The Importance of Walking to Public Health

Exploring sex differences in the longitudinal association between streetlighting and transport walking

Regular physical activity, such as transport walking, is essential for health, yet many adults do not meet recommended physical activity levels. The built environment, particularly streetlighting, plays a critical role in promoting transport walking. However, existing evidence on the relationship between streetlighting and transport walking is largely cross-sectional, with limited longitudinal research exploring potential sex differences. This study aimed to assess the longitudinal association between objectively measured streetlight count and transport walking among mid-to-older-aged adults in Brisbane, Australia, and to explore whether this association varies by sex. Data were from the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study, a multilevel cohort study with five waves over nine years (2007-2016). The analytical sample included participants who did not move during the study. Transport walking was self-reported and dichotomized into walkers and non-walkers. Streetlight counts within a 1 km road network buffer around participants' homes were measured alongside transport walking. Generalized linear mixed-effects models were used, adjusting for sociodemographic factors, length of stay, neighbourhood preference, and built environment attributes. Higher streetlight counts were positively associated with transport walking (OR 1.002; 95% CI 1.001, 1.002), and the association remained significant after adjusting for residential density, street connectivity, and land-use mix. No significant sex differences were found. This study provides longitudinal evidence that well-lit environments promote transport walking among mid-to-older-aged adults. This finding can inform urban planning and public health policies aimed at encouraging transport walking to help reduce the risk of chronic disease.

Effects of 10 weeks of walking-based exercise training on resting substrate oxidation in postmenopausal women with obesity

BACKGROUND AND AIMS

Accumulating evidence supports the effectiveness of moderate-intensity aerobic training on metabolic health, with limited studies investigating change in resting substrate oxidation. The aim of this study was to explore whether 10 weeks of walking-based aerobic training would alter substrate oxidation in postmenopausal women with obesity.

METHODS AND RESULTS

Twenty-four postmenopausal women with obesity who were assigned into the control (n = 12) or exercise groups (n = 12) undertook a 10-week aerobic training program (3 d·week-1) that involved walking exercises at 50-70% of heart rate reserve on a treadmill, with exercise volume increased from 25 to 40 min·day-1. Resting metabolic rate (RMR) and body composition were measured pre- and post-training. Whole-body substrate oxidation was calculated using respiratory data collected during RMR measurement via indirect calorimetry. No significant change was noted (p > 0.05) in resting fat oxidation and carbohydrate oxidation in the exercise group. Resting respiratory exchange ratio and RMR did not alter in response to the training program (p > 0.05).

CONCLUSION

Our results show that a 10-week of moderate-intensity aerobic training does not modify substrate oxidation in postmenopausal women with obesity.

TLR/NLRP3 inflammasome signaling pathways as a main target in frailty, cachexia and sarcopenia

Mobility disability is a common condition affecting older adults, making walking and the performance of activities of daily living difficult. Frailty, cachexia and sarcopenia are related conditions that occur with advancing age and are characterized by a decline in muscle mass, strength, and functionality that negatively impacts health. Chronic low-grade inflammation is a significant factor in the onset and progression of these conditions. The toll-like receptors (TLRs) and the NLRP3 inflammasome are the pathways of signaling that regulate inflammation. These pathways can potentially be targeted therapeutically for frailty, cachexia and sarcopenia as research has shown that dysregulation of the TLR/NLRP3 inflammasome signaling pathways is linked to these conditions. Activation of TLRs with pathogen-associated molecular patterns (PAMPs or DAMPs) results in chronic inflammation and tissue damage by releasing pro-inflammatory cytokines. Additionally, NLRP3 inflammasome activation enhances the inflammatory response by promoting the production and release of interleukins (ILs), thus exacerbating the underlying inflammatory mechanisms. These pathways are activated in the advancement of disease in frail and sarcopenic individuals. Targeting these pathways may offer therapeutic options to reduce frailty, improve musculoskeletal resilience and prevent or reverse cachexia-associated muscle wasting. Modulating TLR/NLRP3 inflammasome pathways may also hold promise in slowing down the progression of sarcopenia, preserving muscle mass and enhancing overall functional ability in elderly people. The aim of this review is to investigate the signaling pathways of the TLR/NLRP3 inflammasome as a main target in frailty, cachexia and sarcopenia.

Is biomechanical loading reduced in individuals with unilateral transtibial amputation during fast-paced walking when using different ankle/foot prostheses? A pragmatic randomized controlled trial

INTRODUCTION

Sound side loading is a risk factor for osteoarthritis development, which has been noted to reduce when using advanced prostheses during normal-paced walking in individuals with unilateral transtibial amputation (UTTA). However, descriptions of loading during fast-paced walking remain relatively unreported. Therefore, the aim of this study was to describe the biomechanical loading of individuals with UTTA while using different ankle/foot prostheses during fast-paced walking.

METHODS

 A blinded, randomized control trial was conducted in a group of K3-K4 ambulators, who used 3 different prosthetic feet (1. a solid ankle cushioned heel foot prosthesis [SACH], 2. a standard energy storage and return foot prosthesis [ESAR], and 3. a novel ESAR foot prosthesis [N-ESAR]) in a 2-week randomized crossover design. The spatiotemporal and kinetic data of the participants' fast walking pace were collected. Data were analyzed using a mixed model and one-way analysis of variances ( p < 0.05) and Cohen d .

RESULTS

Twenty individuals with UTTA (age: 40 ± 16 years; height: 1.76 ± 0.09 m; and BMI: 24.72 ± 3.63 kg/m 2 ) participated in this study. There were minimal changes in the spatiotemporal data between the different prosthetic feet. When the participants used the N-ESAR feet, they had a lower peak vertical ground reaction force ( p = 0.02) and external knee adduction moment ( p = 0.02) on the sound side, as well as a higher distal shank power on the prosthetic side ( p < 0.01).

CONCLUSION

Overall fast-paced walking resulted in higher sound side loading forces compared with normal-paced walking. However, use of the N-ESAR prosthesis reduced the biomechanical loading on the sound side in individuals with UTTA while walking at a fast pace compared with the ESAR and SACH prostheses. The percentage change in the biomechanical loading from normal- to fast-paced walking of the N-ESAR foot was also larger compared with the other prostheses, perhaps because of the individuals' ability to achieve a faster walking pace when using the N-ESAR prosthesis. Longitudinal intervention studies should be performed to further investigate the possible benefits of using advanced prostheses.

Neighborhood walkability and cardiometabolic disease in Texas

Cardiometabolic diseases (CMDs) affect significant numbers of adults in the United States, with 11% diagnosed with diabetes and 10% with cardiovascular diseases. Walking plays a crucial role in reducing health risks, particularly obesity and diabetes. We aim to explore the association between neighborhood walkability and CMD measures in Texas, while controlling for age, sex, racial/ethnic background, and family history of diabetes. We collected 1994 observations for the year 2019, merging data from the Texas Behavioral Risk Factor Surveillance System and the Environmental Protection Agency. We employed multilevel linear regression and multilevel logistic regression analyses to assess the association between CMD measures and neighborhood walkability. Our findings revealed that higher neighborhood walkability is significantly associated with a lower body mass index (BMI) (β = - 0.28, CI - 0.45 to - 0.10) and a reduced risk of diabetes (OR 0.93, CI 0.86-0.99), indicating that when walkability increases by one unit, an individual's BMI decreases by 0.28 kg/m2 and the odds of having diabetes decrease by 7%. We also found that African Americans living in communities with lower walkability scores compared to other racial/ethnic groups. Our findings highlight the need for urban planning policies promoting walkable neighborhoods, suggesting community-based approaches to health promotion.

Causal associations of self-reported walking pace with respiratory diseases: A Mendelian randomization analysis

Although studies have indicated causality between brisk walking and various diseases, the relationships between walking pace and respiratory diseases lack thorough investigation. The underlying relationships between walking pace and various respiratory diseases were examined through univariable Mendelian randomization (MR) analyses. Furthermore, we performed multivariable MR analyses to observe whether relationships between walking pace and respiratory diseases change after adjustment of body mass index (BMI). The genome-wide association study data of self-reported walking pace, BMI, and 42 respiratory diseases were retrieved from publicly available datasets. We employed the inverse-variance weighted, weighted median, and MR-Egger methods for MR analysis. Using the inverse-variance weighted method in univariable MR, we identified statistically significant negative causal associations between self-reported walking pace and 4 respiratory traits, including chronic lower respiratory diseases (odds ratio [OR], 0.27 [95% confidence interval [CI], 0.18-0.41]), asthma (OR, 0.23 [95% CI, 0.14-0.38]), chronic obstructive pulmonary disease (OR, 0.15 [95% CI, 0.08-0.30]), and diseases of the respiratory system (OR, 0.54 [95% CI, 0.41-0.70]). Similar results were observed with the MR-Egger and weighted median methods. These associations remained significant, though slightly attenuated, after adjusting for BMI. A brisk walking pace may significantly benefit respiratory health and aid in disease prevention and risk stratification.

Concurrent Validity of the Japanese Version of the International Physical Activity Questionnaire Long Form for Assessing Walking Behavior Across Adulthood: Applicability to Older Adults

INTRODUCTION

Walking behavior may vary across age groups, highlighting the need for a validated tool to assess walking including older adults. While the Japanese version of the International Physical Activity Questionnaire long form (Japanese IPAQ-L) has been validated for total physical activity in younger populations, its validity in assessing walking behavior remains unclear in any age group.

OBJECTIVE

This study aimed to evaluate the concurrent validity of the Japanese IPAQ-L for assessing walking behavior throughout adulthood, with a special focus on its applicability to older adults.

METHODS

Participants wore an ActiGraph wGT3X-BT (ActiGraph LLC, Pensacola, Florida, United States), an accelerometer-based activity monitor, around their waist for seven consecutive days to objectively measure their physical activity. On the following day, they completed the Japanese IPAQ-L, which asked about their domain-specific physical activity over the preceding seven days. Spearman's rank correlation coefficients (ρ) were calculated to examine the associations of walking (total, work, transport, leisure) and moderate physical activity, both subjectively assessed by the Japanese IPAQ-L, with objectively measured moderate physical activity (3.00-5.99 metabolic equivalents) by the ActiGraph.

RESULTS

All 130 recruited participants completed the data collection. Of these, 113 participants without missing data (aged 23-89 years; 51.3% women) were included in the analysis. Self-reported total walking showed weak to moderate correlations with objectively measured moderate physical activity across all age groups, with the strongest correlation observed in the oldest age group (ρ=0.32 for the total group; ρ=0.38 for the youngest age group; ρ=0.35 for the middle-aged group; ρ=0.55 for the oldest age group). For domain-specific walking, the correlations varied by age group. Meanwhile, no meaningful correlations were found for self-reported moderate physical activity, regardless of whether walking was included.

CONCLUSIONS

The Japanese IPAQ-L showed weak to moderate concurrent validity for assessing total walking when compared to accelerometer-based activity data across age groups. Notably, the validity was higher in older adults. These findings suggest that the Japanese IPAQ-L can be used to rank individuals based on their total walking, with reasonable applicability to older adults.

Influence of surface type on outdoor gait parameters measured using an In-Shoe Motion Sensor System

The objectives of this study were to measure outdoor gait parameters using an In-Shoe Motion Sensor System (IMS) and evaluate how different types of surfaces affect various gait dynamics. Accurate outdoor gait data are crucial for effective fall risk assessment because surface irregularities and tripping hazards often result in falls during walking. An IMS was used in this study to collect spatiotemporal, spatial, and foot parameters from 27 healthy adults walking on indoor asphalt, soil, and grass surfaces. Data were recorded during a 6-minute walk test, with measurements taken every 2 min and analyzed using the Statistical Package for the Social Sciences. The results showed significant differences in foot clearance, heel height, and gait cycle across surfaces. Walking on grass significantly increased foot height, swing time, and roll angle of heel contact. These findings may help develop interventions to prevent falls.

A comprehensive GPS-based analysis of activity spaces in early and late pregnancy using the ActMAP framework

Health implications of mobility during pregnancy entail a need to understand pregnant women's activity spaces. We present ActMAP, a framework for quantifying multiple aspects of activity spaces from distinct trips and stays derived from GPS data. We applied ActMAP to data from 238 pregnant women in Barcelona, Spain (2018-2020) and explored weekday, weekend and intraday associations between pregnancy trimester and activity spaces. Activities were more centred around the home later in pregnancy. However, the number of visited places and daily trips remained largely constant throughout pregnancy. By constructing activity spaces from individual trips and stays, ActMAP could provide a framework for GPS-based holistic assessments of mobility.

One hour walk improves inhibitory control and increases prefrontal cortex activation

Regular physical activity is deemed beneficial to physical, cognitive, and emotional health. Walking may be an accessible means of meeting physical activity recommendations and improving cognition. However, exercise effects on cognition are often explored at shorter durations (30 min or less), with fewer studies exploring how cognition is impacted during longer bouts of exercise. 36 (7 women) civilians and active-duty soldiers completed a VO2 max test and two one-hour walks, one at and one below the ventilatory threshold (VT), on separate days. They completed the Go/No-Go and Task-Switching Tasks before, every 15 min during, and immediately after exercise, while wearing a near-infrared spectroscopy (NIRS) system to monitor prefrontal cortex (PFC) activity. Response speed during the Go/No-Go task was improved at VT compared to sub-VT at the expense of task accuracy. FP cortex was deactivated during exercise in the Task-Switching Task, potentially due to the increased competition for resources between the frontal cortex and movement related areas. As a result, exercise at or below VT may improve or impair cognitive performance and activation in executive function-related areas depending on the task type and exercise intensity level.

How Built Environment Characteristics Influence Social Interactions During Neighbourhood Walks Among Urban Inhabitants

As an accessible and low-risk mode of transportation and recreational activity, walking both produces and is produced by socio-spatial urban features. The health benefits of walking transcend physical fitness, remaining integral to mental health and to fostering social connectedness in urban communities. Understanding what drives walking behaviour, therefore, warrants attention from a public health perspective. This qualitative case study focuses on the social interactions of inhabitants during neighbourhood walks and how built environment features influence walking patterns and experience. Using diaries, maps, and semi-structured interviews with 45 inhabitants of a mid-sized Canadian city, this research investigates the influence of permanent and temporary physical features on the perceived quality of inhabitants' walks. The findings show the public visibility of urban modifications influences walking behaviour and improves social interactions, leading to a heightened sense of belonging and community. Inhabitant-led modifications in the urban space were mostly neighbourhood-bound and voyeuristic, whereas administrative interventions were more successful for collectivization. Both types of interventions are argued to foster social connectedness through different mechanisms, with positive impacts on inhabitants' health and wellbeing. The findings underscore the relevance of community-led and administratively planned interventions in built environments in positioning public health policies associated with social cohesion and connectedness.

Qualitative exploration of determinants of active mobility and social participation in Urban neighborhoods: individual perceptions over objective factors?

BACKGROUND

Urban neighborhood environments play an important role in facilitating or hindering residents to engage in active mobility and social participation. However, while there is much quantitative research, in-depth knowledge that contextualizes residents' subjective perceptions of barriers and facilitators of active mobility and social participation is still insufficient. Therefore, a qualitative approach was used to collect subjectively perceived barriers and facilitators of active mobility and social participation of residents from different neighborhoods with objectively determined high vs. low walkability. Furthermore, to better understand (non) concordance of objective environmental characterizations and actual levels of behavior, low and high walkability neighborhood-specific barriers, proposed improvements, and particularities that determine (non) engagement in active mobility and social participation were explored.

METHODS

Three focus groups (N = 6, N = 6, and N = 5) with 17 participants (7 women, 10 men) aged 21-64 (mean age 43.4 ± 14,6 years) were conducted utilizing a pre-structured interview guideline. Participants lived in 11 different neighborhoods with either high or low objectively determined walkability. The focus groups were transcribed verbatim, followed by a thematic analysis of the content with deductive and inductive code categories, utilizing the MAXQDA software.

RESULTS

Notable was the consensus of many perceived barriers and facilitators of active mobility and social participation along with their assignability to the same context (points-of-interest, infrastructure; safety, communication, community; topography, physical compositions, weather, aesthetics; personal / individual attitudes, influences, evaluations). Another main finding was that high and low walkability neighborhood-specific particularities were revealed that are in contrast to some objective characterizations of walkability: For example, too high density can inhibit active mobility, and too many options can inhibit social participation.

CONCLUSIONS

The consensus of many barriers and facilitators of active mobility and social participation suggests that valuable synergies could be created by coordinating interventions aiming to promote both active mobility and social participation in urban neighborhoods. Also, considering subjective perceptions of residents helps to identify neighborhood-specific factors that determine (non) engagement in active mobility and social participation. The findings can help city planners and public health officials improve the promotion of active mobility and social participation in the creation of health-enhancing urban neighborhoods.

Joint associations of neighbourhood walkability and greenery with walking among middle-aged and older adults: Findings from diverse urban settings in Australia

There is evidence that neighbourhood walkability and greenery are associated with walking, but less is known about their joint associations. We investigated this using data from the AusDiab3 study (2011/12) with 3032 adults (mean age 60 years). Two-level logistic regression models were used with binary walking outcomes. There was an inverse relationship (r = -0.5) between walkability (a composite measure of residential, destinations and intersections densities) and greenery (the size of densely vegetated areas). However, both walkability and greenery were independently positively associated with odds of walking. Regarding joint associations, in low-walkability neighbourhoods, greenery was positively associated with walking. In high-walkability neighbourhoods, greenery was not associated with walking.

The Governance of Traffic Noise Impacting Pedestrian Amenities in Melbourne Australia: A Critical Policy Review

By identifying a unified aim of Federal, State, and Local government authorities to deliver healthier, more liveable urban spaces and enable walkable neighbourhoods in Melbourne, Australia, questions emerge regarding noise data collection methods and the policies that aim to protect pedestrian areas from potential increases in urban traffic noise. It highlights a missed opportunity to develop strategies that provide explicit guidance for designing more compact urban forms without diminishing pedestrian amenities. This study investigates the governance of traffic-induced noise pollution and its impact on pedestrian amenities in Melbourne, Australia. It aims to identify the government bodies best positioned to protect pedestrians from noise pollution and evaluate the strategic justification for reducing traffic noise to enhance urban walkability. This research employs a semi-systematic policy selection method and a hybrid critique and review method to evaluate the multidisciplinary governance frameworks engaged in the management and mitigation of traffic noise in Melbourne. Key findings reveal that while traffic noise poses significant health risks, current policies overlook its impact on pedestrian amenities in urban areas. This study emphasises the benefits of qualitative and subjective noise data collection to inform policy-makers of the pedestrian aural experience and impacts. Discussion points include noise management strategies and the value of implementing metropolitan-scale noise-mapping to illustrate the impact of noise rather than quantities of sound. The conclusions demonstrate that there is strategic justification for managing traffic-induced noise pollution to protect pedestrian areas within international, federal, and state government policies and implicit rationale at a local level.

Walking Activity and Physical Function Among Mexican American Older Adults Over 9 Years of Follow Up

BACKGROUND

Walking activity has been associated with reduction in the development of chronic disease, cognitive and physical function impairment, disability, and mortality. The objective of this study was to examine the relationship between walking activity and physical function over 9 years of follow-up among Mexican Americans aged 78 years and older.

METHODS

Participants (N = 998) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2007-2016). Measures included walking activity duration and frequency, socio-demographics, body mass index, medical conditions, pain, depressive symptoms, limitation in activities of daily living, and the Mini-Mental State Examination. Low physical function was defined as scoring <7 on the Short Physical Performance Battery. At baseline, participants were grouped into nonwalkers (n = 653), walked <150 minutes/week (n = 144), and walked 150 minutes/week or more (n = 201). A Generalized Estimating Equation model was used to estimate the odds ratio and 95% CI of low physical performance as a function of walking activity status.

RESULTS

Compared with nonwalkers, participants walking < 150 minutes/week had lower odds (odds ratio = 0.66, 95% CI, 0.51-0.86) of low physical function over time, after controlling for all covariates, as did those walking ≥ 150 minutes/week (odds ratio = 0.54, 95% CI, 0.41-0.71).

CONCLUSIONS

Mexican American older adults who engage in any walking activity are at reduced risk of low physical function, even those with disability. Interventions at the individual and community level are recommended to reduce physical function impairment, even in those with preexisting medical conditions or disability.

Exploring the Relationship between Built Environment Attributes and Physical Activity in Lower-Income Aging Adults: Preliminary Insights from a Multi-Level Trial

The built environment has been linked to physical activity (PA) behaviors, yet there is limited knowledge of this association among lower-income midlife and older adults who are insufficiently active. The present cross-sectional study utilized baseline data collected between October 2017 and November 2019 from a clustered randomized controlled trial to determine how built environment attributes were associated with PA behaviors among midlife and older adults (n = 255) residing in or near affordable housing sites (n = 10). At each site, perceptions of the built environment were collected and scored at the participant level via the abbreviated Neighborhood Environment Walkability Survey (NEWS-A), while objective built environment attributes were measured and scored by trained research staff using the Physical Activity Resource Assessment (PARA). Multiple PA behaviors-walking, total PA, and moderate-to-vigorous PA (MVPA) (min/wk)-were measured using the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Adjusted linear regression models examined associations between NEWS-A measures and PA behaviors, and site-level correlations between PARA measures and PA behaviors were examined using Spearman's rank correlations. At the participant level, adjusted models revealed that a one point increase in the NEWS-A aesthetics score was associated with a 57.37 min/wk increase in walking (β = 57.37 [95% CI: 20.84, 93.91], p = 0.002), with a similar association observed for street connectivity and MVPA (β = 24.31 min/wk [95% CI: 3.22, 45.41], p = 0.02). At the site level, MVPA was positively correlated with the quality of the features of local, PA-supportive environmental resources (ρ = 0.82, p = 0.004). Findings indicate that participant- and site-level measures of the built environment may play a role in promoting PA behavior among this demographic and similar populations. Results also suggest that improvements in aesthetic attributes and street connectivity, along with enhancing the quality of local, PA-supportive environmental resources, may be effective strategies for promoting physical activity among lower-income midlife and older adults.

Mendelian randomisation and mediation analysis of self-reported walking pace and coronary artery disease

The aim of this study was to assess the causal relationship between habitual walking pace and cardiovascular disease risk using a Mendelian randomisation approach. We performed both one- and two-sample Mendelian randomisation analyses in a sample of 340,000 European ancestry participants from UK Biobank, applying a range of sensitivity analyses to assess pleiotropy and reverse causality. We used a latent variable framework throughout to model walking pace as a continuous exposure, despite being measured in discrete categories, which provided more robust and interpretable causal effect estimates. Using one-sample Mendelian randomisation, we estimated that a 1 mph (i.e., 1.6 kph) increase in self-reported habitual walking pace corresponds to a 63% (hazard ratio (HR) = 0.37, 95% confidence interval (CI), 0.25-0.55, P = 2.0 × 10-6) reduction in coronary artery disease risk. Using conditional analyses, we also estimated that the proportion of the total effect on coronary artery disease mediated through BMI was 45% (95% CI 16-70%). We further validated findings from UK Biobank using two-sample Mendelian randomisation with outcome data from the CARDIoGRAMplusC4D consortium. Our findings suggest that interventions that seek to encourage individuals to walk more briskly should lead to protective effects on cardiovascular disease risk.

Energy Expenditure, Intensity, and Perceived Effort in Recreational Functional Training

Background: Functional training (FT) has become popular and seems to provoke health benefits. However, there are unsubstantiated claims regarding energy expenditure (EE) vs. weight-loss and cardiorespiratory improvements linked to FT. Objective: This study quantified the EE and intensity during FT performed in a conventional fitness center. Additionally, data of FT and moderate continuous walking (WLK) were compared. Methods: Healthy individuals with no previous experience with FT [n = 25, 11 males/14 females, 38.8 ± 9.3 years; 73.9 ± 13.8 Kg; 168.5 ± 8.5 cm; 26.0 ± 4.5 Kg/m2; 16 overweight (BMI >25 Kg/m2)] performed three FT sessions interspersed with 48 h (two familiarization, one assessment). The circuit included 4 rounds of 12 exercises performed at all-out intensity for 20 s with 1-min intervals between rounds. WLK was performed for 25 min with intensity corresponding to scores 3-5 on Borg CR-10 Scale. Outcomes were EE (kcal), movement counts estimated by triaxial accelerometry, heart rate reserve (%HRR), and rate of perceived exertion (RPE). Results: On average, FT sessions lasted 24 min and EE ranged between 124 and 292 kcal (188 ± 41 kcal), corresponding to 5-8 METs (6.1 ± 0.6 METs), and 70-80%HRR (74 ± 8%). Accelerometry (counts/min) showed that vigorous predominated over moderate intensity during FT and WLK (p = .01), with similar EE. The relative intensity and RPE were higher in FT vs. WLK (74% vs. 55%HRR and Borg 5-8 vs. 3-5, respectively; p < .0001). Conclusion: FT and WLK elicited EE consistent with recommendations to reduce cardiovascular disease risk, but only FT achieved relative intensities compatible with cardiorespiratory improvement. FT should be considered an option in health-oriented exercise programs for the general population.

Ten weeks of low-volume walking training improve cardiometabolic health and body composition in sedentary postmenopausal women with obesity without affecting markers of bone metabolism

This study aimed to determine the effects of walking exercise to induce a mild energy deficit and to improve body composition and metabolic status in postmenopausal women (PMW) with obesity as means of minimizing endocrine disruption and maintaining bone health. Twenty-four PMW with obesity (age: 55.0 ± 3.7 y, BMI: 32.9 ± 4.2 kg/m2, percent body fat: 46.2 ± 3.6%) were randomly assigned into either exercise (n = 12) or control (n = 12) groups. Exercise group participated in a-10 week supervised progressive walking programme   and control group maintained regular habits. Pre- and post-training assessments included body composition, bone mass, peak oxygen uptake (V ˙ O2peak), osteocalcin, bone alkaline phosphatase (BAP), type I collagen cross-linked C-telopeptide (CTX)glucose, glycated haemoglobin (HbA1c)), leptin and adiponectin. Results: Following the training program, body weight (2.6%; p < 0.001), fat mass (4.5%; p = 0.002), resting glucose (6.8%; p = 0.017), and HbA1c (3.7%; p = 0.047) decreased, while relative V ˙ O2peak (16%; p < 0.001) increased in the exercise group. Leptin, adiponectin, CTX, osteocalcin or BAP did not change in either group. In conclusion, small dose of aerobic exercise improves key markers of metabolic health in PMW with obesity without negatively affecting markers of bone metabolism.

Attitudes, Barriers, and Motivators Toward Daily Walking and a Mobile App to Increase Walking Among Women: Web-Based Anonymous Survey

BACKGROUND

There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking.

OBJECTIVE

This study explores the relationship between age and women's self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women.

METHODS

A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women's perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments.

RESULTS

Significant barriers to daily walking were observed in the 21-49-year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49-year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75-year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women's walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart.

CONCLUSIONS

Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women's ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages.

Classification of human walking context using a single-point accelerometer

Real-world walking data offers rich insights into a person's mobility. Yet, daily life variations can alter these patterns, making the data challenging to interpret. As such, it is essential to integrate context for the extraction of meaningful information from real-world movement data. In this work, we leveraged the relationship between the characteristics of a walking bout and context to build a classification algorithm to distinguish between indoor and outdoor walks. We used data from 20 participants wearing an accelerometer on the thigh over a week. Their walking bouts were isolated and labeled using GPS and self-reporting data. We trained and validated two machine learning models, random forest and ensemble Support Vector Machine, using a leave-one-participant-out validation scheme on 15 subjects. The 5 remaining subjects were used as a testing set to choose a final model. The chosen model achieved an accuracy of 0.941, an F1-score of 0.963, and an AUROC of 0.931. This validated model was then used to label the walks from a different dataset with 15 participants wearing the same accelerometer. Finally, we characterized the differences between indoor and outdoor walks using the ensemble of the data. We found that participants walked significantly faster, longer, and more continuously when walking outdoors compared to indoors. These results demonstrate how movement data alone can be used to obtain accurate information on important contextual factors. These factors can then be leveraged to enhance our understanding and interpretation of real-world movement data, providing deeper insights into a person's health.

Boosts for walking: how humorous messages increase brisk walking among cognitively fatigued individuals

BACKGROUND

A well-studied internal barrier to regular physical activity, and more specifically brisk walking, is cognitive fatigue. However, thus far little research examined how cognitively fatigued individuals can be motivated to exercise, more specifically to engage in brisk walking. This study investigates whether humorous intervention messages might be an effective strategy to motivate cognitively fatigued individuals to brisk walk, and through which underlying processes.

METHODS

An online experiment was performed in which variation in cognitive fatigue was induced through mental arithmetic questions. Afterwards, participants (n = 250) recruited through Prolific, randomly received either humorous or non-humorous intervention messages related to brisk walking. Potential mediators of the relations between physical activity, humour and cognitive fatigue were measured, were self-efficacy, self-control, and motivation.

RESULTS

First, regression analyses confirmed that cognitive fatigue negatively influences brisk walking intentions and that the perceived humour of the intervention messages moderated this relationship. Second, results showed that self-control and self-efficacy are mediators explaining the relationship between cognitive fatigue and brisk walking intentions. Lastly, this study found that perceived humour of the intervention messages moderated the relationship between cognitive fatigue and self-control, indicating that perceptions of self-control were positively changed after receiving messages that were perceived as humorous compared to messages that were not perceived as humorous, subsequently increasing brisk walking intentions.

CONCLUSIONS

This study is the first to unravel the underlying relationship between humorous intervention messages and brisk walking intentions through positive changes in perceptions of self-control within a cognitively fatigued sample. Results of this study suggest that existing smartphone applications monitoring and promoting brisk walking should integrate tailored message strategies within their cues to brisk walk by implementing humour as a strategy to motivate users when they are cognitively fatigued.

Effectiveness of utilizing step-monitoring devices to prevent and treat obesity in children and adolescents: A systematic review and meta-analysis

Background

Children and adolescents who are overweight and obese represent a growing public health issue. The use of step-monitoring devices as an intervention tool may be a simple, cost-effective, and easily replicable solution for addressing obesity in children and adolescents. No prior systematic reviews have evaluated the effectiveness of utilizing step-monitoring devices as an intervention method for obesity in children and adolescents.

Methods

Previous studies on using step-monitoring devices to prevent and treat obesity in children and adolescents were identified in the following databases: Web of Science, EMBASE, PubMed, Cochrane Library, SPORTDiscus, and SCOPUS. The search period for each database ranged from the year of their inception to 8 March 2023 (updated in June 2024). Meta-analyses were performed for mean differences (MDs) in body mass index (BMI), BMI z-score (BMI-Z), body fat, waist circumference, and body weight.

Results

From 12,907 relevant records, 23 studies were included in this meta-analysis. The included studies were mainly at low risk of bias, except for blinding. Step-monitoring device-based interventions had significant effects in reducing BMI-Z (MD -0.06; 95% CI -0.10 to -0.02), body fat (MD -0.95%; 95% CI -1.35 to -0.54), and body weight (MD -1.23 kg; 95% CI -2.36 to -0.10). However, there was no significant effect on BMI (MD -0.16 kg/m2; 95% CI -0.55 to 0.22) and waist circumference (MD -0.33 cm; 95% CI -1.23 to 0.58). Subgroup analyses indicated that participants who were overweight or obese showed greater intervention effects on BMI and BMI-Z compared to participants with normal weight. The programs with an intervention duration of ≤6 months presented a greater intervention effect on BMI-Z than those with an intervention duration of more than 6 months. The programs that established goals had a greater intervention effect on body fat than those that did not.

Conclusions

Step-monitoring devices may be an effective and generalizable intervention tool for the prevention and treatment of obesity in children and adolescents. Future studies should further explore how to set step goals and the duration of interventions to achieve better intervention effects.

Associations between older adults' going-out frequency and land price of neighbourhoods: Potency of land price as an indicator of homebound tendency

The aim of this study is to identify the potency of land price as a general indicator of the homebound tendency of neighbourhoods. For this purpose, we focus on the associations between land price and older adults' going-out frequency, while considering the similarities and differences from factors associated with walkability. The study targets are 19,270 individuals living in the Tokyo metropolitan area who are aged 65 years or older who are not certified as needing public long-term care insurance. This study uses a two-step procedure: a) the land price of each neighbourhood is estimated using rent price data from 2010 to 2019 collected by an official Japanese realtor organization; b) the associations between older adults' goingout frequency, according to the 2016 Japan Gerontological Evaluation Study, and the estimated land price of their neighbourhoods is identified using multilevel analysis. The results indicate that land price has strong negative associations with older adults' going-out frequency. Associations between land price or other walkability-associated factors, such as population density, ratio of commercial area, and proximity to the nearest train station, only appear when these factors and land price are included within the same model. The results suggest that, when inspecting homebound tendency in some neighbourhoods, factors relating to the built environment must be considered alongside land prices. Furthermore, the homebound status of older adults is a pressing challenge, especially in neighbourhoods with high land prices.

Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis

Urological cancers represent a substantial global public health concern, exerting far-reaching effects on both individuals and their families. There is an urgent need to comprehensively understand the transformations in patients' lifestyles and behaviors, given their critical role in the treatment process and overall well-being. This study, involving 128 urological cancer patients, aims to investigate changes in physical activity levels, problematic drinking behaviors assessed through the Alcohol Use Disorders Identification Test (AUDIT), and smoking habits assessed using the Fagerström Test for Nicotine Dependence (FTND) over four distinct time intervals over the subsequent three years from the time of diagnosis and among individuals diagnosed more than three years ago. The results reveal a significant decrease in physical activity levels between study intervals (p < 0.0001), declining from 69% to 45% between the first and second post-diagnosis assessments. Furthermore, the highest levels of problematic substance use, indicated by mean scores, were noted in the first year following diagnosis (AUDIT: 4.20, p = 0.01; FTND: 4.83, p = 0.08). Given the significant impact of physical activity on the prospects of recovery, it is imperative to delve more deeply into the factors contributing to this decline and devise targeted interventions for its improvement. In the context of substance use, it is essential to ascertain whether the initially high levels are a result of coping with the cancer diagnosis or represent a turning point at which patients modify their behaviors and cease their addiction. A more thorough understanding of this phenomenon would enhance the effectiveness of precisely focused interventions.

Relationship between subjectively-rated and objectively-tested physical function across six different medical diagnoses

OBJECTIVE

To quantify and compare associations and relationships between self-rated and tested assessments of mainly mobility-related physical function in different diagnoses.

DESIGN

Six longitudinal cohort studies before and after inpatient rehabilitation.

PATIENTS

Patients with whiplash-associated disorder (n = 71), low back pain (n = 121), fibromyalgia (n = 84), lipoedema (n = 27), lymphoedema (n = 78), and post-acute coronary syndrome (n = 64).

METHODS

Physical function was measured with the self-rated Short-Form 36 Physical functioning (SF-36 PF) and with the tested 6-Min Walk Distance (6MWD) and assessed by correlation coefficients. Across the 6 cohorts, the relationship between the 2 scores was compared using the ratio between them.

RESULTS

The correlations between the 2 scores were mostly moderate to strong at baseline (up to r = 0.791), and weak to moderate for the changes to follow-up (up to r = 0.408). The ratios SF-36 PF to 6MWD were 1.143-1.590 at baseline and 0.930-3.310 for the changes, and depended on pain and mental health.

CONCLUSION

Moderate to strong cross-sectional and moderate to weak longitudinal correlations were found between the 6MWD and the SF-36 PF. Pain and mental health should be considered when interpreting physical function. For a comprehensive assessment in clinical practice and research, the combination of self-rated and tested physical function measures is recommended.

"It's not time for us to sit down yet": how group exercise programs can motivate physical activity and overcome barriers in inactive older adults

PURPOSE

Physical activity and exercise are critical for older adults' physical and mental health. The purpose of this qualitative study was to richly capture the motivators of and barriers to engaging in physical activity in previously inactive older adults who participated in a three-arm randomized controlled trial (RCT) of eight-week group exercise interventions.

METHODS

We conducted a qualitative content analysis of individual interviews with fifteen participants-five from each study arm: strength training, walking, and inactive control. Participants included nine females and six males ranging from 60 to 86 years of age.

RESULTS

Key motivators of physical activity included perceived improvements in physical and mental health, positive social influences, observed health deterioration in others, and the desire to spend time with and take care of family members. Barriers to physical activity included existing health conditions, fear of getting hurt, negative social influences, perceived lack of time and motivation, inconvenient times and locations, and monetary cost.

CONCLUSIONS

Our findings add to the body of literature identifying factors that motivate and stand in the way of older adults' engagement in physical activity. These factors influence older adults' self-efficacy and should be incorporated into the design of new and existing programs to encourage initiation and maintenance of physical activity.

Modeling and Analysis of Foot Function in Human Gait Using a Two-Degrees-of-Freedom Inverted Pendulum Model with an Arced Foot

Gait models are important for the design and control of lower limb exoskeletons. The inverted pendulum model has advantages in simplicity and computational efficiency, but it also has the limitations of oversimplification and lack of realism. This paper proposes a two-degrees-of-freedom (DOF) inverted pendulum walking model by considering the knee joints for describing the characteristics of human gait. A new parameter, roll factor, is defined to express foot function in the model, and the relationships between the roll factor and gait parameters are investigated. Experiments were conducted to verify the model by testing seven healthy adults at different walking speeds. The results demonstrate that the roll factor has a strong relationship with other gait kinematics parameters, so it can be used as a simple parameter for expressing gait kinematics. In addition, the roll factor can be used to identify walking styles with high accuracy, including small broken step walking at 99.57%, inefficient walking at 98.14%, and normal walking at 99.43%.

Prediction of Gait Kinematics and Kinetics: A Systematic Review of EMG and EEG Signal Use and Their Contribution to Prediction Accuracy

Human-machine interfaces hold promise in enhancing rehabilitation by predicting and responding to subjects' movement intent. In gait rehabilitation, neural network architectures utilize lower-limb muscle and brain activity to predict continuous kinematics and kinetics during stepping and walking. This systematic review, spanning five databases, assessed 16 papers meeting inclusion criteria. Studies predicted lower-limb kinematics and kinetics using electroencephalograms (EEGs), electromyograms (EMGs), or a combination with kinematic data and anthropological parameters. Long short-term memory (LSTM) and convolutional neural network (CNN) tools demonstrated highest accuracies. EEG focused on joint angles, while EMG predicted moments and torque joints. Useful EEG electrode locations included C3, C4, Cz, P3, F4, and F8. Vastus Lateralis, Rectus Femoris, and Gastrocnemius were the most commonly accessed muscles for kinematic and kinetic prediction using EMGs. No studies combining EEGs and EMGs to predict lower-limb kinematics and kinetics during stepping or walking were found, suggesting a potential avenue for future development in this technology.

Cancer Metabolism as a Therapeutic Target and Review of Interventions

Cancer is amenable to low-cost treatments, given that it has a significant metabolic component, which can be affected through diet and lifestyle change at minimal cost. The Warburg hypothesis states that cancer cells have an altered cell metabolism towards anaerobic glycolysis. Given this metabolic reprogramming in cancer cells, it is possible to target cancers metabolically by depriving them of glucose. In addition to dietary and lifestyle modifications which work on tumors metabolically, there are a panoply of nutritional supplements and repurposed drugs associated with cancer prevention and better treatment outcomes. These interventions and their evidentiary basis are covered in the latter half of this review to guide future cancer treatment.

Recreational walking and perceived environmental qualities: a national map-based survey in Denmark

BACKGROUND

The aim of the study is to explore the diversity in recreational walking motives across groups with different sociodemographic characteristics, and to use a dynamic and person-centered approach to geographically assess recreational walking behavior, and preferences for place quality related to recreational walking.

METHODS

A total of 1838 adult respondents (age 15-90 years), who engage in recreational walking, participated in the map-based survey. We used the online platform Maptionnaire to collect georeferenced information on the respondents' home location, other start locations for walking trips, and point of interest on their trips. Distance between home location and other start locations as well as point of interest were computed using a Geographic Information System (GIS). Additional information on recreational walking behavior and motives were collected using the traditional questionnaire function in Maptionnaire.

RESULTS

The most prevalent motives for walking were mental well-being and physical health, together with enjoyment and experiences related to walking. Having a tertiary education was positively associated with mental well-being motive, experiences, and taking the dog and the children outside. Income was also positively associated with experiences and walking the dog together with enjoyment of walking and spending time with others. Using the map-based approach, we found that recreational walking often starts at a location away from home and is not limited to the nearest neighborhood. A total of 4598 points of interest were mapped, and the most frequently reported place qualities were greenery, water, wildlife, good views, and tranquility.

CONCLUSION

We used a dynamic and person-centered approach and thereby giving the respondents the opportunity to point to relevant locations for their walking behavior independently of their residential neighborhood. Recreational walking often starts away from home or is not limit to the nearest neighborhod. The median distance from home to the mapped points of interests was between 1.0 and 1.6 km for home-based trips and between 9.4 and 30.6 km for trips with other start locations. The most popular place quality related to the mapped points were greenery, water, wildlife, good views, and tranquility.

Positive Effects of Physical Activity on Prescription on Glycemic Control, Fitness, and Quality of Life in Newly Diagnosed Type 2 Diabetic Patients

The aim was to investigate the effects of physical activity on prescription (PAP) compared with standard care (SC) in adult drug-naïve T2D patients. A randomized control trial was conducted with drug-naïve T2D patients attending an out-patient clinic Vietnam. Participants were randomly assigned to the PAP group (n+=+44) or the SC group (n+=+43). The PAP group received individualized recommendations for PA, intensive face-to-face training every two weeks. The SC group received the standard recommendations according to WHO guidelines. The mean HbA1c level change was larger (-10.6±6.4 mmol/mol) in the PAP group than in the SC group (-2.4±5.8 mmol/mol) (p<0.001). A one thousand step counts per day increase was significantly associated with a decrease of -2.43 mmol/mol in HbA1c [β=-2.43, 95%CI: (-2.94, -1.92]) in the PAP group. The fasting plasma glucose levels of the PAP group decreased significantly compared with the SC group. The VO2-max increased significantly more in the PAP group than in the SC group. PAP had clear positive effects on health-related Quality of Life [mean between group difference: 9.54 (95%CI 5.84,13.23)]. Insulin resistance, BMI, waist circumference, total cholesterol, LDL cholesterol and triglycerides were significantly more decreased in the PAP group than in the control group. In conclusion, the fact that even a small change in mean step counts over three months had a beneficial effect on health-related outcomes in drug-naïve T2D patients can have large implications for treatment and management practices, not least in a middle-income country like Vietnam.

Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study

BACKGROUND

Mobility is a meaningful aspect of an individual's health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring.

OBJECTIVE

Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies.

METHODS

We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure.

RESULTS

In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device-based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time.

CONCLUSIONS

We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions.

Hold My Hand: Development of a Force Controller and System Architecture for Joint Walking with a Companion Robot

In recent years, there has been a growing interest in the development of robotic systems for improving the quality of life of individuals of all ages. Specifically, humanoid robots offer advantages in terms of friendliness and ease of use in such applications. This article proposes a novel system architecture that enables a commercial humanoid robot, specifically the Pepper robot, to walk side-by-side while holding hands, and communicating by responding to the surrounding environment. To achieve this control, an observer is required to estimate the force applied to the robot. This was accomplished by comparing joint torques calculated from the dynamics model to actual current measurements. Additionally, object recognition was performed using Pepper's camera to facilitate communication in response to surrounding objects. By integrating these components, the system has demonstrated its capability to achieve its intended purpose.

An ecological analysis of walkability and housing affordability in Canada: Moderation by city size and neighbourhood property type composition

The neighbourhood built environment can support the physical activity of adults regardless of their individual-level socioeconomic status. However, physical activity supportive (walkable) neighbourhoods may not be accessible to those with lower incomes if homes in walkable neighbourhoods are too expensive. The objectives of this study were: 1) to estimate the associations between neighbourhood walkability and home values in Canadian cities, and 2) to test whether these associations differ by city size and residential property type composition within neighbourhoods. We linked built environment data from the 2016 Canadian Active Living Environments (Can-ALE) index with neighbourhood-level structural home characteristics and sociodemographic data from the 2016 Canadian census for 33,026 neighbourhoods across 31 Census Metropolitan Areas. We used multilevel linear regression models to estimate covariate-adjusted associations between neighbourhood walkability and natural-log median home values and tested city size and neighbourhood property type composition as moderators. There were no statistically significant associations between walkability and home values overall. The associations between neighbourhood walkability and home values were jointly moderated by city size and property type composition. For small and medium sized cities, within neighbourhoods containing a high proportion of detached homes, walkability was negatively associated with home values (b = -0.05, 95% CI: -0.10, -0.01; and, b = -0.04, 95% CI: -0.06, -0.02, for small and medium cities, respectively). However, for extra-large cities, within neighbourhoods containing a high proportion of detached homes, walkability was positively associated with home values (b = 0.06, 95% CI: 0.01, 0.10). Our findings suggest that, based on housing affordability, higher walkable neighbourhoods are likely accessible to lower income households that are situated in small and medium Canadian cities. In larger cities, however, municipal interventions (e.g., inclusionary zoning or targeted development of subsidized or social housing) may be needed to ensure equitable access to walkable neighbourhoods for lower income households.

Context of walking and loneliness among community-dwelling older adults: a cross-sectional study

BACKGROUND

Older adults are more likely to experience loneliness than younger people. Moreover, greater loneliness in older adults is associated with poor mental health and increased risk of cardiovascular disease and mortality. Physical activity is an effective intervention for reducing loneliness among older adults. Among physical activities, walking is suitable for older adults, because it is easy and safe to incorporate into daily life. We hypothesized that the association between walking and loneliness depends on the presence of others and the number of people present. The aim of this study is to investigate the association between the context of walking (the number of walkers) and loneliness among community-dwelling older adults.

METHODS

This cross-sectional study included 173 community-dwelling older adults aged 65 or older. Context of walking was classified as non-walking, walking alone (days of walking alone > days of walking with someone), and walking with someone (days of walking alone ≤ days of walking with someone). Loneliness was measured using the Japanese version of the University of California Los Angeles Loneliness Scale. A linear regression model was used to investigate the relationship between context of walking and loneliness, adjusted for age, sex, living situation, social participation, and physical activity excluding walking.

RESULTS

Data from 171 community-dwelling older adults (mean age = 78.0 years, 59.6% women) were analyzed. After adjustment, walking with someone was associated with lower loneliness than non-walking (adjusted β: -0.51, 95% confidence interval: -1.00, -0.01).

CONCLUSIONS

The study's findings suggest that walking with a companion may effectively prevent or reduce loneliness among older adults.

Impacts of commute mode on body mass index: A longitudinal analysis before and during the COVID-19 pandemic

Introduction

COVID-19 has impacted millions of commuters by decreasing their mobility and transport patterns. While these changes in travel have been studied, less is known about how commute changes may have impacted individuals' body mass index (BMI). The present longitudinal study explores the relationship between commute mode and BMI of employed individuals in Montréal, Canada.

Methods

This study uses panel data drawn from two waves of the Montréal Mobility Survey (MMS) conducted before and during the COVID-19 pandemic (n = 458). BMI was modeled separately for women and men as a function of commuting mode, WalkScore©, sociodemographic, and behavioral covariates using a multilevel regression modeling approach.

Results

For women, BMI significantly increased during the COVID-19 pandemic, but telecommuting frequency, and more specifically telecommuting as a replacement of driving, led to a statistically significant decrease in BMI. For men, higher levels of residential local accessibility decreased BMI, while telecommuting did not have a statistically significant effect on BMI.

Conclusions

This study's findings confirm previously observed gendered differences in the relations between the built environment, transport behaviors, and BMI, while offering new insights regarding the impacts of the changes in commute patterns linked to the COVID-19 pandemic. Since some of the COVID-19 impacts on commute are expected to be lasting, findings from this research can be of use by health and transport practitioners as they work towards generating policies that improve population health.

Fourteen days free-living evaluation of an open-source algorithm for counting steps in healthy adults with a large variation in physical activity level

BACKGROUND

The number of steps by an individual, has traditionally been assessed with a pedometer, but increasingly with an accelerometer. The ActiLife software (AL) is the most common way to process accelerometer data to steps, but it is not open source which could aid understanding of measurement errors. The aim of this study was to compare assessment of steps from the open-source algorithm part of the GGIR package and two closed algorithms, AL normal (n) and low frequency extension (lfe) algorithms to Yamax pedometer, as reference. Free-living in healthy adults with a wide range of activity level was studied.

RESULTS

A total 46 participants divided by activity level into a low-medium active group and a high active group, wore both an accelerometer and a pedometer for 14 days. In total 614 complete days were analyzed. A significant correlation between Yamax and all three algorithms was shown but all comparisons were significantly different with paired t-tests except for ALn vs Yamax. The mean bias shows that ALn slightly overestimated steps in the low-medium active group and slightly underestimated steps in high active group. The mean percentage error (MAPE) was 17% and 9% respectively. The ALlfe overestimated steps by approximately 6700/day in both groups and the MAPE was 88% in the low-medium active group and 43% in the high active group. The open-source algorithm underestimated steps with a systematic error related to activity level. The MAPE was 28% in the low-medium active group and 48% in the high active group.

CONCLUSION

The open-source algorithm captures steps fairly well in low-medium active individuals when comparing with Yamax pedometer, but did not show satisfactory results in more active individuals, indicating that it must be modified before implemented in population research. The AL algorithm without the low frequency extension measures similar number of steps as Yamax in free-living and is a useful alternative before a valid open-source algorithm is available.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Using a contralateral shoe lift to reduce gait deterioration during an offloading fast-walk setting in diabetic peripheral neuropathy: A comparative feasibility study

AIMS

Diabetic peripheral neuropathy (DPN) is a predictor of foot ulcers and leads to sedentary behaviour. This comparative study evaluated gait and feasibility of a 20-minute fast walk, at 40-60% of cardiopulmonary capacity, in individuals with DPN wearing an offloading boot and a contralateral shoe balancer.

METHODS

Gait parameters were measured with inertial sensors on 32 individuals (group with DPN [n = 16], group with diabetes but without DPN [n = 9], and a group without diabetes/DPN [n = 7]). Feasibility was assessed by feedback on perceived effort and adverse events. Gait outcomes were compared between groups with or without a shoe balancer using one-way ANOVAs.

RESULTS

The three groups were equivalent in terms of activity level and age and gender except for the body mass index. Both groups with diabetes exhibited minimal decreased gait speed (p > 0.005) and the DPN group exhibited increased double-support percentage (+4.6%, p = 0.01) while walking with an offloading boot and contralateral shoe balancer. The use of a contralateral shoe balancer reduced gait asymmetry. Lower physical activity level was associated with further gait deterioration in all groups. Few adverse events were reported, and 91% of participants reported that the proposed activity would be feasible daily.

CONCLUSIONS

The offloading boot deteriorated gait function, but a contralateral shoe balancer minimized its impact, especially in the context of physical activity in people with diabetes and DPN.

Dose-response relationship between daily step count and prevalence of sarcopenia: A cross-sectional study

OBJECTIVES

Daily step counts are an easy-to-understand indicator of physical activity; however, there is limited evidence regarding the optimal daily step count to prevent sarcopenia. This study examined the dose-response relationship between daily step count and the prevalence of sarcopenia and explored the optimal dose.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

The study included 7949 community-dwelling middle-aged and older adults (aged 45-74 years) from Japan.

MEASUREMENTS

Skeletal muscle mass (SMM) was assessed using bioelectrical impedance spectroscopy, and muscle strength was quantified through handgrip strength (HGS) measurement. Participants who exhibited both low HGS (men: <28 kg, women: <18 kg) and low SMM (lowest quartile in each sex-specific category) were defined as having sarcopenia. Daily step counts were measured for 10 days using a waist-mounted accelerometer. To examine the association between daily step count and sarcopenia, a multivariate logistic regression analysis was performed, adjusting for potential confounding factors such as age, sex, body mass index, smoking status, alcohol consumption, protein intake, and medical history. The odds ratios (ORs) and confidence intervals (CIs) were calculated based on the daily step counts categorized into quartiles (Q1-Q4). Finally, a restricted cubic spline curve was fitted to further investigate the dose-response relationship between daily step count and sarcopenia.

RESULTS

The prevalence of sarcopenia in the overall participants was 3.3 % (259/7949 participants), with a mean daily step count of 7292 ± 2966 steps. Expressed in quartiles, the mean daily step counts were 3873 ± 935 steps in Q1, 6025 ± 503 steps in Q2, 7942 ± 624 steps in Q3, and 11,328 ± 1912 steps in Q4. The prevalence of sarcopenia in each quartile of daily step count was 4.7 % (93/1987 participants) in Q1, 3.4 % (68/1987 participants) in Q2, 2.7 % (53/1988 participants) in Q3, and 2.3 % (45/1987 participants) in Q4. The ORs and 95 % CIs adjusted for covariates demonstrated a statistically significant inverse association between daily step count and sarcopenia prevalence (P for trend <0.01), as follows: Q1, reference; Q2, 0.79 (95 % CI: 0.55-1.11); Q3, 0.71 (95 % CI: 0.49-1.03); Q4, 0.61 (95 % CI: 0.41-0.90). The restricted cubic spline curve indicated that the ORs leveled off at approximately 8000 steps per day, and no statistically significant decrease in ORs was observed for daily step counts above this threshold.

CONCLUSIONS

The study found a significant inverse association between daily step count and the prevalence of sarcopenia, with the association plateauing when the daily step count exceeded approximately 8000 steps. These findings suggest that 8000 steps per day may be the optimal dose to prevent sarcopenia. Further intervention and longitudinal studies are needed to validate the results.

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.

The Effect of Walking Combined with Neuromuscular Electrical Stimulation on Liver Stiffness and Insulin Resistance in Patients with Non-alcoholic Fatty Liver Disease: An Exploratory Randomized Controlled Trial

Increased liver stiffness and insulin resistance are important therapeutic targets in patients with nonalcoholic fatty liver disease (NAFLD). A hybrid training system (HTS) has been developed which combines application of electrical stimulation and volitional contractions. We compared the effect of walking exercise (5.6 km/h) both with and without simultaneous HTS on liver stiffness and insulin resistance. In a single-blind, controlled trial, 32 subjects with NAFLD were randomized to 12 weeks of triweekly 30 minute walking exercise with either HTS (HTS group) or without HTS (control group). Transient elastography for the assessment of liver stiffness, body weight, visceral fat, the homeostasis model assessment of insulin resistance, fasting blood glucose, serum aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase were evaluated. Data were evaluated using the linear model after adjusting the baseline value. In the subjects with BMI of 27 kg/m² or more, the decrement of transient elastography in the HTS group was significantly larger than in the control group (mean ± standard error: Δ2.13 ± 0.64 kPa vs. Δ-0.67 ± 0.42 kPa, p=0.0009). There were no significant differences between groups in other endpoints. These results showed that simultaneously combining electrical stimulation with walking exercise could potentially improve liver stiffness in people who have NAFLD. In fact, because the exercise effect was increased by HTS without increasing the walking speed, this HTS could be especially useful for obese or overweight subjects, in whom NAFLD and joint problems often coexist. However, its effects on insulin resistance and body composition were not clear.

Walking and perception of green space among older adults in Japan: subgroup analysis based self-efficacy

Self-efficacy is the key factor for promoting physical activity. Older adults with low self-efficacy tend to be physical inactive than those with high self-efficacy, and an approach is needed to promote physical activity. Among several approaches, increasing the perception of green space may be an effective approach for low self-efficacy not high self-efficacy, but no study has investigated. This study investigated the association between walking and perception of green space among older adults with high and low self-efficacy, respectively. We conducted a cross-sectional study among 204 community-dwelling older adults (mean age = 78.3 years, 62.3% females). Using the median split, the participants were divided into high and low self-efficacy groups based on the median score of 12. Walking was measured using the International Physical Activity Questionnaire and 'more walking' was defined as ≥150 min of walking time per week. Perception of green space was measured using an 8-item questionnaire. We performed logistic regression analysis to investigate the association between walking and perception of green space adjusted for age, gender, years of education, living with someone and income level. For all participants, 94 participants (46.1%) fell under low self-efficacy. After adjustment, higher perception of green space is associated with more walking among older adults with low self-efficacy [adjusted odds ratio (aOR) = 1.07, 95% confidence interval (CI) = 1.00-1.15], but not among those with high self-efficacy (aOR = 1.09, 95% CI= 0.99-1.20). To increase perception of green space, experts should design/improve green spaces considering beneficiaries' characteristics.

Associations between neighborhood walkability and walking following residential relocation: Findings from Alberta's Tomorrow Project

Introduction

Cross-sectional studies consistently find that the neighborhood built environment (e.g., walkability) is associated with walking. However, findings from the few existing longitudinal residential relocation studies that have estimated associations between changes in neighborhood built characteristics and walking are equivocal. The study objective was to estimate whether changes in neighborhood walkability resulting from residential relocation were associated with leisure, transportation, and total walking levels among adults.

Methods

This study included longitudinal data from the "Alberta's Tomorrow Project"-a province-wide cohort study (Alberta, Canada). The analysis included data collected at two time points (i.e., baseline and follow-up) from 5,977 urban adults. The International Physical Activity Questionnaire (IPAQ) captured self-reported walking. We estimated neighborhood walkability, an index capturing intersection, destination, and population counts for the 400 m Euclidean buffer around participants' homes. Using household postal codes reported at baseline and follow-up, we categorized participants into three groups reflecting residential relocation ("non-movers:" n = 5,679; "movers to less walkability:" n = 164, and; "movers to more walkability:" n = 134). We used Inverse-Probability-Weighted Regression Adjustment to estimate differences [i.e., average treatment effects in the treated (ATET)] in weekly minutes of leisure, transportation, and total walking at follow-up between residential relocation groups, adjusting for baseline walking, sociodemographic characteristics, and walkability. The median time between baseline and follow-up was 2-years.

Results

The three residential relocation groups mainly included women (61.6-67.2%) and had a mean age of between 52.2 and 55.7 years. Compared to "non-movers" (reference group), weekly minutes of transportation walking at follow-up was significantly lower among adults who moved to less walkable neighborhoods (ATET: -41.34, 95 CI: -68.30, -14.39; p < 0.01). We found no other statistically significant differences in walking between the groups.

Discussion

Our findings suggest that relocating to less walkable neighborhoods could have detrimental effects on transportation walking to the extent of adversely affecting health. Public health strategies that counteract the negative impacts of low walkable neighborhoods and leverage the supportiveness of high walkable neighborhoods might promote more walking.

Outdoor walking better? environmental elements of cardiorespiratory fitness training trails

In metropolitan areas where land resources are scarce, trails are a more suitable environment for cardiorespiratory fitness training for modern people. Previous studies have demonstrated that cardiorespiratory fitness is an important factor in assessing individual health and have focused on individual training performance, but the relationship between environment and cardiorespiratory fitness training participants has rarely been investigated. The purpose of this study was to investigate the demands for outdoor cardiorespiratory fitness training and a favorable trail environment by comparing the differences in exercise intensity and perceptions between outdoor and indoor environments. In this study, information on physical data, psychological feedback, and visual atmosphere was collected from nine participants during each phase of moderate intensity cardiorespiratory fitness training in indoor and outdoor environments. The results revealed that outdoor cardiorespiratory fitness training provided participants with lower training intensity during the active exercise phase and higher heart rate during the stretching phase compared to indoor training. The participants paid more attention to the slope, length, pavement, Spaciousness, and width of the trails and the circuitous route. The change of the visual atmosphere and the scenery for the environmental factors were the important factors to motivate the participants to train. The results of the study could assist participants to understand a favorable cardiorespiratory training environment and design a suitable training program, as well as provide a model for trail planning and design for government.

Effects of Walking Exercise Program Based on Duration on the Body Composition and Lipid Profile in Overweight and Obesity Female College Students

The lack of physical activity is one factors that causes the increased prevalence of overweight and obesity in Indonesia. A walking exercise program is a simple strategy for weight loss and the prevention of various chronic diseases. This research aims to analyze the effects of walking exercise programs base on duration which involve an increased number of daily steps on the body's composition and lipid profile. The quasi-experimental design included 40 female university students aged 20–30, whose body mass index (BMI) was ≥25 kg/m2. They are divided into two groups: 60 minutes (WE-60) and 40 minutes (WE-40) walking program. All groups performed the program intervention five times per week, carried out for a total of 12 weeks, with a heart rate of 50%-75%. The results showed that an additional 60-minute walking exercise program led to a greater increase in the total daily steps (P<0.001), and it has a significant effect on weight (P=0.005), BMI (P=0.002), WC (P=0.003), visceral fat (P=0.001), fat mass (P=0.001) and the body fat percentage (P=0.007), compared to the 40 minutes walking group intervention. However, the lipid profiles of both groups were not significantly different. In conclusion, the addition of a 60-minute walking exercise program (WE-60) five times per week, improved the daily steps and significantly affected body composition, but it had no significant effect on the lipid profile.

Accuracy of steps measured by smartphones-based WeRun compared with ActiGraph-GT3X accelerometer in free-living conditions

Objectives

The purpose of this study was to evaluate the accuracy and reliability of steps tracked by smartphone-based WeChat app compared with Actigraph-GT3X accelerometer in free-living conditions.

Design

A cross-sectional study and repeated measures.

Methods

A total of 103 employees in the Pudong New Area of Shanghai, China, participated in this study. The participants wore an ActiGraph-GT3X accelerometer during the period of August to September 2019 (Time 1), December 2019 (Time 2) and September 2020 (Time 3). Each time, they wore the ActiGraph-GT3X accelerometer continuously for 7 days to assess their 7-day step counts. The smartphone-based WeRun step counts were collected in the corresponding period when subjects wore accelerometers. The subjects were invited to complete basic demographic characteristics questionnaires and to perform physical examination to obtain health-related results such as height, body weight, body fat percentage, waist circumference, hip circumference, and blood pressure.

Results

Based on 103 participants' 21 days of data, we found that the Spearman correlation coefficient between them was 0.733 (P < 0.01). The average number of WeRun steps measured by smartphones was 8,975 (4,059) per day, which was higher than those measured by accelerometers (8,462 ± 3,486 per day, P < 0.01). Demographic characteristics and different conditions can affect the consistency of measurements. The consistency was higher in those who were male, older, master's degree and above educated, and traveled by walking. Steps measured by smartphone and accelerometer in working days and August showed stronger correlation than other working conditions and time. Mean absolute percent error (MAPE) for step counts ranged from 0.5 to 15.9%. The test-retest reliability coefficients of WeRun steps ranged from 0.392 to 0.646. A multiple regression analysis adjusted for age, gender, and MVPA/step counts measured during Time 1 showed that body composition (body weight, BMI, body fat percentage, waist circumference, and hip circumference) was correlated with moderate-to-vigorous intensity physical activity, but it was not correlated with WeRun step counts.

Conclusions

The smartphone-based WeChat app can be used to assess physical activity step counts and is a reliable tool for measuring steps in free-living conditions. However, WeRun step counts' utilization is potentially limited in predicting body composition.

Machine Learning Models for Weight-Bearing Activity Type Recognition Based on Accelerometry in Postmenopausal Women

Hip-worn triaxial accelerometers are widely used to assess physical activity in terms of energy expenditure. Methods for classification in terms of different types of activity of relevance to the skeleton in populations at risk of osteoporosis are not currently available. This publication aims to assess the accuracy of four machine learning models on binary (standing and walking) and tertiary (standing, walking, and jogging) classification tasks in postmenopausal women. Eighty women performed a shuttle test on an indoor track, of which thirty performed the same test on an indoor treadmill. The raw accelerometer data were pre-processed, converted into eighteen different features and then combined into nine unique feature sets. The four machine learning models were evaluated using three different validation methods. Using the leave-one-out validation method, the highest average accuracy for the binary classification model, 99.61%, was produced by a k-NN Manhattan classifier using a basic statistical feature set. For the tertiary classification model, the highest average accuracy, 94.04%, was produced by a k-NN Manhattan classifier using a feature set that included all 18 features. The methods and classifiers within this study can be applied to accelerometer data to more accurately characterize weight-bearing activity which are important to skeletal health.

Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality

IMPORTANCE

Recommendations for the number of steps per day may be easier to enact for some people than the current time- and intensity-based physical activity guidelines, but the evidence to support steps-based goals is limited.

OBJECTIVE

To describe the associations of step count and intensity with all-cause mortality and cancer and cardiovascular disease (CVD) incidence and mortality.

DESIGN, SETTING, AND PARTICIPANTS

This population-based prospective cohort study used data from the UK Biobank for 2013 to 2015 (median follow-up, 7 years) and included adults 40 to 79 years old in England, Scotland, and Wales. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. Data analyses were performed during March 2022.

EXPOSURES

Baseline wrist accelerometer-measured daily step count and established cadence-based step intensity measures (steps/min): incidental steps, (<40 steps/min), purposeful steps (≥40 steps/min); and peak-30 cadence (average steps/min for the 30 highest, but not necessarily consecutive, min/d).

MAIN OUTCOMES AND MEASURES

All-cause mortality and primary and secondary CVD or cancer mortality and incidence diagnosis. For cancer, analyses were restricted to a composite cancer outcome of 13 sites that have a known association with reduced physical activity. Cox restricted cubic spline regression models were used to assess the dose-response associations. The linear mean rate of change (MRC) in the log-relative hazard ratio for each outcome per 2000 daily step increments were also estimated.

RESULTS

The study population of 78 500 individuals (mean [SD] age, 61 [8] years; 43 418 [55%] females; 75 874 [97%] White individuals) was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause (MRC, -0.08; 95% CI, -0.11 to -0.06), CVD (MRC, -0.10; 95% CI, -0.15 to -0.06), and cancer mortality (MRC, 95% CI, -0.11; -0.15 to -0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps.

CONCLUSIONS AND RELEVANCE

The findings of this population-based prospective cohort study of 78 500 individuals suggest that up to 10 000 steps per day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.