age, sex, type of work, smoking, physical activity, and Mediterranean diet with CVR scales such as REGICOR, SCORE2, and vascular age was evaluated. Results: All the variables analyzed showed an association with the occurrence of moderate-high values in all three CVR scales. Age was the variable that showed the highest odds ratio values: 13.446 (95% CI 11.16-14.77) for REGICOR, 13.90 (95% CI 12.01-15.81) for vascular age, and 14.12 (95% CI 12.01-16.23) for SCORE2. Conclusions: The profile of a healthcare worker with the highest risk of presenting moderate-high values on all three CVR scales would be a male over 60 years old, a nursing assistant or orderly, a smoker, sedentary, and with low adherence to the Mediterranean diet.

An Analysis of Young Women University Students's Physical Activity Levels

The physical activity (PA) level in women, it seems, tends to decrease in adulthood. The aims of the study were: (i) to evaluate the degree of compliance with PA recommendations in young women university students and (ii) to measure steps and the level of PA in different periods during the week. Eighty-eight young adult girls (21.38 ± 2.71 years) were recruited for this study. Participants wore an "Actigraph GT3X" accelerometer for seven days, collecting minutes of moderate-to-vigorous physical activity (MVPA) and steps volume. The results show an 80% of compliance of the 10,000 steps per day and a 220% of compliance of the 300 min/week of MVPA. The analysis shows a trend towards higher steps and PA minutes at the Weekdays (steps/day, BF10 = 168.563, δ = 0.418; meeting recommendations 10,000 steps/day, BF10 = 168.563, δ = 0.419; MVPA minutes/day, BF10 = 10.648, δ = 0.323; meeting recommendations 300 min/week, BF10 = 10.648, δ = 0.324) and during the Out-of-University-Time (steps/day, BF10 = 1.387 × 1010, δ = -0.883; meeting recommendations 10,000 steps/day, BF10 = 1.387 × 1010, δ = -0.886; MVPA minutes/day, BF10 = 1.110 × 1015, δ = -1.138; meeting recommendations 300 min/week, BF10 = 1.1 × 1015, δ = -1.144). This study can provide strategies and motivational PA guidelines at university to enhance well-being in young female university students.

A Body Shape Index as a Simple Anthropometric Marker for the Risk of Cardiovascular Events

PURPOSE OF REVIEW

To provide an overview of the predictive value of A Body Shape Index (ABSI) for the risk of cardiovascular events.

RECENT FINDINGS

ABSI has been reported to have an association with development of cardiovascular diseases, and its usefulness for predicting major cardiovascular events including cardiovascular mortality, nonfatal coronary syndrome and nonfatal stroke has been investigated. The formula for ABSI includes waist circumference, which is not included in the conventional calculation of body mass index (BMI), along with BMI and height. High ABSI is independently associated with a high incidence of cardiovascular events. ABSI with specific cutoff values can be a useful tool for cardiovascular risk stratification by detecting the presence of abdominal obesity and it can be used for evaluation of the risk of cardiovascular events. Nonetheless, other factors such as race, gender, age, and physical, environmental and socioeconomic purviews also need be taken into consideration.