Physical activity in the prevention and treatment of obesity and its comorbidities: evidence report of independent panel to assess the role of physical activity in the treatment of obesity and its comorbidities.

Obesity in children and adolescents worldwide: current views and future directions--Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

To examine self-reported physical activity levels from the International Physical Activity Questionnaire (IPAQ) as an independent predictor of dual-energy x-ray absorptiometry (DXA)-measured percent body fat (%BF) from body mass index (BMI), gender, and race. Two hundred and seventy-eight students, aged 18-24 yr, volunteered to participate. There were 133 males (85 white and 48 black) and 145 females (77 white and 68 black). Total activity levels were quantified in MET hours per week (MET h wk(-1)) using the IPAQ short form. Height and weight were measured, and BMI values were calculated (kg m(-2)). %BF was assessed using DXA. Linear regression analysis was used to develop and compare a body fat prediction equation with (full) and without (reduced) the variable MET-h.wk. Both models included BMI, gender, and race as predictor variables. The prediction sum of squares (PRESS) statistic was used to cross-validate both models, and the individual predictive accuracy was compared using modified Bland-Altman plots. Mean +/- SD values were as follows: BMI = 24.4 +/- 4.1 kg m(-2), %BF = 24.5 +/- 9.3%, and MET h wk(-1) = 37.4 +/- 21.9. Gender, BMI, and race explained 81% of the variance in %BF, with a root mean square error (RMSE) of 4.07. The full model with MET-h.wk improved the prediction of %BF by 2% (R2 = 0.83, RMSE = 3.87). When cross-validated, the corresponding PRESS statistics for the reduced and full model were 4.10 and 3.90, respectively. Bland-Altman limits of agreement were greater for the reduced model compared with the full model (-8.09, 8.10 vs -7.67, 7.68). These results suggest that %BF can be predicted with greater precision and accuracy in a young adult population when MET-h.wk are included in addition to BMI, gender, and race.

Aging, in conjunction with decreasing physical activity, is associated with a range of health problems. Simple, low-maintenance, population-based means of promoting activity to counteract the age-associated decline are required. We therefore assessed the effect of pedometry and buddy support to increase physical activity. We undertook a clustered randomized trial (HKCTR-346) of 24 community centers involving 399 older Chinese participants (≥ 60 yr). Centers were randomly allocated to 1) pedometry and buddy, 2) pedometry and no buddy, 3) no pedometry and buddy, and 4) no pedometry and no buddy with a 2 × 2 factorial design. The trial simultaneously tested the individual and combined effects of the interventions. The intervention groups also received monthly organized group activities to provide encouragement and support. Outcome measures were assessed at 6 and 12 months, including physical fitness and activity and cardiovascular disease risk factors (anthropometry and blood pressure). From the 24 centers, 356 volunteers (89.2%) completed the study. Those receiving the interventions had higher mean physical activity levels at 12 months of 1820 (95% confidence interval (CI) = 1360-2290) and 1260 (95% CI = 780-1740) MET·min·wk(-1), respectively relative to the decrease in the control groups. The buddy peer support intervention significantly improved mean aerobic fitness (12% [95% CI = 4%-21%]) and reduced both body fat (-0.6% [95% CI = -1.1% to 0.0%]) and time to complete the 2.5-m get-up-and-go test (-0.27 [95% CI = -0.53 to -0.01] s). No other improvements in the cardiovascular disease risk factors were observed. The combination of motivational tools was no better than the individual interventions. Both motivational interventions increased physical activity levels, and the buddy style improved fitness. These tools could be useful adjuncts in the prevention of obesity and age-related complications.

Observational studies have demonstrated an increased amyotrophic lateral sclerosis (ALS) risk among professional athletes in various sports. For moderately increased levels of physical activity and fitness, the results are diverging. Through a cohort study, we aimed to assess the relationship between indicators of physical activity and fitness (self-reported physical activity and resting heart rate) and long-term ALS risk. From a large Norwegian cardiovascular health survey (1985-1999), we collected information on self-reported physical activity in leisure time, resting heart rate, and other cardiovascular risk factors. Patients with ALS were identified through health registries covering the whole population. We fitted Cox proportional hazard models to assess the risk of ALS according to levels of self-reported physical activity in 3 categories (1: sedentary; 2: minimum 4 hours per week of walking or cycling; 3: minimum 4 hours per week of recreational sports or hard training), and resting heart rate modeled both on the continuous scale and as quartiles of distribution. Out of 373,696 study participants (mean 40.9 [SD 1.1] years at inclusion), 504 (41.2% women) developed ALS during a mean follow-up time of 27.2 (SD 5.0) years. Compared with participants with the lowest level of physical activity, the hazard ratio was 0.71 (95% CI 0.53-0.95) for those with the highest level. There were no clear associations between resting heart rate and ALS in the total sample. In men, the hazard ratio of ALS was 0.71 (95% CI 0.53-0.95) for those reporting moderate levels of physical activity and 0.59 (95% CI 0.42-0.84) for those reporting high levels, compared with those reporting low levels. Men with resting heart rate in the lowest quartile had 32% reduced risk of ALS (hazard ratio 0.68, 95% CI 0.49-0.94) compared with those in the second highest quartile. In women, no association was detected between neither self-reported levels of physical activity nor resting heart rate and ALS risk. Indicators of high levels of physical activity and fitness are associated with a reduced risk of ALS more than 30 years later in men, but not in women.

Objectives: The mechanisms by which overweight and physical inactivity lead to hypertension are complex. Leptin, an adipocyte-derived hormone, has been linked with hypertension. We studied the relationship between leptin, physical activity, and new-onset hypertension. Methods: A prospective study design based on data from the 3. and 4. Copenhagen City Heart Study (CCHS). From the 3. CCHS, which was performed in 1991 to 1994, we identified 1111 subjects (744 women and 367) who were normotensive. Based on questionnaire items, the participants were divided into two groups with low (n = 674) and high (n = 437) level of leisure time physical activity, respectively. Between the 3. and the 4. CCHS examination, which was performed in 2001 to 2003, 304 had developed hypertension, defined as systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg or use of antihypertensive medication. Results: In a logistic regression model, including age, sex, body mass index, SBP, DBP, level of physical activity, and leptin, we found a significant interaction between leptin and level of physical activity with new-onset hypertension as outcome variable (P = 0.012). When we entered the interaction variables: effect of leptin with low level of physical activity and with high level of physical activity, respectively, in the original model, leptin only predicted new-onset hypertension in participants with low level of physical activity (odds ratio (95% confidence interval): 1.16 (1.01–1.33) for one unit increase in log-transformed leptin levels, P = 0.038), but not in participants with high level of physical activity (0.88 (0.74–1.05), P = 0.15). If we included other risk factors of hypertension and possible mediators of overweight-related hypertension, such as the triglyceride to HDL cholesterol concentration ratio, fibrinogen, glucose, diagnosis of diabetes, adiponectin, and heart rate, in the model, leptin still predicted new-onset hypertension in participants with a low level of leisure time physical activity (P = 0.040). Conclusion: This study is the first prospective study to report that the hypertensive effect of leptin is modified by leisure time physical activity.

Background:Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are associated with an increased risk of developing cardiovascular diseases as a result of complex interaction between traditional risk factors, chronic inflammation and specific impact of antibodies on endothelium. There are very limited data regarding level of physical activity (PA) in APS patients.Objectives:To analyze different domains of PA in Serbian APS patients and their possible relationship to clinical and laboratory criteria of the main disease.Methods:From a large Serbian APS database comprehending 527 APS patients (371 Primary – PAPS, and 156 APS associated with other autoimmune diseases, predominantly systemic lupus erythematosus (SLE)) we interviewed 51 APS patients, age range of 15-69 years: 29 patients with primary APS (PAPS), 25 women, 4 men, age 44±11.50, and 22 APS/SLE, 18 women, 4 men, age 48.41±11.75, using a long form of The International Physical Activity Questionnaire (IPAQ), translated onto Serbian language. Data on last seven days of PA divided onto leisure time PA, domestic and gardening (yard) activities, work-related PA and transport-related PA were acquired, and proposed scoring method was used. Based on the level of PA, patients were categorized to low, moderate or high level of PA. For the purpose of insight into atherosclerotic progression, we performed color Doppler scan of carotid arteries in all patients and presence of atherosclerotic plaques has been notified.Results:Average total PA score was 7706.18±11771.97 MET-minutes/week. The greatest average values for different PA domains were for work (2733.21±6158.66 MET-minutes/week) and domestic/garden/yard (2522.31±3847.24 MET-minutes/week) and the lowest scores achieved in leisure time (500.87±695.45 MET-minutes/week). Majority of Serbian APS patients had low or moderate level of PA (37.3%, 43.1%, respectively) whereas lowest percentage was in high category of PA (19.6%). All domains of PA were significantly negatively correlated to age and BMI. There were no significant difference regarding PA scores between PAPS and APS/SLE patients. Although higher percentage of PAPS patients had high level of PA (27.65 compared to 9.1% of SLE/APS), the overall difference was not significant. There was no significant difference regarding antiphospholipid antibody (aPL) type or thrombotic/obstetric events presence. Significant difference occurred regarding presence of carotid arteries plaques. APS patients with lower PA scores had significantly higher prevalence of carotid arteries plaque especially for PA in transportation (p=0.004), and total PA (p=0.025)Conclusion:Serbian APS patients at younger age, tend to have low or moderate level of PA, with the lowest level of activity in leisure time. Low level of PA was undoubtedly related to progression of atherosclerosis in these patients, emphasizing a need for PA promotion in APS.Disclosure of Interests:Aleksandra Djokovic Speakers bureau: KRKA, Astra Zeneca, Actavis, Ljudmila Stojanovich: None declared, Natasa Stanisavljevic: None declared, Gordana Bogdanovic: None declared, Sandra Djokic: None declared

LOW LEVELS OF PHYSICAL ACTIVITY AND FITNESS ARE ASsociated with a 2-fold increase in risk of all-cause and cardiovascular mortality. The cardiovascular and mortality risk associated with low physical fitness is similar to, and in some cases higher than, the risk attributable to diabetes mellitus, high cholesterol levels, hypertension, or cigarette smoking. Yet only 15% of adults engage in regular vigorous physical activity, and 60% report no regular or sustained leisure time activity. The benefits of physical activity are undisputed. Numerous epidemiological studies suggest a dose-response relationship between higher physical activity and fitness levels and lower mortality risk. Observational evidence suggests that improvements in physical fitness and activity level prolong survival. In addition, recent randomized trials have demonstrated the beneficial effects of moderate levels of regular physical activity on cardiovascular risk factors, such as insulin resistance, hypertension, and obesity. Yet despite this strong evidence, US physicians advise only a minority of their patients about physical activity. Patients at highest risk for weight gain and poorer health outcomes, such as sedentary adults and those with lower income, are least likely to receive physical activity counseling. Several barriers prevent physicians from counseling patients about physical activity, including limitations in time and resources and the perceived ineffectiveness of counseling. While physical training may improve fitness levels, based on the evidence currently available it is not clear whether primary care–based interventions for improving physical activity are effective. The majority of earlier studies have been small or poorly controlled, and although many suggest positive findings in the short term, their methodological shortcomings limit the interpretability of results. The findings of more recent trials have been inconsistent. The Johns Hopkins Medicare Preventive Services Project, which examined the effect of preventive health examinations in an elderly population (n=3097), found no increase in physical activity level at 1 year among those randomized to receive physical activity counseling. The OXCHECK trial randomized 2205 patients in England to receive usual care or physical activity counseling and 5 follow-up visits by trained nurses. After 3 years, a small but statistically significant proportion of the intervention group (32.4%) compared with the control group (29.1%) reported performing vigorous exercise more than once a month. Unfortunately, physical activity level was not measured in a more precise way in this study; the benefit of vigorous exercise once a month is unclear. The Activity Counseling Trial (ACT) reported in this issue of THE JOURNAL adds to the literature on the effectiveness of physical activity counseling in the primary care setting. A volunteer sample of 874 sedentary patients from 11 primary care facilities was randomly assigned to receive 1 of 3 physical activity counseling interventions of varying intensity. The study assessed 2 primary outcomes: (1) physical activity or total energy expenditure as estimated by a 7-day Physical Activity Recall (PAR) interview of specific activities and (2) cardiorespiratory fitness (VO2max) as measured by a graded maximal exercise test. Unfortunately, the ACT does not directly address a central question—whether physical activity counseling by clinicians in primary care settings increases physical activity or improves cardiorespiratory fitness levels. Rather, this study addresses whether high-intensity counseling and behavioral support provided by health educators in a primary care setting improve activity and fitness levels when compared with more modest counseling efforts. The advice or comparison group in the ACT received a higher level of physical activity counseling from their physicians (who were trained in assessing physical activity, providing advice, and selecting a long-term goal) than is currently usual care. These patients also received an average of 3 brief counseling contacts from health educators over a 2-year period. The assistance group received the same advice care from their phy-

Objective. The mechanisms by which overweight and physical inactivity lead to hypertension are complex. Leptin, an adipocyte-derived hormone, has been linked with hypertension. We wanted to investigate the relationship between leptin, physical activity and new-onset hypertension. Methods. The study was a prospective cohort study of 744 women and 367 men, who were normotensive in the third Copenhagen City Heart Study (CCHS) examination, performed 1991–94. Based on questionnaire items, the participants were divided into two groups with low (n = 674) and high (n = 437) levels of leisure-time physical activity, respectively. Results. Between the third and the fourth CCHS examination, performed 2001–03, 304 had developed hypertension, defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg or use of antihypertensive medication. In a logistic regression model, including age, sex, body mass index, SBP, DBP, level of physical activity and leptin, we found a significant interaction between leptin and level of physical activity with new-onset hypertension as outcome variable (p = 0.012). When we entered the interaction variables, effect of leptin with low level of physical activity and with high level of physical activity, respectively, in the original model, leptin predicted new-onset hypertension in participants with low level of physical activity [odds ratio (95% confidence interval): 1.16 (1.01–1.33) for one unit increase in log-transformed leptin levels, p = 0.038], but not in participants with high level of physical activity [0.88 (0.74–1.05), p = 0.15]. Conclusion. We found that leptin predicted new-onset hypertension but only in participants with low level of physical activity.

Relation Between Self-Reported Physical Activity Level, Fitness, and Cardiometabolic Risk

Introduction. Physical activity and good diet are the primary determinants of body weight. The aim of the study was to compare physical activity and eating behaviours of overweight and obese females (taking into consideration their body fat distribution) with individuals with normal levels of body fat. Material and methods. The study included females aged 20-35. The study group consisted of 449 subjects, who were categorised into groups based on their body fat percentage: underweight, normal body fat, overweight and obese. The WHR index was computed in individuals who were overweight or obese. The assessment of physical activity levels was conducted using data obtained from the IPAQ, while eating behaviours were examined using the Dietary Habits And Nutrition Beliefs Questionnaire developed by the Polish Academy of Sciences. Results. Females who were overweight or obese exhibited greater values of the examined physical characteristics in comparison to individuals with normal levels of body fat. Subjects with fat tissue in the abdomen area had higher values of somatic characteristics. There were no statistically significant differences in physical activity levels between individuals with normal body fat and overweight or obese females. However, when the second group was divided into those with abdominal fatness and those with peripheral fatness, it was observed that individuals with abdominal fatness had lower levels of physical activity, including both total activity as well as vigorous and moderate activity. There were no significant differences in eating behaviours found between the groups. Conclusions. The amount and placement of fat tissue in young females is more closely linked to their levels of physical activity rather than their eating habits and knowledge about food and nutrition.

Physical activity and health

To investigate whether out-of-hospital cardiac arrest (OHCA) survivors had lower levels of self-reported physical activity compared to a non-cardiac arrest control group with myocardial infarction (MI), and to explore if symptoms of anxiety, depression, kinesiophobia (fear of movement), and fatigue were associated with a low level of physical activity. Pre-defined case-control sub-study within the international Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Out-of-hospital cardiac arrest survivors at 8 of 61 TTM2 sites in Sweden, Denmark, and the UK were invited. Participants were matched 1:1 to MI controls. Both OHCA survivors and MI controls answered two questions on self-reported physical activity, categorized as a low, moderate, or high level of physical activity, and questionnaires on anxiety and depression symptoms, kinesiophobia, and fatigue 7 months after the cardiac event. Overall, 106 of 184 (58%) eligible OHCA survivors were included and matched to 91 MI controls. In total, 25% of OHCA survivors and 20% of MI controls reported a low level of physical activity, with no significant difference (P = 0.13). Symptoms of kinesiophobia and fatigue were significantly associated with a low level of physical activity in both groups. Out-of-hospital cardiac arrest survivors had significantly more kinesiophobia compared to MI controls (18% vs. 9%, P = 0.04), while levels of anxiety and depression symptoms and fatigue were similar. Out-of-hospital cardiac arrest survivors had similar levels of physical activity compared to matched MI controls. High level of kinesiophobia and fatigue were associated with a low level of physical activity in both groups. ClinicalTrials.gov: NCT03543332.

PURPOSE: To verify the relationship between physical activity and cardiorespiratory fitness levels with the metabolic syndrome in Brazilian adolescents. METHODS: A random sample of 236 girls (mean age, 14.52±1.76 years) and 203 boys (mean age, 14.7±1.83 years) was selected for the study. Physical activity level was determined using the Bouchard questionnaire. Cardiorespiratory fitness was estimated by the Leger 20-meter shuttle run test. Terciles were used to classify the subjects as low, moderate and high physical activity and fitness levels. The metabolic syndrome components assessed included waist circunference, blood pressure, HDL-cholesterol, triglycerides, and fasting plasma glucose. RESULTS: Higher prevalence of the metabolic syndrome was observed in adolescents with low physical activity (males, 13.6%; females, 7.7%) and low cardiorespiratory fitness (males, 20%; females, 10.3%) levels. Significant relationships were found for males between metabolic syndrome with low physical activity (OR: 5.13; 95% CI: 1.06-24.73) and low cardiorespiratory fitness levels (OR: 8.75; 95% CI: 1.89-40.46). CONCLUSIONS: The prevalence of the metabolic syndrome is high among adolescents with low physical activity and fitness levels; a significant relationship between the metabolic syndrome, physical activity, and cardiorespiratory fitness levels was found only for male subjects. Prevention strategies for the metabolic syndrome should concentrate on enhancing fitness and physical activity levels early in life.

Physical activity (PA) is associated with numerous health-related benefits among adults with chronic diseases and the general population. As the benefits are dose-dependent, this review aims to establish the PA levels of adults with spondyloarthritis and to compare these to the general population. Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE/PubMed, PEDro, AMED, CINAHL) were systematically searched from inception to May 2014 using medical subject headings and keywords. This was supplemented by searching conference abstracts and hand-searching reference lists of included studies. Eligible studies were randomized controlled trials and observational studies of adults with SpA in which free-living PA or energy expenditure levels were measured. Subjects less than 18 years or with juvenile-onset SpA were excluded. Outcomes included objective and self-report measurements. Two reviewers independently screened studies for inclusion and assessed methodological quality using the Cochrane risk of bias tool and the RTI item bank. From the 2,431 records reviewed, nine studies involving 2,972 participants were included. This review focused on qualitative synthesis. Meta-analyses were not undertaken due to differences in study design, measurement tools, and participant characteristics. This heterogeneity, coupled with the risk of bias inherent in the included observational studies, limits the generalizability of findings. Objective measurements suggest PA levels may be lower among adults with spondyloarthritis than in healthy population controls. Self-reported PA and self-reported rates of adherence to PA recommendations varied largely across studies; higher disease activity was associated with lower self-reported PA levels. Physical activity levels may be lower in adults with axial spondyloarthritis, with higher disease activity associated with lower PA levels.

To determine the impact of physical activity and fitness on the level of physical activity barriers (kinesiophobia) in women of perimenopausal age, the study included 105 women between the ages of 48 and 58. A Baecke questionnaire was used to evaluate physical activity and a modified Fullerton test was used to evaluate the fitness level. The level of kinesiophobia was assessed using the Kinesiophobia Causes Scale questionnaire.A low level of habitual physical activity has a negative impact on the values of Biological Domain (r = –0.581), Psychological Domain (r = –0.451), and on the Kinesiophobia Cause Scale total score (r = –0.577). Lower physical activity expressed by a lower score in the Fullerton test also has a negative impact on the level of kinesiophobia. Upper body flexibility (r = –0.434) has the strongest influence on the Biological Domain, whereas upper body strength (r = –0.598) has the greatest impact on the Psychological Domain. A low level of upper body strength also has the greatest impact on the Kinesiophobia Cause Scale total score (r = –0.507).Low levels of physical activity and fitness in women of perimenopausal age favour kinesiophobic attitudes and thereby increase the level of barriers against undertaking physical activity.