Current Physical Activity Guidelines Research Articles

Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries.

The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

Combined association of aerobic and muscle strengthening activity with mortality in individuals with hypertension.

Evidence on the association between meeting both aerobic physical activity (PA) and muscle-strengthening activity (MSA) guidelines with mortality in individuals with hypertension is scarce. We included 34,990 adults from the 2007 to 2013 Korea National Health and Nutrition Examination Survey, linking mortality follow-up data until 2019. Adherence to PA guidelines was assessed based on the current PA guidelines using a self-reported questionnaire and categorized as follows: meeting MSA only, aerobic PA only, both MSA and aerobic PA, or neither. Associations of hypertension and adherence to PA guidelines with all-cause and cardiovascular disease (CVD) mortality were examined using Cox proportional hazard models. Over 9.2 years, 1948 participants died from any cause and 419 from CVD. Meeting both PA guidelines was associated with the lowest risk of all-cause and CVD mortalities in the total sample regardless of hypertension status. In individuals with hypertension, meeting aerobic PA guidelines only had a 24% lower risk of both all-cause and CVD mortality, and meeting both PA guidelines further reduced risks by 40% and 43%, respectively; however, meeting MSA guidelines only was not associated with either all-cause or CVD mortality. In individuals without hypertension, only meeting both MSA and aerobic PA guidelines, but not meeting either MSA or aerobic PA guidelines, showed reduced risk of CVD mortality. In Korean population, non-hypertensive individuals who met both guidelines had a lower risk of CVD mortality. However, hypertensive individuals showed a reduced risk of both all-cause and CVD mortality when meeting aerobic PA or both guidelines, but not MSA alone.

Physical Activity Fragmentation and Falls in Older Adults: Findings from the National Health and Aging Trends Study.

Physical activity (PA) may be an important fall prevention strategy. Current PA guidelines emphasize total PA dose, but daily patterning of PA is underappreciated. With aging, PA bouts become less frequent and shorter in duration (i.e.: more fragmented). PA fragmentation may be an indicator of fall risk, but the relationship is not well understood. This study examined daily PA accumulation and patterns with fall risk in older adults. Participants (n=685, 54.3% female, 61.5% aged 70-79 years) from the National Health and Aging Trends Study (NHATS) with wrist-worn accelerometry PA data from Round 11 (baseline) and sample person interviews with fall data from Round 12 (follow-up) were included. PA variables were categorized into tertiles and incident falls were defined as ≥1 self-reported fall in the year following the PA assessment between baseline and follow-up. A modified Poisson approach was used to estimate the relative risk of both PA accumulation and fragmentation with falls. Overall, 40.0% reported an incident fall. After adjustment for sociodemographic and health characteristics, those in the highest tertile of total PA accumulation had lower fall risk (aRR=0.74, 95% CI: 0.57, 0.95) and those in the highest tertile of PA fragmentation had increased fall risk (aRR=1.33, 95% CI: 1.03, 1.73). Models were attenuated after adjustment for physical functioning. PA fragmentation may identify fall risk in older adults. Longitudinal studies are needed to disentangle the temporal sequencing of the complex relationship between PA and physical functioning across the life-course.

Abstract PO4-12-09: National Physical Activity Guidelines and It’s Association with Fatigue in Patients with Breast Cancer Pre- and Post-Chemotherapy in a Prospective, Nationwide Study

Abstract Background: Cancer-related fatigue (CRF) is one of the most pervasive side effects of cancer and its treatment, reported by nearly 90% of patients. Physical activity (PA) during treatment may prevent or lessen CRF burden. Current aerobic PA guidelines for cancer patients recommend at least 150 minutes of moderate PA or 75 minutes of vigorous PA or some equivalent combination of moderate and vigorous PA (MVPA). Many patients have difficulty meeting these guidelines during treatment, however, meeting these guidelines may not be necessary to alleviate CRF. This study evaluated patterns of PA below the recommended guidelines and their association with CRF in cancer patients during treatment. Methods: In a nationwide, prospective cohort study of patients with stage I-IIIC breast cancer (n=580) we assessed the relationship between self-reported PA (Aerobics Center Longitudinal Study PA) and CRF (Multidimensional Fatigue Symptom Inventory, MFSI) pre- and post-chemotherapy. Spearman correlations were utilized to evaluate the association of all PA (MET hr/wk) and MVPA (MET hr/wk) with overall CRF (total MFSI) and 5 CRF subdimensions (general, physical, emotional, mental CRF and vigor) at pre- and post-chemotherapy. ANCOVA estimated mean CRF score according to whether patients weekly MVPA (1) met 100% of the PA guidelines, (2) met 50%-99% of the PA guidelines (75-149 minutes), or (3) did not meet 50% of the PA guidelines (< 75 minutes). Results: Pre-chemotherapy, only 34% of participants met the PA guidelines, post-chemotherapy, only 21% of patients met the PA guidelines. At both time points, we observed small to moderate inverse correlations of MVPA with overall CRF and several subdimensions of CRF (Table 1; r = -0.11, -0.19). Pre-chemotherapy, those who did not meet 50% of the PA guidelines report significantly higher total CRF compared to those who met the PA guidelines (12.5 ± 1.2 vs 5.3 ± 1.5; p< 0.001). However, those who met only 50%-99% of the PA guidelines, had comparable total CRF to those who fully met the PA guidelines (7.2 ± 2.2; p=0.474). A similar pattern was observed for the subdimensions general, mental, and physical CRF. Those who met 50% of the guidelines also had significantly lower vigor compared to those who met the guidelines (11.9 ± 0.3 vs 13.8 ± 0.4; p< 0.001), while those who met 50%-99% of the guidelines had comparable vigor to those who fully met guidelines (13.1 ± 0.6; p=0.278). Post-chemotherapy CRF was higher among all patient’s, again there was no significant difference in total, general, physical CRF and vigor between those who met the PA guidelines and those who met 50%-99% of the PA guidelines. Conclusions: All PA was consistently inversely associated with CRF pre- and post-chemotherapy for patients with breast cancer. Current minimum aerobic PA guidelines for patients with cancer are difficult to achieve during treatment. Lower doses of MVPA than the current PA guidelines suggest may provide equal benefit and represent a more achievable goal for patients with cancer. Table 1: Spearman correlations of CRF and physical activity in patients with breast cancer pre- and post-chemotherapy. Table 2: ANCOVA; Mean CRF score according to the PA guidelines. Citation Format: Lindsey Mattick, Hongying Sun, Karen Mustian, Luke Peppone, AnnaLynn Williams, Po-Ju Lin, Evelyn Arana, Jeremy McGuire, Amarinthia Curtis, Alison Conlin, Lora Weiselberg, Michelle Janelsins. National Physical Activity Guidelines and It’s Association with Fatigue in Patients with Breast Cancer Pre- and Post-Chemotherapy in a Prospective, Nationwide Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-09.

Impact of Previous Dietary and Exercise Education on Knowledge of Obesity and its Comorbidities: Case Study on a College Campus

Greater than 40% of the adult U.S. population is estimated to be clinically obese based on body mass index (BMI) ≥ 30 kg/m2. Obesity is associated with several debilitating comorbidities that impact both physical and mental health including cardiovascular disease, type 2 diabetes, cancer, and depression. A college community is not immune to obesity, but with a typically younger and more active population the prevalence of obesity is generally lower on campus than the neighboring area. We hypothesized that a formal education of diet and exercise would be strongly associated with reduced obesity, and moreover an increased knowledge of obesity-linked comorbidities. College students were surveyed on their educational background, obesity and associated comorbidity knowledge, as well as anthropometric information including height and weight. Correlations were analyzed to determine links between education, obesity knowledge, and BMI. We received completed surveys from 158 students with an average age of 20.5 ± 3.0 years and BMI of 24.5 ± 5.1 kg/m2. Students with formalized education in diet and exercise were more informed about current nutritional and physical activity guidelines than those students who had not received similar education. Despite this disparity, both groups of students were similarly knowledgeable about obesity and its comorbidities. Additionally, there was no difference in the self-reported BMIs between these two groups of students. Based on our survey, the prevalence of obesity was 10.8%, much lower than the national average. We conclude that a formal education in diet and exercise did not lead to differences in weight status or obesity knowledge amongst students on this college campus. This suggests that on-campus health promotion initiatives regarding obesity would be equally beneficial to all students regardless of educational background. Honors Program; Herbert H. & Grace A. College of Health Professions; Offce of Graduate Studies Central Michigan University. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Validity, reliability, and readability of single-item and short physical activity questionnaires for use in surveillance: A systematic review.

Accurate and fast measurement of physical activity is important for surveillance. Even though many physical activity questionnaires (PAQ) are currently used in research, it is unclear which of them is the most reliable, valid, and easy to use. This systematic review aimed to identify existing brief PAQs, describe and compare their measurement properties, and assess their level of readability. We performed a systematic review based on the PRISMA statement. Literature searches were conducted in six scientific databases. Articles were included if they evaluated validity and/or reliability of brief (i.e., with a maximum of three questions) physical activity or exercise questionnaires intended for healthy adults. Due to the heterogeneity of studies, data were summarized narratively. The level of readability was calculated according to the Flesch-Kincaid formula. In total, 35 articles published in English or Spanish were included, evaluating 32 distinct brief PAQs. The studies indicated moderate to good levels of reliability for the PAQs. However, the majority of results showed weak validity when validated against device-based measurements and demonstrated weak to moderate validity when validated against other PAQs. Most of the assessed PAQs met the criterion of being "short," allowing respondents to complete them in less than one minute either by themselves or with an interviewer. However, only 17 questionnaires had a readability level that indicates that the PAQ is easy to understand for the majority of the population. This review identified a variety of brief PAQs, but most of them were evaluated in only a single study. Validity and reliability of short and long questionnaires are found to be at a comparable level, short PAQs can be recommended for use in surveillance systems. However, the methods used to assess measurement properties varied widely across studies, limiting the comparability between different PAQs and making it challenging to identify a single tool as the most suitable. None of the evaluated brief PAQs allowed for the measurement of whether a person fulfills current WHO physical activity guidelines. Future development or adaptation of PAQs should prioritize readability as an important factor to enhance their usability.

Association of aerobic and muscle-strengthening physical activity with all-cause and cardiovascular disease mortality among adults with type 2 diabetes: A prospective cohort of US adults

ObjectiveTo investigate the relationship of moderate physical activity (MPA), vigorous physical activity (VPA), and muscle strengthening activity (MSA), independently and jointly, with all-cause, cardiovascular disease (CVD), and non-CVD mortality in individuals with type 2 diabetes (T2D). Material and methodsThis cohort study included 47,538 adults with T2D and 561,963 adults without T2D from the National Health Interview Survey 1997–2018 who provided data on self-reported physical activity (PA). Mortality data were obtained from the National Death Index through 2019. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI). ResultsIn analyses mutually adjusted, versus no MPA adults with T2D, performing the recommendations of MPA (150–299 min/week) associated with lower all-cause mortality (HR, 0.72; 95% CI, 0.66–0.78), CVD mortality (HR, 0.68; 95% CI, 0.58–0.79), and non-CVD mortality (HR, 0.72; 95% CI, 0.65–0.79). Similar benefits were observed in those meeting recommendations for VPA and MSA. Higher levels of PA beyond current recommendations may provide a few additional benefits without adverse effects on mortality risk, regardless of diabetes onset age, duration of diabetes, and medication status. The joint analysis indicates that combining MSA with aerobic PA could further lower mortality risk, and lowest all-cause mortality was observed among individuals engaging in either 75–150 min/week of VPA and 1 time/week of MSA (HR, 0.30; 95% CI, 0.13–0.70) or 150–299 min/week of MPA and 1 time/week of MSA (HR, 0.33; 95% CI, 0.20–0.55). ConclusionOur study supports the current PA guidelines and suggests that there may be limited benefits gained from exercising beyond recommended levels in adults with T2D, combining recommended levels of aerobic and resistance exercises could yield the greatest benefits.

Predictors of physical activity among Chinese pregnant women during the first trimester: A cross-sectional study

ABSTRACT Physical activity during pregnancy has numerous health benefits for the woman and the foetus. The current study investigated physical activity engagement and its predictors among pregnant Chinese women during the first trimester. A total of 687 pregnant women completed the Pregnancy Physical Activity Questionnaire. Bivariate and multivariate logistic regression were used to analyse the data. The current physical activity guidelines were not met by 64.3% of respondents. Women with higher levels of physical activity self-efficacy (aOR = 0.96; 95% CI: 0.92–0.99) and social support (aOR = 0.95; 95% CI: 0.94–0.97) had lower odds of not meeting the current physical activity guidelines. Women who were aged < 35 years (aOR = 1.85; 95% CI: 1.02–3.34), had lower education (aOR = 1.63; 95% CI: 1.04–2.55), were primiparous (aOR = 11.03; 95% CI: 6.98–17.44), were unsure of their delivery mode (aOR = 2.32; 95% CI: 1.95–5.64), and those who had higher levels of pregnancy-associated discomfort (aOR = 1.10; 95% CI: 1.03–1.19) had higher odds of not meeting the current physical activity guidelines. The current study suggests that healthcare professionals should assess physical activity engagement during routine antenatal care and increase efforts to strengthen pregnant women’s self-efficacy and social support to promote physical activity engagement during the first trimester.

Implementing a Clinical Decision Support Tool to Improve Physical Activity.

Currently, only about half of U.S. adults achieve current physical activity guidelines. Routine physical activity is not regularly assessed, nor are patients routinely counseled by their healthcare provider on achieving recommended levels. The three-question physical activity vital sign (PAVS) was developed to assess physical activity duration and intensity and identify adults not meeting physical activity guidelines. Clinical decision support provided via a best practice advisory in an electronic health record (EHR) system can be triggered as a prompt, reminding healthcare providers to implement the best practice intervention when appropriate. Remote patient monitoring of physical activity can provide objective data in the EHR. This study aimed to evaluate the feasibility and clinical utility of embedding the PAVS and a triggered best practice advisor into the EHR in an ambulatory preventive cardiology practice setting to alert providers to patients reporting low physical activity and prompt healthcare providers to counsel these patients as needed. Three components based in the EHR were integrated for the purpose of this study: Patients completed the PAVS through their electronic patient portal prior to an office visit, a best practice advisory was created to prompt providers to counsel patients who reported low levels of physical activity, and remote patient monitoring via Fitbit synced to the EHR provided objective physical activity data. The intervention was pilot-tested in the Epic EHR for 1 year (July 1, 2021 to June 30, 2022). Qualitative feedback on the intervention from both providers and patients was obtained at the completion of the study. Monthly assessments of the use of the PAVS and best practice advisory and remote patient monitoring were completed. Patients' completion of the PAVS varied from 35% to 48% per month. The best practice advisory was signed by providers between 2% and 65% and was acknowledged by 2%-22% per month. The majority (58%) of patients were able to sync a Fitbit device to their EHR for remote monitoring. Although uptake of each component needs improvement, this pilot demonstrated the feasibility of incorporating a physical activity promotion intervention into the EHR. Qualitative feedback provided guidance for future implementation.

A twin-driven analysis on early aging biomarkers and associations with sitting-time and physical activity.

Current physical activity guidelines may be insufficient to address health consequences in a world increasing in sedentary behavior. Physical activity is a key lifestyle factor to promote healthy aging, but few studies examine activity in conjunction with sitting. We examine how activity intensity and sitting behavior influence health and the extent to which physical activity might counter sitting. We analyzed data from the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife) in adults aged 28-49 years (M = 33.16, SD = 4.93). We fit a linear mixed-effect model for body mass index (BMI) and total cholesterol/high-density lipoprotein ratio (TC/HDL). Leveraging the co-twin control approach, we explore the trade-off between sitting and physical activity. Across established adulthood, TC/HDL and BMI demonstrated increasing age trends with prolonged sitting and vigorous activity inversely associated. Moreover, after considering sitting time, we found an age-equivalent benefit of vigorous exercise where those performing 30 minutes daily had expected TC/HDL and BMI estimates that mirrored sedentary individuals 5 and 10 years younger, respectively. Co-twin control analysis suggests partial exposure effects for TC/HDL, indicating greater vigorous activity may counter sitting-health effects but with diminishing returns. Our findings support the counteracting influence of prolonged sitting and physical activity on indicators of cardiovascular and metabolic health. A compensating role of vigorous activity on sitting health links is indicated while reducing sitting time appears paramount. Public health initiatives should consider sitting and vigorous activity in tandem in guidelines to promote health maintenance and combat accelerated aging.

Targeting skeletal muscle health with exercise in people with type 1 diabetes: A protocol for HOMET1D, a prospective observational trial with matched controls.

Individuals with type 1 diabetes (T1D) experience a complex set of alterations to skeletal muscle metabolic, neuromuscular, and vascular health; collectively referred to as diabetic myopathy. While the full scope of diabetic myopathy is still being elucidated, evidence suggests that even when individuals with T1D are physically active, indices of myopathy still exist. As such, there is a question if adherence to current physical activity guidelines elicits improvements in skeletal muscle health indices similarly between individuals with and without T1D. The objectives of this trial are to: 1) compare baseline differences in skeletal muscle health between adults with and without T1D, 2) examine the association between participation in a home-based exercise program, detraining, and retraining, with changes in skeletal muscle health, and 3) examine the roles of age and sex on these associations. This will be a prospective interventional trial. Younger (18-30 years) and older (45-65 years) males and females with T1D and matched individuals without T1D will engage in a four-phase, 18-week study sequentially consisting of a one-week lead-in period, 12-week exercise training program, one-week detraining period, and four-week retraining period. The exercise program will consist of aerobic and resistance exercise based on current guidelines set by Diabetes Canada. Metabolic, neuromuscular, and vascular outcome measures will be assessed four times: at baseline, post-exercise program, post-detraining, and post-retraining. Differences in baseline metrics between those with and without T1D will be examined with independent sample t-tests, and with two-way analyses of variance for age- and sex-stratified analyses. Changes across the duration of the study will be examined using mixed-model analyses. Findings from this research will be shared locally and internationally with research participants, clinicians, diabetes educators, and patient advocacy organizations via in-person presentations, social media, and scientific fora. NCT05740514.

Comparison of Participation in Strength Activity Among People With and Without Disabilities: 2013-2017 Behavioral Risk Factor Surveillance System.

The current physical activity guidelines recommend engagement in strength activities at least 2 days per week. Currently, there is a lack of literature examining strength activities among people with disabilities. The purpose of this study is to estimate and compare the prevalence of engagement in strength activities and adherence to strength activity guidelines among adults with and without disabilities in the United States. A total of 1,005,644 adults (18-80y old) with and without disabilities from the 2013 to 2017 Behavioral Risk Factor Surveillance System were included in this secondary data analysis. Descriptive analyses were performed to describe the prevalence of strength activity behaviors of adults with and without disabilities. Logistic and Poisson regression models were performed to evaluate the relative contribution of disability status on strength activity behaviors. A higher proportion of participants without disabilities (46.42%, 95% CI, 46.18-46.65) reported engaging in strength activities compared with participants with disabilities (30.68%, 95% CI, 30.29-31.08; P < .01). Participants with disabilities were less likely to engage in strength activities (odds ratio = 0.51, 95% CI, 0.50-0.52; adjusted odds ratio = 0.75, 95% CI, 0.73-0.77) and meet strength activity guidelines (odds ratio = 0.56, 95% CI, 0.54-0.57; adjusted odds ratio = 0.75, 95% CI, 0.73-0.77) than participants without disabilities. Experiencing a disability is associated with lower engagement in strength activities; thus, it is important to identify effective and efficient approaches to promoting strength activities among people with disabilities.

Knowledge Attitude and Practice of Pregnant Women Towards Physical Exercise in Agege Local Government Area of Lagos State, Nigeria

Introduction: Pregnancy is a good time to develop a healthy lifestyle in pregnant women which includes physical exercise. The objective of this study was to assess the knowledge, attitude and practice of physical exercise among pregnant women in Agege local government area in Lagos state, Nigeria. Methodology: A cross-sectional survey method was used; 400 pregnant women were recruited into the study using convenience sampling technique. A structured and validated questionnaire was designed to assess knowledge, attitude and practice of pregnant women towards physical exercise was used to collect data. All the results were tested at 0.05 level of confidence. Results: The result showed that 36% of the pregnant women were between the age of 21-25 years and more than 35% were between 15-20 years, more than (71%) of the women have heard about physical exercise. Nevertheless, only 52% of the pregnant women engaged in physical exercise. Most (54.0%) of them actually prefer domestic activities over real physical exercise. The result suggests that women’s knowledge concerning physical exercise during pregnancy is reasonable and their attitude is positive; however, a large number do not practice physical exercise. Antenatal program may be tailored into introducing guided physical exercise and introduce pregnant women into guided models of fitting exercises for each trimester. Conclusion: Physical exercise in pregnancy is important to aid bodily movement produced by skeletal muscles that results in energy expenditure. Exercise is a subset of physical activity that is planned, structured, and repetitive and has as objective to improve or maintain physical fitness. Physical activity and exercise promote health and longevity, and minimal adherence to current physical activity guidelines is associated with a significant 20-30% reduction in risk of all-cause mortality. Pregnancy leads to a reduced level of physical activity for most women, the activity level is often further reduced throughout pregnancy, and the pre-pregnancy exercise level is usually not regained six months after childbirth

The Critical Role of Physical Activity and Weight Management in Knee and Hip Osteoarthritis: A Narrative Review.

Physical activity (PA) and weight management are critical components of an effective knee and hip osteoarthritis (OA) management plan, yet most people with OA remain insufficiently active and/or overweight. Clinicians and their care teams play an important role in educating patients with OA about PA and weight management, eliciting patient motivation to engage in these strategies, and referring patients to appropriate self-management interventions. The purpose of this review is to educate clinicians about the current public health and clinical OA guidelines for PA and weight management and highlight a variety of evidence-based self-management interventions available in community and clinical settings and online.

The Mediating Role of Physical Activity Self-Efficacy in Predicting Moderate-Intensity Physical Activity in Pregnant People at High Risk for Gestational Diabetes.

Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. Moderate-intensity physical activity during pregnancy can lower the risk of GDM. However, the relationship between moderate-intensity physical activity and correlated factors among pregnant people at high risk for GDM remains unknown. A cross-sectional study was conducted in China. Two hundred fifty-two participants completed the Pregnancy Physical Activity Questionnaire, Pregnancy Physical Activity Self-Efficacy Scale, Physical Activity Knowledge Questionnaire, Physical Activity Social Support Scale, 7-item Generalized Anxiety Disorder Scale, Edinburgh Postnatal Depression Scale, and a sociodemographic data sheet. Structural equation modeling was used to explore the direct and indirect associations between the study variables. A total of 51.6% of the participants did not meet the current physical activity guidelines. Only physical activity self-efficacy was significantly correlated with moderate-intensity physical activity. Physical activity self-efficacy mediated the relationship between moderate-intensity physical activity and knowledge of physical activity, social support for physical activity, and anxiety symptoms. Furthermore, knowledge of physical activity was also associated with improved moderate-intensity physical activity mediated by reduced anxiety symptoms and increased physical activity self-efficacy. Our study revealed a high prevalence of not meeting current physical activity guidelines among pregnant people at high risk for GDM. Physical activity self-efficacy played an important mediating role in predicting moderate-intensity physical activity. Future studies should focus on enhancing self-efficacy to improve moderate-intensity physical activity for pregnant people at high risk for GDM.

The longitudinal association between physical activity, strength and fitness, and lung function: A UK Biobank cohort study

BackgroundWhile physical activity is hypothesized to slow lung-function decline, the evidence is limited at a population level. This study investigated the longitudinal association between physical activity and related measures (grip strength, cardiovascular fitness) and lung function decline. Methods20,111 UK Biobank cohort participants with lung function measures at baseline (2006–2010) and follow-up (2012–2014) were included. Physical activity (International Physical Activity Questionnaire: low, moderate, high categories), grip strength (dynamometer) and cardiovascular fitness (subsample, submaximal stationary bicycle) data were collected. Linear regression was utilized to assess the effect on follow-up FEV1, FVC, FEV1/FVC ratio (as decline in ml/yr and as z-scores) adjusting for baseline lung function and confounders. ResultsAfter 6.3 years mean follow-up, the decline in mean FEV1 and FVC was 30 ml/year and 38 ml/year respectively (n = 20,111). Consistent low physical activity (across baseline and follow-up) was associated with accelerated decline in FEV1 z-score (−0.119, 95 % Confidence Interval (CI) −0.168, −0.071, n = 16,900) and FVC z-score (−0.133, 95%CI -0.178, −0.088, n = 16,832). Accelerated decline in FEV1 z-scores was observed with decreasing baseline grip strength (−0.029, −95%CI -0.034, −0.024, n = 19,903), and with less strong evidence, decreasing fitness (−0.024, 95%CI -0.070, 0.022, n = 3048). ConclusionThis is the largest ever study to date to identify that lower physical activity, grip strength, and potentially cardiovascular fitness over time is associated with accelerated lung function decline. Although the effect sizes appear modest, such changes at population levels can have a substantial overall impact. This study provides evidence for adding ‘lung health benefits’ to the current physical activity guidelines.

Widespread Pain With Nociplastic Features is an Independent Predictor of Low Physical Activity in People with Multiple Sclerosis

Exploring the relationship between underlying pain mechanisms and physical activity could inform interventions to optimize physical activity in persons with multiple sclerosis (PwMS). This cross-sectional nationwide survey examined whether pain phenotype is a significant predictor of self-reported physical activity in PwMS. The study included 938 persons with a self-reported diagnosis of MS (93% reported neurologist-diagnosed MS) who completed surveys of demographic, clinical information, pain intensity, indicators of underlying pain mechanisms (Fibromyalgia Survey Criteria and painDETECT), and physical activity (Godin Leisure-Time Exercise Questionnaire). Responses were used to categorize pain phenotypes as widespread pain with nociplastic features (WPNF), neuropathic, nociceptive, or mixed (neuropathic/WPNF). Following current physical activity guidelines, self-reported physical activity was categorized as active or insufficiently active/sedentary. Applying multivariable logistic regression, participants with no chronic pain had 2.30 higher odds of being physically active when compared to participants with chronic mixed pain. Similarly, participants with neuropathic and nociceptive pain had, respectively, 1.90 and 1.66 higher odds of being physically active compared to individuals with mixed pain. Higher scores on the fibromyalgia survey criteria (operationalized in this study as an indicator of WPNF) were a significant independent predictor of insufficient physical activity (OR = .93, P < .01). Findings indicate that experience and phenotype of chronic pain, in particular WPNF, are associated with physical inactivity in PwMS. This suggests that assessing pain phenotype may be important to identify individuals at risk of inadequate physical activity and may guide the tailoring of behavioral therapeutic approaches to help PwMS achieve the recommended level of physical activity. PerspectiveThis study examines the association between pain mechanism and physical activity in multiple sclerosis. These findings highlight the possibility that a basic screening for pain mechanism could offer clinically useful information without requiring extensive neurobiological phenotyping and may inform the development of behavioral interventions to enhance physical activity in multiple sclerosis.

O.4.5-1 Device-measured physical activity and sedentary time in a national sample of Luxembourg residents: moving beyond the traditional metrics in the ORISCAV-LUX 2 study

Abstract Purpose This is the first study aiming at describing the volume and pattern of device-measured movement behaviours performed by adults living in Luxembourg, spanning the full intensity spectrum, and including markers of sedentary time accumulation. We also demonstrated the added value of a multidimensional approach for the comparison of sub-populations. Methods This observational study included Luxembourg residents aged 18-79y who each provided ≥4 valid days of triaxial accelerometry in 2016-18 (n = 1122). Compliance with the current international physical activity (PA) guideline was quantified. Linear regression models were used to quantify variability in average 24h acceleration (indicative of PA volume), awake-time PA levels, sedentary time and accumulation pattern with sociodemographic characteristics and other covariates. Data were weighted to be nationally representative. Results Overall, participants spent 51% of daily sedentary time (12.1 h/day), 11% in light PA (2.7 h/day), 6% in moderate to vigorous PA (MVPA; 1.5 h/day), and remaining time asleep (7.7 h/day). Adherence to the current PA guideline was high (98.1%), but drop to 22% when including only bouts &amp;gt;10min. Although time spent in MVPA did not differ between women and men, average 24h acceleration and light PA were higher in women than men, while men achieved higher average accelerations across the most active periods of the day. Women performed less sedentary time and shorter sedentary bouts. Older participants (≥55y) registered a lower average 24h acceleration and engaged in less MVPA, more sedentary time and longer sedentary bouts. Average 24h acceleration was higher in participants of lower educational attainment, who also performed less sedentary time, shorter bouts, and fewer bouts of prolonged sedentariness. Average 24h acceleration and levels of PA were higher in participants with standing and manual occupations than a sedentary work type, but manual workers registered lower average accelerations across the most active periods of the day. Standing and manual workers accumulated less sedentary time and fewer bouts of prolonged sedentariness than sedentary workers. Conclusions Traditional metrics may incompletely reflect differences in the physical behaviour between sub-populations. Breaking up continuous sedentary periods and replacing sedentary time with active alternatives should be the focus of public health initiatives in Luxembourg. Funding Luxembourg Institute of Health.

S12-2 The effectiveness of a peer-led school-based walking intervention on adolescent girls’ physical activity: the Walking In ScHools (WISH) study

Abstract Purpose Adolescent girls are failing to meet current physical activity (PA) guidelines. PA behaviours track from childhood to adulthood so providing adolescent girls with opportunities to be physically active may have benefits well beyond childhood. The effects of walking interventions on adult health are known, however less is understood about the potential of walking to promote PA in adolescents. Following the WISH pilot feasibility study that reported an increase in light intensity PA, a full trial has been undertaken to evaluate the effectiveness of a novel school-based walking intervention at increasing PA levels of adolescent girls. Methods The WISH study is a clustered randomised controlled trial in which a peer-led, school-based, brisk walking intervention is compared to usual PA in adolescent girls (12-14years). Data was collected at four timepoints over a 13-month period. Following baseline data collection, schools were randomly allocated to intervention (n = 9) or control (n = 9). In intervention schools, older pupils (aged 15-18years) were trained as walk leaders and led younger girls in 10-15min walks before school and at break-times across the school year (20-22weeks). The primary outcome was accelerometer-measured total PA (post-intervention). Secondary outcomes included anthropometry, quality of life and sleep. Results In total, 590 participants (mean(SD) age 12.6(0.6)years) were recruited from 18 schools across Northern Ireland (n = 9) and the Republic of Ireland (n = 9). Within the intervention schools, 149 walk leaders were trained (mean(SD) age 17.1(0.8)years). At baseline (n = 535), mean(SD) time spent in moderate to vigorous PA (MVPA) was 39.2(17.1)mins/day and only 66 (12%) girls achieved PA guidelines of 60minutes MVPA per day. Post-intervention interviews were conducted with n = 18 walk leaders and n = 9 teachers. Focus groups (n = 9) were conducted with a mix of high and low attenders. Data analysis is ongoing, and the process evaluation is underway (both will be complete by May 2023). Conclusion To our knowledge, this is the first fully powered trial to investigate the effectiveness of a peer-led brisk walking intervention in adolescent girls. The current study builds on a promising pilot trial which confirmed the feasibility of the intervention. If the intervention increases PA, it has potential to be implemented widely.

S12-1 School-based interventions to promote physical activity amongst children and adolescents

Abstract Background Regular physical activity (PA) is associated with many benefits for physiological and mental wellbeing in children and adolescents. Despite this, many children and adolescents are failing to meet current PA guidelines. Given the age-related declines in PA as children move into adolescence, and then adulthood, the development of interventions to promote PA in this population is important. Schools have been identified as a key setting for the promotion of health-related behaviours, and young people spend a significant proportion of their waking day within the school setting. Aim This symposium will engage researchers, practitioners, health care professionals and policy makers to discuss novel school-based interventions. The objectives of this symposium are to: (1) Disseminate the findings of school-based interventions across a number of countries (France, Ireland, United Kingdom, Spain); (2) Highlight cross-cultural challenges in the development and evaluation of school-based interventions, and (3) Outline how co-design and Patient and Public Involvement (PPI) have been utilised in the development of school-based interventions. Symposia presentations 1. The effectiveness of a peer-led school-based walking intervention on adolescent girls’ physical activity: the Walking In ScHools (WISH) study. This presentation will highlight findings from the first fully powered trial to investigate the effectiveness of a peer-led brisk walking intervention in adolescent girls, including primary and secondary outcome data, and process evaluation measures. 2. School-based physical activity promotion in a cross-cultural context: interventions from France and Spain. This presentation will highlight key learnings on how best to connect cross-cultural educational contexts for the promotion of physical activity and discuss the development of a cross-cultural intervention guide. 3. Co-production of the Move Well, Feel Good movement behaviours intervention. This presentation will describe the feasibility evaluation of the Move Well, Feel Good intervention. The Move Well, Feel Good intervention was developed using a co-design approach, and aims to enhance children’s mental health through motor competence and psychosocial development. 4. Physical activity trends among Second-level Active School Flag programme 2019-2021. This presentation will evaluate the impact of the Active School Flag programme and outline changes in physical activity levels over a three-year period.