A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis

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.

Accuracy of an Activity Monitor in Assessing Physical Activity of Hospitalized Geriatric Rehabilitation Patients With Slow Walking Speed Using a Walking Aid

BACKGROUND/OBJECTIVES

Accurate assessment of physical activity is essential in hospital settings, but difficult for geriatric rehabilitation patients who have slow walking speed and rely on walking aids. This study conducted an external validation of the MOX activity monitor accuracy in distinguishing between sedentary (lying, sitting), standing, and dynamic activities among hospitalized geriatric rehabilitation patients. Additionally, the study assessed clinical tolerance and ease of use of the monitor.

METHODS

Inclusion criteria were being hospitalized on the geriatric rehabilitation ward, aged 70 years or older, and using a walking aid. The monitor was placed on the upper leg, and remained in place for 1 week. In a test-session, four activities of 4 min each (lying, sitting, standing, and walking) were filmed. Video analyses created a direct observation timeline. Daily skin irritation assessments were conducted and participants noted their discomfort level at the week's end.

RESULTS

The study included 20 participants who relied on walking aids, with 10 requiring additional physical support while walking. The MOX activity monitor exhibited excellent accuracy in classifying the four activities, with a zero mean percentage error for sedentary activity, 2.2% for standing, and 2.7% for walking. Participants reported minimal hindrance, and the monitor proved user-friendly.

CONCLUSION

The MOX activity monitor demonstrated remarkable accuracy in distinguishing between these four activities in a test-session and displayed strong clinical applicability.

SIGNIFICANCE

The monitor shows substantial promise as a valuable tool for assessing physical activity in hospitalized geriatric rehabilitation patients using walking aids.

Longitudinal increase in physical activity and adverse cardiovascular outcomes following the diagnosis of acute coronary syndrome

OBJECTIVES

Physical activity (PA) provides protective effects against cardiovascular diseases, including ischaemic heart disease. However, recommending moderate to vigorous PA (MVPA) to patients with recent acute coronary syndrome (ACS) raises concerns owing to potential risk of recurrent ACS or fatal arrhythmias. This study investigated the association between longitudinal PA changes following an ACS diagnosis and subsequent cardiovascular outcomes, including non-fatal coronary events, non-fatal stroke and cardiovascular mortality.

METHODS

This longitudinal cohort study used Korean National Health Insurance Service data from 2010 to 2017, comprising 30 840 patients diagnosed with ACS following invasive coronary angiography or bypass surgery. Leisure-time PA was self-reported, with the frequency and intensity measured weekly. The primary endpoint was a composite of nonfatal coronary events, non-fatal stroke and cardiovascular mortality. Multivariable Cox proportional hazards regression models assessed the association between PA changes and cardiovascular outcomes.

RESULTS

Among patients with ACS (mean age: 60±11 years, men: 81.3%), mean PA levels increased from 544±556 metabolic equivalent task (MET)-min/week to 594±567 MET-min/week. Over 6.7 years of median follow-up, 5639 cardiovascular events occurred. Increased PA was associated with lower cardiovascular event risk (HR 0.95, 95% CI 0.92 to 0.98). Consistent MVPA pre-ACS and post-ACS reduced cardiovascular event risk (HR 0.87, 95% CI 0.79 to 0.96) and MVPA initiation showed a modest risk reduction (HR: 0.91, MET-min/95% CI 0.82 to 1.01).

CONCLUSIONS

Longitudinal increases in self-reported PA, maintenance of MVPA and possibly MVPA initiation after ACS reduced the risk of cardiovascular events. Initiating or maintaining MVPA could be an important strategy in improving cardiovascular outcomes following ACS.

Validity of the International Physical Activity Questionnaire-Short Form Among Individuals With Visual Impairments

This study (a) assessed the concurrent validity of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) compared to accelerometer data among individuals with visual impairments (VI); (b) examined differences in validity of the IPAQ-SF among those with no usable vision (NUV) and those with some usable vision (SUV); and (c) assessed validity using both Freedson and Troiano cutpoints. Eighty adults with VI (Mage = 47.7; 62.5% female) wore waist-mounted accelerometers for seven days then completed the IPAQ-SF. For data analysis, participants were grouped by VI level as having SUV or NUV. Physical activity (PA) levels were compared using Mann-Whitney U tests, while Friedman tests assessed differences between IPAQ-SF and accelerometer-derived estimates. Chi-square tests assessed adherence to PA guidelines. Participants engaged in a median of 125.5 minutes of moderate-to-vigorous PA during the week. Agreement between IPAQ-SF and accelerometer-derived moderate and moderate-to-vigorous PA were moderate (ρ = 0.49 and 0.50, respectively; both p < .01) though mean absolute percent error values were high. Agreement was similar across Freedson and Troiano cutpoints (ρ range = 0.22-0.54; all p < .05) and slightly stronger among those with NUV compared to SUV. Agreement for sedentary behavior was negligible (ρ < 0.20; p > .05). Self-reported MVPA from IPAQ-SF showed weak agreement with accelerometer data for both NUV and SUV groups. Researchers should use caution when using IPAQ-SF to assess PA in this population.

Association Between Social Engagement Frequency and the Risk of Depression in South Korea, the United States, and the United Kingdom: Multinational Evidence From Longitudinal Studies of Aging

BACKGROUND

Although a greater social engagement is often associated with a reduced risk of depression, longitudinal studies that account for diverse social structures and cultural contexts among middle-aged or older are limited.

METHODS

This study utilized cohort data from the Korean Longitudinal Study of Aging (n = 11,174; 2006-2020) in South Korea (KR), the Health and Retirement Study (n = 42,405; 2004-2019) in the United States, and the English Longitudinal Study of Aging (n = 28,624; 2002-2019) in the United Kingdom, including a total of 29,378 individuals from the population aged ≥45 years. Social engagement frequency was categorized into infrequent, intermediate, and frequent, with changes classified as unchanged, increased, or decreased. The primary outcome was the onset of depression, assessed using the CES-D scale. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using a Cox proportional hazards regression model.

RESULTS

In the KR cohort, increased social engagement significantly reduced depression risk only in the infrequent group (KR: HR, 0.20 [95% CI: 0.14-0.28]). However, decreased social engagement elevated depression risk in both the intermediate group (KR: 6.92 [3.73-12.83]; United States: 1.44 [1.16-1.79]) and the frequent group (KR: 1.50 [1.30-1.74]; United States: 1.24 [1.13-1.38]). Conversely, in the UK cohort, increased social engagement raised depression risk in the infrequent group (UK: 1.35 [1.01-1.79]) and intermediate group (UK: 1.63 [1.17-2.27]), whereas decreased engagement lowered depression risk only in the frequent group (UK: 0.80 [0.71-0.90]).

DISCUSSION

We observed notable national variations in the association between social engagement and depression risk, influenced by cultural and political differences.

Association Between Sedentary Behavior and Primary Dysmenorrhea in Young Korean Women: A Cross-Sectional Online Survey

BACKGROUND/OBJECTIVES

Sedentary behavior is an independent risk factor for various health conditions, but its association with dysmenorrhea has been little investigated. This study aimed to examine whether sedentary behavior is independently associated with primary dysmenorrhea in young women, controlling for moderate-to-vigorous physical activity and other known risk factors.

METHODS

An online survey was conducted in 603 young women in South Korea in 2023. Menstrual pain intensity was measured using a numeric rating scale, and symptoms were assessed with the Cox Menstrual Symptom Scale. Sedentary behavior and physical activity were assessed using the Global Physical Activity Questionnaire. Known risk factors for dysmenorrhea included menstrual and lifestyle characteristics, sleep quality, and stress.

RESULTS

Longer sedentary time (hours/day) was correlated with more frequent (r = 0.144; p < 0.001) and severe (r = 0.123; p < 0.01) menstrual symptoms but not with pain intensity. Multiple linear regression analysis showed that sedentary time was independently associated with the frequency (β = 0.10; p < 0.01) and severity (β = 0.09; p < 0.05) of menstrual symptoms after adjusting for physical activity and other risk factors for dysmenorrhea. Multiple logistic regression analysis showed that women with higher levels of sedentary time had 1.05 times greater odds (95% CI, 1.00-1.10; p < 0.05) of experiencing severe pain compared to those with less sedentary time, even after adjusting for physical activity and other risk factors.

CONCLUSIONS

Prolonged sedentary behavior in young women is associated with more frequent and severe menstrual symptoms, including more intense menstrual pain. These findings highlight the need for public health strategies that reduce sedentary behavior to alleviate dysmenorrhea.

Effectiveness of Mobile Health Interventions for Reducing Sitting Time in Older Adults: Systematic Review and Meta-Analysis

BACKGROUND

Mobile health (mHealth) provides health information through electronic devices, even at home. The escalating prevalence of sedentary behaviors among older adults, which leads to increased adverse health outcomes, underscores the pressing need for a comprehensive understanding of the effectiveness of mHealth interventions.

OBJECTIVE

This study aims to examine the effectiveness of mHealth interventions in the sitting time of older adults (age 55 years).

METHODS

A systematic review and meta-analysis of randomized controlled trials was conducted to evaluate the effects of mHealth interventions on total sitting time during waking hours, excluding sleep. A literature search was conducted using multiple databases, including PubMed, Embase, Web of Science, and Cochrane, covering articles published from the inception of each database through October 2023. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were explicitly applied to structure this report. Methodological quality was assessed using the Cochrane Risk of Bias (ROB 2) tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies (MINORS) tool for nonrandomized studies. Two independent reviewers screened the studies, extracted data, and assessed methodological quality using established criteria. Meta-analyses were performed using Review Manager (version 5.4; Cochrane Collaboration).

RESULTS

Ten studies were identified, of which 3 were included in the meta-analysis, while the remaining 7 were assessed exclusively in the systematic review. The interventions predominantly took place in community settings (n=3) and home-based settings (n=3). Three studies aimed to decrease sedentary behavior and 7 aimed to increase physical activity. The interventions were primarily conducted once daily (n=7) via mobile devices such as smartphones (n=7) and typically involved a single intervention delivered at different time intervals, such as every 15, 20, or 30 minutes (n=4). The interventions typically lasted 12 weeks (n=4) and used objective assessment tools, such as the ActiGraph GT3X+ (n=8). The included studies applied the habit formation theory (n=1), the self-efficacy theory (n=1), the social cognitive theory (n=1), and the social-ecological theory (n=1) as frameworks. Additionally, behavior change techniques, including "goal setting," "problem-solving," "action planning," and "review behavior goal(s)" (n=6), were used. Meta-analysis of the 3 studies included showed a significant decrease in sedentary behavior with mHealth interventions compared with conventional or no interventions (weighted mean difference [WMD]=59.1 min/d, 95% CI 99.1 to 20.2; P=.003).

CONCLUSIONS

mHealth interventions effectively reduce sitting time in older adults. Strategies using interventions with specific frequencies and durations, dedicated mobile monitoring devices, and behavior change techniques showed the potential to reduce sedentary behavior among older adults. These results also underscore the potential of mHealth as a key tool for promoting the well-being of older adults through technology-driven public health efforts.

TRIAL REGISTRATION

PROSPERO CRD42023443926; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023443926.

Comparative analysis of adherence to 24-hour movement guidelines in adolescents: Objective versus subjective measures

BACKGROUND AND AIMS

Previous studies have investigated the concordance between objective and subjective measures for assessing physical activity, sedentary behaviour, and sleep duration separately. However, no studies have compared adherence to the 24-h movement guidelines using both objective and subjective measures in adolescents. The aim of this study was to compare adherence to the 24-h movement guidelines using both objective and subjective measures.

METHODS AND RESULTS

A comprehensive search was conducted in PubMed, Scopus, Web of Science, EMBASE, CINAHL, and SPORTDiscus up to May 2024. A meta-analysis using a random-effects model was conducted, and a p-value of <0.05 was considered statistically significant of the 5968 studies identified, only 42 met the inclusion criteria, with the included studies reporting a mean age of participants ranging from 11.99 to 17.99 years, comprising a total sample of 856,235 participants. There was no statistically significant difference between objective and self-reported measures of adherence to the 24-h movement guidelines (p > 0.05). When analysing each behaviour separately, there was a statistically significant difference between objective and self-reported measures of physical activity and sleep time (p < 0.05). Regarding sedentary behaviour, all studies used subjective measures; therefore, no meta-analysis was performed for screen time as all studies relied on subjective measures.

CONCLUSION

Based on these findings, both objective and subjective measures can be used to assess adherence to the 24-h movement guidelines in adolescents. Thus, researchers and policymakers can choose either objective or subjective methods to assess adherence to the 24-h movement guidelines, with decisions tailored to the clinical context.

Sedentary behaviors and venous thromboembolism risk among older women: the Objective Physical Activity and Cardiovascular Health study

BACKGROUND

Venous stasis, which can occur with prolonged sedentary behavior (SB), is associated with venous thromboembolism (VTE) risk, but VTE risk associated with accelerometer-measured SB has not been quantified.

OBJECTIVES

To evaluate accelerometer-based measures of SB in relation to incident VTE.

METHODS

We included 5591 participants, aged 63 to 99 years, of the Women's Health Initiative Objective Physical Activity and Cardiovascular Health cohort study without prior VTE. Between May 2012 and April 2014, participants wore the ActiGraph GT3X+ accelerometer at the hip for 7 days. Three SB measures were classified using the Convolutional Neural Network Hip Accelerometer Posture algorithm: total sitting time, mean sitting bout duration, and total time spent in prolonged (≥30 minutes) sitting bouts. VTE events were centrally adjudicated. Multivariable-adjusted Cox models estimated hazard ratios for each SB and VTE risk. Women were censored at first VTE, death, loss to follow-up, or February 2023. Mediation by body mass index (BMI) was evaluated.

RESULTS

Over a mean follow-up of 8.2 years, 229 women experienced a VTE. In adjusted models, longer mean sitting bout duration was associated with greater incident VTE risk (hazard ratio per 5-minute increase, 1.15; 95% CI, 1.04-1.28). BMI mediated approximately 30% of this association (P < .01). We found no significant evidence that total sitting time or total time spent in prolonged sitting bouts were associated with VTE.

CONCLUSION

Longer mean sitting bout duration was associated with greater VTE risk, with substantial mediation by BMI. Behavioral efforts to reduce sedentary bout length in older women may reduce their VTE risk.

Digital citizen science for ethical monitoring of youth physical activity frequency: Comparing mobile ecological prospective assessments and retrospective recall

Physical inactivity is a leading risk factor for mortality worldwide. Understanding youth patterns of moderate-to-vigorous physical activity (MVPA) is essential for addressing non-communicable diseases. Digital citizen science approaches, using citizen-owned smartphones for data collection, offer an ethical and innovative method for monitoring MVPA. This study compares the frequency of MVPA reported by youth using retrospective surveys and mobile ecological prospective momentary assessments (mEPAs) to explore the potential of digital citizen science for physical activity (PA) surveillance. Youth (N = 808) were recruited from Saskatchewan, Canada, between August and December 2018. Sixty-eight participants (ages 13-21) provided complete data on retrospective surveys (International Physical Activity Questionnaire, Simple Physical Activity Questionnaire, Global Physical Activity Questionnaire) and prospective mEPAs. Wilcoxon signed-rank tests compared retrospective and prospective MVPA frequencies, while negative binomial regression analysis examined associations between contextual factors and MVPA. Significant differences were found in the frequency of MVPA reported via retrospective surveys versus mEPAs (p < 0.000). Prospective MVPA was associated with family and friend support, having drug-free friends, part-time employment, and school distance, while retrospective MVPA frequency was associated with school and strength training. Digital citizen science, utilizing mEPAs, can provide more accurate and timely data on youth MVPA. With increasing smartphone access and digital literacy, mEPAs represent a promising method for developing effective and personalized MVPA recommendations for youth. However, these findings should be interpreted with caution, as the sample represents a small subset of youth, limiting generalizability to other youth populations.

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.

Epigenetic markers of adverse lifestyle identified among evening and night shift workers in two UK population-based studies: Generation Scotland and Understanding Society

Epigenetic changes in the form of DNA methylation (DNAm) may act as biological markers of risk factors or adverse health states. In two cohort studies, Generation Scotland (GS) (n = 7,028) and Understanding Society (UKHLS) (n = 1,175), we evaluated associations between evening or night shift work and four lifestyle factors (body mass index, smoking, alcohol, education) through linear regression using both conventionally measured phenotypes and DNA methylation-based scores proxying the phenotypes. DNA methylation-based measures of biological ageing were also generated using six established "epigenetic clocks." Meta-analysis of GS and UKHLS results was conducted using inverse-variance weighted fixed effects. Evening/night shift work was associated with higher BMI (0.79; 95%CI 0.02, 1.56; p = 0.04) and lower education ( - 0.18;  - 0.30,  - 0.07; p = 0.002). There was weak evidence of association between evening/night shift work and DNAm scores for smoking (0.06,  - 0.03, 0.15; p = 0.18) and education ( - 0.24;  - 0.49, 0.01; p = 0.06) in fully adjusted models (adjusted for age, sex, methylation principal components and phenotypic measures). Two of the epigenetic age measures demonstrated higher age acceleration among evening/night shift workers (0.80; 0.42, 1.18; p < 0.001 for GrimAge and 0.46; 0.00, 0.92; p = 0.05 for PhenoAge). In over 8,000 participants from two cohort studies, evening/night shift work was associated with both phenotypic and DNA methylation-based measures of higher BMI and lower education. DNAm predictors of smoking and ageing were also related to evening/night shift work. Epigenetic measures may provide insights into the health and lifestyle profiles of night shift workers.

Associations Between 10-Year Physical Performance and Activities of Daily Living Trajectories and Physical Behaviors in Older Adults

Physical function is likely bidirectionally associated with physical activity (PA), sedentary behavior (SB), and sleep. We examined trajectories of physical function as predictors of these behaviors in community-dwelling adults aged ≥65 y without dementia from the Adult Changes in Thought cohort. Exposures were trajectories of physical performance (short Performance-Based Physical Function [sPPF]) and self-reported activities of daily living (ADL) impairment. Outcomes were device-measured PA and SB and self-reported sleep. We fit linear mixed-effects models to define trajectory slopes and intercepts for each functional measure over the prior 10 years. We used multivariable linear regression to investigate the relationship between trajectory features and outcomes, using bootstrap confidence intervals. Participants (N = 905) were 77.6 (SD = 6.9) years old, 55% female, 91% white, and had a median sPPF score of 9 (IQR = [8, 11]) and median impairment of 1 ADL (IQR = [0, 2]) at the time of activity measurement (baseline). Steeper decreases in sPPF (0.3-unit, 25% of the range) were associated with fewer steps (-1180, 95% CI = [-2853, -185]) and less moderate-to-vigorous PA (-15.7 min/day [-35.6, -2.3]). Steeper increases in ADL impairment were associated with 35.0 min/day (4.3, 65.0) additional sitting time, longer mean sitting bout duration (3.5 min/bout [0.8, 6.2]), fewer steps (-1372 [-2223, -638]), less moderate-to-vigorous PA (-13 min/day [-22.6, -5.0]), and more time-in-bed (25.5 min/day [6.5, 43.5]). No associations were observed with light PA or sleep quality. Worsening physical function is associated with lower PA and higher SB, but not with light-intensity movement or sleep quality, supporting the bidirectional nature of the relationship between physical function and physical behaviors.

An umbrella review of efficacy of digital health interventions for workers

Efficacy of digital health (d-Health) interventions on workers' physical activity (PA), sedentary behavior, and physiological outcomes remains unclear. This umbrella review searched PubMed, Cochrane Library, and Google Scholar up to October 25, 2024. We identified 24 systematic reviews (SRs) and selected 130 individual studies from these SRs for analysis. The AMSTAR 2 tool rated the quality of most SRs as critically low. Narrative syntheses suggested that d-Health interventions could potentially improve all outcomes compared with no intervention. However, whether d-Health interventions outperform non-d-Health interventions remains uncertain. Meta-analyses showed a significantly small effect of d-Health interventions on step counts, sedentary/sitting time, and weight compared with no intervention, while d-Health interventions slightly improved only moderate-to-vigorous PA compared with non-d-Health interventions. Subgroup analyses identified potential sources of heterogeneity (e.g., risk of bias, control conditions), which may vary between outcomes. Further high-quality studies are needed to evaluate the efficacy of d-Health interventions.

Physical activity prescription in general practice in France: where do we stand? A cross-sectional study

BACKGROUND

Physical activity on prescription (PAP) is recognized as an effective preventive and therapeutic tool for various diseases, yet its application by general practitioners (GPs) varies widely. This study aims to analyse PAP usage practices among GPs in France, focusing on prescription frequency, targeted pathologies, and influencing factors. It also explores GPs' perceptions of facilitators and barriers to PAP.

METHODS

A cross-sectional study was conducted between October 23, 2023, and April 23, 2024, collecting data from a sample of GPs across France. A structured questionnaire was used to assess the frequency of PAP usage, target populations, as well as GPs' knowledge and perceived barriers to prescribing PA. Descriptive and analytical methods were employed to analyse the data, and logistic regression was used to examine associations between physician characteristics, PAP practices, and key barriers to prescribing.

RESULTS

Among respondents, 39.1% reported prescribing PAP, with a median prescription rate of approximately twice per month. Reduced sedentary behaviour (< 4 h) was significantly associated with a higher frequency of PAP (pOR 3.6, p = 0.044). Knowledge of a nearby sport-health facility strongly predicted prescription (pOR 3.7 p < 0.001). Prescription support tools positively influenced prescribing rates (pOR 1.6 p = 0.041). In contrast, GPs unaware of any tools prescribed significantly less.

CONCLUSION

These findings suggest that improving access to sport-health facilities and providing GPs with effective support tools could significantly enhance PAP practices.

Physical activity measurement tools among college students in intervention studies: A systematic review

BACKGROUND

Assessing the impact of interventions on college students' physical activity (PA) requires the use of reliable and valid measurement tools. However, the tools employed in existing studies and their respective reliability and validity are not well-documented. This review aims to systematically evaluate the PA measurement tools utilized in interventions targeting college students and to assess the quality of their measurement properties.

METHODS

A comprehensive search was conducted across five databases (MEDLINE, Cochrane, Embase, Web of Science, PsycInfo) to identify studies on PA interventions among college students, using specific inclusion criteria. The screening of literature and data extraction were independently performed by two authors, focusing on the types of PA measurements used and their measurement properties.

RESULTS

A total of 52 studies, involving 63 different PA measurement tools, were included. Of these, 28 studies used self-report tools, 14 employed objective tools (with one study using two different objective tools), and 10 combined both methods. The International Physical Activity Questionnaire (IPAQ) emerged as the most frequently used self-report tool, while pedometers and accelerometers were the primary objective tools. Despite frequent references to reliability and validity, few studies provided specific evidence regarding measurement properties such as internal consistency and criterion validity, particularly those tailored to the studied population.

CONCLUSION

The majority of PA measurement tools for college students rely on self-reported data, with limited verification of their reliability and validity. For a more accurate assessment of PA intervention effects, it is recommended to adapt the widely recognized IPAQ to specific contexts and incorporate objective tools like accelerometers, which offer practical and precise measurement within college settings.

Physical activity and sedentary behavior in peritoneal dialysis patients: a comparative analysis of ActiGraph GT3X data collected via wrist and waist with placement-specific cut-points

BACKGROUND

The increasing adoption of accelerometers for the assessment of sedentary behaviour and physical activity among dialysis patients demands robust validation of these monitoring devices. This study aims to determine the comparability of wrist- versus waist-worn ActiGraph GT3X accelerometers, using placement-specific cut-points for peritoneal dialysis patients, to refine research and clinical practices.

METHODS

This was a cross-sectional study. Thirty-one participants wore two ActiGraph GT3X accelerometers, positioned on the right waist and nondominant wrist, and monitored over a seven-day period in a naturalistic setting. Data were processed with ActiLife v6.13.3 and analysed using intraclass correlation coefficients (ICC), limits of agreement, and pairwise 90% equivalence test within a ± 10% threshold.

RESULTS

The sedentary time measurements from both wrist- and waist-worn GT3X accelerometers were deemed equivalent, with high ICC values (0.98, 95% confidence intervals (CI) 0.97-0.99) and a ratio of 1.0 within the 90% CI of 0.9 to 1.0. Although agreement between accelerometers was good for classification of light-intensity activity (ICC = 0.76), the waist-worn device's estimates exceeded the equivalence criteria compared to the wrist-worn device (ratio 1.4; 90% CI 1.2-1.6). Conversely, the waist-worn device reported a significantly lower duration of moderate-to-vigorous physical activity (MVPA) than the wrist-worn device (Ln transformed ratio 0.3; 90% CI 0.1-0.4).

CONCLUSIONS

The use of placement-specific cut-points did not ensure equivalence in physical activity parameter estimates between wrist- and waist-worn ActiGraph GT3X devices. The findings underscore the necessity for consistent accelerometer placement for reliable monitoring of physical activity in peritoneal dialysis patients.

CLINICAL TRIAL NUMBER

Not applicable.

Relationship Between Sedentary Lifestyle and Handgrip Strength Among Korean Workers

OBJECTIVE

This study examined the relationship between sedentary time and handgrip strength with age-group stratification.

METHODS

This study used 11,295 Korean workers. Participants were divided into two age groups: ≤39 and ≥40 years. Handgrip strength was measured, and sedentary time was self-reported. Multiple logistic and linear regression models were used to examine the association between sedentary time and handgrip strength.

RESULTS

Those with ≥6 hours of daily sedentary time had slightly higher odds of low handgrip strength, though not significant overall (odds ratio 1.09, 95% confidence interval 0.95-1.26). However, younger adults with high sedentary time showed significantly higher odds (odds ratio 1.55, 95% confidence interval 1.13-2.12). Linear regression also indicated a stronger negative association in younger adults.

CONCLUSIONS

Interventions to reduce sedentary time could help maintain muscle strength, especially in younger populations.

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.

Increasing Health Behaviors and Psychological Measures with an Adapted Version of the ACCELERATION Program

BACKGROUND

Recent evidence highlights the importance of interventions tackling physical inactivity and unhealthy eating in lower-income countries. The purpose of this study was to examine the effectiveness of the Canadian ACCELERATION lifestyle program adapted to Brazilians. The main outcomes of the study were changes in the engagement in weekly moderate-to-vigorous physical activity (MVPA) and in the daily consumption of fruits/vegetables.

METHODS

The adapted intervention consisted of a 12-week quasi-randomized controlled trial delivered through email. The data from the original Canadian experimental group (CE, n = 194) and the two groups of Portuguese-speaking Brazilians living in Canada in the adapted program - Brazilian experimental (BE, n = 41) and Brazilian control (BC, n = 35) - were assessed at baseline and post-intervention. The data of the 270 participants were analyzed using two-way repeated measures factorial ANCOVA (group x time) for ratio variables and Chi-square and McNemar tests for the categorical variables.

RESULTS

The BE group had a significant increase in MVPA (mean difference, 95% CI: 86.3, 38.1-134.4 min/week) and fruits/vegetables intake (3.2, 1.4-5.1 servings/day) after the intervention (both p < 0.001). The proportion of participants engaging in ≥ 150 min of MVPA increased from 4.9% to 73.2%, while adoption of a healthy diet increased from 4.9% to 53.7% in the BE group (both p < 0.001). The CE group also improved on these variables (p < 0.05) with no difference vs the BE group (p > 0.05), whereas BC did not show changes (p > 0.05).

CONCLUSION

The Brazilian version of the ACCELERATION program effectively promoted positive health behavior changes in its participants and has the potential to contribute to the fight against risk factors for chronic diseases in Brazilians.

Exercise adherence is associated with improvements in pain intensity and functional limitations in adults with chronic non-specific low back pain: a secondary analysis of a Cochrane review

QUESTION

What is the association between exercise adherence and the effects of exercise on pain intensity and functional limitations in adults with chronic non-specific low back pain (CNSLBP)?

DESIGN

Systematic review with meta-analysis.

PARTICIPANTS

Adults with CNSLBP.

INTERVENTION

Randomised controlled trials of exercise compared with no exercise (eg, usual care, placebo/sham or another conservative treatment). Adherence to exercise must have been reported.

OUTCOME MEASURES

Pain intensity and functional limitations.

RESULTS

This study included 46 trials with 56 exercise groups. High exercise adherence (80 to 100%) was associated with reduced pain intensity (0 to 100 scale) (MD -14.32, 95% CI -18.61 to -10.03, low certainty) and functional limitations (0 to 100 scale) (MD -8.08, 95% CI -10.68 to -5.49, low certainty). Moderate exercise adherence (60 to 79%) was not associated with reduced pain intensity (MD -4.53, 95% CI -9.39 to 0.34, very low certainty) or functional limitations (MD -2.75, 95% CI -6.00 to 0.51, very low certainty). Low exercise adherence (< 59%) was associated with reduced pain intensity (MD -5.33, 95% CI -10.00 to -0.66, low certainty) and functional limitations (MD -4.43, 95% CI -7.14 to -1.72, moderate certainty). Compared with low adherence, additional differences in outcomes for moderate and high adherence were mostly negligible.

CONCLUSION

Higher exercise adherence is associated with larger improvements in clinical outcomes in adults with CNSLBP, although overall differences are small compared with lower adherence. Other factors besides adherence between the trials and exercise programs could explain these results. Further research is needed to determine the causal effect of exercise adherence on outcomes in adults with CNSLBP.

REGISTRATION

PROSPERO CRD42023447355 and Open Science Framework https://osf.io/7p6dw/.

Identifying characteristics of UK university students at risk of developing adverse markers of health and related behaviours across one year at university: a latent transition approach

INTRODUCTION

University students are a population notorious for developing adverse markers of health and related behaviours that can have negative consequences for current and future health status. However, there is a dearth of literature devoted to identifying students at greater risk of developing poorer health-related outcomes. The current study aimed to identify characteristics of UK university students at risk of developing adverse markers of health and related behaviours across one year at university.

METHODS

Four hundred and thirty-eight students completed an online self-report survey to assess markers of health and related behaviours in term one (October) and term three (April) in one of three academic years (2021-22, 2022-23, and 2023-24). Latent Profile Transition analysis was employed to generate health-related profiles and assess transitions over time.

RESULTS

Four latent profiles were detected, largely influenced by physical activity behaviours and psychological markers. The majority of students were identified in profiles considered as less healthy and remained in those profiles over time. Women and trans and gender diverse (TGD) students, and students in their second year at university were at greatest risk of being in, and remaining in, less healthful profiles.

CONCLUSIONS

Most students identify and remain in less healthful profiles throughout the academic year. Students that transition between profiles are more likely to transition to less healthful profiles. Work to develop bespoke interventions aimed at students with higher-risk demographic characteristics should now be prioritised.

Monitoring of child-specific activities in ambulatory children with and without developmental disabilities

BACKGROUND

Pediatric healthcare professionals facilitate children to enhance and maintain a physically active lifestyle. Activity monitors (AM) can help pediatric healthcare professionals assess physical activity in everyday life. However, validation research of activity monitors has often been conducted in laboratories and insight into physical activity of children in their own everyday environment is lacking. Our goal was to study the criterion validity of a prototype AM (AM-p) model in a natural setting.

METHODS

Cross-sectional community-based study with ambulatory children (2-19 years) with and without developmental disability. Children wore the AM-p on the ankle and were filmed (gold standard) while performing an activity protocol in a natural setting. We labelled all videos per 5-second epoch with individual activity labels. Raw AM-p data were synchronized with activity labels. Using machine learning techniques, activity labels were subdivided in three pre-defined categories. Accuracy, recall, precision, and F1 score were calculated per category.

RESULTS

We analyzed data of 93 children, of which 28 had a developmental disability. Mean age was 11 years (SD 4.5) with 55% girls. The AM-p model differentiated between 'stationary', 'cycling' and 'locomotion' activities with an accuracy of 82%, recall of 78%, precision of 75%, and F1 score of 75%, respectively. Children older than 13 years with typical development can be assessed more accurately than younger children (2-12 years) with and without developmental disabilities.

CONCLUSION

The single ankle-worn AM-p model can differentiate between three activity categories in children with and without developmental disabilities with good accuracy (82%). Because the AM-p can be used for a heterogenous group of ambulatory children with and without developmental disabilities, it may support the clinical assessment for pediatric healthcare professionals in the future.

Is the Time Right for Preventive Cardiology Guidelines on Sedentary Behaviours and Sitting Time?

In this review sedentary behaviour (SB) is considered beyond its simplistic definition of "sitting" and also includes sedentary activities. We explore the definition, physiological characteristics, prevalence, and guidelines of SB, contrasting it with physical activity (PA). The discussion encompasses: (1) the association between SB and mortality, with a specific focus on cardiovascular (CV) outcomes; (2) biological mechanisms that link SB to CV health, additionally differentiating between the effects of acute and chronic sitting; (3) sex and gender differences in SB; and (4) SB as an independent CV risk factor is explored. The review concludes with an examination of the potential beneficial effects of PA on mitigating the detrimental effects of SB and an analysis of evidence that supports the use of break-up strategies in preventive cardiology. This analysis sheds light on the significant deleterious consequences of SB on CV health. It highlights the potential of incorporating strategies to reduce and interrupt prolonged sitting alongside existing guidelines that promote PA. These findings suggest considering SB as a major CV risk factor, and emphasize the importance of targeting SB reduction and interruption as a valuable approach for preventing and managing CV disease. However, further research is needed to determine the long-term effectiveness of SB interventions, to inform the development of optimal guidelines for CV health management.

Physical Activity, Sedentary Behaviour, and Cardiovascular Disease Risk Factors in Canadians Living With and Without Cardiovascular Disease

BACKGROUND

Our aim was to describe and compare the proportion of adult Canadians living with and without cardiovascular disease (CVD) and meeting the physical activity (PA) and sedentary behaviour (SB) recommendations of the Canadian 24-Hour Movement Guidelines using accelerometer and self-reported measures.

METHODS

Using adult (18-79 years of age) accelerometer data (Actical, worn during waking hours for 7 consecutive days) as well as chronic condition, sociodemographic, recreational screen time, and PA questions from 3 combined cycles of the Canadian Health Measures Survey, we compared the PA, SB, and CVD risk factors of adults living with and without CVD.

RESULTS

A total of 7035 Canadian adults who reported living with (n = 363) and without (n = 6672) CVD were included. Few adults living with CVD were meeting the PA (29%) and SB (15%) recommendations. CVD status was not significantly associated with the likelihood of meeting the PA or screen time recommendations, but adults living with CVD had a lower likelihood of meeting the sedentary time recommendation when compared with adults without CVD (adjusted odds ratio = 0.49; 95% confidence interval, 0.30-0.82). Adults, primarily men, living with rather than without CVD engaged in less light- and moderate-intensity PA.

CONCLUSIONS

The PA and SB of Canadian adults living with and without CVD are significantly different. Adults living with CVD had a lower likelihood of meeting the sedentary time recommendation, and adults living with CVD, primarily men, engaged in less light- and moderate-intensity PA. The identification of these movement behaviour targets may assist in allocating resources to sedentary individuals with the greatest need of PA.

Efficacy of a Multicomponent Physical Activity Intervention for Teachers With or At Risk of Type 2 Diabetes: The Support, Motivation, and Physical Activity Research for Teachers Health Randomized Controlled Trial

BACKGROUND

Type 2 diabetes is a major cause of illness and disability and physical activity reduces these risks. The SMART Health study aim was to compare the efficacy of a multicomponent intervention to promote aerobic physical activity and resistance training in schoolteachers at risk of or diagnosed with type 2 diabetes, with and without a technology-based behavior change package.

METHODS

We randomized participants (N = 104) into 3 groups: "wait-list" control group, 5 face-to-face visits with a psychologist and exercise specialist (SH group), or 5 face-to-face visits over a 3-month period with a psychologist and exercise specialist, plus a technology-based behavior change package for an additional 6 months (SH+ group). Physical activity was the primary outcome (daily steps measured by pedometers). Systolic and diastolic blood pressure, waist circumference, body mass index, fasting blood glucose, glycosylated hemoglobin, plasma lipids, self-reported resistance training, anxiety and depression were also assessed at 3 and 9 months (primary time point). Linear mixed models were used to assess the intervention efficacy of SH and SH+ compared with wait-list control.

RESULTS

There were no significant group-by-time effects for steps in the SH or SH+ groups compared to the wait-list control group. Self-reported participation in monthly minutes of resistance training significantly increased at 3-month postbaseline in both groups (SH: 136 min, P < .01, d = 0.33 and SH+: 145 min P < .001, d = 0.4) versus the control group. The improvements were maintained for the SH group at 9 months. There was also a meaningful effect (P < .06, d = -0.23) for reducing anxiety for SH group at 9 months.

CONCLUSIONS

SMART Health was a feasible, multicomponent intervention, which increased self-reported resistance training but no other secondary outcomes.

Adding planning strategies to an experiential and conceptual knowledge-based intervention: Does it help to reduce sedentary time?

OBJECTIVE

The study compared the effects of an "active" control condition addressing conceptual and experiential knowledge about sedentary behavior, with an intervention condition combining conceptual and experiential knowledge together with action planning, coping planning, and behavioral substitution. We targeted a decrease in sedentary time as the primary outcome.

METHODS

A preregistered trial (#NCT04131270) was carried out with 603 participants aged 11-86 years (M = 33.57; 65.2% women), randomly assigned to the "planning + knowledge" condition or the "knowledge" condition. Sedentary time was assessed with ActiGraph wGT3X-BT accelerometers at baseline, 1-week, and 36-week follow-ups. Conceptual knowledge strategies involved information about health consequences and instructions on how to perform behaviors while experiential knowledge was enhanced by participants taking/discussing photographs of their home environment that has been triggering sedentary behavior. Action/coping plans referred to ways to substitute sedentary behavior with bouts of physical activity behaviors. Mixed models were fit.

RESULTS

No significant Time × Condition interaction was found. In the total sample, sedentary time estimated to be around 502.34 min/day at baseline, showed a significant linear decline over time (p = .002), by approximately -1.22 min per each month elapsing since baseline (-9.76 min/day across 8 months).

CONCLUSIONS

The findings suggest that applying behavior change techniques targeting both conceptual and experiential knowledge about antecedents, circumstances, and consequences of sedentary behavior may result in a small reduction of sedentary time. Adding action plans, coping planning, and behavioral substitution did not improve the effectiveness of the intervention.

Changing User Experience of Wearable Activity Monitors Over 7 Years: Repeat Cross-Sectional Survey Study

BACKGROUND

Lifestyle behaviors, including physical inactivity, sedentary behavior, poor sleep, and unhealthy diet, significantly impact global population health. Wearable activity trackers (WATs) have emerged as tools to enhance health behaviors; however, their effectiveness and continued use depend on their user experience.

OBJECTIVE

This study aims to explore changes in user experiences, preferences, and perceived impacts of WATs from 2016 to 2023.

METHODS

We conducted a cross-sectional online survey among an international cohort of adults (n=475, comprising 387 current and 88 former WAT users). Results were compared with a 2016 cross-sectional online survey (n=237, comprising 200 current and 37 former WAT users) using descriptive statistics and chi-square tests. The survey examined brand preference, feature usefulness, motivations, perceived health behavior change, social sharing behaviors, and technical issues.

RESULTS

In 2023, Apple (210/475, 44%) and Fitbit (101/475, 21%) were the most commonly used devices, compared with the 2016 survey where Fitbit (160/237, 68%) and Garmin devices (39/237, 17%) were most common. The median usage duration in 2023 was 18 months, significantly longer than the 7 months reported in 2016, with most users planning ongoing use. Users in both survey years reported greater improvements in physical activity than diet or sleep, despite lower improvement in physical activity in 2023 compared with 2016, contrasted with greater perceived improvements in diet and sleep. Social media sharing of WAT data notably rose to 73% (283/387) in 2023 from 35% (70/200) in 2016. However, reports of technical issues and discomfort increased, alongside a decrease in overall positive experiences. There was also a noticeable shift in discontinuation reasons, from having learned everything possible in 2016 to dissatisfaction in 2023.

CONCLUSIONS

The study highlights significant shifts in WAT usage, including extended use and evolving preferences for brands and features. The rise in social media sharing indicates a deeper integration of WATs into everyday life. However, user feedback points to a need for enhanced design and functionality despite technological progress. These findings illustrate WAT's potential in health promotion, emphasizing the need for user-focused design in diverse populations to fully realize their benefits in enhancing health behaviors.

Self-reported and tracker-estimated physical activity outcomes in women with chronic pelvic pain disorders: A longitudinal evaluation of construct validity

Objective

This study aims to evaluate the short form International Physical Activity Questionnaire (IPAQ) for use in women with chronic pelvic pain disorders (CPPDs) by comparing its scores against objectively-estimated physical activity (PA) outcomes. We investigated IPAQ components that are most consistently predictive of habitual PA behavior.

Method

The study sample included 966 weeks of data from 112 women with CPPDs who enrolled in a 14-week mHealth-based self-tracking study. Participants wore Fitbit devices and completed the IPAQ every week. We compared the IPAQ-reported minutes of walking, total activity, sitting, light-, moderate-, and vigorous intensity PA for concordance and divergence against their corresponding Fitbit estimates. We used linear mixed-effects regression models (MLMs) for all analyses and quantified the between-participant variance in the magnitude of agreement between the two methods via random slope terms. We further evaluated temporal consistency in scores using intraclass correlation coefficients (ICCs).

Results

IPAQ-reported walking minutes were strongly associated with Fitbit step counts (B = 3952.36; p = 0.006), minutes of moderate PA (B = 15.498; p = 0.0113), and moderate-to-vigorous PA (MVPA; B = 28.973; p = 0.007). IPAQ total activity minutes were associated with Fitbit minutes of vigorous PA (B = 15.183; p = 0.007) and MVPA (B = 25.658; p = 0.010). IPAQ moderate activity minutes were predictive of Fitbit vigorous PA minutes (B = 9.060; SE = 3.719; p = 0.0151). There was substantial between-individual variance in these point estimates based on the significant random-effect terms, and average weekly PA level was a significant moderator of the association between IPAQ-reported and Fitbit-estimated scores for these variables. IPAQ-reported sitting minutes were inversely associated with Fitbit step counts (B = -3125.61; p = 0.004), and minutes of MVPA (B = -21.848; p = 0.007), vigorous AP (B = -10.854; p = 0.042), and moderate PA (B = -10.985; p = 0.004).

Conclusion

These findings provide support for using IPAQ-reported walking and total activity minutes to monitor several PA domains in women with CPPDs, given their concordance with several tracker-estimated PA outcomes. However, the item on "sitting time" may not be a suitable for assessing sedentary time.

[Sedentary behaviour and physical inactivity considering sex, age and socioeconomic level in the Basque Country. Cross-sectional study]

OBJECTIVE

To describe the prevalence of sedentarism and physical inactivity according to sex, age, and socioeconomic level in the Basque Country.

METHOD

A cross-sectional study was conducted based on the 2018 Basque Autonomous Community Health Survey (n=7814 adults). Crude prevalences of sedentarism and physical inactivity, overall and by age group, were calculated, as well as the existence of a socioeconomic pattern was assessed through robust Poisson regression models.

RESULTS

The overall prevalence of sedentarism was around 32% in sexes, reaching 60% in the age group older than 85 years and 45% in young people aged 18 to 29 years. The prevalence of physical inactivity was 22% in men (15% in the youngest and 37% in the oldest) and 29.5% in women (17% in the youngest and 64% in the oldest). Differences were found in the prevalences of sedentarism and physical inactivity according to socioeconomic level, with people of higher social class being more sedentary, and people with lower educational level being more inactive.

CONCLUSIONS

In the context of the study, there is a different pattern in terms of physical activity and sedentary lifestyle according to socioeconomic level and life cycle.

Association Between Leisure-Time Physical Activity and All-Cause Mortality Among Stroke Survivors: Findings From National Health and Nutrition Examination Survey

BACKGROUND

Stroke is the second leading cause of death and the third leading cause of disability globally. But little is known about the optimal level of physical activity for stroke survivors. Therefore, we aimed to analyze the dose-response relationship between leisure-time physical activity (LTPA) and all-cause mortality in stroke survivors.

METHODS

One-thousand six hundred and sixty-four stroke survivors form from the 1999 to 2018 National Health and Nutrition Examination Surveys were classified into 6 groups: 0, 1 to 149, 150 to 299, 300 to 599, 600 to 899, and ≥900 minutes per week (based on the Global Physical Activity Questionnaire). Cox proportional hazards regression models with different adjustments of covariates were used to investigate the association between LTPA and all-cause mortality.

RESULTS

Except for stroke survivors with LTPA levels ranging from 600 to 899 minutes per week (P = .055), there was a significant difference in survival rates among stroke survivors with different levels of LTPA compared with those without LTPA. Stroke survivors engaging in LTPA levels exceeding 900 minutes per week exhibited the greatest benefit compared with stroke survivors who did not engage in LTPA (hazard ratio = 0.225; 95% confidence interval, 0.122-0.414).

CONCLUSIONS

Our research findings add to the expanding evidence base that highlights the favorable connection between LTPA and decreased risk of all-cause mortality among individuals who have survived a stroke. Our study emphasizes the significance of incorporating physical activity interventions into the poststroke care regimen and underscores the potential advantages of personalized activity guidance.

Sex-specific associations between feto-placental growth and maternal physical activity volume and sitting time: Findings from the Queensland Family Cohort study

INTRODUCTION

Antenatal physical activity (PA) is associated with beneficial changes in placental growth and function; however, the effect of excessive sitting time is less clear. The aim of this study was to investigate whether feto-placental growth changes with maternal activity, and whether these associations differ in a sex-specific manner.

METHODS

This study included women enrolled in the Queensland Family Cohort study who self-reported PA and sitting time at 24 or 36 weeks of gestation. Placental growth factors and feto-placental growth parameters at delivery were analysed by PA volume and sitting time, as well as by fetal sex.

RESULTS

Women who reported excessive sitting time during mid-pregnancy and had a female fetus showed higher placental PlGF (p = 0.031) and FLT1 (p = 0.032) mRNA expression with no difference in placental size at delivery. For the male, excessive sitting time during mid-pregnancy was associated with a lower placental weight (p = 0.001) and placental surface area (p = 0.012) and a higher birthweight to placental weight (BWPW) ratio (p = 0.042), with no change in placental growth factors. Moderate volume PA during mid-pregnancy was associated with lower VEGFA mRNA expression in the male placenta (p = 0.005) and a higher abdominal circumference in the female neonate (p = 0.042), with no overall difference in placental weight or birthweight for either sex.

CONCLUSIONS

The results of this study suggest that mid-pregnancy may be an important timepoint for programming of feto-placental growth in relation to maternal activity. Our findings highlight the independent benefits of reducing sitting time during pregnancy, particularly for women carrying male fetuses.

Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study

BACKGROUND

Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process.

OBJECTIVE

The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention.

METHODS

The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops.

RESULTS

Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed.

CONCLUSIONS

The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention.

Gameplay and physical activity behaviors in adult video game players

Introduction

Since the early 2000s, the video game industry has seen extraordinary booms in product development and market growth, with the total number of video game players globally reaching 2.69 billion by the end of 2020. Despite the rapid growth of the industry, there is little recent data investigating the time adult video game players spend sedentary playing video games and the time they spent engaged in physical activity. The purpose of this quantitative, cross-sectional, non-experimental survey study is to describe the frequency and duration of video game play and physical activity in adult video game players.

Methods

Participants completed an online survey, evaluating their demographic and health history information, video game play, and physical activity behaviors.

Results

The study used data from a total of 221 participants (Males = 153, Females = 68). The mean age of the participants was 27.29 (SD 7.27) years. Of the 221 participants, 145 identified as casual players, 50 amateurs, 24 semi-professionals, and 2 professionals. The participants spent over five days per week and an average of 26.56 h per week playing video games. Personal computers were reported to have the longest duration of play of the four platforms investigated (17.59 h per week). The total amount of time participants spent engaged in cumulative moderate-to-vigorous physical activity (MVPA) was an average of 15.43 (SD 16.79) hours per week. The majority of this time was spent engaged in occupational physical activity (5.11 h per week). Participants spent 2.39 h per week engaged in leisure time MVPA.

Conclusion

Our results indicate an increase in VG play compared to 2018, suggesting United States adult video game players may be more at risk for detrimental effects to their physical health. This could be attributed to the habits formed during the COVID-19 pandemic, the influences from video genre game play mechanics, and the social aspects of playing video games with friends. Future research should focus on developing research methodologies that will objectively measure adult video game player frequencies and durations in video game play alongside extensive observation of different video gameplay mechanic genres and their relationships with physical activity.

Associations of nonoccupational sedentary behaviors with cardiometabolic outcomes: coronary artery risk development in young adults (CARDIA)

BACKGROUND

The association between sedentary behavior (SB) and cardiometabolic risk may differ by SB domain and context. Nonoccupational SB is particularly important because it is discretionary and more amenable to change. This study estimated associations of nonoccupational SB contexts with hypertension (HTN) and diabetes mellitus (DM).

METHODS

A total of 3370 middle-aged adults (50.1 ± 3.6 years; 56% F) from the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Cross-sectional and 5-year prospective associations between self-report total SB and 6 context-specific SBs (television-TV, computer, transportation, phone, music, and paperwork) with HTN and DM were tested using logistic regression. Fully adjusted models controlled for sociodemographic variables, body mass index, and self-report moderate-vigorous intensity physical activity.

RESULTS

Prevalences of HTN and DM at baseline were 48% (1618 cases) and 10% (320 cases), respectively. Each hour per day of total-SB was cross-sectionally associated with HTN (OR: 1.03, 95% CI, 1.01-1.05) but not DM, with nonsignificant prospective associations for HTN and DM. Of the context-specific SBs, only TV-SB was significantly associated with HTN or DM. Each hour of TV-SB was cross-sectionally associated with HTN (OR: 1.09, 95% CI, 1.03-1.15) and DM (OR: 1.18, 95% CI, 1.09-1.29), and prospectively with HTN (OR: 1.14, 95% CI, 1.04-1.26) but not DM.

CONCLUSION

When comparing total-SB and the 6 context-specific SBs, TV-SB was most robustly associated with HTN. The findings were less clear for DM. Behavior change strategies that target TV-SB reduction may be effective at reducing HTN risk in middle-aged adults.

Do delayed responses introduce bias in ecological momentary assessment? Evidence from comparisons between self-reported and objective physical activity

Introduction

Delayed responses are a common yet often overlooked aspect of participant compliance in ecological momentary assessment (EMA) research. This study investigated whether response delays introduce selection bias in the moments captured by EMA.

Methods

Participants (n = 339) self-reported their physical activity behaviors using EMA five times a day over 7 days while wearing a continuous physical activity monitor. The continuous activity monitor data provided an objective reference value to evaluate potential biases in delayed EMA self-reports.

Results

Results showed that participants were significantly more likely to delay EMA responses when they were prompted during higher levels of physical activity, and they subsequently reduced their activity levels, postponing their response until they were in a significantly less active state. There was no significant evidence that response delays systematically biased the levels of EMA reported activities, although delayed responses were associated with significantly more random errors in EMA reports (with small effect sizes).

Discussion

The results suggest that respondents self-select the moments for answering EMA surveys based on their current activity levels, but brief response delays do not translate into marked reductions in the quality of EMA data.

Extending Our Understanding of the Social Determinants of Physical Activity and Sedentary Behaviors in Families: A Systems Mapping Approach

BACKGROUND

The social environment is important to consider for effective promotion of movement behaviors like increased physical activity (PA) and reduced sedentary behavior (SB); yet, it is less often considered than individual and built environments. One way to advance social environment research is to develop system maps, an innovative, participatory, action-oriented research process that actively engages stakeholders to visualize system structures and explore how systems "work." The purpose of this research was to develop PA and SB system maps of the social environment embedded within the core/nuclear family system.

METHODS

The development process began with a 2-day multicountry, 16-researcher, in-person participatory workshop in August 2023, followed by multiple online follow-up consultations. Attendees contributed to the creation of the maps through shared development of critical determinants and their causal pathways. The structure of the final maps was analyzed using network analysis methods to identify indicators of centrality, and key feedback loops and areas for potential intervention were explored.

RESULTS

Key central determinants that were likely critical targets for systems intervention to produce changes in PA and SB and featured prominently in most of the reinforcing and balancing feedback loops included shared family interests, values and priorities, family logistical support, family cohesion/organization, and shared experiences. The maps also highlighted key determinants of the broader social environment external to the family.

CONCLUSIONS

These system maps support current evidence on movement behaviors in family systems and socioecological theories and have the utility to galvanize future research and policy to promote PA and reduce SB.

Sitting time at work and cardiovascular disease risk-a longitudinal analysis of the Study on Mental Health at Work (S-MGA)

PURPOSE

This study analyzed longitudinal data to examine whether occupational sitting time is associated with increases in body mass index (BMI) and five-year cardiovascular disease (CVD) risk.

METHODS

We included 2,000 employed men and women (aged 31-60) from the German Study on Mental Health at Work (S-MGA) for a BMI analysis and 1,635 participants free of CVD at baseline (2011/2012) for a CVD analysis. Occupational sitting time was categorized into five groups (< 5, 5 to < 15, 15 to < 25, 25 to < 35, and ≥ 35 h per week). BMI change was measured from baseline (2011/2012) to follow-up (2017). Incident CVD included hypertension, heart disease, myocardial infarction, and stroke (all self-reported). Multiple linear regression examined the association between sitting time and BMI change, while modified Poisson regression analyzed CVD incidence, adjusting for age, sex, occupation, shift work, leisure activity, and smoking by sex. Covariates were self-reported.

RESULTS

Over five years, the average BMI change was 0.49 (SD 1.9). We found no association between baseline occupational sitting time and BMI changes, with consistent results in sensitivity analyses. During this period, 245 participants developed cardiovascular disease. There was no increased risk of CVD among those with more sitting time compared to less. No differences in risk were found between women and men.

CONCLUSION

There was no association between occupational sitting time and five-year changes in BMI or incident CVD.

Validity of the international physical activity questionnaire short form for assessing physical activity in Japanese adults with type 1 diabetes

Objective

To examine the validity of the International Physical Activity Questionnaire short form (IPAQ-SF) against an objective method for assessing physical activity (PA) in Japanese adults with type 1 diabetes (T1D).

Methods

This cross-sectional study included 126 adults with T1D (aged 20-74 years). The participants wore a triaxial accelerometer for 7 consecutive days and completed the IPAQ-SF (a recall survey for the last 7 days) on the day following the 7-day accelerometer period. This ensured alignment between the periods assessed by both the methods.

Results

A total of 112 participants were analyzed. The IPAQ-SF group had lower daily time in sedentary behavior (SB), total moderate-intensity PA (MPA) (including walking), vigorous-intensity PA (VPA), total PA (including walking), and daily metabolic equivalent (MET)-min in total PA than those in the accelerometer group. Significant correlations were observed between the methods for all variables: daily time in SB, total MPA, VPA, total PA, and daily MET-min in total PA (ρ = 0.203-0.527). In addition, walking time reported in the IPAQ-SF correlated with the step counts recorded by the accelerometer (ρ = 0.444). However, among these parameters, only daily time in VPA was able to provide acceptable levels of validity (≥ 0.50) and predict values recorded by the accelerometer.

Conclusion

These results indicate that the IPAQ-SF scores have a weak correlation with each type of accelerometer-measured PA, while the IPAQ-SF may underestimate each type of PA compared to an accelerometer in Japanese adults with T1D.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00759-w.

Harmonizing measurement tools: examining the concurrent validity of the Daily Activity Behaviors Questionnaire compared to the ActiGraph to assess 24-hour movement behaviors among adults

PURPOSE

An accurate assessment of time spent in 24-hour movement behaviors (24 h-MBs) is crucial in exploring health related associations. This study aims to evaluate the concurrent validity of the Daily Activity Behavior Questionnaire (DABQ) compared to the ActiGraph using absolute and relative indicators of validity.

METHODS

This cross-sectional observational study included 105 adults (45 ± 13 y/o, 54% female). Participants wore an ActiGraph during seven consecutive days followed by filling in the DABQ recalling the past seven days. Intraclass correlations (95% confidence intervals), Bland-Altman plots, Spearman's correlations and the magnitude of error were calculated to estimate the absolute agreement and validity. Interaction effects between sociodemographic variables and the measurement methods were explored in mixed models. All analyses were compared by four commonly used data processing methods for ActiGraph data (cut-points and data reduction method-specific).

RESULTS

Moderate absolute agreement (ICC = 0.56) and validity (rhosleep=0.58) was found for sleep comparing the DABQ with the ActiGraph. Time spent in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) showed poor absolute agreement (ICCSB: 0.01-0.38, ICCLPA: 0.00-0.31; ICCMVPA: 0.23-0.30) and validity (rhoSB: 0.01-0.43, rhoLPA: 0.10-0.46; rhoMVPA: 0.38-0.44) comparing the DABQ with the ActiGraph. The Ranges in ICC and Spearmans' rho include the comparison between the four data processing methods. A significant interaction was found between the measurement method and educational level (p < 0.001), in specific for sleep, SB and LPA.

CONCLUSION

Compared to the ActiGraph, the DABQ showed accurate time-use estimates for sleep but presented poor to moderate evidence of validity regarding SB, LPA and MVPA. This was shown in underestimations regarding SB and MVPA, and overestimations regarding LPA. However, educational level and data processing methods contributed to these variations.

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska

Older adults often face barriers to obtaining recommended diet, physical activity, and fitness levels. Understanding these patterns can inform effective interventions targeting health beliefs and behavior. This cross-sectional study included a multicultural sample of 58 older adults (aged 55+ years, M=71.98) living in independent senior housing in urban Southcentral Alaska. Participants completed a questionnaire and the Senior Fitness Test that assessed self-reported fruit and vegetable intake, physical activity, self-efficacy, and functional fitness. T-tests and bivariate correlation analyses were used to test six hypotheses. Results indicated that participants had low physical activity but had a mean fruit and vegetable intake that was statistically significantly higher than the hypothesized "low" score. Only 4.26% of participants met functional fitness standards for balance/agility, and 8.51% met standards for lower-body strength. However, 51.1% met standards for upper-body strength and 46.8% met standards for endurance The results also indicated that nutrition self-efficacy and exercise self-efficacy were positively related to fruit and vegetable intake and physical activity levels, respectively. Interestingly, income was not related to nutrition or activity patterns. These data complicate the picture on dietary and physical activity patterns for older adults in Alaska and offer recommendations for future health promotion activities.

Psychometrics of Wearable Devices Measuring Physical Activity in Ambulant Children With Gait Abnormalities: A Systematic Review and Meta-analysis

Objective

To evaluate psychometrics of wearable devices measuring physical activity (PA) in ambulant children with gait abnormalities due to neuromuscular conditions.

Data Sources

We searched PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus in March 2023.

Study Selection

We included studies if (1) participants were ambulatory children (2-19y) with gait abnormalities, (2) reliability and validity were analyzed, and (3) peer-reviewed studies in the English language and full-text were available. We excluded studies of children with primarily visual conditions, behavioral diagnoses, or primarily cognitive disability. We performed independent screening and inclusion, data extraction, assessment of the data, and grading of results with 2 researchers.

Data Extraction

Our report follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed methodological quality with Consensus-based Standards for the selection of health measurement instruments. We extracted data on reported reliability, measurement error, and validity. We performed meta-analyses for reliability and validity coefficient values.

Data Synthesis

Of 6911 studies, we included 26 with 1064 participants for meta-analysis. Results showed that wearables measuring PA in children with abnormal gait have high to very high reliability (intraclass correlation coefficient [ICC]+, test-retest reliability=0.81; 95% confidence interval [CI], 0.74-0.89; I 2=88.57%; ICC+, interdevice reliability=0.99; 95% CI, 0.98-0.99; I 2=71.01%) and moderate to high validity in a standardized setting (r +, construct validity=0.63; 95% CI, 0.36-0.89; I 2=99.97%; r +, criterion validity=0.68; 95% CI, 0.57-0.79; I 2=98.70%; r +, criterion validity cutoff point based=0.69; 95% CI, 0.58-0.80; I 2=87.02%). The methodological quality of all studies included in the meta-analysis was moderate.

Conclusions

There was high to very high reliability and moderate to high validity for wearables measuring PA in children with abnormal gait, primarily due to neurological conditions. Clinicians should be aware that several moderating factors can influence an assessment.

Correlations between the Japanese version of the Global Physical Activity Questionnaire and accelerometer-measured physical activity and sedentary time in adult women and men

BACKGROUND

Physical activity (PA) and sedentary behaviour have important health implications. Self-reported measures of PA and sitting time (ST) such as questionnaires are most commonly used in public health studies and surveillance, but their accuracy might be affected by cultural differences between countries. The aim of the present study was to examine the correlation between the self-administered Global PA Questionnaire - Japanese version (GPAQ-J) and accelerometer in Japanese adults.

METHODS

A cross-sectional comparative study was conducted to examine the last 7 days PA by GPAQ-J, comparing with accelerometer data. A convenience sample of 181 women and 85 men were included.

RESULTS

Significant positive correlations using Spearman's rank correlation were observed between total moderate-to-vigorous PA (MVPA) by GPAQ-J and both of accelerometer-measured total MVPA and 10-minute bouts of MVPA in both women and men, with a higher correlation in men (total MVPA: ρ = 0.375, 10-minute bouts of MVPA: ρ = 0.419). GPAQ-J transportation MVPA was significantly correlated with all types of variables for accelerometer-measured MVPA for men, particularly with ambulatory MVPA (ρ = 0.615). On the other hand, for women, a significant positive correlation was observed between GPAQ-J recreation MVPA and accelerometer-measured 10-minute bouts of MVPA. Average MVPA with GPAQ-J was between the accelerometer-measured total MVPA and the 10 min bouts of MVPA in both genders. A significant positive correlation was only observed between ST by accelerometer and the GPAQ-J question in men (ρ = 0.332), not women (ρ = 0.004).

CONCLUSIONS

The GPAQ-J has weak or moderate validity for evaluating both total and 10-minute bouts of MVPA in Japanese women and men. ST by the GPAQ-J has moderate validity only in men.

Combined Self-Reported and Device-Measured Physical Activity Assessment and Disability Incidence in Older Adults

OBJECTIVES

To clarify the relationship between self-reported and device-measured physical activity (PA) and disability incidences in community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

In total, 4504 (median age 75 [range, 72-79] years; women, 52.1%) community-dwelling older adults were included in this study.

METHODS

Device-measured moderate-to-vigorous PA (MVPA) was measured using a triaxial accelerometer. Self-reported MVPA was assessed using the Japanese version of the International Physical Activity Questionnaire, Short Form. The cutoff MVPA was 150 min/wk. PA was divided into 4 groups based on self-reported and device-measured assessments: (1) self-reported/device-measured inactive, (2) self-reported active/device-measured inactive, (3) self-reported inactive/device-measured active, and (4) self-reported/device-measured active. The disability incidence, defined as a long-term care insurance certification of any level indicating a requirement for support or continuous care, was prospectively determined using data extracted from the Japanese long-term care insurance system.

RESULTS

Of the participants, 892 (19.8%) developed disabilities within 62 (range, 60-64) months. The prevalence of self-reported inactive/device-measured inactive, self-reported active/device-measured inactive, self-reported inactive/device-measured active, and self-reported active/device-measured active were 884 (34.9%), 441 (17.4%), 693 (27.3%), and 515 (20.3%) participants, respectively. Multivariate Cox regression analysis showed that self-reported/device-measured active, self-reported inactive/device-measured active, and self-reported active/device-measured inactive independently decreased the disability incidence risk (self-reported/device-measured active: hazard ratio [HR], 0.555, 95% confidence interval [CI], 0.412-0.749; self-report inactive/device-measured active: HR, 0.656; 95% CI, 0.518-0.831; self-reported active/device-measured inactive: HR, 0.718; 95% CI, 0.556-0.928). In the post hoc analysis, those who were self-reported active/device-measured inactive were divided into 2 groups according to involvement in sports. Those who played sports had a lower disability risk; however, the difference was not significant.

CONCLUSIONS AND IMPLICATIONS

Combined self-reported and device-measured PA assessments may allow for disability risk stratification in older adults. The findings will also help in creating methods for evaluating PA levels to prevent disability incidences among older adults.

Associations of physical activity and sedentary time with health-related quality of life in patients with localized renal cell cancer: a cross-sectional analysis within the ReLife study

PURPOSE

This study examined the associations of device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time as well as self-reported MVPA with health-related quality of life (HRQoL) in patients with localized renal cell cancer (RCC) in the recovery phase after surgery.

METHODS

At 3 months post-surgery, 341 patients with stage I-III RCC participating in the ReLife study wore an ActivPAL3 device to determine MVPA and sedentary time. The SQUASH questionnaire was used for assessing self-reported MVPA, and the EORTC QLQ-C30 for assessing HRQoL (range 0-100). Multivariable linear regression models were used to examine the cross-sectional associations of MVPA and sedentary time with HRQoL.

RESULTS

The highest (≥ 6.7 h/week) versus lowest (≤ 2.7 h/week) quartile of MVPA was associated with a better global health status (β, 10.2; 95% CI, 5.1, 15.3), summary score (β, 4.6; 95% CI, 1.1, 8.1), physical (β, 7.7; 95% CI, 3.8, 11.6), role (β, 12.4; 95% CI, 4.7, 20.2), and social functioning (β, 7.3; 95% CI, 0.2, 14.4), and lower fatigue (β, - 11.2; 95% CI, - 18.1, - 4.2). Results for self-reported MVPA were in the same direction but weaker. The lowest (≤ 8.8 h/day) versus highest (≥ 11.5 h/day) quartile of sedentary time was associated with better physical functioning (β, 4.6; 95% CI, 0.8, 8.5).

CONCLUSIONS

In patients with localized RCC, higher MVPA 3 months post-surgery was associated with better HRQoL outcomes including less fatigue whereas lower sedentary time was only associated with better physical functioning. This information can contribute to the development of physical activity guidelines and interventions to improve HRQoL.

Factors related to sedentary behavior of pregnant women during the second/third trimester: prospective results from the large-scale Japan Environment and Children's Study

BACKGROUND

Prolonged sedentary behavior in pregnant women is reported to be associated with worse health-related indices and pregnancy outcomes. The aim of this study was to identify relevant factors that can be targeted in interventions to reduce sedentary behavior during pregnancy.

METHODS

Of 103,057 pregnancies registered in the Japan Environment and Children's Study, 83,733 pregnant women were included for analysis after excluding multiple enrollments, nonresponses, and missing outcome data. Data were collected using the International Physical Activity Questionnaire and analyzed using logistic regression models to calculate crude and adjusted odds ratios. Missing data were handled using multiple imputations, and statistical analyses were performed using SAS software.

RESULTS

Mean sedentary behavior time increased from 5.4 h/day before pregnancy to 5.9 h/day during pregnancy. The percentage of women classified in the high sedentary behavior group increased from 25.6% before pregnancy to 31.2% during pregnancy. Factors associated with high sedentary behavior during pregnancy included longer hours spent watching television and playing video games before pregnancy, higher annual household income, and working status during pregnancy. Possible protective factors against high sedentary behavior included engaging in ≥ 150 min of moderate to vigorous physical activity per week before pregnancy.

CONCLUSIONS

This large-scale cohort study provides valuable insights into sedentary behavior patterns among pregnant women in Japan. To reduce the amount of time engaged in sedentary behavior during pregnancy, the planning and management of time spent watching TV and playing video games as well as establishing exercise habits before pregnancy are recommended.

Device-measured stationary behaviour and cardiovascular and orthostatic circulatory disease incidence

BACKGROUND

Previous studies have indicated that standing may be beneficially associated with surrogate metabolic markers, whereas more time spent sitting has an adverse association. Studies assessing the dose-response associations of standing, sitting and composite stationary behaviour time with cardiovascular disease (CVD) and orthostatic circulatory disease are scarce and show an unclear picture.

OBJECTIVE

To examine associations of daily sitting, standing and stationary time with CVD and orthostatic circulatory disease incidence.

METHODS

We used accelerometer data from 83 013 adults (mean age ± standard deviation = 61.3 ± 7.8; female = 55.6%) from the UK Biobank to assess daily time spent sitting and standing. Major CVD was defined as coronary heart disease, heart failure and stroke. Orthostatic circulatory disease was defined as orthostatic hypotension, varicose vein, chronic venous insufficiency and venous ulcers. To estimate the dose-response hazard ratios (HR) we used Cox proportional hazards regression models and restricted cubic splines. The Fine-Gray subdistribution method was used to account for competing risks.

RESULTS

During 6.9 (±0.9) years of follow-up, 6829 CVD and 2042 orthostatic circulatory disease events occurred. When stationary time exceeded 12 h/day, orthostatic circulatory disease risk was higher by an average HR (95% confidence interval) of 0.22 (0.16, 0.29) per hour. Every additional hour above 10 h/day of sitting was associated with a 0.26 (0.18, 0.36) higher risk. Standing more than 2 h/day was associated with an 0.11 (0.05, 0.18) higher risk for every additional 30 min/day. For major CVD, when stationary time exceeded 12 h/day, risk was higher by an average of 0.13 (0.10, 0.16) per hour. Sitting time was associated with a 0.15 (0.11, 0.19) higher risk per extra hour. Time spent standing was not associated with major CVD risk.

CONCLUSIONS

Time spent standing was not associated with CVD risk but was associated with higher orthostatic circulatory disease risk. Time spent sitting above 10 h/day was associated with both higher orthostatic circulatory disease and major CVD risk. The deleterious associations of overall stationary time were primarily driven by sitting. Collectively, our findings indicate increasing standing time as a prescription may not lower major CVD risk and may lead to higher orthostatic circulatory disease risk.