Physical Activity Promotion: Highlights from the 2018 Physical Activity Guidelines Advisory Committee Systematic Review

Prevalence of Meeting Daily Step Count Recommendations in Cardiovascular Patients With and Without Metabolic Syndrome

Purpose

We compared the prevalence of older cardiovascular patients with and without metabolic syndrome (MetS) who met the recommendations of walking more than 7000 and 10,000 steps/d, and we determined whether MetS status was significantly associated with meeting the daily step count recommendations before and after adjusting for demographic variables, comorbid conditions, and cardiovascular risk factors.

Methods

Older cardiovascular participants with MetS (n = 489) and without MetS (n = 154) were assessed on their walking for seven consecutive days with a StepWatch activity monitor.

Results

The MetS group took significantly fewer steps/d than the non-MetS control group (7307 ± 3625 vs. 8933 ± 4487 steps/d; P < .001). Only 47 % and 21 % of the MetS group walked ≥7000 and 10,000 steps/d, respectively, whereas 68 % and 34 % of the control group met these recommendations (P < .001 and p = .002, respectively). The odds of walking 7000 steps/d were 52 % lower in the MetS group (OR = 0.48, 95 %CI = 0.29-0.77, P = .003), and the odds of walking 10,000 steps/d were a 37 % lower trend (OR = 0.63, 95 %CI = 0.39-1.04, P = .069). Additionally, the odds of walking 7000 and 10,000 steps/d were lower in participants with reduced HDL-cholesterol (OR = 0.35, 95 %CI = 0.21-0.60, P < .001 and OR = 0.45, 95 %CI = 0.25-0.80, P = .007, respectively) and abdominal obesity (OR = 0.52, 95 %CI = 0.37-0.74, P < .001 and OR = 0.45, 95 %CI = 0.30-0.68, P < .001, respectively).

Conclusions

Older cardiovascular participants with MetS had an 18 % lower daily step count compared to those without MetS and were less likely to meet the 7000 and 10,000 steps/d recommendations. Additionally, older cardiovascular participants who were least likely to meet the daily step count recommendations included those who had reduced HDL-cholesterol and abdominal obesity.

Next Steps in Efforts to Address the Obesity Epidemic

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.

Acculturation is associated with 12-month adherence to combined MVPA and sedentary behavior guidelines in a sample of midlife and older Latino/a adults: findings from the COMPASS physical activity trial

BACKGROUND

Although some studies have shown that greater acculturation is associated with an increased risk of cardiovascular disease (CVD) among Latino/a adults, the relationship between acculturation and modifiable health behaviors in older Latino/a adults living in the United States (US) remains underexplored. This secondary analysis of the COMPASS physical activity trial explored the relationship between acculturation and adherence to combined movement behavior guidelines for moderate to vigorous physical activity (MVPA) and sedentary behavior guidelines at 12 months among 245 midlife and older Latino/a adults from the San Francisco Bay Area.

METHODS

Baseline acculturation was measured using the Short Acculturation Scale for Hispanics, yielding a total score and three subscales on a 5-point Likert scale, higher scores represented higher acculturation. MVPA was evaluated via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire, while sedentary behavior was measured using a validated 1-week recall survey. We employed logistic regression to analyze linear and non-linear associations between acculturation and adherence to the combined MVPA (≥ 150 min/wk) and sedentary behavior (< 8 h/day) movement behavior guidelines, adjusting for baseline MVPA and sedentary behavior, intervention arm, gender, income, body mass index, education, and years in the US.

RESULTS

At baseline, 6.4% adhered to combined MVPA and sedentary behavior guidelines, with the prevalence of adherence rising to 30.2% at 12 months. Each one-point increase in language use acculturation subscale score was linked to 1.7 times greater adherence (p = 0.01) at 12 months. A similar pattern was observed when acculturation was operationalized as a binary variable (p = 0.03). For the summary acculturation score, participants with higher acculturation had 2.6 times higher odds of adhering to guidelines at 12 months compared to those with lower acculturation (p = 0.04).

CONCLUSIONS

Higher acculturation was associated with a higher odds of 12 month adherence to MVPA and sedentary behavior guidelines among a sample of older Latino/a adults. Results underscore the importance of incorporating acculturation into behavioral trialsand the need to tailor physical activity interventions for Latino/a older adults with lower acculturation.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02111213 Registered April 2, 2014 https//clinicaltrials.gov/study/NCT02111213.

Plasma Proteomic Signatures of Physical Activity Provide Insights into Biological Impacts of Physical Activity and its Protective Role Against Dementia

Physical activity (PA), including sedentary behavior, is associated with many diseases, including Alzheimer's disease and all-cause dementia. However, the specific biological mechanisms through which PA protects against disease are not entirely understood. To address this knowledge gap, we first assessed the conventional observational associations of three self-reported and three device-based PA measures with circulating levels of 2,911 plasma proteins measured in the UK Biobank (nmax=39,160) and assessed functional enrichment of identified proteins. We then used bi-directional Mendelian randomization (MR) to further evaluate the evidence for causal relationships of PA with protein levels. Finally, we performed mediation analyses to identify proteins that may mediate the relationship of PA with incident all-cause dementia. Our findings revealed 41 proteins consistently associated with all PA measures and 1,027 proteins associated with at least one PA measure. Both conventional observational and MR study designs converged on proteins that appear to increase as a result of PA, including integrin proteins such as ITGAV and ITGAM, as well as MXRA8, CLEC4A, CLEC4M, GFRA1, and ADGRG2; and on proteins that appear to decrease as a result of PA such as LEP, LPL, INHBC, CLMP, PTGDS, ADM, OGN, and PI3. Functional enrichment analyses revealed several relevant processes, including cell-matrix adhesion, integrin-mediated signaling, and collagen binding. Finally, several proteins, including GDF15, ITGAV, HPGDS, BCAN, and MENT, were found to mediate the relationship of PA with all-cause dementia, implicating processes such as synaptic plasticity, neurogenesis and inflammation, through which PA protects against dementia. Our results provide insights into how PA may affect biological processes and protect from all-cause dementia, and provide avenues for future research into the health-promoting effects of PA.

What factors influence the willingness and intensity of regular mobile physical activity?- A machine learning analysis based on a sample of 290 cities in China

Introduction

This study, based on Volunteered Geographic Information (VGI) and multi-source data, aims to construct an interpretable macro-scale analytical framework to explore the factors influencing urban physical activities. Using 290 prefecture-level cities in China as samples, it investigates the impact of socioeconomic, geographical, and built environment factors on both overall physical activity levels and specific types of mobile physical activities.

Methods

Machine learning methods were employed to analyze the data systematically. Socioeconomic, geographical, and built environment indicators were used as explanatory variables to examine their influence on activity willingness and activity intensity across different types of physical activities (e.g., running, walking, cycling). Interaction effects and non-linear patterns were also assessed.

Results

The study identified three key findings: (1) A significant difference exists between the influencing factors of activity willingness and activity intensity. Socioeconomic factors primarily drive activity willingness, whereas geographical and built environment factors have a stronger influence on activity intensity. (2) The effects of influencing factors vary significantly by activity type. Low-threshold activities (e.g., walking) tend to amplify both promotional and inhibitory effects of the factors. (3) Some influencing factors display typical non-linear effects, consistent with findings from micro-scale studies.

Discussion

The findings provide comprehensive theoretical support for understanding and optimizing physical activity among urban residents. Based on these results, the study proposes guideline-based macro-level intervention strategies aimed at improving urban physical activity through effective public resource allocation. These strategies can assist policymakers in developing more scientific and targeted approaches to promote physical activity.

Adherence to the 24-hour movement behavior guidelines and depression risk among older adults from the United States

BACKGROUND

While recent studies, primarily among Asian cohorts, have linked adherence to 24-hour movement behavior (24-HMB) guidelines with improved mental health-some of which show sex differences-few studies have explored these relationships among older adults from the United States.

METHODS

National Health and Nutrition Examination Survey data from 2011-2018 were examined in 2,812 older adults (≥ 65years). Those considered adherent to 24-HMB guidelines had a sleep duration of 7-8 h./night, moderate-vigorous physical activity (MVPA) ≥ 150 min/wk., and sedentary behavior (SB) < 8 h./day. Sleep duration, SB, and MVPA were self-reported, with SB and MVPA obtained from the validated Global Physical Activity Questionnaire. Depression was measured using the Patient Health Questionnaire (PHQ-9), with a score of ≥ 10 indicating depression. Logistic regression was used to evaluate overall and sex-stratified associations between non-adherence to all three behaviors, combinations of two behaviors, or individual behavior guidelines, with odds of depression, adjusted for putative confounders.

RESULTS

Among the full sample, non-adherence to all three 24-HMB guidelines was associated with 1.7 [95% confidence interval (CI):1.1, 3.1; p = 0.02] higher odds of depression versus those that adhered to all three behaviors. After sex stratification, the association only persisted among males [OR = 2.5 (95% CI:1.1, 5.4); p = 0.02]. Within the overall sample, higher odds of depression were observed for those who did not adhere to the SB + sleep duration guidelines and the sleep duration + MVPA guidelines. Sex-stratified findings revealed that associations only remained significant in males. While in the overall sample of older adults, non-adherence to the sleep duration guideline was associated with 2.1 (95% CI:1.4, 3.3; p = 0.001) higher odds of depression compared to those that adhered to the guideline.

CONCLUSIONS

Results provide evidence of associations between non-adherence to 24-HMB and higher odds of depression, specifically in older males, suggesting a potential sex-specific effect that warrants further investigation. Future studies using longitudinal designs are needed to confirm these findings and explore the mechanisms underlying these associations.

Incorporating Lifestyle Medicine Into Occupational Medicine Practice: ACOEM Guidance Statement

ABSTRACT

Lifestyle medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/obesity, sleep, mental well-being, and social connectedness.

The Effects of High-Intensity Functional Training on the Perceptions of Exercise in Middle-Aged Females: A Pilot Study

The high prevalence of obesity and physical inactivity in the U.S. is a public health crisis. This study aims to examine the effects of high-intensity functional training (HIFT) on exercise perceptions and physiological changes in inactive females. A pre-test and post-test, quasi-experimental design was conducted with inactive, middle-aged females (n = 8) participating in an 8-week supervised and verified intervention (2-week High-Intensity Interval Training, 6-weeks HIFT). The Health Belief Model Scale for Exercise (HBMS-E) survey was completed pre-intervention, post-intervention, and 4-week follow-up to assess exercise perceptions. Pre- and post-intervention physiological assessments included: body composition, strength (1-repetition maximum (RM) bench press (BP), 5-RM deadlift (DL), and maximal oxygen consumption (V̇O2max). A within-subjects repeated-measures ANOVA assessed the HBM constructs between pre-intervention, post-intervention, and follow-up. Dependent t-tests compared physiological outcomes pre- to post-intervention. There was a significant decrease between pre-intervention, post-intervention, and follow-up for objective (F(2, 14)=22.24, p < .001) and subjective barriers (F(2, 14) = 11.20, p = .001), and a significant increase in self-efficacy (F(1.08, 7.53)= 8.96, p = .02). There was a significant increase in V̇O2max (p = .001, d = 1.81), 1-RM BP (p < .001, d = 2.51), and 5-RM DL (p = .001, d = 1.83) pre- to post-intervention. Findings suggest HIFT positively influenced middle-aged females' perceptions of barriers and self-efficacy related to exercise and provides fitness benefits to improve health and wellness.

The Force Awakening in HbA1c Control: A Systematic Review and Meta-Analysis on the Efficacy of High-Intensity and Endurance Exercise in Patients With Type 2 Diabetes Mellitus

The increase in the global prevalence of type 2 diabetes mellitus (DM2), driven mainly by obesity and physical inactivity, has increased interest in various nonpharmacological therapies. This systematic review aims to establish the effectiveness of high-intensity interval training (HIIT) and resistance exercise (RE) compared with continuous aerobic exercise in improving control in patients with DM2. We conducted a comprehensive search for clinical trials using databases such as MEDLINE (PubMed) and Web of Science. The search was performed using a controlled vocabulary (MeSH) together with Boolean operators, and the results were limited to English and Spanish. Secondary outcomes were improvements in VO2max and decreases in low-density lipoprotein (LDL). This study aims to explain evidence-based recommendations for primary care physicians on exercise therapies to improve glycemic management as well as cardiovascular health in people with DM2.

Factors on medical clerkship students' quality of life: A survey study

Introduction

Due to the higher demand for healthcare provision in Indonesia, increasing the number of medical schools in Indonesia was highly encouraged. Meanwhile, medical students were considered a susceptible population to a variety of issues that negatively impact their quality of life (QOL) in comparison to the general community.

Objectives

The study aims to assess the QOL of Indonesian medical students during the clinical clerkship program (years 4-5) of their medical training while also exploring the association between the results and their ongoing rotation.

Methods

The survey was conducted online to 311 students at a private medical school in Jakarta using the Indonesian version of WHOQOL-BREF. Participants' characteristics, sleep duration, physical activity, and smoking history were also assessed to see if there was any association. Results: 82% of 311 registered clerkship students responded to the survey. In terms of overall QOL, being in a major department, 7-9 h of sleep duration, and owning a private vehicle increased the QOL.

Conclusion

This study suggested that medical schools' policies may consider sleep duration, travel time, transportation-related infrastructure, and social-related infrastructure to underpin students' social relationships and, afterward, improve their QOL in intangible ways.

Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement

ABSTRACT

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk-1 of moderate-intensity physical activity, and these benefits occur in a dose-response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

A Longitudinal Theory-Based Investigation of How Environmental Aesthetics Predicts Home-Based Exercise

INTRODUCTION

Environmental aesthetics is a recognized macro environmental correlate of physical activity participation. Extrapolating this effect, we hypothesize this variable to also function as a determinant of exercise participation in the microenvironment , such as the home. Specifically, we predict that the environmental aesthetics of the location of cardio and resistance training equipment will predict determinants of exercise participation within the integrated behavior change model.

METHODS

Adult owners of exercise equipment ( N = 231) completed measures on the environmental aesthetics of their cardio and resistance training equipment, exercise time, and constructs from the integrated behavior change model across three consecutive monthly surveys. Study hypotheses were tested using multilevel structural equation modeling with participants (level 2) nested within time (level 1).

RESULTS

The model revealed predictive effects of intention, habit, and planning on exercise participation over time. The findings indicated a total effect of autonomous motivation on intention and habit. In addition, environmental aesthetics of cardio and strength training equipment predicted autonomous motivation, along with habit and intention when accounting for indirect effects. Finally, planning moderated the intention-behavior relationship, indicating that participants who scored higher on planning were more likely to translate their intentions to behavior.

CONCLUSIONS

These findings provide informative notes for designing effective home-based exercise programs, which have increased in popularity over the past recent years. Specifically, experimental studies that provide exercise equipment should ensure that the location of the equipment is appealing to the participant to increase the likelihood equipment use and exercise engagement.

The Association between Bone Mineral Density and Risk of Mortality: A Prospective Cohort Study of 233,397 Taiwanese

PURPOSE

Osteoporosis is an important public health challenge given its high prevalence in western populations and the prevalence has shown an upward trend in recent decades in Asia. However, epidemiological evidence on the association between bone mineral density (BMD) and mortality risk in the Asian population is sparse.

METHODS

The Cox proportional hazards model and cause-specific hazard models were used to investigate the association of BMD with the risk of all-cause mortality and cause-specific mortality.

RESULTS

The present study comprised of 3,332,207 person-years with a median follow-up of 14.6 years. 27,508 participants (15,967 men and 11,541 women) died among 233,397 participants (112,348 men and 121,049 women) during the follow-up period. Compared to those with normal BMD level, both men and women with low BMD had a significantly higher risk of all-cause, cardiovascular disease (CVD), and cancer mortality after adjusting for the covariates. [For men with osteoporosis: all-cause: 1.37 (1.27-1.49); CVD: 1.28 (1.08-1.52); cancer: 1.29 (1.12-1.49); For women with osteoporosis: all-cause: 1.72 (1.63-1.82); CVD: 1.85 (1.64-2.08); cancer: 1.47 (1.35-1.61)]. The P for interactions for BMD with sex were significant for all-cause and CVD mortality. The adverse effects of BMD on the risk of all-cause and CVD were higher in women than in men [men vs. women: all-cause: 1.37 (1.27-1.49) vs. 1.72 (1.63-1.82); CVD: 1.28 (1.08-1.52) vs. 1.85 (1.64-2.08)]. In the nonlinear dose-response analyses, the association between BMD increments and all-cause mortality risk shows an L-shaped pattern in men and a similar U-shaped trend in women (P for non-linear association: <0.001). Likewise, a similar L-shaped association was observed between BMD levels and cancer mortality risk in men.

CONCLUSIONS

Low BMD had an increased risk of all-cause, CVD, and cancer mortality in both men and women. Women had a stronger positive association between low BMD and an increased risk of all-cause and CVD mortality compared to men.

A Comprehensive Planning Framework for Designing Effective Physical Activity Interventions in Youth

BACKGROUND

Effective physical activity (PA) interventions are needed to counter the insufficient and declining levels of PA in youth. These require an updated, comprehensive planning framework that consolidates recent decades of progress in promoting PA in young children, children, and adolescents. Effective PA interventions require program planning and conceptual model development that target a coordinated and multilevel set of age-specific PA determinants. Accordingly, this paper presents a comprehensive planning framework that researchers can use to design intervention research to promote PA in youth.

METHODS

The first author conducted targeted searches through Google Scholar to compile PA models/frameworks/guides applicable to youth, a comprehensive set of PA determinants, and determinant-linked strategies to promote PA focusing on review articles. The information was summarized in tables, synthesized, and used to create a planning framework, all of which were reviewed by coauthors.

RESULTS

The APPLE Framework for Planning PA Opportunities for Youth (APPLE = Age, PA focus, Place and time, Leverage relevant influences and strategies, and ensure Enjoyable PA opportunities) incorporated all core elements from targeted reviews to create a comprehensive planning framework. The APPLE Planning Framework has a set of questions/prompts that guide the intervention planning process and conceptual model templates to organize planning efforts for designing intervention research.

CONCLUSIONS

The APPLE Framework for Planning PA Opportunities for Youth will enable researchers to develop comprehensive conceptual models to guide the design of PA interventions for youth. Future research should refine the model and its components to enable PA intervention research in youth to move forward.

"Losing access to outdoor spaces was the biggest challenge for children to be healthy": pandemic restrictions and community supports for children's movement in Nova Scotia

Introduction

Health-focused communities can promote physical activity for children by providing them with safe and supportive environments to move. Across the COVID-19 pandemic many community spaces and services were closed due to public health restrictions. During the pandemic, Atlantic Canada uniquely implemented an agreement between four provinces to restrict travel and reduce the spread of the virus. The "Atlantic bubble" led to fewer cases of COVID-19 and restrictions to community spaces and services. With restrictions now removed, community spaces and services likely play a critical role in facilitating the recalibration of children's movement. Perspectives from families who experienced the "Atlantic bubble" may offer valuable insights to the use of these spaces during and after the removal of restrictions.

Objective

This study explored the role of community spaces and services on their child's physical activity across the COVID-19 pandemic from the perspectives of Nova Scotia caregivers.

Methods

We employed a qualitative description approach and conducted semi-structured interviews with 14 caregivers of children aged 5-11 years who lived in Nova Scotia, Canada. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis.

Results

Four themes were generated: (1) Public health restrictions limited community movement behaviors and social connections, (2) Spaces, locations, and environments influenced how families experienced physical activity during public health restrictions, (3) Virtual realities: screens supported a new sense of community for children throughout the pandemic, and (4) "Facilitated" and "forced adaptability": public health restrictions changed family dynamics, routines, and movement behaviors.

Conclusion

Despite living in the "Atlantic bubble," Nova Scotian caregivers shared that COVID-19 related public health restrictions shifted their family's dynamics, routines, and ability to engage in physical activity within their communities. Community spaces and services can be leveraged to recalibrate children's movement as pandemic-related restrictions are reduced. In future public health crises, community spaces and services should remain in place to whatever extent possible to reduce the collateral consequences of public health restrictions on children's health.

Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia

AIM

Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP).

METHODS

We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions.

RESULTS

We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE.

CONCLUSIONS

Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP.

Engagement With Remote Delivery Channels in a Physical Activity Intervention for Senior Women in the US

PURPOSE

Identify the effects of engagement with different intervention delivery channels on physical activity (PA), and the participant subgroups engaging with the different channels, among Women's Health Initiative Strong and Healthy (WHISH) PA trial participants.

DESIGN

Secondary analysis of data from WHISH, a pragmatic trial that used passive randomized consent.

SETTING

United States (remote intervention in all 50 states).

SAMPLE

18,080 U.S. women, aged 68-99 years, assigned to the WHISH PA intervention arm.

MEASURES

6 dichotomous variables operationalized engagement: Engagement with Targeted Inserts, Email (opened), Email (clicked links), Website (logging in), Website (tracking), Interactive Voice Response (IVR). PA was measured using the CHAMPS PA questionnaire.

ANALYSIS

Linear regressions evaluated effects of engagement on PA. Conditional Inference Trees identified subgroups of participants engaging with different channels based on demographic and psychosocial variables.

RESULTS

Engagement with each channel, except IVR, was associated with significantly more hours/week of PA (square root coefficients .29 - .13, P values <.001). Consistently across channels, features that identified subgroups of participants with higher engagement included younger age, and higher levels of PA and physical function. Subgroups with the highest engagement differed from those with the lowest in most participant characteristics.

CONCLUSIONS

For equitable population-level impact via large-scale remotely-delivered PA programs, it may be necessary to identify strategies to engage and target harder to reach subgroups more precisely.

CLINICAL TRIAL REGISTRATION

The WHISH trial is registered at ClinicalTrials.gov (No. NCT02425345).

A life span perspective on competencies for a healthy, physically active lifestyle: Findings of a data pooling initiative with over 7000 individuals

Individuals are recommended to lead active lifestyles throughout the life course. The model of physical activity-related health competence (PAHCO) adopts a competence approach by integrating physical, cognitive, and motivational determinants for health-enhancing PA (movement competence, control competence, self-regulation competence). Drawing on a comprehensive dataset pooling, the goal of the present study was to model the idiosyncratic courses of 10 PAHCO indicators over the life span. We identified studies that empirically operationalized PAHCO, combining data of 7134 individuals (age range: 15-97 years; 61% female) from 18 different populations (prevention and rehabilitation sectors). We applied a stepwise multilevel analysis approach with disjunct sub-samples (n = 48) to examine linear and quadratic associations between age and PAHCO. Indicators of movement competence (i.e., manageability of endurance, strength, and balance demands; task-specific self-efficacy) congruently showed negative associations with age (0.054 ≤ R marg 2 ${R}_{\text{marg}}^{2}$  ≤ 0.211). However, parameters of control competence remained stable across the life span (-0.066 ≤ β ≤ 0.028). The three indicators of self-regulation competence revealed an inconsistent relationship with age, though uncovering positive associations for self-control (β = 0.106) and emotional attitude toward PA (β = 0.088). The associations of some indicators varied significantly across sub-samples. The results suggest differential analyses for associations between PAHCO and age. While the physically determined PAHCO indicators (movement competence) probably decline across the life span, the ability to ensure regularity of PA (self-regulation competence) or align PAs with an individual's health (control competence) appear to remain constant or improve with increasing age. The findings reinforce a de-stigmatizing approach for PA promotion practices with considerable space for aligning activities with health also in the elderly.

Outdoor gardening activity with different frequency and duration may be associated with reduction of total and cause-specific mortality risk for general U.S. adults: Findings from the NHANES

BACKGROUND AND AIMS

Engaging in recommended levels of physical activity (PA) is associated with reduced overall and cause-specific mortality rates. Our study aims to examine the relationship between gardening-specific PA and all-cause and cause-specific mortality based on representative U.S. adults.

METHODS AND RESULTS

A total of 13,812 adults representing 663.5 million non-institutionalized U.S. adults were included in the National Health and Nutrition Examination Survey. Self-reported gardening activity (GA) was assessed by a validated questionnaire, and outcomes of interest were all-cause mortality and mortality specific to certain causes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using survey-multivariable Cox proportional hazards models. During a median follow-up period of 16.8 years (Interquartile range = 14.8-18.7), there were 3,476 deaths. After adjusting for potential covariates, we found that participants exposed to GA were more likely to have a lower risk of total mortality [HR (95% CI): 0.76 (0.68, 0.85), P-value < 0.001], cancer-specific mortality [HR (95% CI): 0.81 (0.67, 0.99), P-value < 0.05], cardiovascular disease mortality [HR (95% CI): 0.65 (0.53, 0.80), P-value < 0.001], and respiratory disease mortality [HR (95% CI): 0.66 (0.45, 0.98), P-value < 0.05], compared to those without GA exposure. Furthermore, engaging in GA more frequently and for longer durations was significantly associated with a lower total mortality risk.

CONCLUSION

Our study provides evidence that engaging in GA is associated with a decreased risk of overall and cause-specific mortality. However, further longitudinal or interventional studies are needed to investigate the potential benefits of GA.

A comparison of the effects of two protocols of concurrent resistance and aerobic training on physical fitness in middle school students

Objective

This study aimed to compare the effects of two concurrent training (CT) protocols on the physical fitness of middle school students.

Method

A 12-week quasi-experimental pre-test/post-test study was conducted with 157 middle school students (age = 12.48 ± 0.34, n = 90 females) divided into three groups: CT group A (CT-0h) received combined resistance training (RT) and aerobic training (AT) in each physical education session, CT group B (CT-48h) received RT and AT across two separate physical education classes 48 h apart, and a control group (Con) received no training. Training occurred twice a week. Test indicators included cardiorespiratory fitness (CRF) measured by estimated VO2max and 20 m shuttle run (laps), as well as muscle strength assessed through long jump, vertical jump, and handgrip strength.

Results

The intervention groups exhibited significant increases in estimated VO2max and muscle strength compared to their baseline values (p < 0.05). Both CT-0h and CT-48h groups demonstrated significant improvements in 20 m shuttle run (laps) (mean difference: 8.88 laps, p < 0.01; mean difference: 4.81 laps, p < 0.01, respectively), standing long jump (mean difference: 6.20 cm, p < 0.01; mean difference: 3.68 cm, p < 0.01, respectively), vertical jump (mean difference: 4.95 cm, p < 0.01; mean difference: 4.04 cm, p < 0.01, respectively), and handgrip strength (mean difference: 11.17 kg, p < 0.01; mean difference: 6.99 kg, p < 0.01, respectively). CT-0h group exhibited significantly increased estimated VO2max (mean difference: 1.47 ml/kg/min, p < 0.01) compared to the CT-48h group.

Conclusion

Both CT programs effectively improved adolescents' physical fitness indicators. However, the program that integrated RT and AT within the same physical education class demonstrated superior enhancement in adolescents' CRF.

Weight training and risk of all-cause, cardiovascular disease and cancer mortality among older adults

BACKGROUND

While previous studies indicate muscle-strengthening exercises may reduce mortality risk, further research is needed to increase certainty of the evidence. We investigated overall and dose-response associations between weight training and the risks of all-cause, cardiovascular disease (CVD) and cancer mortality in a large cohort of older adults with long follow-up time and a large number of deaths. We also investigated the joint associations of weight training and aerobic exercise with mortality risk.

METHODS

Weight training was assessed via self-report in 2004-05 in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study (USA; n = 216 339), with follow-up to 2019. Cox regression estimated the hazard ratios (HR) and 95% confidence intervals (CI) for the associations between weight training and mortality, after adjusting for confounders including aerobic exercise.

RESULTS

Around 25% of participants [mean age = 69.9 years (standard deviation = 5.4), 58% men] reported engaging in weight training over the past year, and there were 79 107 (37%) deaths. Engaging in any weight training (vs none) was associated with lower risks of all-cause (HR = 0.94; 95% CI = 0.93-0.96), CVD (HR = 0.92; 95% CI = 0.90-0.95) and cancer mortality (HR = 0.95; 95% CI = 0.92-0.98). More time spent in weight training was associated with only marginally greater risk reductions. Larger risk reductions were observed among women than men. Performing both aerobic exercise and weight training conferred the greatest mortality risk reduction; weight training was not associated with mortality risk among participants who did no aerobic exercise.

CONCLUSION

Performing any amount of weight training lowered mortality risk.

Accelerometer-derived physical activity and the risk of death, heart failure, and stroke in patients with atrial fibrillation: a prospective study from UK Biobank

OBJECTIVE

Data on cardiovascular outcomes according to objectively measured physical activity (PA) in patients with atrial fibrillation (AF) are scarce. This study explored the associations between PA derived from wrist-worn accelerometers and the risk of death, incident heart failure (HF), and incident stroke in patients with AF.

METHODS

From 37 990 patients with AF in UK Biobank, 2324 patients with accelerometer data were included. Weekly moderate-to-vigorous PA (MVPA) duration was computed from accelerometer data. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, incident HF, and incident stroke. Restricted cubic splines estimated the dose-response associations between MVPA duration and the outcomes. The adjusted HRs (aHRs) of the outcomes according to adherence to PA standard guidelines (performing MVPA≥150 min/week) were also evaluated.

RESULTS

The mean age was 66.9±6.2 years and 64.9% were male. During a median follow-up of 6.7 years, there were 181 all-cause deaths, 62 cardiovascular deaths, 225 cases of incident HF, and 91 cases of incident stroke; the overall incidence rate per 1000 patient-years was 11.76, 4.03, 15.16 and 5.99, respectively. There was a linear inverse dose-response relationship between MVPA (≥108 min/week) and all-cause mortality. Performing MVPA for 105-590 min/week was associated with a lower risk of HF than those with no measurable MVPA. The risk of stroke and cardiovascular mortality was not associated with MVPA. Performing guideline-adherent MVPA was related to a 30% lower risk of all-cause mortality (aHR: 0.70 (0.50-0.98), p=0.04) and 33% lower risk of HF (aHR 0.67 (0.49-0.93), p=0.02).

CONCLUSION

In patients with AF, accelerometer-derived PA data supports lower risks of all-cause mortality and HF according to a greater level of MVPA and adherence to PA guidelines. Regular MVPA should be encouraged in patients with AF as a part of integrated management.

Associations Between Physical Activity and the Risk of Hip Fracture Depending on Glycemic Status: A Nationwide Cohort Study

CONTEXT

Although physical activity (PA) is recognized to reduce fracture risk, whether its benefits differ according to glycemic status remains unknown.

OBJECTIVE

We investigated the effect of PA on incident hip fracture (HF) according to glycemic status.

METHODS

We studied 3 723 097 patients older than 50 without type 1 diabetes mellitus (DM) or past fractures. HF risks were calculated using Cox proportional hazard regression. Participants were categorized by glycemic status into 5 groups: normal glucose tolerance, impaired fasting glucose, new-onset type 2 DM, type 2 DM less than 5 years, and type 2 DM of 5 years or greater. PA was evaluated using the Korean adaptation of the International Physical Activity Questionnaire Short Form.

RESULTS

The highest HF risk were associated with the lowest PA level (<500 metabolic equivalent task [MET]-min/wk). While similar risks emerged across MET 500 to 1000, 1000 to 1500, and greater than 1500 categories, the relationship showed variations in different glycemic status groups. Exceptions were particularly noted in women with normoglycemia. However, a consistent inverse pattern, with few exceptions, was observed both in men and women with type 2 DM of 5 years or greater. Furthermore, the benefit of PA in the prevention of HFs was most evident in participants with type 2 DM of 5 years or greater. Compared to the reference group (lowest physical activity level <500 MET-min/wk within type 2 DM ≥5 years), the adjusted hazard ratios were 0.74 (0.62-0.88) in men and 0.74 (0.62-0.89) in women, suggesting a significant reduction in risk.

CONCLUSION

Higher PA levels are associated with a lower risk of HF. This protective effect of PA on fracture risk is greatest in patients with DM, particularly in those with DM of 5 years or greater.

Physical Impact of Traditional and Virtual Physical Exercise Programs on Health Outcomes among Corporate Employees

Background: Technology-based exercise programs have the potential to reduce chronic disease prevalence and obesity-related risks. This research focuses on the impact of both traditional and virtual exercise programs on the health metrics of corporate employees. Methods: The study involved 30 corporate employees (16 females, average age ± SD = 37.8 ± 8.8 years) from Nigeria, who were divided into two experimental groups (one experiencing traditional exercises with an on-site trainer, and the other participating in live, virtual classes via Zoom) and a control group continuing usual practices. The 6-week intervention measured several health outcomes, including resting heart rate, blood pressure (both diastolic and systolic), body mass index (BMI), waist circumference, and waist-hip ratio, both before and after the intervention. Results: One-way analysis of covariance yielded significantly greater decreases in the diastolic blood pressure, F(2,27) = 3.7, p < 0.04; systolic blood pressure F(2,27) = 3.5, p < 0.04, body mass index, F(2,26) = 7.8, p < 0.01, and waist circumference, F(2,27) = 39.1, p < 0.01. Conclusions: The study concludes that virtual-based exercise programs are as effective as traditional ones. Offering a virtual exercise option provides flexibility, potentially increasing adherence to exercise routines among corporate workers.

Light physical activity predicts long-term mortality in individuals with a different cardiovascular health status: a cohort study

Studies have showed that LIPA seems to be favorably associated with mortality in the general population and illness individuals, but the association between different cardiovascular health status and mortality is not clear.  After adjustment , the HRs of LIPA in individuals with CVRF and CVD from quartiles 2-4 were less than 1, which were 0.78 (95%CI, 0.61 ~ 0.99; P = 0.042), 0.63 (95%CI, 0.47 ~ 0.83; P = 0.001), 0.55（95%CI, 0.40 ~ 0.76; P < 0.001）, and 0.52 (95%CI, 0.37 ~ 0.74; P < 0.001)，0.39 (95%CI, 0.27 ~ 0.58; P < 0.001), 0.33 (95%CI, 0.22 ~ 0.51; P < 0.001)  LIPA is beneficial for reducing mortality, but the shape of the association depends on cardiovascular health status.

Lifestyle and patterns of physical activity in Hadza foragers

OBJECTIVES

Physically active lifestyles are associated with several health benefits. Physical activity (PA) levels are low in post-industrial populations, but generally high throughout life in subsistence populations. The Hadza are a subsistence-oriented foraging population in Tanzania known for being physically active, but it is unknown how recent increases in market integration may have altered their PA patterns. In this study, we examine PA patterns for Hadza women and men who engage in different amounts of traditional foraging.

MATERIALS AND METHODS

One hundred and seventy seven Hadza participants (51% female, 19-87 years) wore an Axivity accelerometer (dominant wrist) for ~6 days during dry season months. We evaluated the effects of age, sex, and lifestyle measures on four PA measures that capture different aspects of the PA profile.

RESULTS

Participants engaged in high levels of both moderate-intensity PA and inactivity. Although PA levels were negatively associated with age, older participants were still highly active. We found no differences in PA between participants living in more traditional "bush" camps and those living in more settled "village" camps. Mobility was positively associated with step counts for female participants, and schooling was positively associated with inactive time for male participants.

CONCLUSIONS

The similarity in PA patterns between Hadza participants in different camp types suggests that high PA levels characterize subsistence lifestyles generally. The sex-based difference in the effects of mobility and schooling on PA could be a reflection of the Hadza's gender-based division of labor, or indicate that changes to subsistence-oriented lifestyles impact women and men in different ways.

Benefits, risks, barriers, and facilitators to cycling: a narrative review

There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.

Accuracy of visceral adiposity indices and lipid accumulation products in the identification of adults at high cardiovascular risk

INTRODUCTION

The lipid accumulation product (LAP) and visceral adipose index (VAI) are clinical markers of visceral obesity and were proposed as simple tools to estimate cardiovascular risk and mortality. The objective of this study was to analyze the accuracy of the VAI and LAP for high cardiovascular risk patients.

METHODS

A cross-sectional observational study of accuracy was carried out in 193 patients of both sexes. In addition to the variables VAI and LAP, presence of comorbidities, education, level of physical activity and anthropometric data were obtained. Cardiovascular risk was determined by the Framingham score.

RESULTS

No significant difference was observed in the sample in gender distribution (44.6% women; 55.4% men), 24.4% had low cardiovascular risk, 48.7% intermediate risk and 26.9% high cardiovascular risk. Linear regression analysis showed that VAI and LAP explain, respectively, only 2.4% and 5.2% of the variation in cardiovascular risk expressed by the Framingham score. The analysis of areas under the curve (AUC) for receiver operating characteristic (ROC) indicated a significant effect only of LAP to diagnose individuals with high cardiovascular risk, but with low sensitivity and specificity.

CONCLUSION

Our results indicate that VAI and LAP explain only a small percentage of the variation in the Framingham cardiovascular risk score. LAP index still deserves more attention in a cohort study, because, even with the limitations of a cross-sectional study, we observed an acceptable sensitivity for it so that the LAP can be used as a screening criterion for requesting more accurate tests.

Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation?

Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.

Empowerment through participation in community-based participatory research-effects of a physical activity promotion project among socially disadvantaged women

Introduction

Community-based participatory research (CBPR) approaches are associated with a range of positive impacts on empowerment. However, only a few studies have investigated the influence of different modes of target group participation on empowerment. The present study examined the empowerment processes and outcomes of women in difficult life situations through their participation as co-researchers in the form of Photovoice in "Stark durch Bewegung" (English: "Strong through Movement"), a CBPR project for physical activity (PA) promotion. The extent to which women's participation as co-researchers leads to empowerment was compared with other forms of participation.

Methods

The Photovoice approach consisted of three components: (1) photo task, (2) focus group interviews, and (3) exhibition of photos. It was then extended through participant observation. A total of 18 women took part in Photovoice. They took photos, were involved in four focus groups, helped in the analysis of data, and supported their exhibition. Two additional short focus group interviews in which four more women participated were conducted at the end of the project. The interview guideline was based on the SHOWeD questions proposed within the framework of Photovoice and enriched with various other questions (e.g., self-efficacy, social contacts, and community involvement). The data were analyzed based on a grounded theory approach.

Results

"Stark durch Bewegung" contributed to women's empowerment in several ways. By participating in the project's PA programs, the women reported numerous empowerment effects, such as improved self-efficacy, perceived competencies like swimming and language skills, and social networks. By participating as co-researchers, they perceived empowering processes on organizational and community levels that are comparable with other forms of participation (e.g., participation in a cooperative planning group) but also differ from them at relevant points (e.g., encouraging them to reflect on their own PA behaviors). The willingness to get involved in Photovoice was estimated to be significantly higher than in other possible forms of participation.

Conclusion

Our findings support the notion that health promotion interventions with marginalized groups can contribute to their empowerment on multiple levels when participants become equal partners in the CBPR project. Involving women as co-researchers has advantages over other forms of participation in terms of their empowerment.

Global disease burden attributed to low physical activity in 204 countries and territories from 1990 to 2019: Insights from the Global Burden of Disease 2019 Study

The purpose of this investigation is to estimate the global disease burden attributable to low physical activity (PA) in 204 countries and territories from 1990 to 2019 by age, sex, and Socio-Demographic Index (SDI). Detailed information on global deaths and disability-adjusted life years (DALYs) attributable to low PA were collected from the Global Burden of Disease Study 2019. The ideal exposure scenario of PA was defined as 3000-4500 metabolic equivalent minutes per week and low PA was considered to be less than this threshold. Age-standardization was used to improve the comparison of rates across locations or between time periods. In 2019, low PA seems to contribute to 0.83 million [95% uncertainty interval (UI) 0.43 to 1.47] deaths and 15.75 million (95% UI 8.52 to 28.62) DALYs globally, an increase of 83.9% (95% UI 69.3 to 105.7) and 82.9% (95% UI 65.5 to 112.1) since 1990, respectively. The age-standardized rates of low-PA-related deaths and DALYs per 100,000 people in 2019 were 11.1 (95% UI 5.7 to 19.5) and 198.4 (95% UI 108.2 to 360.3), respectively. Of all age-standardized DALYs globally in 2019, 0.6% (95% UI 0.3 to 1.1) may be attributable to low PA. The association between SDI and the proportion of age-standardized DALYs attributable to low PA suggests that regions with the highest SDI largely decreased their proportions of age-standardized DALYs attributable to low PA during 1990-2019, while other regions tended to have increased proportions in the same timeframe. In 2019, the rates of low-PA-related deaths and DALYs tended to rise with increasing age in both sexes, with no differences between males and females in the age-standardized rates. An insufficient accumulation of PA across the globe occurs together with a considerable public health burden. Health initiatives to promote PA within different age groups and countries are urgently needed.

National policies on physical activity from 64 countries with different economies: a scoping review with thematic analysis

In 2018, the World Health Organization (WHO) launched a Global Action Plan on Physical Activity (PA), which included 20 policy actions for creating active societies, environments, people and systems. The objective of this scoping review was to summarize the themes/contents of national PA policies/plans conforming to the WHO's proposals and the country's economy. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. A systematic search of electronic databases (Web of Science, Medline/PubMed, LILACS, PsycINFO, Scopus and SPORTDiscus) and 441 government documents/websites from 215 countries/territories was conducted (February 2021). Documents on national-level policies, published in English, Spanish and Portuguese since 2000, were eligible. The information on content and structure was systematically extracted and summarized into dimensions proposed by the WHO: active societies, environments, people and systems. The search identified 888 article references and 586 potentially relevant documents. After the screening, 84 policy documents from 64 countries were eligible. Most documents (n = 46) provided detailed PA policies/plans amid other health topics (e.g. non-communicable diseases, named 'general documents'), and 38 were PA-specific. The content analysis merged 54 visions, 65 missions, 108 principles, 119 objectives, 53 priorities, 105 targets, 126 indicators and 1780 actions/strategies from 38 PA-specific and 46 general documents. Among the PA-specific documents, the active system's dimension was the most contemplated in the principles (n = 43), priorities (n = 51) and action/strategies (n = 530) elements. At the same time, the objectives (n = 39), targets (n = 52) and indicators (n = 58) presented contents more frequently related to the active people dimension. For the general documents, all principles (n = 4), objectives (n = 14) and priorities (n = 7) were related to the dimension of active people, while target (n = 51), indicator (n = 53) and actions/strategies (n = 292) elements presented content related to all dimensions. The increase in countries with national PA policies/plans should be followed by improving the current ones because important dimensions seem to be not considered in these documents. This will facilitate a global PA agenda that considers the complexity and multidimensionality of PA promotion.

Documents Publication Evolution (1990-2022) Related to Physical Activity and Healthy Habits, a Bibliometric Review

This research aims to provide an overview of the growing number of scientific literature publications related to Physical Activity and Healthy Habits. A bibliometric analysis between 1990 and 2022 in the Web of Science was carried out, following the bibliometric analysis law, using Microsoft Excel and VosViewer Software for analysis and data processing. A total of 276 documents (262 primary studies and 14 revisions) related to the topic under study were located. The results reveal an exponential growth of scientific production by 48% between 2006 and 2022. Public Environmental Occupational Health, Kaprio, J., and the USA were the knowledge field, author, and country most productive, respectively. A great thematic diversity was found related to the most used keywords by the authors, such as "physical activity", "health habits", "exercise", and "obesity". Thus, the research related to this theme is really in an exponential phase, with great interest in the importance of physical activity and healthy habits, implying practical decisions in policies to develop programs to promote physical activity and healthy habits.

Physical activity among adolescent-parent dyads: 2017-2019 Korea National Health and Nutrition Examination Surveys of Korean adolescents and that of their parents

This study investigated physical activity (PA) levels among adolescents and their parents in South Korea. Repeated cross-sectional data from 2017-2019 Korea National Health and Nutrition Examination Survey (KNHANES) were used. The KNHANES uses a complex, multi-stage probability sample design. Data included 875 Korean adolescents aged 12 to 18years and their parents. Adolescents were asked how many days during the week they were physically active for at least 60 minutes. Compliance was defined as 4+ days per week. Logistic regressions were used and odds ratios and 95% confidence intervals were provided. The adherence to PA compliance and guideline among adolescents (≥60 min/d for at least 4 d/week) and their parents (≥600MET/min per week) were 11.54% and 23.09%, respectively. Parents who adhered to the PA guideline were more likely to have a child who also adhere to the PA than the parents who did not adhere to the PA guideline (OR=2.48, 95% CI=1.39-4.49). Only mothers (OR=1.31, 95% CI=0.65-2.57) and fathers (OR=1.37, 95% CI=0.74-2.55) were not significant in association to their adolescents' PA when complying with the PA guidelines, respectively. Parental PA appears to be important for PA among adolescents. Therefore, strategies to promote PA among adolescents should target families in South Korea.

Strength-training and balance activities in Canada: historical trends and current prevalence

INTRODUCTION

Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000-2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22 physical activities. In 2020, a healthy living rapid response module (HLV-RR) on the CCHS asked new questions on the frequency of muscle/bonestrengthening and balance activities. The objectives of the study were to (1) estimate and characterize adherence to meeting the muscle/bone-strengthening and balance recommendations; (2) examine associations between muscle/bone-strengthening and balance activities with physical and mental health; and (3) examine trends (2000-2014) in adherence to recommendations.

METHODS

Using data from the 2020 CCHS HLV-RR, we estimated age-specific prevalence of meeting recommendations. Multivariate logistic regressions examined associations with physical and mental health. Using data from the 2000-2014 CCHS, sex-specific temporal trends in recommendation adherence were explored using logistic regression.

RESULTS

Youth aged 12 to 17 years (56.6%, 95% CI: 52.4-60.8) and adults aged 18 to 64 years (54.9%, 95% CI: 53.1-56.8) had significantly greater adherence to the muscle/ bone-strengthening recommendation than adults aged 65 years and older (41.7%, 95% CI: 38.9-44.5). Only 16% of older adults met the balance recommendation. Meeting the recommendations was associated with better physical and mental health. The proportion of Canadians who met the recommendations increased between 2000 and 2014.

CONCLUSION

Approximately half of Canadians met their age-specific muscle/bonestrengthening recommendations. Reporting on the muscle/bone-strengthening and balance recommendations elevates their importance alongside the already recognized aerobic recommendation.

Association Between the Use of Wearable Devices and Physical Activity Among US Adults With Depression and Anxiety: Evidence From the 2019 and 2020 Health Information National Trends Survey

Objective The objective of this study was to examine the relationship between wearable device (WD) use and physical activity (PA) levels among US adults with self-reported depression and anxiety. Methods Data were pooled from 2026 adults who self-reported depression and anxiety from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels and resistance strength training. Logistic regression was conducted to investigate the association between WD and PA parameters. Results About 33% of adults with self-reported depression/anxiety reported WD use. Only 32.5% and 34.2% of the population reported meeting the weekly recommended levels of physical activity (≥150 minutes/week) and strength and resistance exercise (≥2 times weekly), respectively. In adjusted analyses, the use of WD was not associated with meeting the national weekly recommendation for physical activity (OR 1.38, 95% CI (0.94, 2.04); p=0.10) or resistance strength training (OR 1.31, 95% CI (0.82, 2.08); p=0.26). Further exploratory analysis also showed that physical activity levels did not differ with the frequency of WD use. Conclusion Despite the popularity of WD use among people with mental disorders, we found that use of WD was not associated with increased physical activity measures, suggesting that although there is a promise for these tools to augment mental health, their real-world effectiveness in promoting physical activity in people with mental disorders remains to be proven.

KLB and NOX4 expression levels as potential blood-based transcriptional biomarkers of physical activity in children

Insufficient physical activity (PA) in children is considered one of the major contributors to obesity and cardiometabolic complications later in life. Although regular exercise may contribute to disease prevention and health promotion, reliable early biomarkers are required to objectively discern people performing low PA from those who exercise enough. Here, we aimed to identify potential transcript-based biomarkers through the analysis of a whole-genome microarray in peripheral blood cells (PBC) from physically less active (n = 10) comparing with more active (n = 10) children. A set of genes differentially expressed (p < 0.01, Limma test) in less physically active children were identified, including the down-regulation of genes related to cardiometabolic benefits and improved skeletal function (KLB, NOX4, and SYPL2), and the up-regulation of genes whose elevated expression levels are associated with metabolic complications (IRX5, UBD, and MGP). The analysis of the enriched pathways significantly affected by PA levels were those associated with protein catabolism, skeletal morphogenesis, and wound healing, among others, which may suggest a differential impact of low PA on these processes. Microarray analysis comparing children according to their usual PA has revealed potential PBC transcript-based biomarkers that may be useful in early discerning children expending high sedentary time and its associated negative consequences.

Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective

Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as anexemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors.

Exercising Caution: A Case for Ethics Analysis in Physical Activity Promotion

Despite the important role of physical activity in population health and well-being, it has received less focus in public health ethics as compared to other modifiable lifestyle factors such as smoking and diet. However, when considering the current and potential role of physical activity within public health—including interventions and policies to encourage physical activity in schools and workplaces, changes to the built environment and the equity issues associated with access to physical activity—it is a ripe territory for ethical analysis. This paper makes a case for a more sustained focus on physical activity within public health ethics by reviewing two ethical issues within physical activity and public health: physical activity inequity as a structural injustice issue, and stigma in physical activity promotion. While the benefits of physical activity for every age group and demographic are numerous, ethics oversight is encouraged to ensure that these efforts do not impose unnecessary risks or stigmatize marginalized populations.

Like I said, I would not have likely gotten up otherwise: patient experiences of using an Activity Board after abdominal cancer surgery

PURPOSE

Most patients treated in a hospital setting are fully or partially immobilised. The Activity Board (Träningstavlan^® Phystec) is a useful tool to enhance mobilisation after major abdominal cancer surgery. Knowledge of patient experiences of the mobilisation tool is crucial in implementing the Activity Board in health care. This study aimed to describe patient experiences of using the Activity Board after surgery for abdominal cancer.

MATERIALS AND METHODS

Semi-structured face-to-face interviews were conducted in 15 patients who underwent abdominal surgery due to colorectal, ovarian or urinary bladder cancer. All 15 patients (mean age 67.7 years, range 40-86) used the Activity Board postoperatively. The interviews were transcribed verbatim and analysed according to inductive content analysis.

RESULTS

The overarching theme that emerged from the interviews was that "enabling participation facilitates empowerment over rehabilitation". Three categories supported the theme: prerequisites for using the Activity Board, the value of using supportive behavioural techniques, and the possibility to influence the patients' care.

CONCLUSIONS

These findings suggest that the Activity Board could be a viable tool that activates the person-centred postoperative rehabilitation process by cooperating with the medical team at the hospital ward.Implications for rehabilitationPatients who are in hospital due to cancer surgery are often immobilised, which increases the risk of complications.The Activity Board can stimulate the patients to participate in the rehabilitation process in a more active way.The Activity Board can be used to improve and clarify the person-centred approach in hospital settings.

The Effectiveness of Wearable Devices in Non-Communicable Diseases to Manage Physical Activity and Nutrition: Where We Are?

Wearable devices are increasingly popular in clinical and non-clinical populations as a tool for exercise prescription, monitoring of daily physical activity and nutrition, and health-related parameters management. In this regard, smart devices not only assist people in pursuing a healthier lifestyle, but also provide a constant stream of physiological and metabolic data for management of non-communicable diseases (NCDs). Although the benefits of lifestyle-based interventions (exercise and nutrition) for NCDs are well known, the potential of wearable devices to promote healthy behaviors in clinical populations is still controversial. In this narrative review, we aimed to discuss the current application of wearable devices in NCDs, highlighting their role in prescribing and monitoring daily physical activity and dietary habits in the population living with chronic diseases. None of the studies considered specifically addressed the efficacy of the use of wearable devices, and limited are those that incorporate monitoring of both physical activity and nutrition for NCDs. However, there is evidence that such devices have helped improve physical activity levels, physical fitness, body composition, and metabolic and psychological parameters. Therefore, the authors believe that the benefits obtained from the use of wearable devices are likely to translate to public health and represent one of the important tools for the development of prevention plans in everyday life and clinical practice for optimal patient management.

Gym staff perspectives on disability inclusion: a qualitative study

PURPOSE

To explore gym staff perspectives on the inclusion of people with disability in the gym setting.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model.

RESULTS

Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy).

CONCLUSION

Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Implications for rehabilitationGym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise.Standardised disability inclusion training for gym staff is recommended.Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services.Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities.

Inclusive community playgrounds benefit typically developing children: An objective analysis of physical activity

Purpose

Limited research is available on the physical activity levels of children while playing on an inclusive playground, specifically designed to accommodate children with physical disabilities. The aims of this study were to objectively measure ambulatory activity and heart rate (HR) of children during unstructured play on an inclusive community playground.

Methods

Typically developing children at least 4 years of age were recruited to play freely upon entering the playground. Participants wore a StepWatch4 Activity Monitor and a Polar V800 Sport Watch. Ambulatory measures included total steps, percentage of recommended steps, total ambulatory time (TAT), bout intensity levels/duration periods. Time spent in HR zones and moderate-to-vigorous physical activity (MVPA) was determined.

Results

95 children (48 males; Avg. age: 7 ± 2 years.) were included in this study. Children played for 31.8 ± 14.7 min., were ambulatory for 25.9 ± 12.0 min., took 1826 ± 824 steps, and accumulated 17 ± 8% of the recommended daily step count. Ambulatory bout intensity was predominantly lower intensity and bout durations varied in length. 99% of the play time was spent at a moderate HR or higher. Significant correlations were found between ambulatory and HR measures (ρ range from 0.23 to 0.99, p < 0.05), and 7-10 yo children spent a significantly higher percentage of TAT at higher intensity ambulation (p < 0.05).

Conclusions

Typically developing children can achieve moderate or higher intensity exercise and HR on an inclusive playground. Both typically developing children and those with disabilities, would benefit from a setting where they can interact and participate in parallel play with their peers.

Anthropometry and Physical Performance in 13-Year-Old Australian Talent-Identified Male and Female Athletes Compared to an Age-Matched General Population Cohort

Talent-identified male and female athletes are assumed to have greater speed and power than the general population at a given age. However, a comparison of the jump and sprint performance of an Australian cohort of male and female youth athletes from various sports to age-matched controls has not occurred. Therefore, the aim of this study was to compare anthropometric and physical performance markers between ~13-year-old talent-identified youth athletes and general population Australian youth. The anthropometry and physical performance in talent-identified youth athletes (n = 136, 83 males) and general population youth (n = 250, 135 males) were tested during the first month of the school year in an Australian high school within a specialized sports academy. Talent-identified females were taller (p < 0.001; d = 0.60), sprinted faster (20 m: p < 0.001; d = -1.16), and jumped higher (p < 0.001; d = 0.88) than general population youth females. Similarly, talent-identified males sprinted faster (20 m: p < 0.001; d = -0.78) and jumped higher (p < 0.001; d = 0.87) than general population youth males, but were not taller (p = 0.13; d = 0.21). Body mass was not different between groups for males (p = 0.310) or females (p = 0.723). Overall, youth, particularly females, who are trained in a variety of sports, exhibit greater speed and power during early adolescence compared to their age-matched peers, with anthropometric differences only occurring in females at 13 years of age. Whether talented athletes are selected because they exhibit these traits or whether speed and power are developed through sport participation requires further investigation.

Physical Activity and Habitus: Parental Support or Peer Support?

Social support can affect an individual's physical activity and activity habitus. This study aims to explore: (1) the correlations between physical activity and parental/peer support among Chinese college students; (2) the differences between the effects of parental/peer support on college students' physical activity. To achieve these aims, we conducted a cross-sectional study from September to December 2021, recruiting 1005 students (479 male respondents) from seven comprehensive universities in western China. Through OLS linear regression and quantile regression, we empirically testify that both parental support and peer support have significant influence on physical activity and activity habitus of Chinese college students, and peer support has greater impact. We also examine such effects of both types of support by grouping the samples into two groups on the bases of their existing physical activity habitus. We posit that as the most intimate interpersonal relationships, parental support and peer support play a key role in college students' physical activity and activity habitus, and peer support has greater impact as they step into college. Our study provides insights into the factors of physical activity and activity habitus and we propose that attention regarding the impact of social support should be paid when we are trying to promote the physical activity of college students.

mHealth Apps Targeting Obesity and Overweight in Young People: App Review and Analysis

BACKGROUND

Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low.

OBJECTIVE

The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs).

METHODS

A search for apps was conducted in Google Play Store using the following search string: ["best weight loss app for obese teens 2020"] OR ["obesity applications for teens"] OR ["popular weight loss applications"]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app.

RESULTS

The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app "Morphe," intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings.

CONCLUSIONS

The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness.

Developmental disparities in sedentary time by period of the day among US youth: a cross-sectional study

Background

Definitive evidence shows sedentary time (ST) is an independent risk factor for chronic disease, irrespective of physical activity. Despite calls to limit youth ST, studies demonstrate a spike in ST at the transition from childhood to adolescence. Identifying periods of the day (e.g., before school, during school, afterschool, and evenings) during which ST is higher in adolescents vs. children—that is, specifying when within daily routines ST disparities emerge—may be important to inform intervention strategies, as periods of the day correspond with variations in setting and supervision. The purpose of this study was to examine device-assessed ST engagement by period of day and developmental stage in a nationally representative sample of United States youth.

Methods

Youth (N = 2,972 between 6–18 years) from the 2003–2004 and 2005–2006 waves of NHANES reported demographic variables and wore an accelerometer for seven consecutive days to determine ST. Linear regression analyses were applied to study associations between ST and developmental stage (childhood or adolescence) by period of the week and weekend days, while controlling for sex, race/ethnicity, annual family income, and body mass index.

Results

Adjusted linear regressions (p-values < 0.0001) showed that adolescents were more sedentary than children during school, afterschool, and weekday evening periods as well as all the weekend periods. However, during school (36.3 ± 7.3 vs. 28.2 ± 7.2 min/hour; b = -7.4 [-8.1, -6.6]) and afterschool periods (31.1 ± 7.7 vs. 22.7 ± 7.0 min/hour; b = -7.8 [-8.6, -7.0]) showed the largest weekly ST disparities by developmental stage. Overall, the during school and after school hours constitute most (during school = 35% and afterschool = 16%) of the weekly ST disparity between children and adolescents.

Conclusions

Our data provide interventionists with estimates of the potential for ST reduction in each setting and period of the day among US adolescents. Future research should gather information about the barriers and facilitators of ST in adolescents by period of the day to help understand factors driving disparities.

Engagement of older adults in STRIDE's multifactorial fall injury prevention intervention

BACKGROUND

Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal.

METHODS

This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement.

RESULTS

The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR = 2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR = 1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR = 0.90 [95% CI, 0.83-0.99]).

CONCLUSIONS

The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.