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McBride P, Henson J, Edwardson CL, Maylor B, Dempsey PC, Rowlands AV, Davies MJ, Khunti K, Yates T. Four-Year Increase in Step Cadence Is Associated with Improved Cardiometabolic Health in People with a History of Prediabetes. Med Sci Sports Exerc 2023; 55:1601-1609. [PMID: 37005498 DOI: 10.1249/mss.0000000000003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
PURPOSE To investigate associations between 4-yr change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. METHODS In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of cardiometabolic health (body mass index, waist circumference, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides, and glycated hemoglobin A1c [HbA1c]), and free-living stepping activity (activPAL3™) at baseline, 1 yr, and 4 yr. Brisk steps per day were defined as the number of steps accumulated at ≥100 steps per minute and slow steps per day as those accumulated at <100 steps per minute; the mean peak stepping cadence during the most active 10 minutes of the day was also derived. Generalized estimating equations examined associations between 4-yr change in step cadence and change in cardiometabolic risk factors, with interactions by sex and ethnicity. RESULTS Seven hundred ninety-four participants were included (age, 59.8 ± 8.9 yr; 48.7% women; 27.1% ethnic minority; total steps per day, 8445 ± 3364; brisk steps per day, 4794 ± 2865; peak 10-min step cadence, 128 ± 10 steps per minute). Beneficial associations were observed between change in brisk steps per day and change in body mass index, waist circumference, HDL-C, and HbA1c. Similar associations were found between peak 10-min step cadence and HDL-C and waist circumference. Interactions by ethnicity revealed change in brisk steps per day and change in peak 10-min step cadence had a stronger association with HbA1c in White Europeans, whereas associations between change in 10-min peak step cadence with measures of adiposity were stronger in South Asians. CONCLUSIONS Change in the number of daily steps accumulated at a brisk pace was associated with beneficial change in adiposity, HDL-C, and HbA1c; however, potential benefits may be dependent on ethnicity for outcomes related to HbA1c and adiposity.
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Shin SW, Kim H, Kang YH, Kim J. Accelerometer-derived physical activity and sedentary behavior patterns among Korean adults. Phys Act Nutr 2023; 27:25-33. [PMID: 37583069 PMCID: PMC10440183 DOI: 10.20463/pan.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE This study aimed to provide an overview of accelerometer-derived physical activity (PA) and sedentary behavior (SB) patterns among Korean adults. We also investigated the association between participant characteristics and the likelihood of adherence to moderate-to-vigorous physical activity (MVPA), SB, and the MVPA-SB guidelines. METHODS Data from the 2014-2017 Korea National Health and Nutrition Examination Survey were used. The study involved a nationally representative sample of 2,260 Korean adults aged ≥20 years. Accelerometers were used to measure PA and SB for seven days. Multivariate logistic regression models were used to assess the association between the participant characteristics and the likelihood of adhering to the MVPA, SB, and MVPA-SB guidelines. RESULTS SB (60.61%), light intensity (26.22%), and lifestyle activities (9.4%) accounted for the majority of the participants' days. MVPA and vigorous physical activity (VPA) accounted for 3.72% and 0.06% of the days, respectively. The MVPA guidelines were more likely to be adhered to by men, older adults, participants with higher education, non-smokers, and individuals without multimorbidity. Participants with higher education and household income were less likely to adhere to the SB guidelines. Women (OR=0.51), participants with high education levels (OR=0.54), current smokers (OR=0.47), and patients with multimorbidity (OR=0.46) were less likely to adhere to the MVPA-SB guidelines. CONCLUSION This study found that participants were predominantly sedentary, with only a small proportion engaging in VPA. There were differences related to demographic factors and health status. Most Korean adults do not adhere to the recommended MVPA-SB guidelines, and that is a serious public health concern. These findings highlight the need to promote PA and reduce SB through public health policies and interventions, particularly for adults facing PA barriers.
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Affiliation(s)
- Seung Woo Shin
- Sports and Exercise Medicine Laboratory, Korea Maritime & Ocean University, Busan, Republic of Korea
| | - Hyunmin Kim
- Sports and Exercise Medicine Laboratory, Korea Maritime & Ocean University, Busan, Republic of Korea
| | - Young Hun Kang
- Research Institute of Ocean Science and Technology, Korea Maritime & Ocean University, Busan, Republic of Korea
| | - Junghoon Kim
- Sports and Exercise Medicine Laboratory, Korea Maritime & Ocean University, Busan, Republic of Korea
- School of Applied Health, Cal Poly Humboldt, Arcata, CA 95521, USA
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Jang M, Park JH, Kim GM, Song S, Huh U, Kim DR, Sung M, Tak YJ. Health Provider's Feedback on Physical Activity Surveillance Using Wearable Device-Smartphone Application for Adults with Metabolic Syndrome; a 12-Week Randomized Control Study. Diabetes Metab Syndr Obes 2023; 16:1357-1366. [PMID: 37193576 PMCID: PMC10183188 DOI: 10.2147/dmso.s406065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023] Open
Abstract
Purpose Research on whether wearable device interventions can effectively prevent metabolic syndrome remains insufficient. This study aimed to evaluate the effect of feedback on clinical indicators in patients with metabolic syndrome on activities measured using wearable devices, such as smartphone apps. Methods Patients with metabolic syndrome were recruited and prescribed to live for 12 weeks using a wrist-wearable device (B.BAND, B Life Inc., Korea). A block randomization method was used to distribute participants between the intervention (n=35) and control groups (n=32). In the intervention group, an experienced study coordinator provided feedback on physical activity to individuals through telephonic counseling every other week. Results The mean number of steps in the control group was 8892.86 (4473.53), and those in the intervention group was 10,129.31 (4224.11). After 12 weeks, metabolic syndrome was resolved. Notably, there were statistically significant differences in the metabolic composition among the participants who completed the intervention. The mean number of metabolic disorder components per person remained at 3 in the control group, and decreased from 4 to 3 in the intervention group. Additionally, waist circumference, systolic and diastolic blood pressure, and triglyceride levels were significantly reduced, while HDL-cholesterol levels were significantly increased in the intervention group. Conclusion Overall, 12 weeks of telephonic counseling intervention using wearable device-based physical activity confirmation improved the damaged metabolic components of patients with metabolic syndrome. Telephonic intervention can help increase physical activity and reduce waist circumference, which is a typical clinical indicator of metabolic syndrome.
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Affiliation(s)
- Minwoo Jang
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
| | - Jong-Hwan Park
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
| | - Gwon-Min Kim
- Department of Medical Research Institute, Pusan National University, Busan, 46241, South Korea
| | - Seunghwan Song
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan, 50612, South Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, 49241, South Korea
| | - Up Huh
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan, 50612, South Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, 49241, South Korea
| | - Du-ri Kim
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
| | - Minji Sung
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
| | - Young Jin Tak
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, 50612, South Korea
- Department of Family Medicine, Pusan National University Hospital, Busan, 49241, South Korea
- Correspondence: Young Jin Tak, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 42941, Republic of Korea, Tel +82 10 7172 5905, Email
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Bezzina A, Ashton L, Watson T, James CL. Workplace wellness programs targeting weight outcomes in men: A scoping review. Obes Rev 2022; 23:e13410. [PMID: 35076133 DOI: 10.1111/obr.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
Workplaces have been identified as a priority setting for the delivery of wellness programs to address risk factors for overweight and obesity. Men in particular may benefit greatly from these types of programs as they are typically harder to engage in health promotion. A scoping review was performed to provide an overview of interventions that have been implemented within the workplace that target weight outcomes in men. A searched of six electronic databases (Medline, Embase, CINAHL, Scopus, Cochrane Database of Systematic Review, and Business Source Ultimate) was conducted from January 2010 to August 2020. Of the 2191 articles identified, 25 were included. The majority took place in North America or Europe (72%). Over half (n = 17, 68%) utilized both a nutrition and physical activity component. Thirteen of the 19 articles (68%) that reported weight as an outcome showed the program to be efficacious in reducing weight. Overall, only seven articles were solely focused on an all-male population. Workplace wellness programs targeting weight outcomes in men have been conducted to some extent, with majority being successful in reducing weight. However, there is a need for more randomized controlled trials (RCTs), long-term follow-up, and male-only programs.
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Affiliation(s)
- Aaron Bezzina
- Centre for Resources Health and Safety, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Lee Ashton
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, Australia
| | - Trent Watson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Ethos Health, Newcastle West, Australia
| | - Carole L James
- Centre for Resources Health and Safety, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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Ma J, Kim H, Kim J. Isotemporal Substitution Analysis of Accelerometer-Derived Sedentary Behavior and Physical Activity on Cardiometabolic Health in Korean Adults: A Population-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111102. [PMID: 34769622 PMCID: PMC8583396 DOI: 10.3390/ijerph182111102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
Reducing sedentary behavior and increasing physical activity may be important for maintaining good cardiometabolic health. However, many studies have focused on the independent effect of sedentary behavior and physical activity, but it is unclear whether replacing time spent in sedentary behavior with physical activity is beneficial for cardiometabolic health. Therefore, this population-based cross-sectional study aimed to investigate the effect of behavioral transformations between sedentary behavior and level of physical activity on cardiometabolic health in Korean adults using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2017. The study participants included 2197 adults from the KNHANES. In the partition model, moderate-to-vigorous physical activity (MVPA) was significantly associated with adverse cardiometabolic health, adjusted for potential confounding factors. The odds ratio for adverse cardiometabolic health significantly decreased with the replacement of sedentary behavior and light intensity activity with MVPA in the isotemporal substitution model (p < 0.05). In the models stratified by sex, we observed significant associations between handgrip strength and cardiometabolic health in women (p < 0.001), but not in men. Thus, our findings suggest that replacing sedentary behavior with MVPA may contribute to improved cardiometabolic health.
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Affiliation(s)
- Jiameng Ma
- Faculty of Physical Education, Sendai University, Miyagi 989-1693, Japan; (J.M.); (H.K.)
| | - Hyunshik Kim
- Faculty of Physical Education, Sendai University, Miyagi 989-1693, Japan; (J.M.); (H.K.)
| | - Junghoon Kim
- Sports and Exercise Medicine Laboratory, Korea Maritime and Ocean University, 727 Taejong-ro, Yeongdo-gu, Busan 49112, Korea
- Correspondence: ; Tel.: +82-51-410-4792
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Impacts of lifestyle behavior and shift work on visceral fat accumulation and the presence of atherosclerosis in middle-aged male workers. Hypertens Res 2019; 43:235-245. [DOI: 10.1038/s41440-019-0362-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
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Jung D, An KO, Kim J. Association between Meeting the Physical Activity Guidelines and Participation in ‘Sports for All’ and the Risk of Hypertension in Community-dwelling Korean Adults. THE ASIAN JOURNAL OF KINESIOLOGY 2018. [DOI: 10.15758/ajk.2018.20.4.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Increasing walking steps daily can reduce blood pressure and diabetes in overweight participants. Diabetol Int 2017; 9:75-79. [PMID: 30603352 DOI: 10.1007/s13340-017-0333-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 07/28/2017] [Indexed: 01/19/2023]
Abstract
Background High blood pressure (BP) and diabetes have been suggested to be non-communicable diseases (NCDs), and they are components in the definition of metabolic syndrome. Further, several studies have reported that the risk of developing NCDs can be reduced by increased physical activity. In addition, a daily target of 10,000 steps has been generally suggested to increase physical activity in sedentary lifestyles. Therefore, the purpose of this study was to determine the effect of an accumulation of 10,000 steps daily on BP and blood glucose in overweight participants. Methods Participants were recruited from males and females, aged 35-59 years, with sedentary lifestyles. A longitudinal quasi-experimental study was designed with 35 participants who had body mass indices ≥25 kg/m2. These volunteers were assigned to the 12-week pedometer-based walking program (an accumulation of at least 10,000 steps daily). Blood glucose and BP were measured before and after the intervention. Results Systolic blood pressure (SBP) was significantly lower in 30 individuals who accumulated 10,000 steps daily (-13.74 mmHg). In addition, the reduction of blood glucose levels (-14.89 mg/dl) in the intervention participants was statistically significant (p < 0.001). Conclusion The accumulation of at least 10,000 steps daily resulted in decreased SBP and blood glucose in overweight Thai subjects. It could also reduce the risk of cardiovascular disease (e.g., hypertension and diabetes).
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Kim J. Association between Meeting Physical Activity Guidelines and Mortality in Korean Adults: An 8-year Prospective Study. J Exerc Nutrition Biochem 2017; 21:23-29. [PMID: 28715883 PMCID: PMC5545214 DOI: 10.20463/jenb.2016.0054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/31/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Although previous studies have investigated the association between physical activity and various health outcomes, limited information is available on the effect of meeting new governmental guidelines for physical activity on the risk of mortality in Korean adults. This study aimed to examine the prospective association between meeting these guidelines and all-cause mortality during an 8-year follow-up using a large nationwide sample of middle-aged and older adults in Korea. METHODS This prospective study was conducted based on the Korean Longitudinal Study of Ageing. The study participants included 9,177 adults aged 45 years or older at baseline, and all participants were monitored in a 2-year cycle during an 8-year period (70,873 person-years). The risk of mortality was analyzed by determining physical activity levels using the Cox proportional hazard models, and the hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox models. RESULTS A statistically significant effect of physical activity on the reduced risk of mortality was observed in cases in which the participants met the guidelines compared to the inactive group (HR: 0.68, 95% CI: 0.58-0.81 vs. the inactive group). A strong association between meeting the recommended physical activity levels and the reduced risk of mortality was also found for non-smokers (HR: 0.62; 95% CI: 0.51-0.76 vs. the inactive group), but not for current smokers (HR: 0.93; 95% CI: 0.67-1.29 vs. the inactive group). CONCLUSION Meeting physical activity guidelines was associated with a decreased risk of all-cause mortality for Korean adults. Our results also suggest that smoking reduces the protective effect of physical activity on the risk of mortality.
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Affiliation(s)
- Junghoon Kim
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
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Arija V, Villalobos F, Pedret R, Vinuesa A, Timón M, Basora T, Aguas D, Basora J. Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the "Pas-a-Pas" community intervention trial. BMC Public Health 2017; 17:576. [PMID: 28619115 PMCID: PMC5471891 DOI: 10.1186/s12889-017-4485-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 06/01/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Physical activity is a major, modifiable, risk factor for cardiovascular disease (CVD) that contributes to the prevention and management of CVD. The aim of this study was to assess the short- and medium-term effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults. METHODS Multicentered, randomized, controlled community intervention involving 364 patients in four primary care centers. The participants were randomly assigned to a Control Group (CG = 104) or Intervention Group (IG = 260); mean age 65.19 years; 76.8% women. The intervention consisted of 120 min/week walking (396 METs/min/week) and sociocultural gathering once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose) and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. Incidence of adverse cardiovascular events and continued adherence to the physical activity were assessed 2 years after intervention. RESULTS At the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity (774.81 METs/min/week), a significant change during the intervention period in systolic blood pressure (-6.63 mmHg), total cholesterol (-10.12 mg/dL) and LDL-cholesterol (-9.05 mg/dL) even after adjustment for potential confounders. At 2 years after the intervention, in the IG, compared with the CG, tthe incidence of adverse cardiovascular events was significantly lower (2.5% vs. 10.5%) and the adherence to regular physical activity was higher (72.8% vs 27.2%) in IG compared to CG. CONCLUSIONS This community-based physical activity program improved cardiovascular health in the short- as well as medium-term, and promoted regular physical activity in the medium-term in older Spanish adults. TRIALS REGISTRATION Clinicaltrials.gov ID NCT02767739 . Trial registered on May 5th, 2016. Retrospectively registered.
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Affiliation(s)
- Victoria Arija
- Unit of Research Support Reus-Tarragona, Institut d'Investigació en Atenció Primária, IDIAP Jordi Gol, Barcelona, Spain.
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona, Spain.
- Unit of Research Support Reus-Tarragona, Institut d'Investigació en Atencio Primária, (IDIAP) Jordi Gol (Barcelona), Camí de Riudoms 57, 43202, Reus, Spain.
| | - Felipe Villalobos
- Unit of Research Support Reus-Tarragona, Institut d'Investigació en Atenció Primária, IDIAP Jordi Gol, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Roser Pedret
- Primary Health Care Area, Reus, Tarragona, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Angels Vinuesa
- Primary Health Care Area, Reus, Tarragona, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Mercé Timón
- Primary Health Care Area, Reus, Tarragona, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Teresa Basora
- Primary Health Care Area, Reus, Tarragona, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Dolors Aguas
- Department of Activities and Projects, Reus Esport i Lleure SA, Reus, Tarragona, Spain
| | - Josep Basora
- Unit of Research Support Reus-Tarragona, Institut d'Investigació en Atenció Primária, IDIAP Jordi Gol, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona, Spain
- Primary Health Care Area, Reus, Tarragona, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
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Tran VD, James AP, Lee AH, Jancey J, Howat PA, Thi Phuong Mai L. Effectiveness of a Community-Based Physical Activity and Nutrition Behavior Intervention on Features of the Metabolic Syndrome: A Cluster-Randomized Controlled Trial. Metab Syndr Relat Disord 2016; 15:63-71. [PMID: 27997282 DOI: 10.1089/met.2016.0113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) and its subclinical diseases are now public health problems in Vietnam. This study aimed at determining the effectiveness of a physical activity and nutrition program for reducing MetS proportion and its components among adults with MetS in Hanam province, Vietnam. METHODS A total of 417 volunteers aged 50-65 years with MetS were recruited from 10 communes. The communes were randomly allocated to an intervention group (five communes, n = 214) and a control group (five communes, n = 203). The participants in the intervention group received a nutrition and physical activity program for 6 months, whereas participants in the control group received standard diet and physical activity advice on only one occasion. Anthropometry, lipid profiles, glycemic status, and blood pressure were measured at baseline and at 6 months to evaluate program effectiveness. RESULTS In total, 175 intervention (81.8%) and 162 control (79.8%) participants completed the post-program evaluation. After controlling for the effects of clustering and confounding factors, the intervention group showed significant improvements in high-density lipoprotein cholesterol (+0.42 mM, P < 0.001), waist circumference (-1.63 cm, P < 0.001), waist-to-hip ratio (-0.024, P < 0.001), weight (-1.44 kg, P < 0.001), and body mass index (-0.59 kg/m2, P < 0.001) when compared with the control group. A reduction in the MetS proportion was found in both intervention and control groups (P < 0.001), decreasing to 56.0% and 75.9%, respectively, but the post-program proportion was significantly lower among the intervention participants (P < 0.001). Furthermore, the mean number of MetS components exhibited by individuals decreased significantly in the intervention group (P < 0.001). CONCLUSIONS The community-based physical activity and nutrition program reduced MetS proportion, with significant improvements in several metabolic and anthropometric parameters for Vietnamese adults with MetS.
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Affiliation(s)
- Van Dinh Tran
- 1 Department of Community Health and Network Coordination, National Institute of Hygiene and Epidemiology , Hanoi, Vietnam .,2 School of Public Health, Curtin University , Perth, Western Australia
| | - Anthony P James
- 2 School of Public Health, Curtin University , Perth, Western Australia .,3 Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
| | - Andy H Lee
- 2 School of Public Health, Curtin University , Perth, Western Australia
| | - Jonine Jancey
- 2 School of Public Health, Curtin University , Perth, Western Australia .,4 Collaboration for Evidence, Research and Impact in Public Health, Curtin University , Perth, Western Australia
| | - Peter A Howat
- 2 School of Public Health, Curtin University , Perth, Western Australia .,4 Collaboration for Evidence, Research and Impact in Public Health, Curtin University , Perth, Western Australia
| | - Le Thi Phuong Mai
- 1 Department of Community Health and Network Coordination, National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
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Effects of a Lifestyle-Based Physical Activity Intervention on Medical Expenditure in Japanese Adults: A Community-Based Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7530105. [PMID: 27493963 PMCID: PMC4963587 DOI: 10.1155/2016/7530105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/19/2016] [Accepted: 06/20/2016] [Indexed: 12/04/2022]
Abstract
Background. This study aimed to investigate whether a lifestyle-based physical activity program could contribute to reduced medical expenditure. Methods. The study participants were 60 adults aged 63.1 (standard deviation, 4.4) years in the intervention group; the case-control group consisted of 300 adults who were randomly selected from Japan's national health insurance system. This community-based retrospective study incorporated a 3-year follow-up. Results. The total and outpatient medical expenditure in the intervention group were significantly lower than in the control group: total expenditure, $US640.4/year; outpatient expenditure, $369.1/year. The odds ratio for outpatient visiting was 6.47-fold higher in the control than in the intervention group. Conclusion. Our study suggests that a health program to promote physical activity can result in reduced total medical expenditure, outpatient medical expenditure, and possibly also inpatient medical expenditure.
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Kim J, Choi YH. Physical activity, dietary vitamin C, and metabolic syndrome in the Korean adults: the Korea National Health and Nutrition Examination Survey 2008 to 2012. Public Health 2016; 135:30-7. [DOI: 10.1016/j.puhe.2016.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/07/2015] [Accepted: 01/07/2016] [Indexed: 01/22/2023]
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Bottorff JL, Seaton CL, Johnson ST, Caperchione CM, Oliffe JL, More K, Jaffer-Hirji H, Tillotson SM. An Updated Review of Interventions that Include Promotion of Physical Activity for Adult Men. Sports Med 2016; 45:775-800. [PMID: 25430599 PMCID: PMC4440891 DOI: 10.1007/s40279-014-0286-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The marked disparity in life expectancy between men and women suggests men are a vulnerable group requiring targeted health promotion programs. As such, there is an increasing need for health promotion strategies that effectively engage men with their health and/or illness management. Programs that promote physical activity could significantly improve the health of men. Although George et al. (Sports Med 42(3):281, 30) reviewed physical activity programs involving adult males published between 1990 and 2010, developments in men's health have prompted the emergence of new sex- and gender-specific approaches targeting men. The purpose of this review was to: (1) extend and update the review undertaken by George et al. (Sports Med 42(3):281, 30) concerning the effectiveness of physical activity programs in males, and (2) evaluate the integration of gender-specific influences in the content, design, and delivery of men's health promotion programs. A search of MEDLINE, CINAHL, ScienceDirect, Web of Science, PsycINFO, the Cochrane Library, and the SPORTDiscus databases for articles published between January 2010 and August 2014 was conducted. In total, 35 studies, involving evaluations of 31 programs, were identified. Findings revealed that a variety of techniques and modes of delivery could effectively promote physical activity among men. Though the majority of programs were offered exclusively to men, 12 programs explicitly integrated gender-related influences in male-specific programs in ways that recognized men's interests and preferences. Innovations in male-only programs that focus on masculine ideals and gender influences to engage men in increasing their physical activity hold potential for informing strategies to promote other areas of men's health.
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Affiliation(s)
- Joan L Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, University of British Columbia, ART223, 3333 University Way, Kelowna, BC, V1V 1V7, Canada,
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15
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Workplace health programme among individuals with metabolic syndrome. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2015. [DOI: 10.1108/ijwhm-09-2014-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to ascertain the effect of a physical activity intervention using a combination of Facebook and standing banners on improvements in metabolic syndrome.
Design/methodology/approach
– In all, 120 (82.8 per cent) government employees with metabolic syndrome completed the programme. A Lifecorder e-STEP accelerometer (Suzuken Company Limited, Nagoya, Japan) was utilized to quantify physical activity. Metabolic syndrome was defined according to “Harmonized” definition at baseline, post-intervention and follow-up.
Findings
– There were significantly higher step counts in the intervention group as compared to the control group over time. There were significant within-group differences in the step count at the baseline, post-intervention and follow-up assessments (p
<
0.001) in both the intervention and control groups. The step count of the intervention group increased by 4,522 steps in the post-intervention assessment compared to the assessment at baseline. The step count of the intervention group in the follow-up assessment was lower than in the post-intervention assessment, but it was still 2,126 steps higher than at baseline. For control group, the difference between the post-intervention assessment and the assessment at baseline was 520 steps per day, while the difference between the follow-up assessment and assessment at baseline was 379 steps per day. The greatest decrease in the percentage of metabolic syndrome was observed in the intervention group, with a reduction of 88.6 per cent in the post-intervention assessment as compared to that at baseline.
Research limitations/implications
– Future studies should incorporate measures which will be of interest to employers. Greater understanding and assessment of desirable employer-related outcomes are warranted, such as decreased job stress, turnover, absenteeism and improved job satisfaction, productivity and exploration of how these associated with physical activity.
Practical implications
– The findings show that delivering information on physical activity through an easily implemented and low-cost physical activity intervention via a combination of Facebook and standing banners was successful in improving step counts and metabolic parameters among individuals with metabolic syndrome.
Social implications
– The findings draw on supporting evidence for advocacy, which is about influencing the larger environment of public policy, and raising awareness of a single programme is insufficient to create lasting social change. Public policy must be shaped in a way that will sustain change across institutions.
Originality/value
– Despite the well-documented health benefits of physical activity, a growing number of people not achieving the recommended levels of physical activity necessary for good health. Importantly, the study provides a new insight on lifestyle-based physical activity interventions capable of improving step counts and metabolic parameters.
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Lee H, Kang HM, Ko YJ, Kim HS, Kim YJ, Bae WK, Park S, Cho B. Influence of urban neighbourhood environment on physical activity and obesity-related diseases. Public Health 2015. [PMID: 26198685 DOI: 10.1016/j.puhe.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The impact of characteristics of neighbourhood environment on physical activity and obesity-related diseases is still the subject of debate. This study aimed to explore the impact of urban neighbourhood environment on physical activity and obesity-related diseases. STUDY DESIGN Cross-sectional study. METHODS Individuals who participated in the 2009 national health-screening programme, submitted all necessary information, and had lived in Community 1 (Haengdang) or Community 2 (Ilsan) for at least 2 years (n = 16,178) were selected for inclusion in this study. Anthropometric measures were taken and physical activity was assessed using a short questionnaire. RESULTS No significant difference in the trigger factors for walking, including the amount of neighbourhood park space, number of shopping malls, and distance between the community and shopping malls, was found between the two communities. However, Community 2 had a better street environment than Community 1. Participants who lived in Community 2 were more physically active [adjusted odds ratio (OR) 1.31, 95% confidence interval (CI) 1.16-1.48] and walked more regularly (adjusted OR 1.09, 95% CI 1.02-1.17) than participants who lived in Community 1, and were less likely to have abdominal obesity (adjusted OR 0.83, 95% CI 0.77-0.91), hypertension (adjusted OR 0.88, 95% CI 0.80-0.97) and diabetes (adjusted OR 0.86, 95% CI 0.75-0.99). However, the risk of dyslipidaemia, especially in terms of low-density lipoprotein cholesterol, was higher in Community 2. CONCLUSIONS These results suggest that a walkable environment has a positive influence on hypertension and diabetes, and physical activity is the possible mechanism for this association. A walkable environment may function as an important tool for health promotion in urban areas.
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Affiliation(s)
- H Lee
- Department of Family Medicine and Health Promotion Centre, Seoul National University Hospital, Seoul, Republic of Korea
| | - H-M Kang
- Department of Architecture and Graduate Programme of Urban Design, Seoul National University, Seoul, Republic of Korea
| | - Y-J Ko
- Department of Family Medicine and Health Promotion Centre, Seoul National University Hospital, Seoul, Republic of Korea
| | - H-S Kim
- Department of Family Medicine and Health Promotion Centre, Seoul National University Hospital, Seoul, Republic of Korea
| | - Y-J Kim
- Department of Family Medicine and Health Promotion Centre, Seoul National University Hospital, Seoul, Republic of Korea
| | - W K Bae
- Health Promotion Center, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - S Park
- Department of Architecture and Graduate Programme of Urban Design, Seoul National University, Seoul, Republic of Korea
| | - B Cho
- Department of Family Medicine and Health Promotion Centre, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea; Advanced Institutes of Convergence Technology, Seoul National University, 145 Gwanggyo-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 443-270, Republic of Korea; Institute on Aging, Seoul National University College of Medicine, 71 Ihwajang-Gil, Jongno-gu, Seoul 110-810, Republic of Korea.
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Kanagasabai T, Thakkar NA, Kuk JL, Churilla JR, Ardern CI. Differences in physical activity domains, guideline adherence, and weight history between metabolically healthy and metabolically abnormal obese adults: a cross-sectional study. Int J Behav Nutr Phys Act 2015; 12:64. [PMID: 25982079 PMCID: PMC4490726 DOI: 10.1186/s12966-015-0227-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 05/11/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO). To date, MHO individuals have been shown to have higher levels of physical activity (PA), but little is known about the importance of PA domains or the influence of weight history compared to their metabolically abnormal (MAO) counterpart. OBJECTIVE To evaluate the relationship between PA domains, PA guideline adherence, and weight history on MHO. METHODS Pooled cycles of the National Health and Nutritional Examination Survey (NHANES) 1999-2006 (≥20 y; BMI ≥ 30 kg/m(2); N = 2,753) and harmonized criteria for metabolic syndrome (MetS) were used. Participants were categorized as "inactive" (no reported PA), "somewhat active" (>0 to < 500 metabolic equivalent (MET) min/week), and "active" (PA guideline adherence, ≥ 500 MET min/week) according to each domain of PA (total, recreational, transportation and household). Logistic and multinomial regressions were modelled for MHO and analyses were adjusted for age, sex, education, ethnicity, income, smoking and alcohol intake. RESULTS Compared to MAO, MHO participants were younger, had lower BMI, and were more likely to be classified as active according to their total and recreational PA level. Based on total PA levels, individuals who were active had a 70% greater likelihood of having the MHO phenotype (OR = 1.70, 95% CI: 1.19-2.43); however, once stratified by age (20-44 y; 45-59 y; and; ≥60 y), the association remained significant only amongst those aged 45-59 y. Although moderate and vigorous PA were inconsistently related to MHO following adjustment for covariates, losing ≥30 kg in the last 10 y and not gaining ≥10 kg since age 25 y were significant predictors of MHO phenotype for all PA domains, even if adherence to the PA guidelines were not met. CONCLUSION Although PA is associated with MHO, the beneficial effects of PA may be moderated by longer-term changes in weight. Longitudinal analysis of physical activity and weight change trajectories are necessary to isolate the contribution of duration of obesity, PA behaviours, and longer-term outcomes amongst MHO individuals.
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Affiliation(s)
- Thirumagal Kanagasabai
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - Niels A Thakkar
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - Jennifer L Kuk
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - James R Churilla
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA.
| | - Chris I Ardern
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
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Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis 2015; 47:181-90. [PMID: 25739820 DOI: 10.1016/j.dld.2014.09.020] [Citation(s) in RCA: 473] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 02/07/2023]
Abstract
The conventional paradigm of nonalcoholic fatty liver disease representing the "hepatic manifestation of the metabolic syndrome" is outdated. We identified and summarized longitudinal studies that, supporting the association of nonalcoholic fatty liver disease with either type 2 diabetes mellitus or metabolic syndrome, suggest that nonalcoholic fatty liver disease precedes the development of both conditions. Online Medical databases were searched, relevant articles were identified, their references were further assessed and tabulated data were checked. Although several cross-sectional studies linked nonalcoholic fatty liver disease to either diabetes and other components of the metabolic syndrome, we focused on 28 longitudinal studies which provided evidence for nonalcoholic fatty liver disease as a risk factor for the future development of diabetes. Moreover, additional 19 longitudinal reported that nonalcoholic fatty liver disease precedes and is a risk factor for the future development of the metabolic syndrome. Finally, molecular and genetic studies are discussed supporting the view that aetiology of steatosis and lipid intra-hepatocytic compartmentation are a major determinant of whether fatty liver is/is not associated with insulin resistance and metabolic syndrome. Data support the novel paradigm of nonalcoholic fatty liver disease as a strong determinant for the development of the metabolic syndrome, which has potentially relevant clinical implications for diagnosing, preventing and treating metabolic syndrome.
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Affiliation(s)
- Amedeo Lonardo
- AUSL Modena and University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Division of Internal Medicine, NOCSAE - Baggiovara, Modena, Italy.
| | - Stefano Ballestri
- AUSL Modena, Department of Internal Medicine, Division of Internal Medicine, Hospital of Pavullo, Pavullo nel Frignano, Italy
| | - Giulio Marchesini
- "Alma Mater Studiorum" University, Unit of Metabolic Diseases and Clinical Dietetics, Bologna, Italy
| | - Paul Angulo
- University of Kentucky, Division of Digestive Diseases & Nutrition, Section of Hepatology, Medical Center, Lexington, KY, USA
| | - Paola Loria
- AUSL Modena and University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Division of Internal Medicine, NOCSAE - Baggiovara, Modena, Italy
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Macías-Cervantes MH, Rodríguez-Soto JMD, Uribarri J, Díaz-Cisneros FJ, Cai W, Garay-Sevilla ME. Effect of an advanced glycation end product-restricted diet and exercise on metabolic parameters in adult overweight men. Nutrition 2015; 31:446-51. [DOI: 10.1016/j.nut.2014.10.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/09/2014] [Accepted: 10/17/2014] [Indexed: 01/12/2023]
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Zhang WH, Xue P, Yao MY, Chang HM, Wu Y, Zhang L. Prevalence of metabolic syndrome and its relationship with physical activity in suburban Beijing, China. ANNALS OF NUTRITION AND METABOLISM 2014; 63:298-304. [PMID: 24503608 DOI: 10.1159/000355575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The present study aimed to estimate the up-to-date prevalence of metabolic syndrome and its relationship with physical activity among suburban adults in Beijing, China. METHODS A cross-sectional survey in a representative sample of 19,003 suburban adults aged 18-76 years was carried out in 2007-2008. Data was collected via questionnaires and blood pressure, anthropometric, and laboratory measurements. RESULTS Of the residents aged 18-76 years in suburban Beijing, 25.9% (27.3% in men and 25.1% in women), 21.3% (19.4% in men and 22.9% in women), and 25.3% (24.2% in men and 26.1% in women) had 1 component, 2 components, and 3 or more components of metabolic syndrome, respectively. The age-standardized prevalence of metabolic syndrome and its components, including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting plasma glucose, decreased across categories with increasing physical activity. After adjusting for age, sex, education level, smoking, and alcohol consumption, residents were more likely to have metabolic syndrome across categories with decreasing physical activity; a similar relationship also applied to components of metabolic syndrome. CONCLUSION A high prevalence of metabolic syndrome and its components is commonly present in suburban Beijing. Increasing physical activity can reduce the relative risk of metabolic syndrome and it components.
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Affiliation(s)
- Wei-Hong Zhang
- Department of Basic Medicine, Nursing College, Zhengzhou University, Zhengzhou, China
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Barwais FA, Cuddihy TF, Tomson LM. Physical activity, sedentary behavior and total wellness changes among sedentary adults: a 4-week randomized controlled trial. Health Qual Life Outcomes 2013; 11:183. [PMID: 24168638 PMCID: PMC4228472 DOI: 10.1186/1477-7525-11-183] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/24/2013] [Indexed: 11/23/2022] Open
Abstract
Background The construct of total wellness includes a holistic approach to the body, mind and spirit components of life. While the health benefits of reducing sedentary behavior and increasing physical activity are well documented, little is known about the influence on total wellness of an internet-based physical activity monitor designed to help people to achieve higher physical activity levels. Purpose The purpose of this four-week, personal activity monitor-based intervention program was to reduce sedentary behavior and increase physical activity levels in daily living for sedentary adults and to determine if these changes would also be associated with improvement in total wellness. Methods Twenty-two men and 11 women (27 years ± 4.0) were randomly assigned to either an intervention (n = 18) or control group (n = 15). The intervention group interacted with an online personal activity monitor (Gruve Solution™) designed to reduce sedentary time and increase physical activity during activities of daily living. The control group did not interact with the monitor, as they were asked to follow their normal daily physical activities and sedentary behavior routines. The Wellness Evaluation of Lifestyle (WEL) inventory was used to assess total wellness. Sedentary time, light, walking, moderate and vigorous intensity physical activities were assessed for both intervention and control groups at baseline and at week-4 by the 7-day Sedentary and Light Intensity Physical Activity Log (7-day SLIPA Log) and the International Physical Activity Questionnaire (IPAQ). Results Significant increases in pre-post total wellness scores (from 64% ± 5.7 to 75% ± 8.5) (t (17) = -6.5, p < 0.001) were observed in the intervention group by the end of week four. Intervention participants decreased their sedentary time (21%, 2.3 hours/day) and increased their light (36.7%, 2.5 hours/day), walking (65%, 1057 MET-min/week), moderate (67%, 455 MET-min/week) and vigorous intensity (60%, 442 MET-min/week) physical activity (all p < 0.001). No significant differences for total wellness were observed between the groups at baseline and no pre-post significant differences were observed for any outcome variable in the control group. Conclusion Total wellness is improved when sedentary, but sufficiently physically active adults, reduce sedentary time and increase physical activity levels (i.e. light, waking, moderate and vigorous).
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Affiliation(s)
- Faisal A Barwais
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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