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Physical activity volume, frequency, and intensity: Associations with hypertension and obesity over 21 years in Australian women. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:S2095-2546(24)00071-1. [PMID: 38735532 DOI: 10.1016/j.jshs.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Optimal patterns of accrual of recommended levels of physical activity (PA) for prevention of hypertension and obesity are not known. The overall aim of this study was to investigate whether different patterns of accumulation of PA are differentially associated with hypertension and obesity in Australian women over 21 years of age. Specifically, we investigated whether, for the same weekly volume of PA, the number of sessions (frequency) and vigorousness of PA (intensity) were associated with a reduction in the occurrence of hypertension and obesity in women. METHODS Data from the 1973-1978 and 1946-1951 cohorts of the Australian Longitudinal Study of Women's Health were analyzed (n = 20,588; 12%-16% with a Bachelor's or higher degree). Self-reported PA, hypertension, height, and weight were collected using mail surveys every 3 years from 1998/2000 to 2019/2021. Cox proportional hazard models were used to investigate the association of PA volume (none; 33-499; 500-999; ≥1000 metabolic equivalent min/week), weekly frequency (none; 1-2 times; 3-4 times; 5-7 times; ≥8 times), and the proportion of vigorous PA to total volume of PA (none; 0%; 1%-33%; 34%-66%; 67%-100%) with odds of hypertension and obesity from 2000 to 2021. RESULTS The cumulative incidence of hypertension was 6% in the 1973-1978 and 23% in the 1946-1951 cohort; 27% of women in the 1973-1978 and 15% in the 1946-1951 cohort developed obesity over the period. Overall, a higher volume of PA was associated with reduced odds of hypertension and obesity. When the volume of PA was considered, the odds of hypertension did not vary according to the frequency or intensity of PA. However, increased proportion of vigorous PA to the total volume of PA was associated with a small additional reduction in the risk of obesity. CONCLUSION PA volume appears to be more important than the pattern of accumulation for the prevention of hypertension and obesity. Incorporating more sessions, particularly of vigorous-intensity PA, may provide extra benefits for the prevention of obesity.
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Physical activity across midlife and health-related quality of life in Australian women: A target trial emulation using a longitudinal cohort. PLoS Med 2024; 21:e1004384. [PMID: 38696367 PMCID: PMC11065283 DOI: 10.1371/journal.pmed.1004384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND There is little long-term causal evidence on the effect of physical activity on health-related quality of life. This study aimed to examine the associations between longitudinal patterns of physical activity over 15 years and health-related quality of life in both the physical and mental health domains, in a cohort of middle-aged Australian women. METHODS AND FINDINGS We used data collected at 3-year intervals (1998 to 2019) from 11,336 participants in the Australian Longitudinal Study on Women's Health (ALSWH) (1946 to 1951 birth cohort). Primary outcomes were the physical (PCS) and mental health component summary (MCS) scores (range from 0 to 100; higher scores indicate higher perceived physical/mental health) from the SF-36 in 2019 (when women aged 68 to 73 years). Using target trial emulation to imitate a randomized controlled trial (RCT), we tested 2 interventions: (1) meeting the World Health Organization (WHO) physical activity guidelines consistently throughout the 15-year "exposure period" (2001 to 2016; when women aged 50-55 to 65-70 years; physical activity assessed every 3 years); and (2) not meeting the guidelines at the beginning of the exposure period but starting to first meet the guidelines at age 55, 60, or 65; against the control of not meeting the guidelines throughout the exposure period. Analysis controlled for confounding using marginal structural models which were adjusted for sociodemographic and health variables and conditions. Consistent adherence to guidelines during the exposure period (PCS: 46.93 [99.5% confidence interval [CI]: 46.32, 47.54]) and first starting to meet the guidelines at age 55 (PCS: 46.96 [99.5% CI: 45.53, 48.40]) were associated with three-point higher PCS (mean score difference: 3.0 [99.5% CI: 1.8, 4.1] and 3.0 [99.5% CI:1.2, 4.8]) than consistent non-adherence (PCS: 43.90 [99.5% CI: 42.79, 45.01]). We found a similar pattern for most SF-36 subscales but no significant effects of the interventions on MCS. The main limitations of the study were that it may not account for all underlying health conditions and/or other unmeasured or insufficiently measured confounders, the use of self-reported physical activity and that findings may not be generalizable to all mid-age women. CONCLUSIONS Results from the emulated RCT suggest women should be active throughout mid-age, ideally increasing activity levels to meet the guidelines by age 55, to gain the most benefits for physical health in later life.
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Changes in neighbourhood walkability and body mass index: An analysis of residential mobility from a longitudinal multilevel study in Brisbane, Australia. Health Place 2024; 87:103245. [PMID: 38631216 DOI: 10.1016/j.healthplace.2024.103245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research.
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Lifestyle behaviour changes associated with osteoarthritis: a prospective cohort study. Sci Rep 2024; 14:6242. [PMID: 38485979 PMCID: PMC10940587 DOI: 10.1038/s41598-024-54810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
The aim of this prospective cohort study was to compare changes in lifestyle behaviours over nine years in women who were and were not diagnosed with osteoarthritis (OA). Data were from the 1945-51 cohort of the Australian Longitudinal Study on Women's Health (aged 50-55 in 2001) who completed written surveys in 2001, 2004, 2007 and 2010. The sample included 610 women who were, and 3810 women who were not diagnosed with OA between 2004 and 2007. Descriptive statistics were used to assess changes in lifestyle behaviours (weight, sitting time, physical activity, alcohol and smoking) in the two groups, over three survey intervals: from 2001-2004 (prior to diagnosis); from 2004-2007 (around diagnosis); and from 2007-2010 (following diagnosis). Compared with women without OA (28%), a greater proportion of women with OA (38%) made at least one positive lifestyle change (p < 0.001). These included losing > 5 kg (9.8% vs. 14.4%, p < 0.001), and reducing sitting time by an hour (29.5% vs. 39.1%, p < 0.001) following diagnosis. However, women with OA also made negative lifestyle changes (35% vs. 29%, p < 0.001), for example, gaining > 5 kg around the time of diagnosis (21.4% vs. 14.5%, p < 0.001) and increasing sitting time by an hour following diagnosis (38.4% vs. 32.3%, p = 0.003). More women with OA also started smoking following diagnosis (8.9% vs. 0.8%, p < 0.001). While some women made positive changes in lifestyle behaviours during and following OA diagnosis, others made negative changes. Consistent support from clinicians for managing OA symptoms may enable patients to make more positive changes in lifestyle behaviours.
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Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort. Birth 2024; 51:198-208. [PMID: 37849409 DOI: 10.1111/birt.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. METHODS We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. RESULTS UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. CONCLUSION While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.
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Trajectories of physical activity from mid to older age in women: 21 years of data from the Australian Longitudinal Study on Women's Health. Int J Behav Nutr Phys Act 2024; 21:4. [PMID: 38191462 PMCID: PMC10773129 DOI: 10.1186/s12966-023-01540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Women's physical activity varies across the adult lifespan. However, changes in physical activity among mid-aged women are not well understood. We analysed 21 years of data from women born in 1946-51 to identify: (1) trajectories of physical activity in the transition from mid- to old-age and (2) determinants of different physical activity trajectories. METHODS Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (N = 10,371). Surveys were mailed at three-year intervals from 1998 (age 47-52) to 2019 (age 68-73) to collect data on physical activity, sociodemographic factors (country of birth, area of residence, educational attainment, marital status, income management, paid work hours, living with children age < 18, providing care), health indicators (menopause status, BMI, physical and mental health, chronic conditions), and health behaviours (smoking, alcohol status). Group-based trajectory modelling was used to identify trajectories of physical activity. Multinomial logistic regression models were used to examine the determinants of physical activity trajectories. RESULTS Five trajectories were identified: Low-stable (13.3% of participants), Moderate-stable (50.4%), Moderate-increasing (22.2%), High-declining (7.7%), and High-stable (6.6%). Sociodemographic characteristics (area of residence, education, income management, living with children, and providing care) were determinants of physical activity trajectories, but the strongest factors were BMI, physical and mental health. Women who were overweight/obese and had poor physical and mental health were less likely to be in the High-stable group than in any other group. Changes in these variables (increasing BMI, and declining physical and mental health) and in marital status (getting married) were positively associated with being in trajectories other than the High-stable group. CONCLUSIONS Although most women maintained physical activity at or above current guidelines, very low physical activity levels in the Low-stable group, and declining levels in the High-declining group are concerning. The data suggest that physical activity promotion strategies could be targeted to these groups, which are characterised by socioeconomic disadvantage, high (and increasing) BMI, and poor (and worsening) physical and mental health. Removing barriers to physical activity in these women, and increasing opportunities for activity, may reduce chronic disease risk in older age.
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Older Adult Compendium of Physical Activities: Energy costs of human activities in adults aged 60 and older. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:13-17. [PMID: 38242593 PMCID: PMC10818108 DOI: 10.1016/j.jshs.2023.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE To describe the development of a Compendium for estimating the energy costs of activities in adults ≥60 years (OA Compendium). METHODS Physical activities (PAs) and their metabolic equivalent of task (MET) values were obtained from a systematic search of studies published in 4 sport and exercise databases (PubMed, Embase, SPORTDiscus (EBSCOhost), and Scopus) and a review of articles included in the 2011 Adult Compendium that measured PA in older adults. MET values were computed as the oxygen cost (VO2, mL/kg/min) during PA divided by 2.7 mL/kg/min (MET60+) to account for the lower resting metabolic rate in older adults. RESULTS We identified 68 articles and extracted energy expenditure data on 427 PAs. From these, we derived 99 unique Specific Activity codes with corresponding MET60+ values for older adults. We developed a website to present the OA Compendium MET60+ values: https://pacompendium.com. CONCLUSION The OA Compendium uses data collected from adults ≥60 years for more accurate estimation of the energy cost of PAs in older adults. It is an accessible resource that will allow researchers, educators, and practitioners to find MET60+ values for older adults for use in PA research and practice.
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A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world. JOURNAL OF SPORT AND HEALTH SCIENCE 2023:S2095-2546(23)00130-8. [PMID: 38158180 DOI: 10.1016/j.jshs.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide. METHODS To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country. RESULTS We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA. CONCLUSION Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.
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The Efficacy and Feasibility of a High Intensity Interval Training Program to Improve Cardiorespiratory Fitness in Truck Drivers: The Fit 2 Drive Cluster Controlled Pilot Study. J Occup Environ Med 2023; 65:836-840. [PMID: 37367634 DOI: 10.1097/jom.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This cluster-controlled pilot study assessed the efficacy and feasibility of "Fit 2 Drive," a depot-delivered, high-intensity interval training (HIIT) program to improve the cardiorespiratory fitness (CRF) of truck drivers. METHODS Companies of local delivery drivers (44 men; mean [SD] age = 50.5 [9.8] years; Brisbane, Australia) were assigned to "Fit 2 Drive" (4 clusters; 27 drivers; 1 × 4 minutes supervised to self-managed HIIT, 3 times a week, 12 weeks) or a control (5 clusters; 17 drivers). Analyses assessed between group changes in CRF (VO 2peak ), HIIT session attendance, and delivery costs. RESULTS Driver clusters allocated to "Fit 2 Drive" significantly improved CRF compared to a control (mean difference of 3.6 mL·kg -1 ·min -1 ; P < 0.019; 95% confidence interval = 0.7-6.5 mL·kg -1 ·min -1 ). Drivers who completed the program attended 70% of sessions (25/36) with delivery costs averaging $710 AUD per driver. CONCLUSIONS The findings support the efficacy and feasibility of Fit 2 Drive but also highlight challenges for in-person delivery at scale.
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Day-to-day variability in accelerometer-measured physical activity in mid-aged Australian adults. BMC Public Health 2023; 23:1880. [PMID: 37770833 PMCID: PMC10540459 DOI: 10.1186/s12889-023-16734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE The aim was to use accelerometer data to describe day-to-day variability in physical activity in a single week, according to sociodemographic variables, in mid-aged Australian adults. METHODS Data were from participants in the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study who took part in a 2014 sub-study (N = 612; Mean age 60.6 [SD 6.9; range 48-73]). Participants wore a triaxial accelerometer (ActiGraph wGT3X-BT) on their non-dominant wrist for seven days, and data were expressed as acceleration in gravitational equivalent units (1 mg = 0.001 g). These were, used to estimate daily acceleration (during waking hours) and daily time spent in moderate-vigorous physical activity (MVPA, defined as ≥ 100mg). Coefficient of variation (calculated as [standard deviation/mean of acceleration and MVPA across the seven measurement days] * 100%) was used to describe day-to-day variability. RESULTS Average values for both acceleration (24.1-24.8 mg/day) and MVPA (75.9-79.7 mins/day) were consistent across days of the week, suggesting little day-to-day variability (at the group level). However, over seven days, average individual day-to-day variability in acceleration was 18.8% (SD 9.3%; range 3.4-87.7%) and in MVPA was 35.4% (SD 15.6%; range 7.3-124.6%), indicating considerable day-to-day variability in some participants. While blue collar workers had the highest average acceleration (28.6 mg/day) and MVPA (102.5 mins/day), their day-to-day variability was low (18.3% for acceleration and 31.9% for MVPA). In contrast, variability in acceleration was highest in men, those in professional occupations and those with high income; and variability in MVPA was higher in men than in women. CONCLUSION Results show group-level estimates of average acceleration and MVPA in a single week conceal considerable day-to-day variation in how mid-age Australians accumulate their acceleration and MVPA on a daily basis. Overall, there was no clear relationship between overall volume of activity and variability. Future studies with larger sample sizes and longitudinal data are needed to build on the findings from this study and increase the generalisability of these findings to other population groups.
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A stepped down physical activity support program for military service veterans: The Active Choices pilot study. Health Promot J Austr 2023. [PMID: 37724696 DOI: 10.1002/hpja.807] [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: 04/17/2023] [Revised: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
ISSUE ADDRESSED Referral to supervised physical activity (PA) programs is an effective treatment for military service veterans (MSVs) suffering from a range of chronic diseases. However, many MSVs fail to maintain PA regimes once discharged from supervision. This pilot study assessed Active Choices, a stepped-down program to support MSVs in the transition from allied health treatment to self-managed PA. METHODS Participants were 34 Australian MSVs (mean [SD] age = 61 [15.8] years) who were completing supervised referral to an exercise physiologist or physiotherapist. MSVs stepped-down to Active Choices and received a 12-week, evidence-based PA support program (2020-2021). Analyses compared within-group changes in accelerometer-assessed PA at three time points (Weeks 0, 12, and 24; linear mixed model). Program retention, PA choices, and allied healthcare service costs were also evaluated. RESULTS Relative to baseline (64 [26] min/day), mean (SD) moderate-to-vigorous PA increased (74 [28] min/day; p < .05) and was maintained (62 [28] min/day) at weeks 12 and 24, respectively. Retention in the program was high (86% [29/34 participants] completion rate at 12 weeks), with water-based group activities the most popular PAs of choice (14/24 activities). Average allied healthcare service costs during the study were lower than typical costs for MSVs (60.51 vs. 97.06 AUD/week). CONCLUSION The findings highlight the potential of Active Choices to support MSVs in the transition from supervised to self-managed MVPA. SO WHAT?: The program could promote the health of veterans and reduce costs for ongoing referral if impact is replicated at scale.
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Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. Br J Sports Med 2023; 57:1164-1174. [PMID: 37349084 PMCID: PMC10579182 DOI: 10.1136/bjsports-2022-106620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/24/2023]
Abstract
The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data.In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes.Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments.This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.
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Association between the use of weight management strategies and weight change among Australian adults over 12 months: an observational study. BMC Public Health 2023; 23:1461. [PMID: 37525173 PMCID: PMC10391811 DOI: 10.1186/s12889-023-16277-4] [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: 12/29/2022] [Accepted: 07/10/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Obesity is a growing, global public health issue. This study aimed to describe the weight management strategies used by a sample of Australian adults; examine the socio-demographic characteristics of using each strategy; and examine whether use of each strategy was associated with 12-month weight change. METHODS This observational study involved a community-based sample of 375 healthy adults (mean age: 40.1 ± 5.8 years, 56.8% female). Participants wore a Fitbit activity monitor, weighed themselves daily, and completed eight online surveys on socio-demographic characteristics. Participants also recalled their use of weight management strategies over the past month, at 8 timepoints during the 12-month study period. RESULTS Most participants (81%) reported using at least one weight management strategy, with exercise/physical activity being the most common strategy at each timepoint (40-54%). Those who accepted their current bodyweight were less likely to use at least one weight management strategy (Odds ratio = 0.38, 95% CI = 0.22-0.64, p < 0.01) and those who reported being physically active for weight maintenance had a greater reduction in bodyweight, than those who did not (between group difference: -1.2 kg, p < 0.01). The use of supplements and fasting were associated with poorer mental health and quality of life outcomes (p < 0.01). CONCLUSIONS The use of weight management strategies appears to be common. Being physically active was associated with greater weight loss. Individuals who accepted their current body weight were less likely to use weight management strategies. Fasting and the use of supplements were associated with poorer mental health. Promoting physical activity as a weight management strategy appears important, particularly considering its multiple health benefits.
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Public health guidelines for physical activity during pregnancy from around the world: a scoping review. Br J Sports Med 2023; 57:940-947. [PMID: 36604155 DOI: 10.1136/bjsports-2022-105777] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite the known health benefits of physical activity (PA), pregnancy is a time of marked decline in PA levels. To provide women with reliable and trustworthy information, and to encourage greater participation in PA during pregnancy, many governments have developed guidelines for PA during pregnancy. Our aim was to synthesise the most recent public health guidelines on PA during pregnancy from different countries in order to understand the nature and extent of advice that is available. DESIGN Scoping review. DATA SOURCES Search of the grey literature, direct contact with international experts, screening of relevant academic literature and citation searching. ELIGIBILITY CRITERIA Public health guidelines developed or endorsed by government departments published since 2010. RESULTS Our search located 30 eligible guidelines, published in 11 different languages. There is remarkable concordance in the advice offered. For women with uncomplicated pregnancy, guidelines recommend: 150-300 min/week of moderate intensity aerobic activity; pelvic floor and muscle strengthening exercises; modification of some exercises (eg, supine position); and provide lists of warning signs to cease activity (eg, persistent dizziness, vaginal bleeding) and activities that should be avoided (eg, if high risk of falling/collision). Few guidelines offer specific advice for highly active women (eg, athletes), or trimester-specific or culturally specific considerations. CONCLUSIONS This review provides a summary of public health recommendations for PA during pregnancy around the world. The challenge is now to ensure that all who provide healthcare for women understand the guidelines and encourage safe participation in PA during pregnancy.
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High intensity and sprint interval training, and work-related cognitive function in adults: A systematic review. Scand J Med Sci Sports 2023; 33:814-833. [PMID: 36916717 DOI: 10.1111/sms.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/06/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To assess evidence on the impact of acute and chronic high intensity interval training (HIIT) and sprint interval training (SIT) on work-related performance tests of cognitive function in adults. METHODS The databases PubMed, CINAHL, Scopus, PsycINFO, Embase and the Cochrane Library were searched for relevant articles up to August 2022. Eligible studies assessed the effects of HIIT (70-100% VO2max ) and/or SIT (≥100% VO2max ) on cognitive function test scores in cognitively healthy adults, relative to a control or comparative exercise group/condition. Data on participant characteristics, exercise protocol, key outcomes and intervention setting were extracted. Study quality was assessed using a 9 (single session HIIT/SIT) and 14 (multiple session HIIT/SIT) item checklist. RESULTS 36 studies (15 countries; n=11 to 945 participants) met inclusion criteria. Mean quality scores were 'fair-to-good' for acute (single session; mean=6.9 [SD 1.0]), and chronic (multiple session; mean=9.8 [SD 1.6]) training studies. Eighteen from 36 studies (12/20 [55%] acute and 6/16 [38%] chronic training studies) evidenced significant improvements in aspects of cognitive function related to work performance (i.e., attention, inhibition, memory, information processing speed, cognitive flexibility, intelligence, reaction time and learning). Only four studies tested the impact of HIIT/SIT on cognitive function in a work-based setting (e.g., the office or home). CONCLUSIONS While there is promising evidence, particularly from acute training studies, to indicate that high intensity, short duration exercise benefits cognitive function in adults, there is very limited evidence of application in workplace contexts. To better understand the potential benefits to employee performance and safety, HIIT/SIT and cognitive function research needs to transition from laboratory to 'in-situ' occupational settings.
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Response to 'Effects of parity on lifestyle changes: from a methodological perspective to societal applications'. Int J Epidemiol 2023; 52:645-646. [PMID: 36811390 DOI: 10.1093/ije/dyad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
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Levels of physical activity and sitting time in women with infants, toddlers and preschoolers: a population-based cross-sectional study. Public Health 2023; 214:1-9. [PMID: 36417813 DOI: 10.1016/j.puhe.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Insufficient physical activity (PA) and prolonged sitting time (ST) increase the risk of chronic disease and mortality. Caring for young children can potentially impact maternal PA and sedentary behaviours. The aims of this study were to explore the levels of PA and ST in women with young children (infants, toddlers and preschoolers) and sociodemographic and behavioural factors associated with these. STUDY DESIGN This was a population-based cross-sectional study. METHODS Survey 5 data collected in 2009 (n = 4290) of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health were used. Multiple linear and logistic regression models were used to examine associations. RESULTS In adjusted models, compared with women with preschoolers, women whose youngest child was an infant aged 0-6 months, aged >6-12 months or toddler had lower PA (-321.3 MET.min/week [95% confidence interval (CI) -416.2, -226.4], -147.9 MET.min/week [95% CI -237.6, -58.1] and -106.4 MET.min/week [95% CI -172.3, -40.5]). ST was higher in women whose youngest child was an infant aged 0-6 months (0.48 h/day; 95% CI 0.19, 0.77) but lower with infants aged >6-12 months (-0.33 h/day; 95% CI -0.60, -0.05) and toddlers (-0.40 h/day; 95% CI -0.60, -0.20) than in those with preschoolers. The findings were similar in the logistic model. Sociodemographic and behavioural factors such as occupation and marital status also influenced PA and ST. CONCLUSIONS Women with infants and toddlers have lower PA than women with preschoolers. Women are more likely to sit more in the first 6 months after childbirth. These findings can inform resources and intervention development to improve activity levels in women with young children through consideration of the age of the youngest child, sociodemographic and behavioural factors.
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Longitudinal association of physical activity during pregnancy with maternal and infant outcomes: Findings from the Australian longitudinal study of women's health. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221142357. [PMID: 36560920 PMCID: PMC9793022 DOI: 10.1177/17455057221142357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Physical activity has known benefits during pregnancy; however, the optimum volume of physical activity through the different stages of pregnancy is not well known. OBJECTIVES The aims of this study were to investigate the associations of physical activity volume in pregnant women in each trimester of pregnancy with maternal and infant outcomes. DESIGN The study involved 1657 pregnant women from the Australian Longitudinal Study on Women's Health, who completed surveys from 2006 to 2012 (aged 28-39 years). METHODS Women reported being in either the first, second or third trimester of pregnancy. Women were grouped into four groups according to their self-reported physical activity during pregnancy: (1) Nil (0-<33.3 MET.min/week), (2) Low (33.3-<500 MET.min/week), (3) Moderate (500-<1000 MET.min/week) and (4) High (⩾1000 MET.min/week). Women who reported their physical activity during pregnancy completed a survey within three years after the birth, relating to outcomes associated with pregnancy and childbirth (gestational diabetes, hypertension, and antenatal depression and anxiety) and infant outcomes (birthweight and prematurity). RESULTS There was no association of physical activity in any trimester with infant birthweight, prematurity, gestational diabetes, hypertension or antenatal depression. Antenatal anxiety was less prevalent in women who reported low (1.7%) or moderate (1.1%) physical activity than in those who reported no activity (4.7%; p = 0.01). CONCLUSION Different amounts of physical activity during pregnancy were not associated with the measured adverse health outcomes. However, low and moderate amounts of physical activity were associated with reduced incidence of antenatal anxiety.
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Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114284. [PMID: 36361159 PMCID: PMC9657872 DOI: 10.3390/ijerph192114284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 05/21/2023]
Abstract
Achieving system-level, sustainable 'scale-up' of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as 'reach without scale', 'planned serendipity' and 'simple complexity'. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders' assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of 'tensions' and 'paradoxes', we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.
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Accelerometer-measured physical activity in mid-age Australian adults. BMC Public Health 2022; 22:1952. [PMID: 36271338 PMCID: PMC9585757 DOI: 10.1186/s12889-022-14333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Raw data from accelerometers can provide valuable insights into specific attributes of physical activity, such as time spent in intensity-specific activity. The aim of this study was to describe physical activity assessed with raw data from triaxial wrist-worn accelerometers in mid-age Australian adults. Methods Data were from 700 mid-age adults living in Brisbane, Australia (mean age: 60.4; SD:7.1 years). Data from a non-dominant wrist worn triaxial accelerometer (Actigraph wGT3X-BT), expressed as acceleration in gravitational equivalent units (1 mg = 0.001 g), were used to estimate time spent in moderate-vigorous intensity physical activity (MVPA; >100 mg) using different bout criteria (non-bouted, 1-, 5-, and 10-min bouts), and the proportion of participants who spent an average of at least one minute per day in vigorous physical activity. Results Mean acceleration was 23.2 mg (SD: 7.5) and did not vary by gender (men: 22.4; women: 23.7; p-value: 0.073) or education (p-value: 0.375). On average, mean acceleration was 10% (2.5 mg) lower per decade of age from age 55y. The median durations in non-bouted, 1-min, 5-min and 10-min MVPA bouts were, respectively, 68 (25th -75th : 45–99), 26 (25th -75th : 12–46), 10 (25th -75th : 3–24) and 8 (25th -75th : 0–19) min/day. Around one third of the sample did at least one minute per day in vigorous intensity activities. Conclusion This population-based cohort provided a detailed description of physical activity based on raw data from accelerometers in mid-age adults in Australia. Such data can be used to investigate how different patterns and intensities of physical activity vary across the day/week and influence health outcomes.
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Parity and mode of birth and their relationships with quality of life: A longitudinal study. PLoS One 2022; 17:e0273366. [PMID: 36084030 PMCID: PMC9462673 DOI: 10.1371/journal.pone.0273366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.
Design
Prospective cohort study
Setting
Australia
r sample
A total of 7770 women participating in the 1973–1978 cohort of the Longitudinal Study of Women’s Health.
Methods
Linear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories.
Main outcome measure
Quality of Life as measured by the SF36
Results
Women experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05).
Conclusions
Parity and mode of birth may have long-term implications for women’s physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.
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Patterns of Accelerometer-Measured Physical Activity and Health Outcomes in Adults: A Systematic Review. Med Sci Sports Exerc 2022; 54:1155-1166. [PMID: 35220369 DOI: 10.1249/mss.0000000000002900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to systematically review the literature on accelerometer-measured physical activity and health outcomes in adults. METHODS Eight electronic databases were searched for relevant articles published up to March 2021. Only population-based studies of adults (age ≥18 yr) that directly compared two or more categories of physical activity (i.e., bout duration, intensity, and daily/weekly frequency) with a health outcome (e.g., mortality, cardiometabolic, healthy aging, depression, sleep, and brain structure) were included. RESULTS Of the 15,923 publications retrieved, 52 articles were included. Twenty-eight studies directly compared the associations between physical activity accumulated in different bout durations, 31 studies directly compared the associations between physical activity accumulated in different intensities, and 9 studies directly compared the associations between the effects of varying daily and weekly frequencies of physical activity, with health outcomes. Most showed no differences in relationships with health outcomes when physical activity was accumulated in short (<10-min) or long (≥10-min) bouts. Overall, there were no differences in the relationships with most health outcomes when different intensities and daily/weekly frequencies were compared. However, in most studies, researchers did not adjust their analyses for total volume of physical activity. Moreover, variations in researcher-driven decisions about data collection and processing methods made it difficult to compare study findings. CONCLUSIONS These findings suggest that physical activity accumulated in many patterns of bout duration, intensity, or daily/weekly frequency is associated with a range of beneficial health outcomes in adults. Lack of adjustment for total volume of physical activity in most studies and inconsistent methods for defining components of physical activity prevent firm conclusions about which specific patterns of bout duration, intensity, and daily/weekly frequency are most important for health benefits.
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Assessing patterns of change in lifestyle behaviours by parity: a longitudinal cohort study. Int J Epidemiol 2022; 52:589-599. [PMID: 35776100 PMCID: PMC10114083 DOI: 10.1093/ije/dyac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The time constraints and reprioritization of personal health associated with having children may lead women to adopt less healthy lifestyles. We assessed the patterns of change in weight and lifestyle behaviours associated with having children and whether these differ between primiparous and multiparous women. METHODS Data were from Surveys 3 and 5 of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health. In women who were nulliparous at Survey 3, we assessed changes in weight, energy intake, diet (diet quality, macronutrients and micronutrients), physical activity and sitting time by parity status at Survey 5 using one-way analysis of covariance. RESULTS Of 4927 eligible women, 2503 gave birth (1090 primiparous and 1413 multiparous) by Survey 5. Women who had given birth 6 years later increased weight (1.0 kg; 95% CI 0.5, 1.5), energy intake (833.9 kJ/day; 95% CI 706.7, 961.1) and diet quality (1.5 units; 95% CI 0.8, 2.1), but decreased physical activity [-405.0 Metabolic Equivalent of Task.min/week; 95% CI -464.2, -345.8] and sitting time (-1.8 h/day; 95% CI -1.9, -1.6) (adjusted mean differences) relative to those who remained nulliparous. In subgroup analysis involving further stratification by parity, the increase in diet quality was only seen in women who became primiparous and the decrease in sitting time was more marked in multiparous women. CONCLUSION Childbearing is associated with increased weight and energy intake, decreased physical activity, increased diet quality and decreased sitting time. More research targeting weight, energy intake and physical activity for improvement in women during the childbearing years is warranted.
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Effects of fitness and fatness on age-related arterial stiffening in people with type 2 diabetes. Clin Obes 2022; 12:e12519. [PMID: 35293141 PMCID: PMC9285462 DOI: 10.1111/cob.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
People with type 2 diabetes (T2D) are at a greater risk of cardiovascular disease than the general population. Both non-modifiable (age) and modifiable (low aerobic fitness, high body fatness) factors are separately predictive of cardiovascular risk, although they often occur concomitantly. This study aimed to examine the (1) association between age and arterial stiffness, a subclinical marker of cardiovascular risk; and (2) effects of body fatness and aerobic fitness on age-related increases in arterial stiffness in people with T2D. Data from 64 individuals with T2D (age 59.8 ± 8.7 years, 40% female, HbA1c 8.4 ± 1.6%) were included in this cross-sectional analysis. Carotid-femoral pulse wave velocity (cfPWV) was used to quantify arterial stiffness. Aerobic fitness (relative V̇O2peak ) was determined via indirect calorimetry during maximal exercise testing. Central body fatness was determined using waist circumference. Data were analysed using hierarchical multiple regressions. After adjustment for sex and duration of T2D, each one standard deviation (SD) increase in age (8.68 years) was associated with a 0.63 m·s-1 increase in cfPWV (β = 0.416, p = 0.001). Following adjustment for aerobic fitness and body fatness, the standardized β was unchanged (0.417). A one SD increase in waist circumference (13.9 cm) and relative V̇O2peak (5.3 ml·kg-1 ·min-1 ) were associated with a similar magnitude of difference in cfPWV (0.47 m·s-1 and -0.44 m·s-1 , respectively). Therefore, age is a significant correlate of increased arterial stiffness in T2D, with higher aerobic fitness attenuating, and higher body fatness exacerbating, this increase. Interventions aimed at improving cardiovascular outcomes in people with T2D should target both increased aerobic fitness and reduced body fatness.
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Australian Guidelines for Physical Activity in pregnancy and postpartum. J Sci Med Sport 2022; 25:511-519. [DOI: 10.1016/j.jsams.2022.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis. JMIR Mhealth Uhealth 2022; 10:e31607. [PMID: 35044318 PMCID: PMC8811692 DOI: 10.2196/31607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023] Open
Abstract
Background Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.
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Psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the COVID-19 pandemic. Australas Psychiatry 2021; 29:617-624. [PMID: 34192474 DOI: 10.1177/10398562211025040] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES People with mental illness may be vulnerable to psychological distress and reduced well-being during the COVID-19 pandemic. The aim of this study was to assess psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the pandemic. METHOD People with mental illness who participated in an exercise programme prior to the pandemic were invited to complete surveys about mental health and lifestyle corresponding to before and during the pandemic. RESULTS Social support reduced, alcohol intake increased, and sleep quality and diet worsened during the pandemic, contributing to distress. Psychological distress was associated with the two or more mental illnesses, and negatively associated with having a physical disease. Better diet appeared to protect against increases in distress; loneliness hindered improvements in well-being. CONCLUSIONS Healthy lifestyle programmes designed to improve social connection may improve health for people with mental illnesses during and after the COVID-19 pandemic.
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Weight gain and lifestyle factors in women with and without polycystic ovary syndrome. Hum Reprod 2021; 37:129-141. [PMID: 34788426 DOI: 10.1093/humrep/deab239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/11/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do extrinsic factors including lifestyle, psychosocial factors and healthcare professional engagement independently contribute to weight gain in women with and without polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Women with PCOS had a higher rate of weight gain than women without PCOS which was most marked in those with unhealthy lifestyles. WHAT IS KNOWN ALREADY Women with PCOS have a higher prevalence of overweight/obesity and greater weight gain than women without PCOS. The association of lifestyle factors with weight change in PCOS is not known. STUDY DESIGN, SIZE, DURATION The study was a population-based observational study with data collected from seven surveys over 19 years (N = 14 127; Survey 1) involving women with and without PCOS. PARTICIPANTS/MATERIALS, SETTING, METHODS We used data from the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health. MAIN RESULTS AND THE ROLE OF CHANCE Women with PCOS gained more weight annually (0.26 kg/year; 95% CI 0.12, 0.39; P < 0.0001) and over 19 years (4.62 kg; 95% CI 3.04, 6.21; P < 0.0001) than women without PCOS (adjusted analyses). For all women, there were positive associations between weight gain and energy intake, sitting time and stress; inverse associations with fibre intake and physical activity (PA); and no associations with diet quality, glycaemic index, healthcare utilization, depression or anxiety. There were interactions between lifestyle factors (energy intake P = 0.006, glycaemic index P = 0.025, sitting time P = 0.041 and PA P = 0.021), PCOS status and time such that weight gain varied between women with and without PCOS according to these factors. LIMITATIONS, REASONS FOR CAUTION The limitations of this study include the use of self-reported measures such as diet, PA, sitting time, psychological factors and health care utilization. WIDER IMPLICATIONS OF THE FINDINGS While women with PCOS are more prone to weight gain, lifestyle factors have a more profound impact on weight gain in women with PCOS than without PCOS. These study findings have implications for understanding the mechanisms of weight gain in women with PCOS. They also highlight the importance of early lifestyle intervention as soon as PCOS is diagnosed to address modifiable extrinsic factors and prevent excess weight gain and worsening of the clinical features of PCOS. STUDY FUNDING/COMPETING INTEREST(S) M.A.A. is funded by the Monash International Tuition Scholarship and Monash Graduate Scholarship and L.J.M. is funded by a National Heart Foundation Future Leader Fellowship. The authors declared no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:863. [PMID: 34627214 PMCID: PMC8502269 DOI: 10.1186/s12891-021-04741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. Methods Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women’s Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated. Results Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters (‘none or infrequent’, ‘frequent’ and ‘persistent’) for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity. Conclusion Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04741-4.
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Physical activity in the management of obesity in adults: A position statement from Exercise and Sport Science Australia. J Sci Med Sport 2021; 24:1245-1254. [PMID: 34531124 DOI: 10.1016/j.jsams.2021.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022]
Abstract
This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300-420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change.
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Longitudinal associations between bicycling and having dependent children, in middle-aged men and women. Prev Med Rep 2021; 23:101479. [PMID: 34345577 PMCID: PMC8319440 DOI: 10.1016/j.pmedr.2021.101479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/13/2022] Open
Abstract
Bicycling has multiple health benefits. Child-rearing may influence bicycling, but little is known about the impact of this between men's and women's bicycling, or of number and ages of children on bicycling. This study examined the longitudinal associations between having dependent children and bicycling for transportation and recreation over 4 years among mid-aged men and women. Data were from the HABITAT study (Australia). We analysed data from three survey waves (2007, 2009, 2011) using multilevel logistic regression stratified by gender (n = 7758). Findings indicate that having dependent children was associated with bicycling for transportation and recreation in contrasting ways for men and women. The odds of bicycling were higher in men with ≥2 children aged under 18y than men without children (transportation: OR = 1.93, 95% CI: 1.26, 2.98; recreation: OR = 2.37, 95% CI: 1.67, 3.37). Over time, the odds of recreational bicycling were lower in women with ≥2 children than women without children (OR = 0.83, 95% CI: 0.73, 0.93). However, for both men and women, the odds of recreational bicycling were higher in those with children aged 6-12y than those with younger or older children (men: OR = 1.86, 95% CI: 1.39, 2.49; women: OR = 1.79, 95% CI: 1.31, 2.46). Interventions to promote bicycling must therefore consider gendered differences in bicycling for travel and active leisure, and family circumstances. An opportunity to promote bicycling might be to target parents with children aged 6-12y.
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Erratum to: Efficacy of an m-health physical activity and sleep intervention to improve sleep quality in middle-aged adults: The Refresh Study randomized controlled trial. Ann Behav Med 2021; 55:1043. [PMID: 34373903 DOI: 10.1093/abm/kaab067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Urinary incontinence, body mass index, and physical activity in young women. Am J Obstet Gynecol 2021; 225:164.e1-164.e13. [PMID: 33652055 DOI: 10.1016/j.ajog.2021.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current evidence suggests that excess weight and obesity are important risk factors for urinary incontinence in women. However, limited data exist regarding the relationships among body mass index, physical activity, and urinary incontinence in women in their 20s. OBJECTIVE This study aimed to (1) compare prevalence rates of urinary incontinence and high body mass index in 2 cohorts of young women, (2) explore associations between changes in body mass index and urinary incontinence using analysis of combined data from the 2 cohorts, and (3) explore the associations between physical activity and urinary incontinence, with adjustment for body mass index. STUDY DESIGN Data were collected from 2 cohorts of young women in the Australian Longitudinal Study of Women's Health (n=16,065), born 17 years apart: 1973-1978 (cohort 1) and 1989-1995 (cohort 2). The women in both cohorts completed the surveys at age 18 to 23 years (T1), with follow-up 4 years later (age, 22-27 years; T2). Self-reported urinary incontinence and body mass index were assessed in both surveys. As physical activity was measured using different questions in cohort 1 at T1, self-reported physical activity data were from T2 only. A total of 9 body mass index transition categories (based on body mass index status at baseline and follow-up) and 4 physical activity categories were created to assess multivariate-adjusted prevalence ratios for urinary incontinence at T2, using Poisson regression. RESULTS Rates of obesity increased in both cohorts over 4 years, from 6.6%% (95% confidence interval, 6.1-7.2) to 10.4% (95% confidence interval, 9.7-11.0) in cohort 1 and from 11.7% (95% confidence interval, 11.0-12.4) to 19.6% (95% confidence interval, 18.7-20.5) in cohort 2. Compared with women who maintained normal body mass index at T1 and T2, the prevalence ratio for urinary incontinence among those with body mass index >30 at age 22 to 27 years was higher, regardless of body mass index category at age 18 to 23 years (prevalence ratio at T1: 1.39 for normal body mass index [95% confidence interval, 1.1-1.76]; 1.44 for overweight [95% confidence interval, 1.27-1.63]; and 1.51 for obese [95% confidence interval, 1.36-1.67]). In cohort 1, there was no relationship between physical activity and urinary incontinence. However, in cohort 2 there was an inverse dose-response relationship between physical activity and urinary incontinence. CONCLUSION The strong association between obesity and urinary incontinence in young women is a public health concern, given that obesity rates are likely to increase further with age and parity. The potential mitigating effects of physical activity on the obesity-incontinence relationship merit further investigation.
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Cohort Profile: HABITAT-a longitudinal multilevel study of physical activity, sedentary behaviour and health and functioning in mid-to-late adulthood. Int J Epidemiol 2021; 50:730-731h. [PMID: 33247900 DOI: 10.1093/ije/dyaa175] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/19/2022] Open
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Efficacy of an m-Health Physical Activity and Sleep Intervention to Improve Sleep Quality in Middle-Aged Adults: The Refresh Study Randomized Controlled Trial. Ann Behav Med 2021; 54:470-483. [PMID: 31942918 DOI: 10.1093/abm/kaz064] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Poor sleep health is highly prevalent. Physical activity is known to improve sleep quality but not specifically targeted in sleep interventions. PURPOSE To compare the efficacy of a combined physical activity and sleep intervention with a sleep-only intervention and a wait-list control, for improving sleep quality in middle-aged adults without a diagnosed sleep disorder. METHODS Three-arm randomized controlled trial (Physical Activity and Sleep Health (PAS), Sleep Health Only (SO), Wait-list Control (CON) groups; 3-month primary time-point, 6-month follow-up) of 275 (PAS = 110, SO = 110, CON = 55) inactive adults (40-65 years) reporting poor sleep quality. The main intervention component was a smartphone/tablet "app" to aid goal setting and self-monitoring physical activity and/or sleep hygiene behaviors (including stress management), and a pedometer for PAS group. Primary outcome was Pittsburgh Sleep Quality Index (PSQI) global score. Secondary outcomes included several self-reported physical activity measures and PSQI subcomponents. Group differences were examined stepwise, first between pooled intervention (PI = PAS + SO) and CON groups, then between PAS and SO groups. RESULTS Compared with CON, PI groups significantly improved PSQI global and subcomponents scores at 3 and 6 months. There were no differences in sleep quality between PAS and SO groups. The PAS group reported significantly less daily sitting time at 3 months and was significantly more likely to report ≥2 days/week resistance training and meeting physical activity guidelines at 6 months than the SO group. CONCLUSIONS PIs had statistically significantly improved sleep quality among middle-aged adults with poor sleep quality without a diagnosed sleep disorder. The adjunctive physical activity intervention did not additionally improve sleep quality. CLINICAL TRIAL INFORMATION Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; Universal Trial number: U1111-1194-2680; Human Research Ethics Committee, Blinded by request of journal: H-2016-0267.
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Stepped-down intervention programs to promote self-managed physical activity in military service veterans: A systematic review of randomised controlled trials. J Sci Med Sport 2021; 24:1155-1160. [PMID: 34246553 DOI: 10.1016/j.jsams.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 04/28/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES A stepped-down program is one where clients transition from the care of a health professional to self-managed care. This study reviewed the effectiveness of stepped-down interventions to promote self-managed physical activity for health in military service veterans. DESIGN Systematic review. METHODS Literature searches of 11 electronic databases were performed (up to 28th April 2020) to identify randomised controlled trials that assessed self-managed physical activity interventions in military service veterans. Data were extracted on study characteristics, intervention programs (with strategies mapped against a taxonomy of behaviour change techniques), and physical activity outcomes; secondary outcomes were physical fitness/function, psychosocial health, and cost effectiveness. Study quality was assessed using a 15-item checklist adapted from the TESTEX scale. RESULTS Searches identified 26 studies (all from the United States; N = 45 to 531 participants) representing 17 intervention programs. Studies were of good quality (M = 10.7; SD = 2.3). More than half (54%) reported positive between-group intervention effects for physical activity outcomes (mean increase of 80 min/week in self-reported physical activity at 10-12 months). Physical fitness/function outcomes improved in 38% of studies, but no studies found significant intervention effects for psychosocial health or cost effectiveness outcomes. Behaviour change techniques most frequently used to elicit physical activity changes were education, goal setting, goal review and self-monitoring. CONCLUSIONS Stepped-down programs that include specific behaviour change techniques have the potential to promote self-management of physical activity in military service veterans. Multi-national randomised controlled trials that use objective physical activity measures are needed to further build the evidence base.
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Associations between indicators of energy intake and expenditure with excess weight and obesity among women in sedentary and less-sedentary jobs. Prev Med 2021; 147:106507. [PMID: 33667468 DOI: 10.1016/j.ypmed.2021.106507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/25/2021] [Accepted: 02/27/2021] [Indexed: 11/27/2022]
Abstract
The aim of this study was to compare the associations between indicators of energy intake and expenditure with excess weight and obesity in women who work full-time in sedentary and less sedentary jobs. Data were from 3444 participants the Australian Longitudinal Study on Women's Health, who reported their weight, dietary intake, physical activity and occupation in 2009 (baseline), and weight in 2012 (follow-up). Participants were categorised as being in a 'less sedentary' or 'sedentary' job, based on occupational activity patterns. Odds of excess weight (BMI ≥ 25) at baseline and of being obese (BMI ≥ 30) at follow-up, by indicators of energy intake and expenditure, were compared in the two occupational groups. In multivariate analyses, high non-work sitting time and saturated fat intake were associated with increased odds of obesity at 3-year follow-up in both occupational groups. In the sedentary job group, high physical activity (in leisure and transport) was associated with a 51% reduction in odds of obesity (OR 0.49, 95%CI 0.25-0.97). In the less-sedentary job group, energy intake and high soft drink consumption were associated with markedly increased odds of obesity (OR 1.67 95%CI 1.07-2.61; OR 2.08 95%CI1.42-3.05, respectively). In this cohort of young Australian women, sedentariness at work did not markedly affect the prevalence of excess weight or obesity. Indicators of high energy intake and low energy expenditure were associated with increased odds of both excess weight and obesity, regardless of sedentariness of occupational group.
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Prospective associations between physical activity and BMI with irregular periods and heavy menstrual bleeding in a large cohort of Australian women. Hum Reprod 2021; 36:1481-1491. [PMID: 33846724 DOI: 10.1093/humrep/deab055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are physical activity (PA) and body mass index (BMI) associated with irregular periods and heavy menstrual bleeding (HMB) in Australian women? SUMMARY ANSWER Overweight and obese women have higher odds of both irregular periods and HMB than underweight/normal-weight women, but high levels of PA reduce the odds of HMB. WHAT IS KNOWN ALREADY Most studies on relationships between PA and menstrual problems have focused on female athletes, but there have been few population-based studies. STUDY DESIGN, SIZE, DURATION Prospective cohort study, 10618 participants in the Australian Longitudinal Study of Women's Health (ALSWH) who completed mailed surveys in 1996, with follow-ups in 2000, 2003, 2006, 2009, 2012, and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were aged 22 to 27 in 2000. They were asked to report their PA levels and the frequency of irregular periods and HMB in each survey. BMI was calculated at every survey from self-reported weight and height. Generalised estimating equation population-averaged model analyses were conducted to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). MAIN RESULTS AND THE ROLE OF CHANCE At age 22 to 27 years, the prevalence of irregular periods was 19.4%. This remained stable over 15 years. There were no associations between PA and irregular periods. Overweight and obese women had higher odds of irregular periods [overweight: OR 1.08, (95% CI 1.00-1.17); obese: OR 1.29, (95%CI 1.18-1.41)] than women who were underweight/normal weight.The prevalence of HMB at age 22-27 years was 15.9%; this doubled over 15 years. Women who were highly active had 10% lower odds of HMB than women who reported no PA [OR 0.90, (95%CI 0.82-0.98)]. Overweight and obese women had higher odds of HMB [overweight: OR 1.15, (95%CI 1.07-1.23); obese: OR 1.37, (95%CI 1.26-1.49)] than women who were underweight/normal weight. Among obese women, high levels of PA were associated with 19% [OR 0.81, (95%CI 0.68-0.97)] reduction in the odds of HMB. LIMITATIONS, REASONS FOR CAUTION Data collected in the ALSWH are self-reported, which may be subject to recall bias. Reverse causation, due to menstrual problems impacting PA, is possible although sensitivity analyses suggest this is unlikely to have affected the results. Other conditions, e.g., polycystic ovary syndrome, for which no or incomplete data were available, could have affected the results. WIDER IMPLICATIONS OF THE FINDINGS Intervention studies are needed to assess the effect of increasing PA in women with HMB, but these preliminary findings suggest that promoting PA could be an affordable and feasible strategy for reducing HMB in young adult women. STUDY FUNDING/COMPETING INTEREST(S) The ALSWH is funded by the Australian Government. Funding for these analyses was provided by a University of Queensland (UQ) International Postgraduate Research Scholarship and a UQ International Development Fellowship. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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VO 2peak and 24-hour sleep, sedentary behavior, and physical activity in Australian truck drivers. Scand J Med Sci Sports 2021; 31:1574-1578. [PMID: 33793972 DOI: 10.1111/sms.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
This study assessed cardiorespiratory fitness (CRF) and 24-h sleep, sedentary behavior (SB), and physical activity (PA) in Australian truck drivers. Participants (n = 37 men) attended clinic sessions for an exercise test to exhaustion to establish CRF and wore an accelerometer (Actigraph GT3X+) to estimate sleep, SB, and PA. Relative to normative values, CRF was "below percentile 25" in 51% of drivers (mean [SD] VO2peak=30 .1 [7.6] mL.kg-1.min-1). Accelerometer data indicated that total vigorous-intensity (3.5-4.5 min/day) and sustained moderate- to vigorous-intensity PA (>5 min; 0.5-1.6 bouts/day) were limited. The findings show there is a need to design and test PA interventions that can improve poor levels of CRF in truck drivers.
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Associations between Device-measured Physical Activity and Cardiometabolic Health in the Transition to Early Adulthood. Med Sci Sports Exerc 2021; 53:2076-2085. [PMID: 33966000 DOI: 10.1249/mss.0000000000002696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSES The aims of this study were to investigate the cross-sectional and prospective associations between accelerometer-measured physical activity and cardiometabolic health in the transition to adulthood. METHODS Data from the 1993 Pelotas (Brazil) Birth Cohort were analysed (N=2,280). Moderate-to-vigorous intensity physical activity (MVPA, measured using a triaxial accelerometer) and cardiometabolic health (total fat mass, blood glucose, non-HDL cholesterol, triglycerides and mean resting blood pressure) were examined at age 18 and 22 yr. RESULTS Overall, inverse dose-response associations between MVPA and cardiometabolic health at age 18 and 22 yr were observed in cross-sectional analyses of data from males and females. Prospective analyses showed that, in general, MVPA declined, and cardiometabolic health worsened in this 4-yr period in both males and females. Cardiometabolic health at age 22 reflected both MVPA at age 18 [β: -0.007 (95% CI: -0.014; 0.000)] and changes in MVPA from 18 to 22 yr [β: -0.030 (95% CI: -0.043; -0.016)] in males, but only changes in MVPA in females [β: -0.035 (95% CI: -0.058; -0.011)]. In analyses of change over time, males who improved MVPA by 20-30 min per day showed significant improvements in cardiometabolic health over 4 yr. The magnitude of association was slightly stronger for MVPA in 10-min bouts than for MVPA accumulated in bouts of 1-min, especially in females. CONCLUSION MVPA is an important predictor of cardiometabolic health in early adulthood. Strategies to prevent declines in MVPA at this life stage are required to prevent deteriorating cardiometabolic health profiles.
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Longitudinal Weight Gain and Lifestyle Factors in Women With and Without Polycystic Ovary Syndrome. J Endocr Soc 2021. [PMCID: PMC8266190 DOI: 10.1210/jendso/bvab048.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: While women with polycystic ovary syndrome (PCOS) have a higher prevalence of overweight/obesity and increased weight gain than women without PCOS, the association of lifestyle behaviours with weight change is not known. Methods: We used data from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health for longitudinal analysis over 19 years (N=14127 at survey 1). Linear mixed-effects models were used to examine weight change and its association with diet, physical activity and sitting time, adjusted for sociodemographic, psychological factors and health care utilisation. Results: Women with PCOS gained more weight annually (0.27 kg/year, 95% CI 0.14, 0.40; P<0.001) and over 19 years (15.3 kg 95% CI 10.9, 19.7 Vs. 10.8 kg 95% CI 5.5, 16.2) than women without PCOS. There was a three-way interaction between energy intake (0.31 kg, 95% CI 0.004, 0.61; P=0.047), glycaemic index (0.44 kg, 95% CI 0.13, 0.74; P=0.005), sitting time (0.55 kg 95% CI 0.002, 1.10; P=0.049), physical activity (-0.37 kg, 95% CI -0.69, -0.05; P=0.022) and PCOS and time. While women with PCOS had higher weight gain than those without PCOS overall, this difference was greater for women with PCOS with higher energy intake, glycaemic index and longer sitting time and those not meeting PA guidelines. Conclusions: Women with PCOS had a higher rate of weight gain than those without PCOS with those with unhealthy lifestyle behaviours having the greatest weight gain. Women with PCOS may be biologically predisposed to weight gain when experiencing adverse lifestyle factors. This reinforces the contribution of lifestyle factors to weight change and the importance of early lifestyle intervention in PCOS.
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Joint association of physical activity and sleep difficulties with the incidence of hypertension in mid-age Australian women. Maturitas 2021; 149:1-7. [PMID: 34134885 DOI: 10.1016/j.maturitas.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Little is known about the joint effects of physical activity and sleep difficulties on hypertension. The aim of this study was to examine the joint associations of physical activity and sleep difficulties with the incidence of hypertension in mid-aged women. STUDY DESIGN Prospective cohort study. MAIN OUTCOME MEASURES Mid-aged participants (n = 5,300) in the Australian Longitudinal Study on Women's Health completed four triennial surveys starting in 2004, when they had a mean age of 55 years. The presence of hypertension, physical activity and the number of sleep difficulties (range 0-4) were reported at each survey. Total MET.min/week of physical activity was assessed, and dichotomised as inactive (<500 MET.min/wk) or active (≥500 MET.min/wk). Joint categories of physical activity and sleep difficulties were created using six mutually exclusive groups. Associations of joint physical activity and sleep difficulty groups with incident hypertension were examined via discrete-time survival analysis using logit-hazard models. RESULTS There were 1,175 cases of incident hypertension (22.2%). Compared with the Active and No Difficulties group, women in the Inactive and 1 Difficulty (Odds Ratio (95% confidence interval) (1.31 (1.06, 1.62)) and Inactive and 2-4 Difficulties (1.44 (1.16, 1.78)) groups were more likely to develop hypertension. Sleep difficulties were not associated with hypertension among active women. CONCLUSIONS Mid-aged inactive women with sleep difficulties were more likely to develop hypertension. Physical activity appeared to protect against the increased risk of hypertension in women with sleeping difficulties.
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Abstract
OBJECTIVES People with mental illness may be vulnerable to decline in mental health and reduced physical activity because of the COVID-19 pandemic and associated restrictions. The aim of this study was to inform the design of physical activity interventions for implementation under these conditions to improve/maintain well-being and physical activity in this population. METHODS People with mental illness who had participated in a physical activity program prior to the pandemic were invited to complete a survey about the impact of COVID-19 on mental health and physical activity and their preferences for engaging in a physical activity program under pandemic-related restrictions. RESULTS More than half the 59 respondents reported worse mental health and lower physical activity during the pandemic. The preferred format for a physical activity program was one-on-one exercise instruction in-person in a park. Program components endorsed as helpful included incentivization, provision of exercise equipment and fitness devices, and daily exercise programs. About a third of the participants reported limitations in using technology for a physical activity program. CONCLUSIONS In-person exercise support is preferred by people with mental illnesses during pandemic-related restrictions. Enablement strategies such as providing equipment and self-monitoring devices should be utilized; assistance may be needed to incorporate the use of technology in exercise programs.
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Effect of a physical activity and sleep m-health intervention on a composite activity-sleep behaviour score and mental health: a mediation analysis of two randomised controlled trials. Int J Behav Nutr Phys Act 2021; 18:45. [PMID: 33766051 PMCID: PMC7992852 DOI: 10.1186/s12966-021-01112-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine if a composite activity-sleep behaviour index (ASI) mediates the effects of a combined physical activity and sleep intervention on symptoms of depression, anxiety, or stress, quality of life (QOL), energy and fatigue in adults. METHODS This analysis used data pooled from two studies: Synergy and Refresh. Synergy: Physically inactive adults (18-65 years) who reported poor sleep quality were recruited for a two-arm Randomised Controlled Trial (RCT) (Physical Activity and Sleep Health (PAS; n = 80), or Wait-list Control (CON; n = 80) groups). Refresh: Physically inactive adults (40-65 years) who reported poor sleep quality were recruited for a three-arm RCT (PAS (n = 110), Sleep Health-Only (SO; n = 110) or CON (n = 55) groups). The SO group was omitted from this study. The PAS groups received a pedometer, and accessed a smartphone/tablet "app" using behaviour change strategies (e.g., self-monitoring, goal setting, action planning), with additional email/SMS support. The ASI score comprised self-reported moderate-to-vigorous-intensity physical activity, resistance training, sitting time, sleep duration, efficiency, quality and timing. Outcomes were assessed using DASS-21 (depression, anxiety, stress), SF-12 (QOL-physical, QOL-mental) and SF-36 (Energy & Fatigue). Assessments were conducted at baseline, 3 months (primary time-point), and 6 months. Mediation effects were examined using Structural Equation Modelling and the product of coefficients approach (AB), with significance set at 0.05. RESULTS At 3 months there were no direct intervention effects on mental health, QOL or energy and fatigue (all p > 0.05), and the intervention significantly improved the ASI (all p < 0.05). A more favourable ASI score was associated with improved symptoms of depression, anxiety, stress, QOL-mental and of energy and fatigue (all p < 0.05). The intervention effects on symptoms of depression ([AB; 95%CI] -0.31; - 0.60,-0.11), anxiety (- 0.11; - 0.27,-0.01), stress (- 0.37; - 0.65,-0.174), QOL-mental (0.53; 0.22, 1.01) and ratings of energy and fatigue (0.85; 0.33, 1.63) were mediated by ASI. At 6 months the magnitude of association was larger although the overall pattern of results remained similar. CONCLUSIONS Improvements in the overall physical activity and sleep behaviours of adults partially mediated the intervention effects on mental health and quality of life outcomes. This highlights the potential benefit of improving the overall pattern of physical activity and sleep on these outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN12617000680369 ; ACTRN12617000376347 . Universal Trial number: U1111-1194-2680; U1111-1186-6588. Human Research Ethics Committee Approval: H-2016-0267; H-2016-0181.
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Changes in diet, activity, weight, and wellbeing of parents during COVID-19 lockdown. PLoS One 2021; 16:e0248008. [PMID: 33657182 PMCID: PMC7928513 DOI: 10.1371/journal.pone.0248008] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic has dramatically impacted lifestyle behaviour as public health initiatives aim to “flatten the curve”. This study examined changes in activity patterns (physical activity, sedentary time, sleep), recreational physical activities, diet, weight and wellbeing from before to during COVID-19 restrictions in Adelaide, Australia. This study used data from a prospective cohort of Australian adults (parents of primary school-aged children; n = 61, 66% female, aged 41±6 years). Participants wore a Fitbit Charge 3 activity monitor and weighed themselves daily using Wi-Fi scales. Activity and weight data were extracted for 14 days before (February 2020) and 14 days during (April 2020) COVID-19 restrictions. Participants reported their recreational physical activity, diet and wellbeing during these periods. Linear mixed effects models were used to examine change over time. Participants slept 27 minutes longer (95% CI 9–51), got up 38 minutes later (95% CI 25–50), and did 50 fewer minutes (95% CI -69–-29) of light physical activity during COVID-19 restrictions. Additionally, participants engaged in more cycling but less swimming, team sports and boating or sailing. Participants consumed a lower percentage of energy from protein (-0.8, 95% CI -1.5–-0.1) and a greater percentage of energy from alcohol (0.9, 95% CI 0.2–1.7). There were no changes in weight or wellbeing. Overall, the effects of COVID-19 restrictions on lifestyle were small; however, their impact on health and wellbeing may accumulate over time. Further research examining the effects of ongoing social distancing restrictions are needed as the pandemic continues.
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Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial. JMIR Res Protoc 2021; 10:e21911. [PMID: 33625365 PMCID: PMC7946582 DOI: 10.2196/21911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans. Objective This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans’ Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA. Methods The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans’ Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences. Results Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so. Conclusions Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents. Trial Registration Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/21911
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The Role of Lifestyle Intervention in the Prevention and Treatment of Gestational Diabetes. Semin Reprod Med 2021; 38:398-406. [PMID: 33472245 DOI: 10.1055/s-0040-1722208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obesity during pregnancy is associated with the development of adverse outcomes, including gestational diabetes mellitus (GDM). GDM is highly associated with obesity and independently increases the risk of both complications during pregnancy and future impaired glycemic control and risk factors for cardiovascular disease for both the mother and child. Despite extensive research evaluating the effectiveness of lifestyle interventions incorporating diet and/or exercise, there remains a lack of definitive consensus on their overall efficacy alone or in combination for both the prevention and treatment of GDM. Combination of diet and physical activity/exercise interventions for GDM prevention demonstrates limited success, whereas exercise-only interventions report of risk reductions ranging from 3 to 49%. Similarly, combination therapy of diet and exercise is the first-line treatment of GDM, with positive effects on maternal weight gain and the prevalence of infants born large-for-gestational age. Yet, there is inconclusive evidence on the effects of diet or exercise as standalone therapies for GDM treatment. In clinical care, women with GDM should be treated with a multidisciplinary approach, starting with lifestyle modification and escalating to pharmacotherapy if needed. Several key knowledge gaps remain, including how lifestyle interventions can be optimized during pregnancy, and whether intervention during preconception is effective for preventing the rising prevalence of GDM.
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Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults. BMC Public Health 2021; 21:70. [PMID: 33413247 PMCID: PMC7791783 DOI: 10.1186/s12889-020-10054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents. METHODS A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models. DISCUSSION Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.
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Trajectories and determinants of weight gain in two cohorts of young adult women born 16 years apart. Int J Obes (Lond) 2021; 45:1553-1564. [PMID: 33941842 PMCID: PMC8090508 DOI: 10.1038/s41366-021-00819-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/07/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aims were to compare: (1) baseline weights and weight gain trajectories; (2) sociodemographic, behavioural and health characteristics driving weight gain; and (3) estimated average weight in 20 years' time, in two cohorts of young women. METHODS Data were from 16066 participants in two population-based cohorts of young adult women, born in 1973-78 ("GenX") and 1989-95 ("millennials"). Weight was reported at baseline (age 18-23 in both cohorts) and 4 years later. High weight gain was defined as >2.5% per year. Data were analysed in 2020. RESULTS Women born in 1989-95 were almost 4 kg heavier at age 18-23 and gained weight over 4 years 1.7 times faster than those born in 1973-78. Prevalence of high weight gain was 34.2% in the 1989-95 cohort and 24% in the 1973-78 cohort. In both cohorts, older age, higher education and high physical activity were associated with lower odds of high weight gain, and more hours in paid work, poorer self-rated health and higher baseline BMI were associated with higher odds of high weight gain. Five factors (outer regional areas, one child, ex or current smoker, high stress and depression) were determinants of high weight gain in the 1989-95 cohort, but not in the 1973-78 cohort. Based on average weight at age 21 and annual percentage weight gain, we estimate that women born in 1989-95 will, on average, be 16.7 kg heavier at age 41 (93.2 kg), than women in the 1973-78 cohort (76.5 kg). CONCLUSION High weight gain was evident in every sociodemographic group in both cohorts but most evident in millennial women with high levels of stress and depression. Without effective weight gain prevention strategies we estimate that more than 50% of the millennial women will be in the obese BMI category in 20 years. This will have serious economic, health and societal consequences.
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Rates, costs and determinants of lumbar spine imaging in population-based women born in 1973-1978: Data from the Australian Longitudinal Study on Women's Health. PLoS One 2020; 15:e0243282. [PMID: 33270739 PMCID: PMC7714143 DOI: 10.1371/journal.pone.0243282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022] Open
Abstract
Objective There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women. Methods The Australian Longitudinal Study on Women’s Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973–1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database. Results 38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30–39 years were AU$51,735,649 over 2011–2015. Conclusions Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.
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