Baseline Physical Activity Levels Research Articles

Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level. Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m2, 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m2, 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53-0.81] and severe obesity (OR 0.56, 95% CI 0.42-0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06-1.29) among the obese patients. Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.

Postoperative recovery of accelerometer-based physical activity in older cancer patients

IntroductionRecovery of physical activity is an important functional outcome measure after cancer surgery. However, objective data on physical activity for older cancer patients is scarce. The aims of this study were to quantify perioperative physical activity levels, assess recovery of physical activity three months after surgery, and characterise patients who achieved recovery. Materials and methodsThis observational cohort study analysed physical activity data collected from patients aged >65 who were scheduled for cancer surgery between May 2018 and July 2019. Perioperative daily step count was measured using a Fitbit device. The primary outcome measure was the percentage of patients who returned to (≥90% of) their preoperative (baseline) physical activity levels three months after surgery. ResultsFifty patients (mean age 73) were recruited, and available Fitbit data was analysed. Median daily step counts at baseline (n = 40), before hospital discharge (n = 40), and three months postoperative (n = 37) were 5,974 (IQR 4,250–7,922), 1,619 (IQR 920–2,839), and 4,674 (IQR 3,047–7,592), respectively. The 15/37 (41%) patients who had reached baseline levels three months after surgery seemed to have more preoperative self-reported physical activity, better anaesthesiologists’ physical status classification, and fewer in-hospital complications compared to patients who had not, although the differences were statistically non-significant. ConclusionPerioperative physical activity was quantified for older cancer patients, and 41% returned to baseline levels within three months. Accelerometer-based physical activity provided a valuable outcome measure for postoperative physical recovery. Future studies using objective physical activity measures are needed to evaluate effects of interventional studies aimed at improving physical activity.

Meal Habits, Body Fat Composition and Mood Status in Young Adults

Abstract Objectives To examine the association between meal habits (i.e., eating breakfast every day, usually ≥80% fullness at breakfast, and not eating snacks at night), body composition and the subsequent changes in mood status in young adults. Methods This is a longitudinal follow-up study based on a randomized trial (ClinicalTrials.gov Identifier: NCT03828812). Young adults were recruited based in a university campus in Taipei City, Taiwan. In total, 125 participants were recruited and 103 completed the follow-ups. Measured body composition (TANITA BC-418) and moods (Depression Anxiety Stress Scale, DASS) were assessed at baseline, the third month and 15th month from baseline. Baseline meal habits were based on the participants’ recall of their diets in the month before interview. We used mixed-effect model to test the association of baseline total body fat percentage and trunk body fat percentage and moods during follow-ups, adjusting for age, sex, baseline body mass index (BMI), food security status. Results After controlling for sex, age, BMI, and food security status at baseline, having breakfast every day at baseline was associated with 2.04 (se = 0.78, P = 0.0098) lower anxiety score and with 2.58 (se = 1.26, P = 0.0409) lower stress score at baseline. Meal habits were not associated with the subsequent changes in mood status. As for body composition, one % of trunk body fat replacing one % of non-trunk body fat at baseline was associated with 1.19 (se = 0.57, P = 0.0381) higher depression score, 1.02 (se = 0.47, P = 0.0327) higher anxiety score, 2.06 (se = 0.76, P = 0.0075) higher anxiety score at baseline. One % of non-trunk body fat percentage was associated with 2.60 (se = 1.02, P = 0.0116) lower anxiety score, as trunk body fat % is controlled. Baseline body fat composition parameters were not associated with the temporal changes in mood scores. The significance patterns were similar after adjusting for baseline physical activity level, assessed by International Physical Activity Questionnaire. Conclusions Breakfast habits and body composition, especially trunk body fat, was associated with university-based young adults’ emotional health status. Funding Sources Ministry of Science and Technology, Taiwan.

Physical activity and risk of cardiovascular events and all-cause mortality among kidney transplant recipients.

Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs. A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan-Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time. Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59-0.98]}, CVD mortality [HR 0.58 (95% CI 0.35-0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59-0.98)]. Results were similar in unadjusted models. PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.

Prospective associations between physical activity levels and white matter integrity in older adults: results from the MAPT study

BackgroundHigher levels of physical activity (PA) are known to be associated with better white matter integrity measured by diffusion tensor imaging (DTI) in older adults in cross-sectional studies. However, no studies have investigated the association between PA levels and the evolution of DTI parameters (fractional anisotropy and mean diffusivity). ObjectivesTo examine the cross-sectional associations between PA levels and DTI parameters, then to investigate the association between baseline PA levels and the evolution of DTI parameters in older adults. MethodsData on magnetic resonance imaging with DTI method from the Multidomain Alzheimer’s Preventive Trial (MAPT) study were used; 228 participants had data on DTI measured at three time-points over five years. Fractional anisotropy and mean diffusivity were acquired for six different brain regions. ResultsNo significant associations were found in the cross-sectional analyses. Only one association was found: compared with active individuals, a faster worsening in the mean diffusivity of the uncinate fasciculus region was found in inactive individuals (-5.0 × 10-6 (-9.5 × 10-5, 4.9 × 10-6)). ConclusionsIn this study, we found that the condition of the uncinate fasciculus region may be susceptible to changes in PA levels in older adults. Longitudinal studies that assess fitness and PA using objective measurements (e.g. cardiorespiratory fitness and accelerometry) could shed some new light on this topic.

Association between physical activity and subsequent changes in disease activity in people living with rheumatoid arthritis

Various studies have demonstrated how rheumatoid arthritis (RA) patients perform less physical activity than the general population, likely due to joint pain and impaired physical function. However, physical activity (PA) may have beneficial effects on reducing inflammation and RA disease activity. The objective of this study was to evaluate the association between baseline PA levels and self-reported changes in measures of RA disease activity.
 
 We conducted a longitudinal study using 2015-2017 data from an annual survey administered to an RA cohort in BC. Subjects were grouped into three levels (Low, Medium and High) of PA at the baseline year (2015) according to the specifications of the International Physical Activity Questionnaire. Subsequently, we examined whether baseline PA was associated with changes in RA disease activity outcomes over 2015 to 2017, using fitted linear mixed models for each measure and adjusting for age, sex and other covariates.
 
 Of the 169 patients who responded to the 2015 survey, 29.6%, 42.0%, and 28.4% were grouped into Low, Medium, and High levels of PA, respectively. Our results demonstrated that the Low PA group experienced significant worsening of disease activity outcomes over the three years, including those of the Rheumatoid Arthritis Disease Activity Index (RADAI) (p=0.007), Fatigue (p=0.007), and Pain (p=0.007). Those in the Medium and High PA groups at baseline experienced either a decrease or no change in their disease activity outcomes over time. These results add to the accumulating evidence that physical activity may reduce disease activity and is essential to RA management.

Abstract 54: Addressing Cardiovascular Health Using Artificial Intelligence: Randomized Clinical Trial to Increase Physical Activity in Cancer Survivors Using Intelligent Voice Assist (Amazon Alexa) for Patient Coaching

Importance: Physical Activity (PA) has numerous health benefits to cancer survivors, but motivation remains problematic. Coaching may increase PA and improve survivorship outcomes, but it is challenging to deliver personalized coaching at scale Objective: To determine if the use of a novel Artificial Intelligence (AI) agent delivered by smart speaker (Amazon Echo) increases PA among overweight or obese cancer survivors compared to autonomous SMS or standard health education publications Method: A single center 3-arm randomized clinical trial in Maryland, USA with 1:1:1 allocation. One-week base-line period followed by 4-week interventions. Participants were adult overweight or obese physically inactive cancer survivors (who completed their active treatments three or more months prior to the time of recruitment) with an emphasis on racial/ethnic minorities. Interventions were: (A) on-demand AI coaching using interactive digital voice assist on Amazon Echo; (B) autonomous data-driven text message via mobile phone; or (C) NCI health education materials about the benefit of PA for cancer survivors (Control). Outcome was the change in average steps per day from baseline to the end of follow-up Results: Of 90 candidates, 42 were enrolled and randomized (N=14 in each arm). 90.5% of the participants were female, 36% Black/African American, average age was 62.1(SD 9.8) years, with average BMI of 32.9(SD 5.0). The majority were breast cancer survivors (85.7%). No differences in baseline characteristics or baseline PA levels found between the groups. After 4-week intervention, only group (A) achieved significant gain in PA adding 3618.2 steps/day (95% CI: 2490.1 - 4764.2, P <0.001). Group (A) also achieved significant net gain in PA compared to group (B) & (C), table 1. Group (A) also peaked around 10k steps/day each week, figure 1. Conclusions: Using AI voice-assist may be a practical method to deliver scalable individualized behavioral health coaching to address cardiovascular health in cancer survivors.

Characterising a Weight Loss Intervention in Obese Asthmatic Children.

The prevalence of obesity in asthmatic children is high and is associated with worse clinical outcomes. We have previously reported that weight loss leads to improvements in lung function and asthma control in obese asthmatic children. The objectives of this secondary analysis were to examine: (1) changes in diet quality and (2) associations between the baseline subject characteristics and the degree of weight loss following the intervention. Twenty-eight obese asthmatic children, aged 8–17 years, completed a 10-week diet-induced weight loss intervention. Dietary intake, nutritional biomarkers, anthropometry, lung function, asthma control, and clinical outcomes were analysed before and after the intervention. Following the intervention, the body mass index (BMI) z-score decreased (Δ = 0.18 ± 0.04; p < 0.001), %energy from protein increased (Δ = 4.3 ± 0.9%; p = 0.002), and sugar intake decreased (Δ = 23.2 ± 9.3 g; p= 0.025). Baseline lung function and physical activity level were inversely associated with Δ% fat mass. The ΔBMI z-score was negatively associated with physical activity duration at baseline. Dietary intervention is effective in achieving acute weight loss in obese asthmatic children, with significant improvements in diet quality and body composition. Lower lung function and physical engagement at baseline were associated with lesser weight loss, highlighting that subjects with these attributes may require greater support to achieve weight loss goals.

Physical activity calorie expenditure (PACE) labels in worksite cafeterias: effects on physical activity

BackgroundRegular physical activity is an important component of healthy living and wellbeing. Current guidelines recommend that adults participate in at least 150 min of moderate or vigorous-intensity physical activity weekly. In spite of the benefits, just over half of U.S. adults meet these recommendations. Calorie-only food labels at points of food purchase have had limited success in motivating people to change eating behaviors and increase physical activity. One new point of purchase approach to promote healthy behaviors is the addition of food labels that display the physical activity requirement needed to burn the calories in a food item (e.g. walk 15 min).MethodsThe Physical Activity Calorie Expenditure (PACE) Study compared activity-based calorie-expenditure food labels with calorie-only labels at three Blue Cross and Blue Shield of North Carolina worksite cafeterias. After 1 year of baseline data collection, one cafeteria had food items labeled with PACE labels, two others had calorie-only food labels. Cohort participants were asked to wear an accelerometer and complete a self-report activity questionnaire on two occasions during the baseline year and twice during the intervention year.ResultsA total of 366 study participants were included in the analysis. In the PACE-label group, self-reported physical activity increased by 13–26% compared to the calorie-only label group. Moderate-to-vigorous physical activity (MVPA) increased by 24 min per week in the PACE-label group compared to the calorie-label group (p = 0.06). Changes in accelerometer measured steps, sedentary time, and MVPA had modest increases. Change ranged from 1 to 12% with effect size values from 0.08 to 0.15. Baseline physical activity level significantly moderated the intervention effects for all physical activity outcomes. Participants in both label groups starting in the lowest tertile of activity saw the largest increase in their physical activity.ConclusionResults suggest small positive effects for the PACE labels on self-reported and objective physical activity measures. Minutes of weekly MVPA, strength training, and exercise activities showed modest increases. These results suggest that calorie-expenditure food labels may result in some limited increases in physical activity.

Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis.

The aim of this study was to examine the use of pedometers as a tool to promote daily physical activity levels in patients with COPD.A systematic review meta-analysis of pedometer physical activity promotion in patients with COPD was conducted. Medline/PubMed, Cochrane Library, Web of Science and CINAHL were searched from inception to January 2019. The search strategy included the following keywords: physical activity promotion, pulmonary rehabilitation and daily physical activity. The eligibility criteria for selecting studies were randomised controlled trials reporting pedometer physical activity promotion in patients with COPD.Improvements in steps per day were found with pedometer physical activity promotion either standalone (n=12, mean 0.53 (95% CI 0.29-0.77); p=0.00001) or alongside pulmonary rehabilitation (n=7, 0.51 (0.13-0.88); p=0.006). A subgroup analysis reported significant differences in the promotion of physical activity based on baseline physical activity levels and the type of instrument used to assess levels of physical activity.Future trials should consider the way in which pedometers are used to promote physical activity to inform clinical practice in the setting of pulmonary rehabilitation.

Neighborhood walkability and 12-year changes in cardio-metabolic risk: the mediating role of physical activity

BackgroundLiving in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers.MethodsThe Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999–2000, 2004–05, and 2011–12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants’ homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation.ResultsThere was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P < 0.001), and high-density lipoprotein cholesterol (P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590).ConclusionsOur mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.

The Roles of Physical Activity and Inflammation in Mortality, Cognition, and Depressive Symptoms Among Older Mexican Americans.

A higher level of physical activity (PA) is associated with decreased risk of mortality, dementia, and depression, yet the mechanisms involved are not well understood, and little evidence exists for Mexican Americans. With data from the Sacramento Area Latino Study on Aging (1998-2007), we used Cox proportional hazards regression to separately evaluate associations of baseline PA level with mortality, dementia/cognitive impairment without dementia (CIND), and depressive symptoms, and we estimated the mediating effects of inflammatory markers in additive hazard models. A low level of PA (<35 metabolic equivalent of task-hours/week) was associated with increased mortality (hazard ratio (HR) = 1.50, 95% confidence interval (CI): 1.20, 1.88), dementia/CIND (HR = 1.37, 95% CI: 0.96, 1.96), and depressive symptoms (HR = 1.23, 95% CI: 1.00, 1.52). A low PA level added 512 (95% CI: -34, 1,058) cases of dementia/CIND per 100,000 person-years at risk (direct effect), while, through a mediating path, interleukin 6 (IL-6) added another 49 (95% CI: 5, 94) cases, or 9% of the total effect. For mortality, 8%-10% of the PA total effect was mediated through IL-6, tumor necrosis factor α (TNF-α), or TNF-α receptors. None of the inflammatory markers mediated the association between PA and depressive symptoms. Our results suggest that antiinflammation (especially as assessed by IL-6 and TNF-α levels) may partly explain how PA protects against dementia/CIND and mortality.

A Mobility-Focused Knowledge Translation Randomized Controlled Trial to Improve Physical Activity: Process Evaluation of the Move4Age Study.

BackgroundMaintaining physical activity and physical function is important for healthy aging. We recently completed a randomized controlled trial of a targeted knowledge translation (KT) intervention delivered through the McMaster Optimal Aging Portal with the goal to increase physical activity and physical mobility in middle-aged and older adults, with results reported elsewhere.ObjectiveThe purpose of this process evaluation study is to explore which KT strategies were used by both intervention and control group participants, as well as the intervention groups’ engagement, satisfaction, and perceived usefulness of the targeted KT intervention.MethodsData on engagement with the intervention materials were gathered quantitatively through Google Analytics and Hootsuite throughout the intervention. Qualitative data were collected through a combination of open-ended surveys and qualitative interviews with a subset of participants at the end of the study to further understand engagement, satisfaction, and usefulness of the KT strategies.ResultsThroughout the intervention period, engagement with content delivered through weekly emails was highest, and participants rated email content most favorably in both surveys and interviews. Participants were generally satisfied with the intervention, noting the ease of participating and the distillation of information in an easy-to-access format being beneficial features. Participants who did not find the intervention useful were those with already high levels of baseline physical activity or physical function and those who were looking for more specific or individualized content.ConclusionsThis process evaluation provides insight into our randomized controlled trial findings and provides information that can be used to improve future online KT interventions.Trial RegistrationClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/nct02947230 (Archived by WebCite at http://www.webcitation.org/78t4tR8tM)

An m-Health Intervention Using a Smartphone App to Improve Physical Activity in College Students: A Randomized Controlled Trial (P16-025-19)

ObjectivesDetermine the efficacy of a 12-week mobile health (m-Health) intervention with the goal of increasing daily step counts on physical activity, improve body mass index (BMI), and body fat mass among college students. MethodsA 12- week randomized control trial was conducted. College students (n = 130) between 18–30 years of age were randomized to one of two conditions: Intervention (n = 65) and control (n = 65). All participants then had the Smartphone app downloaded onto their mobile phone to record their daily step count in order to provide a measurement of their baseline physical activity levels. Intervention group received physical activity goals of (10,000 step/day), information on the benefits of exercise, and automatic feedback. Control group received information on the benefits of exercise without any kind of intervention. The primary change was daily step count between baseline and follow-up. ResultsIn this study, there were no significant intervention effects for BMI, fat mass and % body fat. Significant intervention effects were found for body weight (mean ± SE: 0.419 ± 0.164; P = 0.013). Physical activity as expressed by step counts significantly increased from baseline to post intervention (10,022 weekly/step; P = 0.008). Despite this, post intervention changes in outcomes were not significantly different from controls. ConclusionsThe m-Health appeared to be feasible and acceptable. In this study, the results demonstrate that (m-Health) app can significantly increase physical activity in a college student sample by setting specific goal, using self monitoring and feedback. Funding SourcesNone.

Change in Physical Activity and Cardiac Structure over 10 Years: The Multi-Ethnic Study of Atherosclerosis.

Physical activity (PA) is inversely associated with risk of heart failure and cardiovascular disease (CVD), whereas increased left ventricular (LV) mass and mass to volume (m:v) ratio are unfavorable CVD risk factors. We assessed whether changes in leisure time PA were associated with longitudinal changes in cardiac structure in a community-based population. We included 2779 Multi-Ethnic Study of Atherosclerosis participants, free of baseline CVD, who had available data on PA and cardiac magnetic resonance imaging at examinations 1 (2000-2002) and 5 (2010-2012). Physical activity was measured by a Typical Week PA Survey and converted to MET-minutes per week of moderate+vigorous activity. We used linear mixed effect models to estimate the associations of baseline and change in PA with baseline and change in cardiac structure, adjusting for CVD risk factors and body size. At baseline, the mean age was 59 yr, 53% were women, and 58% of nonwhite race/ethnicity. During average 10-yr follow-up, and after accounting for baseline PA levels, the highest quintiles of PA increase were significantly associated with increases in LV mass (2.3 g; 95% confidence interval [CI], 0.4-4.2), LV end-diastolic volume (4.7 mL; 95% CI, 2.4-7.0), and stroke volume (3.3 mL; 95% CI, 1.6-5.1), but lower M:V ratio (-2.9; 95% CI, -5.0 to -0.8) compared with the lowest quintiles. Increasing exercise PA was associated with increases in LV diameter and reductions in M:V ratio, whereas occupational PA was associated with increases in m:v ratio. Increasing PA over 10 yr was also associated with greater risk of eccentric dilated LV hypertrophy at examination 5. After accounting for baseline PA, greater positive changes in leisure-time PA levels were associated with a more eccentric-type of LV remodeling pattern over 10 yr. The clinical implications of such findings remain to be determined.

Pilot feasibility study of the Walking Away from Diabetes programme for adults with intellectual disabilities in two further education colleges: Process evaluation findings

People with intellectual disabilities remain at high risk of developing type 2 diabetes (T2D) due to lifestyle-associated risk factors. Educational programmes have been adapted for people with intellectual disabilities targeting ongoing T2D self-management. However, there are no adapted programmes which aim to prevent T2D through reducing risk factors. The present study initiates addressing this gap. Further education (FE) colleges in Scotland were recruited for feasibility study using the Walking Away (WA) from Diabetes programme. Process evaluation assessed recruitment, retention, baseline physical activity levels, and acceptability and accessibility using focus groups. Ninety six percent of invited students agreed to participate. WA was positively received, and some short-term impact was described. Suggestions for further adaptations regarding materials, delivery and content were provided, including delivery embedded within FE college curriculum. Recruitment, retention and acceptability provide rationale for further research on T2D prevention in FE colleges.

Abstract MP35: Physical Activity and Risk of Cardiovascular Events and All-Cause Mortality Among Kidney Transplant Recipients

Introduction: Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events and all-cause mortality among a cohort of KTRs. Methods: N = 4377 participants were examined from a large, multiethnic, multicenter trial (37% female; mean age 51.9 ± 9.4 years; 75% White; 20% with prevalent CVD). PA was measured at baseline and was derived from a modified PA summary score from the Yale Physical Activity Survey (YPAS) and divided into tertiles (T1, T2, T3), from lowest to highest PA. Kaplan-Meier survival curves were used to graph the risk of CVD events and all-cause mortality between PA tertiles. Cox proportional hazards regression models were constructed to examine the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction, CVD death) and all-cause mortality over time. There was no violation of the proportional hazards assumption. Covariates include age, sex, race, smoking status, diastolic blood pressure, blood lipids, BMI, transplant vintage, and donor type. Results: Participants were followed up to 2,500 days. The cohort reported 486 CVD events and 419 deaths. Fully adjusted models revealed that compared to the lowest tertile, the highest tertile had significantly lower risk of: CVD events (HR, 0.628, 95% CI, 0.499-0.790) and all-cause mortality (HR, 0.533, 95% CI, 0.414-0.688). Compared to middle T2 scores, T3 of PA scores had significantly lower: risk of CVD events (HR, 0.709, 95% CI, 0.563-0.895) and all-cause mortality (HR, 0.635, 95% CI, 0.491-0.822). Results were similar in unadjusted models. Conclusion: Physical activity was associated in a dose-response manner with a reduced risk of CVD events and all-cause mortality in kidney transplant recipients. These observed associations in a large, international sample of KTRs, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs. Future work to confirm these associations and to determine whether increasing PA will reduce risk in KTRs is needed, which may help inform if PA should be integrated into lifestyle management strategies among KTRs.

Pattern of Habitual Physical Exercise in Myasthenia Gravis Patients

Notwithstanding the amount of deliberate exercise, the daily patterns of active versus sedentary behavior have a major influence on health outcomes [1]. Patterns of habitual active and sedentary behavior in Myasthenia Gravis (MG) patients, as well as their possible relations to disease activity, are not known. To evaluate baseline patterns of physical and sedentary behavior in MG patients. Activity patterns of twenty-seven MG patients were assessed by a Dynaport MoveMonitor (McRoberts) accelerometer, worn for seven consecutive days. The amount of time spent in moderate and vigorous intensity activities, physical activity level (PAL), number of steps/day and sedentary time were assessed and correlations to disease severity were analyzed. The results were compared to general recommendations and published data of healthy individuals and to data of patients with the chronic disorders chronic obstructive pulmonary disease (COPD) and mitochondrial myopathy. MG patients had sedentary behavior during 78±7% of the day. There was neither a correlation between disease severity and number of steps/day (R = -0.15; p = 0.56) nor between disease severity and PAL (R = 0.33; p = 0.26). Nevertheless, the MG patients met the recommendations of daily deliberate exercise (181±158 MET min/day). PAL was lower in MG patients (1.5±0.138) than in healthy individuals (1.67±0.145, p < 0.00001). Although a majority of MG patients meet the recommendations of deliberate exercise, their baseline physical activity levels are dominated by sedentary behavior. In comparison with a healthy population, MG patients are less physically active, but the reason for this remains unclear with no correlations between disease severity and physical activity patterns.

Understanding the Effect of Adding Automated and Human Coaching to a Mobile Health Physical Activity App for Afghanistan and Iraq Veterans: Protocol for a Randomized Controlled Trial of the Stay Strong Intervention.

BackgroundAlthough maintaining a healthy weight and physical conditioning are requirements of active military duty, many US veterans rapidly gain weight and lose conditioning when they separate from active-duty service. Mobile health (mHealth) interventions that incorporate wearables for activity monitoring have become common, but it is unclear how to optimize engagement over time. Personalized health coaching, either through tailored automated messaging or by individual health coaches, has the potential to increase the efficacy of mHealth programs. In an attempt to preserve conditioning and ward off weight gain, we developed Stay Strong, a mobile app that is tailored to veterans of recent conflicts and tracks physical activity monitored by Fitbit Charge 2 devices and weight measured on a Bluetooth-enabled scale.ObjectiveThe goal of this study is to determine the effect of activity monitoring plus health coaching compared with activity monitoring alone.MethodsIn this randomized controlled trial, with Stay Strong, a mobile app designed specifically for veterans, we plan to enroll 350 veterans to engage in an mHealth lifestyle intervention that combines the use of a wearable physical activity tracker and a Bluetooth-enabled weight scale. The Stay Strong app displays physical activity and weight data trends over time. Enrolled participants are randomized to receive the Stay Strong app (active comparator arm) or Stay Strong + Coaching, an enhanced version of the program that adds coaching features (automated tailored messaging with weekly physical activity goals and up to 3 telephone calls with a health coach—intervention arm) for 1 year. Our primary outcome is change in physical activity at 12 months, with weight, pain, patient activation, and depression serving as secondary outcome measures. All processes related to recruitment, eligibility screening, informed consent, Health Insurance Portability and Accountability Act authorization, baseline assessment, randomization, the bulk of intervention delivery, and outcome assessment will be accomplished via the internet or smartphone app.ResultsThe study recruitment began in September 2017, and data collection is expected to conclude in 2019. A total of 465 participants consented to participate and 357 (357/465, 77%) provided baseline levels of physical activity and were randomized to 1 of the 2 interventions.ConclusionsThis novel randomized controlled trial will provide much-needed findings about whether the addition of telephone-based human coaching and other automated supportive-coaching features will improve physical activity compared with using a smartphone app linked to a wearable device alone.Trial RegistrationClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293 (Archived by WebCite at http://www.webcitation.org/75KQeIFwh)International Registered Report Identifier (IRRID)DERR1-10.2196/12526

Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial.

Lack of physical activity (PA), weight gain, and overweight have been associated with increased risk of recurrence and mortality after breast cancer diagnosis. We evaluated the feasibility of implementing an individualized exercise program and nutritional counseling during adjuvant treatment of localized invasive breast cancer. Sixty-one patients eligible for adjuvant chemotherapy were randomized 2:1 to receive a 6-month program of weekly aerobic exercises associated with nutritional counseling (n = 41) or usual care with nutritional counseling (n = 20, one withdrawal). The primary endpoints were the proportion of patients compliant with two weekly supervised sessions and their overall adherence (i.e., proportion of supervised and unsupervised sessions completed versus planned sessions). Ten percent of patients in the intervention group were compliant with the two weekly supervised sessions for 6months, but the overall median adherence rate was 85% of supervised and non-supervised sessions completed. Non-adherence was mainly due to intrinsic reasons (medical, organizational, psychological barriers). Adherence was positively associated with education and baseline PA level and inversely associated with baseline weight and tumor grade. No statistically significant benefits were observed in the intervention group, even if overall PA level and body composition improved and anthropometrics were maintained over time (p < 0.05). Overall, there was good adherence with the 6-month exercise program during adjuvant treatment for breast cancer, despite poor compliance to twice-weekly supervised sessions. This study highlights the need for flexible exercise modalities and innovative experimental design to reach patients who would most adhere and benefit from intervention. ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1.