Physical Activity Among Adults in Rural Western North Carolina During the COVID-19 Pandemic

INTRODUCTION

During the COVID-19 pandemic, measures implemented to protect community health may have influenced how and where people engaged in physical activity. In rural communities, access to resources, the environment, and socioeconomic status could play a role in how adults are physically active. Our study examined locations where rural residents of a county in western North Carolina engaged in physical activity early in the COVID-19 pandemic, their reasons for being physically active, and their perceptions of benefits and barriers related to engaging in physical activity.

METHODS

Rural adults (N =297) completed an online survey from August 3 through September 15, 2020, describing their physical activity during the summer of 2020. Data were analyzed using nonparametric measures.

RESULTS

Survey respondents frequently engaged in physical activity in the home (57.8%), at parks or on trails (45.3%), and around their neighborhood (39.4%). The most common types of physical activities at parks or on trails were walking and hiking (99.5%). Across all locations, the most frequently reported reasons for engaging in physical activity were getting out of the house, maintaining fitness and mental health, and exercising.

CONCLUSION

Our study showed many locations where rural residents were physically active and their reasons for participating in physical activity during the pandemic. Data about perceived benefits of and barriers to physical activity during the pandemic can assist in meeting the current need to increase physical activity levels in rural communities.

Active living environments mediate rural and non-rural differences in physical activity, active transportation, and screen time among adolescents

Disparities in physical activity-related behaviors among rural and non-rural adolescents are important to consider given the relatively recent concerns surrounding the health of rural populations. Differences in rural and non-rural environments may facilitate or hinder physical activity opportunities. The purpose of this study is to examine differences between non-rural and rural adolescents' moderate-to-vigorous physical activity (MVPA), screen time, and active transportation, including the mediating role of neighborhood resources. Data came from 1,128 adolescents (207 rural, 18%) aged 12-17 years old and their parents living in the United States in the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Counterfactual mediation models were used to compare MVPA and screen time (linear regression) and active transit (log-binomial regression) among rural and non-rural adolescents, adjusting for demographics and health and measuring the mediating influence of neighborhood resources for PA. In adjusted models, rural adolescents engaged in less MVPA at school compared to non-rural adolescents (B = -1.14 min/day, p = 0.031) while no difference was found in MVPA at home or on weekends. Rural adolescents had less screen time (B = -2.1 min/day, p = 0.036) than their non-rural peers and were less likely to report active transit trips than non-rural adolescents (OR = 0.66, p = 0.016). Much of the differences in MVPA (70%) and active transit (54%) were mediated by differences in neighborhood resources. Improving the neighborhood resources in rural areas may encourage adolescents to be more active. This includes providing physical activity resources in rural areas such as sidewalks, bike lanes, greenways, playgrounds, fitness facilities, and parks/green space.

Parental Impact on Child Physical Activity and Sedentary Time in Appalachian North Carolina

Introduction

Physical activity has positive health benefits across the lifespan including reduced rates of chronic disease. Despite having ample availability of outdoor space for physical activity in the Appalachian Mountain region, there are low rates of physical activity along with high rates of sedentary time and increased prevalence of overweight individuals across all age groups. Therefore, there is a need to understand the factors that influence family's physical activity and sedentary time.

Purpose

To assess whether parental attitudes and behaviors influence children's physical activity and sedentary time.

Methods

The current study was a secondary analysis of the baseline data from a pilot study of a pediatrician prescription program for outdoor physical activity. Parents (N = 70) with children aged 5-13 years living in a county served by a single-pediatrician office completed surveys in the pediatrician's office during a well-child visit. The survey included questions related to parental attitudes toward children's physical activity and the physical activity and sedentary time performed by the parent and their child.

Results

Parent sedentary time was the only factor that had an impact on child sedentary time, with 18% of the variance in children's sedentary time being explained by parent sedentary time. No factors predicted children's physical activity.

Implications

To decrease child sedentary time, interventions should focus on reducing parental and joint parent-child sedentary time.

Physical activity levels among rural adolescents with a history of ankle sprain and chronic ankle instability

Ankle sprains and their common sequalae are thought to negatively affect physical activity levels and health-related quality of life among active populations, but limited evidence has described this among younger populations. This study aimed to determine the prevalence rate of ankle sprain and chronic ankle instability among rural adolescents and subsequently compare their physical activity levels based on ankle injury status. The study was conducted in a rural high school in North Carolina. High school students completed an online survey that assessed ankle injury history, perception of ankle instability and function, and physical activity. Respondents were categorized into one of four groups based on ankle injury history and complaints of instability: 1) uninjured (no history of injury); 2) unstable (history of injury >1 year and recurrent instability); 3) copers (history of injury >1 year and no recurrent instability); and 4) potentially unstable (injury within the past year). Frequency of physical activity was compared across groups using analysis of variance, Kruskall-Wallis test (α = 0.05), and responses to activity type were assessed using chi-square. Physical activity was found to differ significantly between the four groups [Formula: see text] with unstable respondents reporting more physical activity than uninjured respondents (unstable = 4706.05 ± 4610.56 MET-minutes/week; uninjured = 2592.93 ± 2946.02 MET-minutes/week). No differences were found between other groups. Despite injury history and sensations of instability, respondents with chronic ankle instability reported greater physical activity levels than uninjured participants. As this is contrary to pre-existing hypotheses, it is possible that continued physical activity after injury among adolescents may contribute to deleterious outcomes such as increased frequency of chronic instability.

Use of Physical Activity Monitoring Devices by Families in Rural Communities: Qualitative Approach

BACKGROUND

Several studies support the impact of information communication technology-based interventions to promote physical activity among youth. However, little is known on how technology can be used by the entire family to encourage healthy behavior. Previous studies showed that children and youth rely and are dependent upon the decisions and values of their caregivers when it comes to having a healthy lifestyle. Thus, the exploration of behavior and attitudes of the entire family is needed.

OBJECTIVE

The study aimed to explore (1) perceptions of how the use of physical activity tracking devices (Fitbit Zip) by families in rural communities influence their patterns of participation in physical activity, (2) how attitudes toward physical activity change as a result of using physical activity tracking devices as a family, and (3) what factors influence participation in physical activity among families in rural communities.

METHODS

A total of 11 families with 1 to 3 children of different ages (7-13 years) took part in semistructured group interviews following 2 weeks of using physical activity tracking devices (Fitbit Zip) as a family. The participants were asked to discuss their experience using the Fitbit Zip as a family, the motivation to be physically active, the changes in their pattern of participation in those activities, the level of engagement by different family members, and the factors that affected their participation. All interviews were voice-recorded with the participants' permission and later transcribed verbatim using pseudonyms. To analyze the data, the principal investigator (IS) used open, axial, and selective coding techniques.

RESULTS

A total of 3 themes and several subthemes appeared from the data. The families in rural communities reported no or minimal changes in physical activities as a result of using physical activity tracking devices (Fitbit Zip) because of a lack of interest or an already active lifestyle. However, the attitude toward physical activity was altered. The family members reported an increased awareness of their activity level, introduced more conversations about active and healthy lifestyles, and changed their view of physical activity to a more positive one. The participants described the changes they were able to make and the constraining factors that stopped them from making further changes in their lifestyle.

CONCLUSIONS

Technology might serve as a facilitator to participation in physical activity among families. Technology can motivate the change in attitude toward active recreation. As long-term changes in lifestyle require internal motivation, the change in the attitude might have a more long-lasting impact than the change in the immediate behavior. More longitudinal studies are needed to further explore long-term change in both behavior and attitude toward physical activity. Additional exploration of constraints to participation in physical activity among families is also an important area of exploration.

Prescribing Outdoor Physical Activity to Children: Health Care Providers' Perspectives

Little evidence exists on health care provider (HCP) prescriptions for children’s outdoor physical activity (PA). Semistructured interviews were conducted with 15 children’s HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included.

Pediatrician prescriptions for outdoor physical activity among children: A pilot study

Research indicates that promoting time spent in the outdoors and outdoor physical activity increases children's daily physical activity and improves health. One method showing promise is doctor prescriptions for outdoor physical activity for children; however, no empirical evidence currently exists on prescriptions for children's outdoor physical activity. A pilot study was conducted at one pediatric practice in western North Carolina during 2015 to test the feasibility and potential effectiveness of conducting an outdoor physical activity prescription program for children aged 5–13 years. Three pediatricians wrote prescriptions for children (n = 38), discussed benefits of outdoor physical activity, and provided information packets to parents on nearby places for physical activity. Parents of patients of five pediatricians served as control (n = 32). Prior to seeing a pediatrician, parents completed a baseline survey that asked height and weight, assessed their views of children's physical activity, and their personal and child's physical activity/sedentary behaviors. A nurse measured children's height and weight. Parents were emailed one-month and three-month follow-up surveys that asked the questions listed above. Changes in children's physical activity, outdoor physical activity, time spent in the outdoors, and sedentary activities were not significant between intervention and control groups. About half of parents (49%) viewed prescriptions as beneficial for their children and most used the intervention materials at home (70%). A larger study is needed to assess whether prescriptions increase children's physical activity. A critical examination of the intervention, pilot study design, and suggestions for a larger future study are provided.

•

Conducted a physician prescription program for outdoor physical activity for children.

•

Program did not have significant effect on physical activity or sedentary behavior.

•

Feasibility is discussed in terms of suggestions for future prescription programs.

•

Suggestions for future research on prescription programs are provided.

Index of mechanical efficiency in competitive and recreational long distance runners

The purpose of this investigation was to compare external work and net energy expenditure during a bout of repetitive stretch-shortening cycles between competitive and recreational long-distance runners. Participants were divided into either competitive or recreational runners based on their maximal oxygen consumption and self-reported 1600 m times. The stretch-shortening cycle involved a repetitive hopping protocol on a force plate while measuring oxygen consumption and lactate accumulation for a total of 10 min. External work and net energy expenditure were calculated for 3 min after steady state was achieved and the ratio between these variables was utilised as an index of mechanical efficiency. Lower extremity stiffness was calculated during this interval as well. Net energy expenditure was significantly lower in competitive runners (152.6 ± 33.3 kJ) in comparison to recreational runners (200.6 ± 41.4 kJ) (P = 0.02) given similar amounts of external work performed in both groups (competitive runners = 65.6 ± 20.1 kJ, recreational runners = 68.8 ± 12.1 kJ) (P = 0.67). Index of mechanical efficiency was significantly different between competitive runners (43.2 ± 9.0%) and recreational runners (34.8 ± 5.3%) (P = 0.03). No significant differences were found in lower extremity stiffness (P = 0.64). Competitive distance runners can perform similar levels of external work with lower net energy expenditure and thus a higher index of mechanical efficiency during repetitive stretch-shortening cycles in comparison to recreational runners with similar values of lower extremity stiffness. This ability could possibly be due differences in muscle-tendon length changes, muscle pre-activation, cross-bridge potentiation and short-latency reflex responses as a result of training which should be considered for future investigation.

Improving the physical activity and nutrition environment through self-assessment (NAP SACC) in rural area child care centers in North Carolina

OBJECTIVE

To determine if child care centers in rural, Western North Carolina met recommendations for nutrition and physical activity, if focusing on nutrition and physical activity practices and policies was effective in improving the center environment, and if differences existed between centers affiliated or unaffiliated with schools.

METHODS

Of 33 child care centers in three counties, 29 submitted mini-grant requests and participated in a pre-post evaluation using Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). NAP SACC assesses compliance for nutrition and physical activity recommendations and standards. Between October 2011 and April 2012, centers participated in workshops and goal setting specific to nutrition and physical activity.

RESULTS

At baseline, over 95% of the centers met all recommendations. However, post-intervention, Wilcoxon Signed Ranks Test (p<0.05) indicated significant improvement across center types in five out of 37 nutrition and seven out of 17 physical activity standards following the intervention. Centers unaffiliated with schools made significant changes in ten nutrition standards, while those affiliated with schools improved in only two standards and decreased on one standard.

CONCLUSION

Overall, rural child care centers in Western North Carolina were meeting standards, they were still able to strengthen policies and practices by following NAP SACC. This was especially true for centers unaffiliated with schools. Continued financial support may assist centers in sustaining increased physical activity in children.

High-intensity interval training induces a modest systemic inflammatory response in active, young men

THE PURPOSE OF THIS STUDY WAS TO DETERMINE

1) the extent to which an acute session of high-intensity interval training (HIIT) increases systemic inflammatory cytokines and chemokines, and 2) whether 2 weeks of HIIT training alters the inflammatory response. Eight recreationally active males (aged 22±2 years) performed 2 weeks of HIIT on a cycle ergometer (six HIIT sessions at 8-12 intervals; 60-second intervals, 75-second active rest) at a power output equivalent to 100% of their predetermined peak oxygen uptake (VO2max). Serum samples were collected during the first and sixth HIIT sessions at rest and immediately, 15, 30, and 45 minutes post-exercise. An acute session of HIIT induced significant increases in interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α, and monocyte chemotactic protein-1 compared with rest. The concentrations of interferon-γ, granulocyte macrophage-colony-stimulating factor, and IL-1β were unaltered with an acute session of HIIT Two weeks of training did not alter the inflammatory response to an acute bout of HIIT exercise. Maximal power achieved during a VO2max test significantly increased 4.6%, despite no improvements in VO2max after 2 weeks of HIIT. These data suggest that HIIT exercise induces a small inflammatory response in young, recreationally active men; however, 2 weeks of HIIT does not alter this response.

Physiologic responses during indoor cycling

During the last decade, there has been active interest in indoor cycling (e.g., spinning) as a method of choreographed group exercise. Recent studies have suggested that exercise intensity during indoor cycling may be quite high and may transiently exceed Vo2max. This study sought to confirm these findings, as the apparent high intensity of indoor cycling has implications for both the efficacy and the risk of indoor cycling as an exercise method. Twenty healthy female students performed an incremental exercise test to define Vo2max and performed 2 videotaped indoor exercise classes lasting 45 minutes and 35 minutes. Vo2, heart rate (HR), and rating of perceived exertion (RPE) were measured during the indoor cycling classes, with Vo2 data integrated in 30-second intervals. The mean %Vo2max during the indoor cycling classes was modest (74 +/- 14% Vo2max and 66 +/- 14%Vo2max, respectively). However, 52% and 35% of the time during the 45- and 35-minute classes was spent at intensities greater than the ventilatory threshold (VT). The HR response indicated that 35% and 38% of the session time was above the HR associated with VT. In 10 of the 40 exercise sessions, there were segments in which the momentary Vo2 exceeded Vo2max observed during incremental testing, and the cumulative time with exercise intensity greater than Vo2max ranged from 0.5 to 14.0 minutes. It can be concluded that although the intensity of indoor cycling in healthy, physically active women is moderate, there are frequent observations of transient values of Vo2 exceeding Vo2max, and a substantial portion of the exercise bouts at intensities greater than VT. As such, the data suggest that indoor cycling must be considered a high-intensity exercise mode of exercise training, which has implications for both efficacy and risk.

The Risk in Exercise Training

Although exercise training is unequivocally of benefit relative to the risk of cardiovascular disease, there is a definable risk of complications during exercise training. In younger individuals, the risk is almost exclusively related to the presence of congenital abnormalities, whereas in older (∼40 years) individuals, the risk is largely related to atherosclerotic disease. In both groups, the risk of the underlying pathology leading to clinical presentation is increased by higher intensity exercise. In older individuals, preexercise screening is of potential benefit but is not generally well done. Exercise prescription should favor lower intensity exercise during the early weeks of an exercise program. Subjective methods, which do not rely on the results of an exercise test, including the Rating of Perceived Exertion and the Talk Test, are to be recommended because preliminary exercise testing is performed inconsistently. There are inadequate data regarding the spontaneous exercise training intensity in both healthy individuals and patients.

VO2max during successive maximal efforts

The concept of VO(2)max has been a defining paradigm in exercise physiology for >75 years. Within the last decade, this concept has been both challenged and defended. The purpose of this study was to test the concept of VO(2)max by comparing VO(2) during a second exercise bout following a preliminary maximal effort exercise bout. The study had two parts. In Study #1, physically active non-athletes performed incremental cycle exercise. After 1-min recovery, a second bout was performed at a higher power output. In Study #2, competitive runners performed incremental treadmill exercise and, after 3-min recovery, a second bout at a higher speed. In Study #1 the highest VO(2) (bout 1 vs. bout 2) was not significantly different (3.95 +/- 0.75 vs. 4.06 +/- 0.75 l min(-1)). Maximal heart rate was not different (179 +/- 14 vs. 180 +/- 13 bpm) although maximal V(E) was higher in the second bout (141 +/- 36 vs. 151 +/- 34 l min(-1)). In Study #2 the highest VO(2) (bout 1 vs. bout 2) was not significantly different (4.09 +/- 0.97 vs. 4.03 +/- 1.16 l min(-1)), nor was maximal heart rate (184 + 6 vs. 181 +/- 10 bpm) or maximal V(E) (126 +/- 29 vs. 126 +/- 34 l min(-1)). The results support the concept that the highest VO(2) during a maximal incremental exercise bout is unlikely to change during a subsequent exercise bout, despite higher muscular power output. As such, the results support the "classical" view of VO(2)max.

Comparisons of physical characteristics and performances among female collegiate rowers

The physical characteristics and performances of female collegiate rowers were examined from two perspectives: level (novice, varsity) and years of participation (0, 1, 2, 3) in collegiate rowing. The participants were 90 female collegiate rowers from three US Division I university teams, of the National Collegiate Athletic Association (NCAA). Height, body mass, sitting height, arm span, skinfolds, limb circumferences, and skeletal breadths were measured. Leg length was estimated and Heath-Carter anthropometric somatotypes were calculated. Performance measures included lower-back flexibility, vertical jump, and 2-km time on a rowing ergometer. Descriptive statistics were calculated for the total sample and by level and years of experience. Multivariate analysis of variance and a Bonferroni-adjusted alpha level (P < 0.05) were used to test differences. Varsity rowers had significantly more rowing experience ( approximately 0.5 years) before college, higher vertical jumps ( approximately 3 cm), faster 2-km times ( approximately 25 s), and lower endomorphic characteristics than novice rowers. Anthropometric and performance differences among rowers by years of experience were negligible with the exception of slower 2-km times ( approximately 32 s) in rowers with no collegiate experience than rowers with collegiate experience. In conclusion, collegiate rowers differ to some extent in physical and performance characteristics by level and experience.

Estimated maturity status and perceptions of adult autonomy support in youth soccer players

In this study, we examined the relations between biological maturity status, body mass index, age, and perceptions of adult autonomy support in the context of youth soccer. A total of 70 female and 43 male soccer players, aged 9 - 15 years, completed three adult-specific versions (i.e. mother, father, coach) of the perceived autonomy support subscale from the Interpersonal Style Scale. The participants' percent predicted adult stature was used as an estimate of biological maturity status. Multiple linear regression analyses revealed that advanced maturity status in male players predicted lower perceptions of autonomy support from the coach. Maturity status was unrelated to perceptions of autonomy support from the coach in female soccer players, and paternal and maternal autonomy support in male and female players. Age and body mass index were unrelated to perceptions of adult (i.e. coach, mother, father) autonomy support in male and female players.

Stereotactic radiosurgery for acoustic neuromas: a survey of the American Neurotology Society

OBJECTIVE

The purpose of this study was to better understand the complications, outcomes, and surgical difficulties in treating acoustic neuroma patients who have undergone stereotactic radiosurgery (SRS).

STUDY DESIGN

A six-page, 28-item questionnaire was mailed to 395 members of the American Neurotology Society.

SETTING

The study was conducted through an academic neurotologic practice. Questionnaire respondents were neurotologic physicians in private and academic practice.

PATIENTS

A total of 46 patients who had undergone SRS were evaluated.

INTERVENTIONS

Twelve (26%) of the 46 patients required microsurgery after SRS.

MAIN OUTCOME MEASURES

Posttreatment cranial nerve status and the development of complications such as cerebrospinal fluid leak, meningitis, and cerebrovascular accident were evaluated.

RESULTS

In the group of 12 patients who underwent microsurgery after SRS, 11 patients had some form of postoperative facial paralysis. Anacusis was present in all 12 patients. Two of the 12 patients had new-onset trigeminal neuropathy postoperatively.

CONCLUSION

Microsurgical resection of acoustic neuroma after SRS is technically difficult. The difficulty exists regardless of the time of microsurgical resection after SRS. Patients who underwent microsurgery after SRS had uniformly poor cranial nerve results.

Evaluation of three intraoperative auditory monitoring techniques in acoustic neuroma surgery

OBJECTIVE

To assess the efficacy of three intraoperative auditory monitoring techniques: auditory brainstem response (ABR), electrocochleography (ECoG), and direct eight nerve monitoring (DENM).

STUDY DESIGN

A retrospective review of the intraoperative recordings of ABR, ECoG, and DENM was performed.

SETTING

A private, neurotologic practice.

PATIENTS

Sixty-six patients with usable preoperative hearing underwent intraoperative auditory monitoring with ABR, ECoG, or DENM.

INTERVENTIONS

Intraoperative auditory monitoring.

MAIN OUTCOME MEASURES

Postoperative pure-tone hearing threshold and word recognition scores.

RESULTS

Of the 66 patients, 16 (24%) had postoperative serviceable hearing. Five (18%) of the 28 with ABR monitoring, 3 (17%) of the 18 with ECoG monitoring, and 8 (40%) of the 20 with DENM monitoring had serviceable hearing after surgery.

CONCLUSIONS

This study suggests that DENM may be more effective than ABR or ECoG, although the differences in hearing preservation rates are not statistically significant.