Changes In Physical Activity Habits Research Articles

Impact of changes in physical activity and incident fracture after acute ischemic stroke

Stroke survivors are at an increased risk of falls and fractures. Physical activity is inversely associated with the fracture risk in the general population. However, the association between incident fracture risk and changes in habitual physical activity before and after an index stroke remains unclear. This study attempted to explore the association between incident fracture risk and changes in physical activity after stroke. Using the claims database of the National Health Insurance Program in Korea, participants with their first ischemic stroke between 2010 and 2016 were enrolled in the study. The participants were divided into four groups according to changes in physical activity habits evaluated using two consecutive self-reported questionnaires before and after stroke, if available: persistent non-exercisers, exercise dropouts, new exercisers, and persistent exercisers. The primary outcome was a composite of vertebral, hip, and other fractures. We performed multivariable Cox proportional hazard regression analysis and provided adjusted hazard ratios and 95% confidence intervals for each outcome. Among 202,234 participants included from 1,005,879 datasets, 16,621 (8.22%) experienced any type of fracture as the primary outcome. After multivariable adjustment, exercise dropouts (n = 37,106), new exercisers (n = 36,821), and persistent exercisers (n = 74,647) had a significantly reduced risk of any type of fracture (aHR 0.932, 95% CI 0.893–0.973; aHR 0.938, 95% CI 0.900–0.978; aHR 0.815, 95% CI 0.780–0.852, respectively) compared to the persistent non-exercisers (n = 53,660). Furthermore, regardless of pre-stroke exercise status, those who exercised ≥ 1000 metabolic equivalents of tasks post-stroke had a significantly reduced risk of fractures. Initiating or continuing moderate-to-vigorous regular physical activity after acute ischemic stroke was associated with a significantly lower risk of incident fractures, including hip, vertebral, and other types.

Changes in physical activity habits in subjects with type 1 diabetes: A comparative study 10 years apart

IntroductionPhysical activity (PA) is highly recommended in type 1 diabetes (T1D). Few studies have reported the amount of PA performed by individuals with T1D in their daily life, and there is no information about changes over time. Material and methodsCross-sectional study in patients with T1D from a referral hospital recruited in two different periods: data from the Biobank registers from 2009 and data from patients attending visits at the hospital in 2019, on a consecutive basis. Data included clinical characteristics and the PA assessment through the International Physical Activity Questionnaire-short form (IPAQ-SF). ResultsIn 2019, participants with T1D (n=135) reported a lower sedentary lifestyle and greater levels of high PA compared to subjects with T1D (n=355) from 10 years earlier (6.7% vs. 14.1% sedentariness, p=0.015; and 52.6% vs. 25.4% of high PA, p<0.001, respectively). Similar results were identified when the groups were divided according to sex. Both groups presented similar distribution by sex (women, 54% vs. 55%), age (40 vs. 39 years old), years with diabetes (20 vs. 18 years), BMI (25 vs. 24kg/m2) and glycated haemoglobin (7.5% vs. 7.5%, respectively; p>0.05 for all comparisons). Sex and age groups were not determinant for sedentary lifestyle in the different years studied.Analysing all the 490 participants, there was an inverse correlation of age with sitting hours (p=0.024, r=−0.102), total METs (p<0.001, r=−0.146) and HbA1c (p=0.038, r=−0.097). No correlations were found between PA and HbA1c or BMI. ConclusionsThe findings indicate that PA has significantly increased in subjects with T1D over the last 10 years. Future studies are needed to assess whether these healthier habits translate into better outcomes in this high-risk population.

Impact of Fitness Influencers on the Level of Physical Activity Performed by Instagram Users in the United States of America: Analytical Cross-Sectional Study.

Physical activity positively influences the general population's health. Social media networks may promote changes in physical activity habits. This study aimed to analyze the relation between being encouraged to perform physical activity by fitness influencers on Instagram and the level of physical activity performed. An analytical cross-sectional study was performed in 890 United States residents with an Instagram account. The sample was made up of 79.2% females and of 75.4% millennials (born between 1981-1996). Physical activity was measured with the International Physical Activity Questionnaire. Sociodemographic characteristics were registered. The percentage of females (p = 0.001), millennials (p &lt; 0.001), students (p &lt; 0.001), participants with normal BMI (p = 0.001), and participants performing more than 150 min per week of moderate physical activity (p = 0.014) was significantly higher in the group that felt encouraged to perform physical activity by the information posted by fitness influencers. This group spent a median of 2 h per week on Instagram checking for nutrition or exercise (p &lt; 0.001). United States residents who felt encouraged to perform physical activity by fitness influencers on Instagram achieved more the World Health Organization recommendations for substantial health benefit for moderate physical activity. They were predominantly females and millennials with normal weight and spent more time on Instagram checking for nutrition or exercise.

Social influences on physical activity for establishing criteria leading to exercise persistence.

Despite well-documented health benefits from exercise, a study on national trends in achieving the recommended minutes of physical activity guidelines has not improved since the guidelines were published in 2008. Peer interactions have been identified as a critical factor for increasing a population's physical activity. The objective of this study is for establishing criteria for social influences on physical activity for establishing criteria that lead to exercise persistence. A system of differential equations was developed that projects exercise trends over time. The system includes both social and non-social influences that impact changes in physical activity habits and establishes quantitative conditions that delineate population-wide persistence habits from domination of sedentary behavior. The model was generally designed with parameter values that can be estimated to data. Complete absence of social or peer influences resulted in long-term dominance of sedentary behavior and a decline of physically active populations. Social interactions between sedentary and moderately active populations were the most important social parameter that influenced low active populations to become and remain physically active. On the other hand, social interactions encouraging moderately active individuals to become sedentary drove exercise persistence to extinction. Communities should focus on increasing social interactions between sedentary and moderately active individuals to draw sedentary populations to become more active. Additionally, reducing opportunities for moderately active individuals to engage with sedentary individuals through sedentary social activities should be addressed.

Changes in physical activity habits in subjects with type 1 diabetes: A comparative study 10 years apart

IntroductionPhysical activity (PA) is highly recommended in type 1 diabetes (T1D). Few studies have reported the amount of PA performed by individuals with T1D in their daily life, and there is no information about changes over time. Material and methodsCross-sectional study in patients with T1D from a referral hospital recruited in two different periods: data from the Biobank registers from 2009 and data from patients attending visits at the hospital in 2019, on a consecutive basis. Data included clinical characteristics and the PA assessment through the International Physical Activity Questionnaire-short form (IPAQ-SF). ResultsIn 2019, participants with T1D (n=135) reported a lower sedentary lifestyle and greater levels of high PA compared to subjects with T1D (n=355) from 10 years earlier (6.7% vs. 14.1% sedentariness, p=0.015; and 52.6% vs. 25.4% of high PA, p<0.001, respectively). Similar results were identified when the groups were divided according to sex. Both groups presented similar distribution by sex (women, 54% vs. 55%), age (40 vs. 39 years old), years with diabetes (20 vs. 18 years), BMI (25 vs. 24kg/m2) and glycated haemoglobin (7.5% vs. 7.5%, respectively; p>0.05 for all comparisons). Sex and age groups were not determinant for sedentary lifestyle in the different years studied.Analysing all the 490 participants, there was an inverse correlation of age with sitting hours (p=0.024, r=−0.102), total METs (p<0.001, r=−0.146) and HbA1c (p=0.038, r=−0.097). No correlations were found between PA and HbA1c or BMI. ConclusionsThe findings indicate that PA has significantly increased in subjects with T1D over the last 10 years. Future studies are needed to assess whether these healthier habits translate into better outcomes in this high-risk population.

Does Change in Physical Activity During the Initial Phase of the COVID-19 Pandemic Predict Psychological Symptoms in Physically Active Adults? A Six-Month Longitudinal Study.

Objectives: The current study aimed to investigate if change in physical activity during the initial phase of the COVID-19 pandemic predicted severity of anxiety and depression symptoms 6 months later in physically active adults. Methods: A total of 855 respondents (32.6% women) completed the Hospital Anxiety and Depression Scale (HADS) at two time points and reported change in physical activity habits in the first 3 months of the COVID-19 lockdown in Norway. Results: Women had higher prevalence rates than men for both anxiety and depression symptoms in the Unchanged, Increased and Decreased physical activity (PA) subgroups. Women and men who reported Increased PA at baseline were associated with increased risk for anxiety symptoms at time 2. Increased PA was associated with higher risk for depression at time 2 for women, but not for men. Conclusion: The results indicate that the COVID-19 pandemic is associated with deterioration in mental health also for physically active adults.

COVID-19 lockdown and physical activity changes in Italy: a cross-sectional survey

BackgroundThe global pandemic of COVID-19 has caused radical changes in the structure of people's daily routines in most of the countries around the world and have had a big impact on physical activity (PA) and daily movement. Previous studies reported the increase of sedentary behaviours during movement restrictions. This study investigates the impact of the first Italian lockdown measures (9 march - 3 may 2020) on PA habits and factors potentially associated with starting or ceasing PA practice during home confinement.MethodsA web-based cross-sectional survey was carried out using an online 40-item questionnaire spread in May 2020 in Italy. Multivariable regressions were performed.ResultsA total of 1865 people were enrolled. During lockdown, PA was performed by 65.5% of the sample. Overall, the number of physically active people increased by 8%, compared to the pre-pandemic period level (56%). A change in PA habits occurred in 34.1% of the sample (37.9% of them stopped PA and 62.1% started it). Starting PA during lockdown was related to being on a diet, whereas living with children and having poor psychological well-being were inversely related with starting PA. Conversely, unhealthy factors like being overweight or obese, having poor mental well-being and the occurrence of emotional overeating were related to stopping PA during lockdown.ConclusionsThe first Covid-19 Italian lockdown had a significant impact on healthy habits of the population, leading to an increase of physically active individuals. Furthermore, a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.Key messages Physical activity habits changed during lockdown due to Covid-19 pandemics and a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found.European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.

Habits and Psychological Factors Associated With Changes in Physical Activity Due to COVID-19 Confinement.

The confinement that COVID-19 has brought about has had a negative influence on people’s psychological health. However, this impact is not widespread throughout the population, and men and women may be affected differently and it is not known what protective factors may exist. In this sense, physical activity has classically been shown to be a habit associated with psychological health. The study aimed to analyze the impact of confinement on psychological health (psychological well-being, coping, emotions, and perception of daily difficulties), taking into account gender, and perceived changes in physical activity. After the project was approved by the University’s Ethics Commission, the participants, after signing the informed consent, completed the online questionnaires during the days from 6 to 20 April, the time when, in Spain, confinement was in place and the highest peak of deaths and infections from COVID-19 occurred. A total of 457 Spanish participants (247 men and 210 women) were evaluated in psychological well-being, in its adaptation to Spanish, in coping, with the Spanish adaptation of the COPE Inventory, in daily habits and difficulties (ad hoc questionnaire) and the level of physical activity they had (sedentary, active, and federated players) was recorded. Besides, the perceived change in physical activity due to confinement was recorded. The results showed that perceived emotions, difficulties for certain routines, psychological well-being, and coping differed according to sex. On the other hand, depending on the change in physical activity habits, it was observed that participants who increased their physical activity responded differently in the perception of emotions, and difficulties for routines and in psychological well-being. Finally, differences were also observed in most variables between sedentary, active, and federated participants. Results are discussed highlighting the importance of physical activity as a moderating factor of the impact of confinement.

Effect of COVID-19 Pandemic on Physical Activity Habits, Musculoskeletal Pain, and Mood of Healthcare Workers.

Objectives:Self-isolation seems to be the best way to slow down the coronavirus disease 2019 (COVID-19) outbreak, but it may also have negative impact on physical and mental health. The aim of this study was to investigate the changes in physical activity habits during the outbreak and also the impact of the pandemic on musculoskeletal pain and mood in correlation with physical activity in healthcare workers.Methods:This study is conducted through Google Forms web survey platform. A total of 310 hospital staffs completed the Google Forms questionnaire in 2 weeks during lockdown and curfew period in Istanbul. The questionnaire included 60 questions including demographic, occupational, COVID-19 exposure data, physical activity habits, musculoskeletal pain, and mood.Results:There was a significant difference between physical activity habits before and after the pandemic (p<0.001). Individuals engaged in regular physical activity (regardless of duration) had significantly higher happiness ratings (p=0.002). No statistically significant difference was found between the duration of physical activity and the musculoskeletal pain during the pandemic.Conclusion:Pandemic caused a decrease in physical activity, an unhappy and anxious mood, and an increase in musculoskeletal pain of healthcare workers. Participants who were doing regular physical activity were less unhappy, but no relationship between exercise and musculoskeletal pain was found which might be related to psychosocial state of the participants who worked under great stress with high effort during the pandemic.

Mental health and sleep disturbances in physically active adults during the COVID-19 lockdown in Norway: does change in physical activity level matter?

Study objectiveTo assess mental health and sleep disturbances among physically active adults during the Norwegian lockdown caused by the coronavirus disease 2019 (COVID-19), and to investigate if change in physical activity (PA) level during the lockdown moderates the association between mental health and sleep disturbances. MethodsMembers of a Norwegian fitness association were invited to fill out an online questionnaire including the Hospital Anxiety and Depression Scale (HADS), sleep disturbances and change in PA habits (decreased, unchanged, increased) during the COVID-19 lockdown from 12 March to 15 June 2020. ResultsA sample of 1281 members aged 19–81 years were included (31% females; mean ± SD age 49 ± 11.5). Prevalence of anxiety and depressive symptoms was 9.0% and 4.4%, respectively. During the lockdown period, 13.8% reduced, 21.9% increased and 64.3% did not change PA level. In total 21.9% reported sleeping disturbances. Anxiety symptoms and depressive symptoms were statistically significantly associated with sleep disturbances. Change in PA did not influence the association between mental health and sleep. ConclusionCompared to studies from the general population during the COVID-19 pandemic levels of anxiety and depressive symptoms were substantial lower in this Norwegian sample of relatively physically active adults. Anxiety and depressive symptoms were associated with sleep disturbances, but change in PA level during the COVID-19 lockdown did not influence the association between mental health and sleep disturbances.

The Effects of Playing Pokemon Go on Physical Activity and Lifestyle Changes

Pokémon Go, an augmented reality smartphone game has been credited for improving physical activity and wellness. PURPOSE: To examine changes in physical activity habits and mental and physical wellness as a result of playing Pokémon Go. METHODS: Surveys were administered to seventeen regular Pokémon Go users, ages 18-65 years old. The survey was designed to compare time, type and frequency of physical activity (PA) as well as physical, mental and lifestyle factors prior to and following playing Pokémon Go. Paired-sample t-test compared the difference in the number of PA sessions/week before and after Pokémon. IBM SPSS Statistics version 24 were used for statistical analyses. RESULTS: For all participants surveyed, 30% of their time playing Pokémon Go is spent in a seated position (car, golf cart, other) and 70% is spent in a mode of PA (walk, bike, rollerblade). 24% of participants solely play utilizing a form of PA, while nearly half of the participants said that ≥75% of play is spent walking. Half of the participants categorized their intensity while playing as light, while the other half play with moderate intensity. Paired-sample t-test compared the difference in the number of PA sessions/week before and after Pokémon, which was 0.44±1.72 (P=0.306). 41% have engaged in more PA as a result of playing, while the difference in minutes of PA/week before and after Pokémon is only 0.147±14 min. Since beginning Pokémon, participants have moved an average of 104 km and report decreased stress and less anxiety from playing. CONCLUSION: The majority of participants who play Pokémon Go do so while walking at various intensity levels. The popular exergame can lead to an increase in physical activity frequency, however the duration of exercise does not seem to be affected. Improved wellness was also noted with reports of decreased stress and anxiety as a result of playing. Overall, Pokémon Go can have a positive influence on both physical and mental wellness.

Does cardiac rehabilitation after an acute cardiac syndrome lead to changes in physical activity habits? Systematic review.

Optimal physical activity levels have health benefits for patients with acute coronary syndrome (ACS) and are an important goal of cardiac rehabilitation (CR). The purpose of this study was to systematically review literature regarding short-term effects (<6 months after completion of CR) and long-term effects (≥6 months after completion) of standard CR on physical activity levels in patients with ACS. PubMed, EMBASE, CINAHL, and PEDro were systematically searched for relevant randomized clinical trials (RCTs) published from 1990 until 2012. Randomized clinical trials investigating CR for patients with ACS reporting physical activity level were reviewed. Two reviewers independently selected articles, extracted data, and assessed methodological quality. Results were summarized with a best evidence synthesis. Results were categorized as: (1) center-based/home-based CR versus no intervention, (2) comparison of different durations of CR, and (3) comparison of 2 types of CR. A total of 26 RCTs were included. Compared with no intervention, there was, at most, conflicting evidence for center-based CR and moderate evidence for home-based CR for short-term effectiveness. Limited evidence and no evidence were found for long-term maintenance for center-based and home-based CR, respectively. When directly compared with center-based CR, moderate evidence showed that home-based CR has better long-term effects. There was no clear evidence that increasing training volume, extending duration of CR, or adding an extra intervention to CR is more effective. Because of the variety of CR interventions in the included RCTs and the variety of outcome measures in the included RCTs, pooling of data was not possible. Therefore, a best evidence synthesis was used. It would appear that center-based CR is not sufficient to improve and maintain physical activity habits. Home-based programs might be more successful, but the literature on these programs is limited. More research on finding successful interventions to improve activity habits is needed.

Identifying barriers to remaining physically active after rehabilitation: differences in perception between physical therapists and older adult patients.

Cross-sectional study. To describe readiness for change and barriers to physical activity in older adults and to contrast perceptions of physical therapists and patients using the Barriers to Being Active Quiz. Regular physical activity is vital to recovery after discharge from physical therapy. Physical therapists are positioned to support change in physical activity habits for those transitioning to home care. Understanding of readiness for change and barriers to physical activity could optimize recovery. Thirteen physical therapists enrolled in the study and invited patients who met the inclusion criteria to enroll (79 patients enrolled). The physical therapists provided the ICD-9 code, the physical therapist diagnosis, and completed the Barriers to Being Active Quiz as they perceived their patients would. The enrolled patients provided demographics and filled out the Satisfaction With Life Scale, the stages-of-change scale for physical activity, and the Barriers to Being Active Quiz. Patients were predominantly in the early stages of readiness for change. Both patients and physical therapists identified lack of willpower as the primary barrier to physical activity. Patients identified lack of willpower and social influence as critical barriers more often than physical therapists, whereas physical therapists identified fear of injury and lack of time more often than their patients did. Differences between physical therapists and their patients were noted for fear of injury (z = 2.66, P = .008) and lack of time (z = 3.46, P = .001). The stage of change for physical activity impacted perception of social influence (χ2 = 9.64, P<.05), lack of willpower (χ2 = 21.91, P<.01), and lack of skill (χ2 = 12.46, P<.05). Women ranked fear of injury higher than men did (χ2 = 6.76, P<.01). Understanding readiness for change in and barriers to physical activity may allow physical therapists to better tailor intervention strategies to impact physical activity behavior change.

Current cardiac rehabilitation programmes are not sufficient for ACS patients to reach long-lasting changes in physical activity habits. A systematic review

Current cardiac rehabilitation programmes are not sufficient for ACS patients to reach long-lasting changes in physical activity habits. A systematic review

Working on wellness (WOW): A worksite health promotion intervention programme

BackgroundInsufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease.MethodsThe intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees’ preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N = 928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12 months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months.DiscussionThe formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention.Trial registrationUnited States Clinical Trails Register NCT 01494207

Short-term results of community-based interventions for improving physical activity: Isfahan Healthy Heart Programme.

IntroductionTo assess the effect of a comprehensive community-based programme for increasing physical activity (PA) after 2 years of interventions.Material and methodsA 6-year, action-oriented, comprehensive, and integrated community-based study, entitled the Isfahan Healthy Heart Programme, was conducted in Iran from the year 2000. The interventions targeted the whole population of nearly 2,180,000 living in two cities, and were compared with another city considered as a reference. Educational, environmental and legislative interventions were conducted at the community level. Annual evaluations were performed among 6,000 representative individuals. This paper presents the changes in PA habits after 2 years of interventions for increasing PA. The PA habits were assessed by using the Baecke questionnaire, and an energy expenditure of 150 kcal for daily leisure time physical activity was adopted as a cut-off for defining active and inactive lifestyle.ResultsIn the intervention and reference areas, respectively 85 and 83% of the population were physically inactive. From 2000 to 2002, the daily PA among both genders decreased in both intervention and reference communities. Meanwhile, the leisure-time PA increased significantly in the intervention area, but decreased in the reference area. The transportation PA did not significantly change in the intervention area, but showed a remarkable decline in the reference area.ConclusionsWe suggest that the synergism resulting from community collaborations has been effective in improving some aspects of PA in our community. The ongoing changes in environmental factors and policies can help in increasing the worksite and transportation PA in later stages of this community-based programme.

Evaluation of Physical Activity Habits in Patients with Posttraumatic Stress Disorder

OBJECTIVEIn this study, we present data from a survey that aimed to assess the physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder.METHODFifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37±12 years, and the mean time between diagnosis and follow-up was 3.6±4.2 years.RESULTSSubstantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation.DISCUSSIONSeveral studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits.CONCLUSIONOur findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.

Effects of physical activity on exercise tests and respiratory function

Background: Exercise is an important component of pulmonary rehabilitation for patients with chronic lung disease. Objective: To explore the role of physical activity in maintaining cardiac and respiratory function in...

COMPARING THE 7-DAY PHYSICAL ACTIVITY RECALL WITH SUPPLEMENTARY ACTIVITY QUESTIONS IN PROJECT ACTIVE 1374

Research studies vary widely in methods of assessing habitual physical activity; however, little investigation has been made of the comparability or concurrent validity of different assessment methods. In Project Active, a randomized clinical trial of 235 sedentary adult men and women, we added questions about daily walking, daily stair climbing, and weekly sitting to the 7-Day Physical Activity Recall (PAR) questionnaire. By examining physical activity assessed at baseline and after 6 months of intensive intervention, we will learn if activity measured by the supplementary questions is comparable to the calculated energy expenditure (EE) from the PAR. Overall, we measured an average EE increase of 1.4 kcal·kg-1·day-1(p<0.001), an average decrease of 6.1 hr·week-1 spent sitting(p<0.001), an average increase of 1.6 flights·day-1 of stairs climbed (p=0.02), and an average increase of 18.6 min·day-1 spent walking (p<0.001). Comparison of the two methods at the baseline and 6-month assessments suggests there is a significant but weak correlation between minutes walked per day and EE, e.g. the highest correlation was r=0.16(p=0.01). Correlations of the changes after 6 months support this finding, with an r=0.15 (p=0.02) for EE and minutes walked per day, while all other correlations were not significant. Therefore, we conclude these supplementary questions do not provide equivalent information to that gathered by the PAR. Although not correlated with the PAR, the supplementary questions do show changes in physical activity habits occurred after intervention and they may be of value in assessing some aspects of physical activity.