What if physiotherapists reimagined physical activity as relational and planetary health-enhancing? – Editorial

To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation. Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed. Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05). Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered. Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Physical activity and health

Review Question/Objective The objective of this systematic review is to synthesise the best available evidence on the effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2. The specific review question is: What is the effectiveness of physical leisure time activities on glycaemic control in patients with diabetes type 2? Types of participants This review will consider adults over 18 years old diagnosed with type 2 diabetes mellitus according to 2003 American Diabetes Association criteria. Patients receiving oral or insulin medicine treatment will be considered for inclusion, regardless of severity of diabetes or other treatment regimes, but patients who had recently undergone serious operations or who had myocardial infarction, stroke, severe liver or kidney diseases, or any illness limiting participation in the physical activity program, or who were participating in a physical exercise program at the same time will be excluded from the study. Types of Interventions Regular physical leisure time activities for people with type 2 diabetes are defined as at least 150 minutes of moderate-intensity physical activity (50-70% of maximum heart rate) per week, or at least 90 minutes of vigorous-intensity physical activity (>70% of maximum heart rate) per week.26 The minimum duration of the intervention will be at least two months. The review will include the following forms of moderate or vigorous leisure time activities: (1) tai chi exercise (2) walking (3) swimming (4) gardening (5) gigong (an ancient Chinese breathing exercise that combines aerobics, isometric, and isotonic movements and meditation) (6) jogging (7) riding a bicycle (8) dancing. Types of outcomes The outcome measures will include long-term and short-term glycaemic control indicators to reflect the patients’ immediate and two to three months blood sugar changing condition. Therefore, haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) indicators will be included in this study.

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.

0516 In recent years, it has been reported that only one-half of young people regularly participate in physical activity, and participation declines as age declines. However, there is little empirical data as to why this might occur, especially in the areas of race and gender. PURPOSE: (a) to investigate the amount of physical and sedentary activity that adolescents participated in across gender and race, (b) to investigate adolescents? attractions to physical activity, and (c) to investigate the relationship between the environment and physical and sedentary activity participation. METHODS: Participants were 1174 adolescents aged between 12 and 19 years from Midwest public and private high schools. A self-report questionnaire (Self- Administered Physical Activity Checklist, Sallis, 1996) was used to measure minutes of physical and sedentary activity, and to obtain a measure of intensity. Children?s Attraction to Physical Activity (CAPA) scale was used to assess interest in physical activity. The Perceived Environments Related to Physical Activity Scale was used to establish correlations between physical and sedentary activity and perceived environment. RESULTS: Two separate 2 (gender) × 2 (race) × 3 (age) MANOVA were conducted on physical activity and attraction to physical activity subscales. Results from the physical activity analyses indicated significant main effects for gender (minutes of moderate to vigorous physical activity, energy expenditure), race (minutes of sedentary activity) and age (energy expenditure). Results regarding the attraction toward physical activity participation indicated significant main effects for gender (liking of games and sport, fun of physical exertion), age (liking of games and sport, fun of physical exertion), and race (vigorous physical activity, liking for games and sport, fun of physical exertion). Significant positive correlations existed between the environment and physical activity and convenient facilities for adolescents 15–16 years old, and females. Minutes of sedentary activity was negatively correlated with convenient facilities for both females and males, and also negatively correlated with the home environment for females. CONCLUSION: Differences in attractions to physical activity and perceived environment may assist practitioners and researchers to develop and implement specific activity interventions for adolescents while taking into account gender and race differences.

0516 In recent years, it has been reported that only one-half of young people regularly participate in physical activity, and participation declines as age declines. However, there is little empirical data as to why this might occur, especially in the areas of race and gender. PURPOSE: (a) to investigate the amount of physical and sedentary activity that adolescents participated in across gender and race, (b) to investigate adolescents? attractions to physical activity, and (c) to investigate the relationship between the environment and physical and sedentary activity participation. METHODS: Participants were 1174 adolescents aged between 12 and 19 years from Midwest public and private high schools. A self-report questionnaire (Self- Administered Physical Activity Checklist, Sallis, 1996) was used to measure minutes of physical and sedentary activity, and to obtain a measure of intensity. Children?s Attraction to Physical Activity (CAPA) scale was used to assess interest in physical activity. The Perceived Environments Related to Physical Activity Scale was used to establish correlations between physical and sedentary activity and perceived environment. RESULTS: Two separate 2 (gender) × 2 (race) × 3 (age) MANOVA were conducted on physical activity and attraction to physical activity subscales. Results from the physical activity analyses indicated significant main effects for gender (minutes of moderate to vigorous physical activity, energy expenditure), race (minutes of sedentary activity) and age (energy expenditure). Results regarding the attraction toward physical activity participation indicated significant main effects for gender (liking of games and sport, fun of physical exertion), age (liking of games and sport, fun of physical exertion), and race (vigorous physical activity, liking for games and sport, fun of physical exertion). Significant positive correlations existed between the environment and physical activity and convenient facilities for adolescents 15–16 years old, and females. Minutes of sedentary activity was negatively correlated with convenient facilities for both females and males, and also negatively correlated with the home environment for females. CONCLUSION: Differences in attractions to physical activity and perceived environment may assist practitioners and researchers to develop and implement specific activity interventions for adolescents while taking into account gender and race differences.

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

Evidence has suggested that physical and sexual activity might be triggers of acute cardiac events. To assess the effect of episodic physical and sexual activity on acute cardiac events using data from case-crossover studies. MEDLINE and EMBASE (through February 2, 2011) and Web of Science (through October 6, 2010). Case-crossover studies investigating the association between episodic physical or sexual activity and myocardial infarction (MI) or sudden cardiac death (SCD). Two reviewers extracted descriptive and quantitative information from each study. We calculated summary relative risks (RRs) using random-effects meta-analysis and absolute event rates based on US data for the incidence of MI and SCD. We used the Fisher P value synthesis method to test whether habitual physical activity levels modify the triggering effect and meta-regression to quantify the interaction between habitual levels of physical activity and the triggering effect. We identified 10 studies investigating episodic physical activity, 3 studies investigating sexual activity, and 1 study investigating both exposures. The outcomes of interest were MI (10 studies), acute coronary syndrome (1 study), and SCD (3 studies). Episodic physical and sexual activity were associated with an increase in the risk of MI (RR = 3.45; 95% confidence interval [CI], 2.33-5.13, and RR = 2.70; 95% CI, 1.48-4.91, respectively). Episodic physical activity was associated with SCD (RR = 4.98; 95% CI, 1.47-16.91). The effect of triggers on the absolute rate of events was limited because exposure to physical and sexual activity is infrequent and their effect is transient; the absolute risk increase associated with 1 hour of additional physical or sexual activity per week was estimated as 2 to 3 per 10,000 person-years for MI and 1 per 10,000 person-years for SCD. Habitual activity levels significantly affected the association of episodic physical activity and MI (P < .001), episodic physical activity and SCD (P < .001), and sexual activity and MI (P = .04); in all cases, individuals with lower habitual activity levels had an increased RR for the triggering effect. For every additional time per week an individual was habitually exposed to physical activity, the RR for MI decreased by approximately 45%, and the RR for SCD decreased by 30%. Acute cardiac events were significantly associated with episodic physical and sexual activity; this association was attenuated among persons with high levels of habitual physical activity.

The Call for a Physical Activity Vital Sign in Clinical Practice

The health benefits of regular physical activity and the relation between physical inactivity and chronic disease morbidity and mortality are well established. Also clear is the fact that efforts to increase physical activity at the population level will require collective action by government, nongovernment, for-profit, and nonprofit entities working together at the local, state, and national levels. The US National Physical Activity Plan (NPAP), developed by the National Physical Activity Plan Alliance, of which the American Heart Association (AHA) is a member, is designed to facilitate this collective action, to help organizations from all sectors of society work together to increase physical activity in all segments of the American population. The purposes of this advisory are to summarize the data that describe the health benefits of regular physical activity and the public health burden of low levels of physical activity, to describe the NPAP and the role it will play in increasing population levels of physical activity, and to encourage readers of Circulation to join the AHA’s efforts to promote its implementation. As summarized in Table 1, there is substantial evidence supporting the benefits of regular physical activity to prevent a wide variety of disease conditions and to enhance quality of life. Interestingly, there is less of an appreciation of noncardiovascular benefits of lifestyle physical activity and structured exercise, and this is an area of great opportunity for educating the public and healthcare practitioners. View this table: Table 1. The Health Benefits of Regular Physical Activity Physical inactivity is rapidly becoming a major global concern and is the fourth leading cause of death worldwide.2,3 As noted by Kohl and colleagues, “In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.”4 According …

BackgroundThe level of physical activity (PA) among patients with coronary heart disease (CHD) living in Chinese communities who do not participate in cardiac rehabilitation programs and the factors contributing to patient maintenance of PA are unclear.ObjectiveThis cross-sectional study, guided by the Transtheoretical Model, evaluated (1) the maintenance of PA in Chinese patients with CHD 12 months after hospital discharge and (2) the demographic, clinical, and psychological characteristics associated with maintenance of PA.MethodsA total of 1162 patients completed 6 questionnaires at 12 months posthospitalization to assess their maintenance of PA, stage of change, symptoms of depression and anxiety, and health-related quality of life and sleep.ResultsOnly 40% of patients with CHD maintained regular PA 12 months after hospital discharge. Walking was their primary PA. Thirty-seven percent of patients reported no intention of having regular PA. Male sex (odds ratio [OR], 1.69), awareness of PA's cardiac benefit (OR, 4.12), a history of regular PA before the cardiac event (OR, 6.08), history of chronic disease (OR, 1.43), mild depressive symptoms (OR, 1.40), moderate and severe depressive symptoms (OR, 0.41), smoking (OR, 0.54), and years of CHD (OR, 0.96) were related to maintenance of regular PA. Patients with CHD who maintained regular PA had better quality of life and sleep (P < .001) and fewer unplanned clinic visits (P = .001) and cardiac cause readmissions (P = .012) and reported fewer declines in PA capacity (P < .001).ConclusionsWalking is the most common form of PA 12 months posthospitalization among patients with CHD in China. Patient education and counseling about the cardiac benefits of PA, taking into account stage of change, are important considerations to improve maintenance of PA.

Risk of Increased Physical Inactivity During COVID-19 Outbreak in Older People: A Call for Actions.

BackgroundPhysical inactivity is one of the biggest health problems nowadays. Recent research shows that socio-cultural barriers to physical activity are mostly related to modern lifestyles. However, there is a lack of research on how social and group dynamics influence engagement in physical activity. Furthermore, there are few cross-cultural studies that have compared the social dynamics of (in)activity in different cultural settings. This paper therefore aims to analyse how social group dynamics influence physical activity and inactivity in informal social environments and whether physical activity is influenced by the socio-cultural settings.MethodsThe paper presents the qualitative data collected within a covert participant observation study. Data was collected by keeping observational notes in order to record typical, regular patterns regarding physical (in)activity related behaviour of groups at an artificial open air swimming pool in Germany and a natural pond in Hawai’i. The data collection period was eight and a half months. Data was interpreted based on constant comparative analysis in order to identify most generative patterns in the field notes.ResultsGroup structures appear to play a significant role regarding the activity of the group members. In this study, we identified four key factors that influence group based physical activity: 1) Physical activity seems to be a group disturbing behaviour particularly in larger groups of adults; 2) Physical activity appears to be more functional and less joyful in adults than in children; 3) Group activity is influenced by (in)activity anchors, including ‘domestication’ of a group’s site, obesity, and controlling parents. 4) Physical activity is to a certain extent socially contagious, particularly with regard to playful activities.ConclusionsSuccessful promotion of physical activity should target the social structures of inactive individuals’ groups. In this regard, one of the main problems is that fun and wellbeing, as very important targets of public health strategies for the adult population, appear not to be compatible with physical activity. Developing strategies to reframe physical activity rather as ‘fun’ and less as functional may be one way to engage inactive individuals in physical activity in leisure settings.

Previous studies have revealed that physical activity can affect brain function and cognitive decline. Additionally, we confirmed that brain activation in the prefrontal cortex (PFC) during a cognitive task was correlated with cognitive function. Based on these findings, we hypothesized that brain activation also affects cognitive function, which increases due to stimulation from physical activity. The purpose of this study was to verify causal relationships between physical activity, PFC activation, and cognitive function using the statistical method of path analyses in a multi-model approach. Forty-six healthy volunteers (10 males, mean age: 76.1, standard deviation: 6.8) participated in this study. Informed consent was obtained from all participants prior to enrollment. This study was approved by the Ethics Committee of Seirei Christopher University (approval No. 10067). We assessed physical activity via participants' self-reports, determined PFC activation during a dual task using near-infrared spectroscopy, and measured cognitive function with the Trail-Making Test Part B. To determine the causal relationship between physical activity, PFC activation, and cognitive function, path analyses were conducted using AMOS 16 structural equation modeling. The structural equation model was a good fit (root mean square error of approximation = 0.001). Several significant direct paths were identified: (1) from physical activity to PFC activation (b = 0.37), and (2) from PFC activation to cognitive function (b = 0.32). This study statistically revealed the causal relationships between physical activity, PFC activation, and cognitive function. Path analyses indicated that physical activity affected cognitive function via PFC activation.

Brazilian fitness programme registers health benefits