Exercise Research Articles

Impact of Hypertension on the Dose-Response Association Between Physical Activity and Stroke: A Cohort Study.

Regular physical activity is associated with a reduced stroke risk. However, this relationship might be attenuated in the presence of hypertension and antihypertensive medication use. We examined the dose-response relationship between physical activity and stroke in normotensive and hypertensive individuals. A Dutch population-based cohort including 139 930 individuals (41% men; mean age, 44±13) was performed (median follow-up, 6.75 years). Participants were stratified at baseline as hypertensive (44%) or normotensive (56%) and categorized into quartiles of the lowest (Q1) to the highest (Q4) moderate-to-vigorous, self-reported physical activity. The primary outcome was incident stroke (fatal and nonfatal). Cox regression estimated hazard ratios and 95% CIs. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Hypertensives were stratified into medicated (21%) or non-medicated (79%). Compared with Q1, adjusted hazard ratios were 0.87 (0.69-1.10; P=0.23), 0.75 (0.59-0.95; P=0.02), and 0.94 (0.74-1.20; P=0.64) for Q2 to Q4, respectively in the total population. Hazard ratios for normotensives were 0.79 (0.50-1.25; P=0.32), 0.75 (0.48-1.18; P=0.22), 0.97 (0.62-1.51; P=0.90) for Q2 to Q4, respectively. In hypertensives, hazard ratios were 0.89 (0.68-1.17; P=0.41), 0.74 (0.56-0.98; P=0.03), 0.92 (0.69-1.23; P=0.56) for Q2 to Q4, respectively. There was no significant interaction between hypertension status for the relation between physical activity and stroke risk. The stratified analysis revealed a smaller benefit of moderate-to-vigorous physical activity in medicated hypertensives compared with nonmedicated hypertensives, but no significant interaction effect was found. Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension. Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke, but further research is warranted.

Long-term trends of occupational physical activity intensity in Japan

Objectives Although physical inactivity is a global concern, quantitative data on its long-term trends in physical activity (PA) are limited. This study aimed to estimate long-term trends in the intensity of occupational PA, constituting the largest portion of PA in Japan.Methods Data on the number of workers in Japan by occupational category were obtained from the Labour Force Survey. PA intensity (metabolic equivalents [METs]) was assigned to 329 occupations in the Japanese Standard Occupational Classification based on the methods and data of Tudor-Locke et al. (2011), and representative intensity values for 11 occupational categories were calculated. Based on intensity, occupational categories were reclassified into sedentary (≤1.5 METs), light (1.6-2.9 METs), and moderate (≥3 METs). Trends in the prevalence of workers in each category were analyzed, along with the annual mean occupation-related METs from 1953 to 2022. The mean occupation-related METs represented the weighted average of PA intensity, calculated based on the annual worker population for each occupational category. Results From 1953-2022, the prevalence of moderate-intensity occupations significantly declined, whereas sedentary and light-intensity occupations increased. The mean occupation-related METs decreased continuously for 70 years. During the 48-year period from 1962 to 2010, when there were no major changes in occupational classification methods, there was a decline of 0.25 METs, representing a 9.6% decrease, from 2.60 to 2.35 METs.Conclusion Over the past 70 years, occupations in Japan have transitioned to ones with lower PA intensity. Consequently, the average PA intensity across all occupations decreased by at least one-tenth. Since this study assumes a constant intensity for each occupation, the actual decline in occupational PA intensity may be even more significant because of societal automation.

Prevalence and associated factors of napping among older adults in the Philippines.

The aim of the study is to estimate the prevalence and associated factors of insomnia among older adults in the Philippines. In all, 5206 cross-sectional nationally representative data from older adults (≥ 60 years) of the 2018 Longitudinal Study on Ageing and Health in the Philippines (LSAHP) was analysed. Napping frequency and duration were assessed by self-report. The prevalence of regular nappers was 35.7%, low or moderate napping (1-59min) was 10.5% and long napping (≥ 60min) duration was 25.2%. In the final adjusted model, older age was not significantly associated with low or moderate napping duration but older age was positively associated with long napping duration. High wealth status, physical activity and late insomnia were positively associated with low or moderate napping duration. High wealth status, urban residence, daily activity limitations, and physical activity were positively associated, and currently working status, poor self-rated health status and current alcohol use were negatively associated with long napping duration. One in four older adults reported long napping duration. Sociodemographic, health status and behaviour and sleep parameters were associated with low or moderate and/or long napping duration.

Hepatic histopathological and morphometric changes in male mice exposed to rosuvastatin from pre-puberty to adulthood: a possible adaptive hepatic response.

Lifestyle changes, such as poor eating habits and a reduction in physical exercise, have impaired human lipid profiles. Statins are widely used to treat dyslipidemias, of which rosuvastatin shows greater improvement in the lipid profile and may be used since childhood. This study aimed to assess the hepatic effects when male mice were given 0.9% saline solution or doses of rosuvastatin of 1.5 or 5.5 mg/kg/day from postnatal day (PND) 23 until PND 80. Body mass gain and water and food consumption were monitored during the treatment. Mice were euthanized on PND 80 when blood was collected for serum obtainment, and several organs were collected and weighed. Serum was used for evaluating lipid profiles and markers of hepatic injuries. The liver was assessed for histopathological, morphometric, and stereological changes. There was a temporary reduction in body mass gain and water and food consumption in the rosuvastatin-exposed groups. Both rosuvastatin-treated groups exhibited reduced total cholesterol levels and showed signs of hepatic tissue adaptation in response to prolonged exposure, such as sinusoidal dilation, inflammatory infiltrates, and cell death of hepatocytes. These results are considered side effects of the treatment and may indicate a hepatic adaptation to the chronic exposure.

Public health unit engagement in school mental health programs and adolescent mental health during the COVID-19 pandemic: COMPASS, 2018-2022.

Public health unit (PHU) engagement in schools is important for promoting wellness in students. We aimed to investigate if PHU engagement with schools may have provided protection against the risk of depression and anxiety in students during the COVID-19 pandemic. We used longitudinal data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour survey between the 2018/19 and 2020/21 academic years. Multilevel models were used to assess the association between PHU engagement with school mental health programs prior to the COVID-19 pandemic and depressive (Center for Epidemiologic Studies Depression scale Revised) and anxiety symptoms (Generalized Anxiety Disorder scale) during the COVID-19 pandemic. The sample included 23894 students across 104 secondary schools in British Columbia, Alberta, Ontario and Quebec. In confounder-adjusted models, PHU engagement before the pandemic was not associated with student depressive symptoms (B=-0.01, 95% CI=-0.04, 0.02), but was protective against anxiety symptoms (B=-0.03, -0.06, 0.001) during the COVID-19 pandemic. The results highlight that PHU engagement with mental health programming in schools was protective against anxiety for students during the COVID-19 pandemic. The findings support the importance of PHU engagement for improving student mental health and pandemic recovery.

Gender preference of conceptions toward caloric-balanced living

ABSTRACT Background Caloric-unbalanced lifestyle has been documented as one critical reason for childhood obesity. Educating students with the knowledge about caloric-balanced living with a focus on healthy eating and physical activity may help raise their awareness to address obesity. Gender preference has limited the benefits of acquiring such knowledge for its impacts on the way for students to acquire knowledge. It is necessary, therefore, to identify the extent to which gender preference is associated with caloric-balanced living conceptions to enhance the literature about gender roles and to develop equitable interventions to promote healthful living. Purpose The purpose of this study was to identify the influence of gender preference on high school students’ caloric-balanced living conceptions, including naïve- and mis-conceptions and scientific conceptions. Method This research adopted a mix-method design and recruited 72 students. A semi-structured interview was conducted with each student to acquire their conceptions toward caloric-balanced living. After coding their responses, we tallied the number of responses consistent with naïve- and mis-conceptions as well as the scientific conceptions. Then a χ 2 analysis was conducted to determine the association between gender and naïve-, mis-, and scientific conceptions, respectively. Findings Students possessed three types of naïve conceptions that were specified as power, eating, or exercising to represent caloric-balanced living and two types of misconceptions that were specified as an object and activity. Gender preference was identified in naïve conception; female students preferred to exclusively conceptualize caloric-balanced living as eating, while male students as exercising only. No gender preference was identified in misconceptions and the scientific conception. Conclusion This study is significant in that it revealed potential flaw of the physical education curriculum where the core science of kinesiology may not be taught systematically, and gender-related issues may not address appropriately. It advocates that teaching scientific conceptions should be given the priority in curriculum design and teaching practices to help students acquire scientific conceptions that subsequently develop a coherent knowledge system and behavior of caloric-balanced living.

Physical activity modification following a Transient Ischemic Attack in individuals with diabetes

BackgroundIndividuals with diabetes exhibit a higher risk of cardiovascular disease and mortality compared to healthy individuals. Following a transient ischemic attack (TIA) the risk of stroke and death increase further. Physical activity engagement after a TIA is an effective way of secondary prevention. However, there's a lack of research on how individuals with diabetes modify physical activity levels and how these adjustments impact survival post-TIA. This study aimed to determine the extent to which individuals with diabetes alter their physical activity levels following a TIA and to assess the impact of these changes on mortality.MethodsThis was a nationwide longitudinal study, employing data from national registers in Sweden spanning from 01/01/2003 to 31/12/2019. Data were collected 2 years retro- and prospectively of TIA occurrence, in individuals with diabetes. Individuals were grouped based on decreasing, remaining, or increasing physical activity levels after the TIA. Cox proportional hazards models were fitted to evaluate the adjusted relationship between change in physical activity and all-cause, cardiovascular, and non-cardiovascular mortality.ResultsThe final study sample consisted of 4.219 individuals (mean age 72.9 years, 59.4% males). Among them, 35.8% decreased, 37.5% kept steady, and 26.8% increased their physical activity after the TIA. A subsequent stroke occurred in 6.7%, 6.4%, and 6.1% of individuals, while death occurred in 6.3%, 7.3%, and 3.7% of individuals, respectively. In adjusted analyses, participants who increased their physical activity had a 45% lower risk for all-cause mortality and a 68% lower risk for cardiovascular mortality, compared to those who decreased their physical activity.ConclusionsPositive change in physical activity following a ΤΙΑ was associated with a reduced risk of mortality. Increased engagement in physical activity should be promoted after TIA, thereby actively supporting individuals with diabetes in achieving improved health outcomes.

Hypothetical mechanisms driving physical activity levels in ethnic minority groups living in Europe: a systematically identified evidence-based conceptual systems model

BackgroundIn Europe, physical activity levels tend to be lower in ethnic minority groups than the general population. Interventions and policies based on research examining isolated determinants of physical activity have had limited success in increasing physical activity levels. This study used systems dynamics theory and the capability approach theoretical framework to develop a conceptual model of how individual characteristics, institutional and physical environments and the migration context may interact to promote or hinder physical activity in ethnic minority groups living in Europe.MethodsA systematic update of Langøien et al.’s 2017 review of the determinants of physical activity in ethnic minority groups living in Europe was conducted. Our target population included individuals of all ages who reported a familial migration background from any low- and middle-income countries or belonging to minority indigenous population in Europe. Outcomes pertaining to non-work related physical activity of light, moderate or vigorous intensity performed in any setting were included. Included studies provided an evidence base from which to derive the causal loop diagrams comprising our conceptual model. Sub-system causal loop diagrams were interpreted in co-author review sessions to explicate non-linear system mechanisms, such as reinforcing and balancing feedback loops.ResultsForty-one studies were identified, of which the majority was qualitative. The conceptual model consisted of 4 causal loop diagrams relating to psychosocial constructs; sociocultural constructs; health and health communication and social and material resources, in interaction with environmental/migration context. Four hypothetical mechanisms were identified, e.g. hypothesizing that participation in organised activities leads to increased self-efficacy, thereby enabling further participation.ConclusionsThis study contributes an evidence-based conceptual systems model which elucidates how low levels of physical activity in ethnic minority groups in Europe could be supported by reinforcing and balancing mechanisms involving factors relating to physical and institutional environments, migration context and individuals. A pluralistic approach to literature review, integrating complexity methods such as CLDs into more conventional systematic literature review, supports novel insights into how factors could interact to support persistently low levels of activity, moving beyond the identification of potential relationships between isolated factors to indicating the ways in which these relationships are sustained and could be modified by intervention or policy.

Mapping the ‘lifelong journey’ of physical literacy: a biographical assessment method for the physical activity and health context

ABSTRACT Physical literacy (PL) describes individuals’ unique relationship with physical activity by integrating physical, cognitive, affective, and social aspects. The person-centered concept highlights a ‘lifelong journey’ for each individual and postulates beneficial effects on biopsychosocial health. Despite extensive suggestions on how to assess the concept, no instrument has so far sufficiently aligned with these ‘individual journeys’ for PL. Therefore, the goal of this conceptual article is to introduce the biographical PL mapping (BMAP-PL) as a purposive, flexible, and paradigmatically open method for the broad physical activity and health context. Intending to provoke individual narratives by plotting domain-driven courses across the lifespan, the BMAP-PL involves four sequential phases guided by a trained facilitator: (a) introduction and overview; (b) personalization and registration of life events; (c) evaluation and biographical visualization of PL dimensions; (d) final overview. The idiosyncratic courses can undergo both qualitative and quantitative analysis, including a potential for synthetic integration. Qualitative analyses can span the identification of life events, transition phenomena, domain-differential analyses, and inter-individual patterns via narrative analysis, thematic analysis, typological analysis, or the grounded theory approach. We suggest quantitative analyses with descriptive and inferential statistical potential on the intra-individual, inter-individual, and group/population level. Given the profound cognitive engagement with the complex behavior of physical activity, BMAP-PL allows for a smooth transition to interventional endeavors (e.g. self-exploration of identity facets, prospective projections, goal setting). The application of the method has value for both research and practice but is based on requirements on the personal and atmospheric level. Emphasizing the need to complement the conceptual ideas through empirical data, we conclude by outlining an agenda for future activities.

Policymaking and the role of government in promoting public health during Covid-19 in Indonesia?

The global COVID-19 pandemic has significantly impacted inadequate physical activity, which has an impact on public health. Government policies are critical in supporting public health and encouraging physical activity during COVID-19. In addition, collaboration between public and health authorities, influencers, and governments is essential in implementing public education campaigns to promote physical activity and healthy behaviors. In Indonesia, strategies to encourage physical activity among children can include home-based physical activity programs, online physical education classes, and outdoor activities that adhere to social distancing guidelines.

Baseline engagement with healthy lifestyles and their associations with health outcomes in people with multiple sclerosis enrolled in an online multimodal lifestyle course.

Healthy lifestyle behaviour modification may improve health outcomes in people with multiple sclerosis (pwMS), but empirical evidence is needed to confirm prior study findings. We developed an online multimodal lifestyle intervention (Multiple Sclerosis Online Course) to examine the impact of lifestyle modification on health outcomes in pwMS via a randomized control trial (RCT). However, the present study specifically analyses baseline data to assess engagement with healthy lifestyles by RCT participants and cross-sectional associations with health outcomes. Baseline engagement with six "healthy lifestyle behaviours" of the intervention course (high-quality, plant-based diet; ≥5000 IU/day vitamin D; omega-3 supplementation; ≥30 min physical activity 5 times/week; ≥30 min/week meditation; and nonsmoking) was examined. Associations between individual versus collective behaviours (individual behaviours summated) and health outcomes (quality of life [QoL]/fatigue/disability) were evaluated using multivariate modelling (linear/log-binomial/multinomial). At baseline, 33.7% and 30.0% of participants (n = 857) engaged in one or two healthy behaviours, respectively. In total, engagement with healthy lifestyles by participants was as follows: nonsmoking, 90.7%; omega-3 supplementation, 34.5%; vitamin D supplementation, 29.8%; physical activity, 29.4%; diet, 10.7%; and meditation, 10.5%. Individual behaviours (nonsmoking/physical activity/diet) were independently associated with better health outcomes. Engagement with multiple behaviours, especially diet and physical activity, was associated with better outcomes; engaging with ≥4 behaviours was associated with a 9.0-point higher mental QoL and a 9.5-point higher physical QoL, as well as 23% and 56% lower prevalence of fatigue and moderate disability, respectively. Baseline engagement with ≥4 healthy behaviours, including diet and physical activity, was associated with better health outcomes.

In search of the ‘like-minded’ people: pregnant women’s sense-making of their physical activity-related social experiences

ABSTRACT Aims/Background Social factors are increasingly recognised as influential on antenatal physical activity. While pregnant women describe the people and support they require to remain physically active, little is known about how pregnant women select and make sense of their social experiences throughout pregnancy. This study followed pregnant women’s sense-making of their physical activity-related social experiences as pregnancy progressed, and physical activity declined. Design/Methods This study used a qualitative design. Four pregnant women were recruited in their second trimester, participated in three individual semi-structured interviews and submitted diary entries throughout trimesters two and three. Data were analysed using longitudinal interpretative phenomenological analysis. Results To facilitate physical activity, pregnant women were ‘searching for the “like-minded” people who motivate, share and understand’, namely pregnant women and prenatally trained exercise professionals. When making sense of social experiences, pregnant women were ‘grading and critiquing the quality and paucity of “active pregnancy” information’, and‘cherry-picking social experiences necessary for “nesting”, obtaining support and protecting self-esteem as physical activity declined’. This involved disengaging from social experiences, and consequently, some pregnant women found themselves ‘lamenting interactions with the “like-minded” people, contending with grief and inner conflict’. Conclusion Pregnant women proactively seek and make sense of social experiences to facilitate physical activity. In an increasingly digitalised society, interventions should support pregnant women to utilise social media constructively and safely to access ‘like-minded’ people, provide in-person and virtual networks to meet individual support needs throughout pregnancy and encourage health professionals to demonstrate interest in the ‘active pregnancy’ to maximise influence.

Effects of a telehealth-delivered Mediterranean diet intervention in adults with Rheumatoid Arthritis (MEDRA): a randomised controlled trial

ObjectiveTo compare the effects a Mediterranean diet (MedDiet) versus the Irish Healthy Eating Guidelines (HEG) on physical function and quality of life in adults with rheumatoid arthritis (RA) in Ireland.MethodsForty-four adults with RA were randomised (1:1) to the MedDiet or HEG for 12 weeks. The intervention included three video teleconsultations and two follow-up telephone calls facilitated by a Registered Dietitian (RD). Changes in physical function by Health Assessment Questionnaire- Disability Index (HAQ-DI) and quality of life by Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) were the primary outcomes measured. Secondary outcomes included changes in dietary adherence, physical activity by Yale Physical Activity survey (YPAS), patient-perceived pain and general health, and anthropometric measures. All measurements were administered at baseline and repeated at 6 and 12 weeks.ResultsForty participants completed the study. Participants were primarily females (87.5%), mean age was 47.5 ± 10.9 years. At the end of the intervention, participants in the MedDiet group reported significantly better physical function (p = 0.006) and quality of life (p = 0.037) compared to HEG group. From baseline to 12 weeks, physical function significantly improved in both diet groups, MedDiet (0.9 ± 0.5 to 0.5 ± 0.4 units, p < 0.001) and HEG (1.4 ± 0.7 to 1.0 ± 0.6 units, p < 0.001). Quality of life also significantly improved in the MedDiet (10.1 ± 7.5 to 4.0 ± 4.7 units, p < 0.001) and HEG group (11.25 ± 7.2 to 7.9 ± 6.4 units, p = 0.048). Physical activity improved significantly in the MedDiet (56.7 ± 28.6 to 70.6 ± 33.5 points, p = 0.01) but not within the HEG group despite similar recommendations.ConclusionAdhering to the MedDiet and Irish Healthy Eating Guidelines resulted in improvements in RA patient-reported outcomes. The changes observed in both diet groups are likely due to the improvement in overall diet quality irrespective of dietary prescription.Trial registration numberNCT04262505.

Association Between Physical Activity Levels and Cognitive Function in Older Adults: A Replication Cohort Analysis Using the Brazilian Longitudinal Study of Aging

Introduction: Few studies address the complex relationship between physical activity and cognitive function in aging individuals. This topic has gained significant attention in recent years, as cognitive decline poses a substantial public health challenge. There is a lack of research focusing on the effect of physical activity on cognitive function in the Brazilian population. Purpose: Our study aims to replicate the findings of Lautenschlager et al. using a Brazilian cohort from the ELSI study, a comprehensive longitudinal study capturing aging processes and determinants among individuals in Brazil. Method: In line with the reference study, our analysis focused on individuals aged 50 and older without depression and dementia. The primary outcome was cognitive function, assessed using a summary score obtained from the ELSI study to replicate the ADAS-Cog, as in the original study. Participants were categorized into two groups: those engaging in moderate to vigorous exercise (exercise) and those who did not meet this exercise threshold (no exercise). To evaluate the relationship between exercise and cognitive function, we performed three linear regression models: one without adjustments for covariates, a second model adjusting for sex, education, and race (main model), and a third model with multiple adjustments. A sensitivity analysis using Cohen's D was also conducted. Results: In this study from the ELSI cohort, data from 7,292 individuals were available, and 6,147 met the inclusion criteria for analysis. A total of 935 individuals were excluded due to depression, and 98 were excluded due to dementia. Baseline characteristics were not well balanced between groups. The mean age in the exercise group was 64 years compared to 67 years in the no exercise group, with a higher percentage of males (48% vs. 39%) and a higher education level (12% with university education vs. 6%). In the unadjusted linear regression, there was a positive correlation between exercise and cognitive function (2.19, 95% CI 1.89-2.48, p&lt;0.001). In the second model, which emulated the reference trial by including sex, race, and educational status, the positive correlation persisted, though with a lower effect size (1.53, 95% CI 1.25-1.82, p&lt;0.001). A third model with additional adjustments was employed to assess the consistency of the association, which was maintained (1.92, 95% CI 1.62-2.23, p&lt;0.001). Conclusion: Our study reaffirms the potential benefits of moderate to vigorous exercise on cognitive function in older adults with mild cognitive impairment.

Willingness to participate in a personalized health cohort – insights from the swiss health study pilot phase

BackgroundThis paper explores the feasibility of establishing a large-scale population-based cohort and biobank in Switzerland by assessing potential participants’ needs, expectations, and concerns about such an infrastructure providing information on health, lifestyle, and exposure trajectories, the development of disease, and risk factors over time.MethodsWe utilized a scenario-based questionnaire in the Swiss Health Study pilot phase (2020–2021), involving 1349 adults aged 20–69 from the cantons Vaud and Bern. We conducted descriptive statistics supported by R and qualitative content analysis of n = 374 open responses related to attitudes towards research.ResultsWe highlight the benefits and challenges of the scenario-based approach, discuss the sample represented in the pilot phase, and present implications for building a full cohort. We also report on participants’ attitudes towards and previous experience with health research. We analyze references regarding informed consent and feedback, attitudes towards the Swiss Health Study, and recommendations on improving its scope, design, and instruments. Results indicate a high interest (90%) in participating in a national health study, with 85% of a random population sample willing to join a long-term cohort. Only 43% were familiar with biobanks, and 44% preferred general consent. Trust was high for Swiss-based public research but lower for researchers from other countries or private sector. Over 95% expressed willingness to complete online questionnaires, undergo physical examination, and donate biosamples. Almost all participants wanted to know the outcomes of the medical tests (99.5%) and the exposure to environmental stressors (95%) from their study center visit. Preferred tools for monitoring sleep, physical activity, and diet were known smartphone apps with automatic data management.ConclusionOverall, the study reveals a positive attitude towards personalized health research, with a strong willingness to share data and samples. Key insights focus the meaning of informed consent for participation, the relevance of sampling and representativeness, as well as the significance and challenges of personalized feedback, especially regarding environmental health concerns. Findings emphasize participants’ supportive yet reflexive stances, underscoring the importance of aligning research values with individual values in personalized health research. These insights contribute valuable considerations for refining the scope, design, and instruments of future cohort studies.

Association between functional capacity and motivation to engage in physical activity before surgery.

Association between functional capacity and motivation to engage in physical activity before surgery.

The moderating effect of access to food facilities and recreational activity space on mHealth multiple health behavior change intervention.

To evaluate whether the neighborhood social and built environment moderates response to a mobile health multiple health behavior change intervention targeting fruit/vegetable intake, sedentary behavior, and physical activity. Participants were 156 Chicago-residing adults with unhealthy lifestyle behaviors. Using linear mixed models, we evaluated whether access to food facilities (fast food restaurants and grocery stores) and recreational activity spaces (gyms and parks) moderated the difference in behavior change between the active intervention condition relative to control. Using spatial data analysis (cross K functions), we also assessed whether participants who achieved goal levels of behaviors ("responders") were more or less likely than those who did not achieve intervention goals ("non-responders") to reside near fast food restaurants, grocery stores, gyms, or parks. According to linear mixed models, none of the neighborhood social and built environment factors moderated the difference in behavior change between the active intervention condition and the control condition (Likelihood Ratio (χ²[1] = 0.02-2.33, P-values > 0.05). Cross K functions showed that diet behavior change responders were more likely than non-responders to reside near fast food restaurants, but not grocery stores. The results for activity behavior change were more variable. Sedentary screen time responders were more likely to reside around recreational activity spaces than non-responders. Moderate-vigorous physical activity responders had greater and lesser clustering than non-responders around parks, dependent upon distance from the park to participant residence. A complex relationship was observed between residential proximity to Chicago facilities and response to multiple health behavior change intervention. Replication across diverse geographic settings and samples is necessary.

Natural health product knowledge as a significant factor associated with health-promoting lifestyle in a low-income urban community in Kuala Lumpur

BackgroundLow income communities are vulnerable to non-communicable diseases (NCDs), which affect their economy and disability status. An effective approach to address the NCD burden is through the multidimensional concept of health-promoting lifestyle. Another preferred approach by the population worldwide for NCD treatment is natural health product (NHP). Studies on NHP and health-promoting lifestyle among this vulnerable population, specifically the low-income urban community, are limited. Therefore, this study, aimed at investigating the NHP knowledge and health-promoting lifestyle, and to determine the factors associated with health-promoting lifestyle in a low income urban community in Cheras, Kuala Lumpur. This study has focused on sociodemographic characteristics, annual health monitoring activities, and health status, which are modifiable and non-modifiable factors.MethodsPhase 1 of the study involves developing the Malay-version NHP knowledge questionnaire, whereas Phase 2 involves a cross-sectional study of 446 randomly selected low-income respondents to determine their level of health-promoting lifestyle and the associated factors. The respondents’ sociodemographic, socioeconomic, health monitoring activity, health status, and NHP knowledge data were obtained using the newly developed Malay-version NHP questionnaire and the Health-Promoting Lifestyle Profile II (HPLP II) questionnaire. The independent variables include sociodemographic status, annual health monitoring activities, health status and NHP knowledge were analysed using simple and multiple linear regression.ResultsIn this study, the 10-item NHP knowledge questionnaire developed in the Malay version contains two domains [safe use (eight items) and point of reference (two items)] (total variance explained: 77.4%). The mean of NHP knowledge score was 32.34 (standard deviation [SD] 7.37). Meanwhile, the mean score of health-promoting lifestyle was 109.67 (SD 25.01). The highest and lowest scores of health-promoting lifestyles are attributed to spiritual growth and physical activity, respectively. Ethnicity is associated with a higher health-promoting lifestyle level, same goes to the occupational status − NHP knowledge interaction. “Unclassified” education status and annual blood glucose level monitoring are associated with a lower level of health-promoting lifestyle.ConclusionA new questionnaire in Malay version was developed to measure NHP knowledge. Compared to other subpopulations, the respondents’ health-promoting lifestyle levels in this study were low, associated with ethnicity, education status, and health monitoring activities. The findings provided insight into the interaction between NHP knowledge and occupational status, which is associated with a higher health-promoting lifestyle level. Accordingly, the future health-promoting lifestyle intervention programmes in healthcare delivery should target these factors.

Correlates of lifestyle patterns among children in Singapore aged 10 years: the growing up in Singapore towards healthy outcomes (GUSTO) study

ObjectiveTo characterise lifestyle patterns (comprising dietary and movement behaviour aspects) of children in Singapore and examine the correlates of these patterns.DesignAn observational study approach was used. Children recorded their diet and activities over two weekdays and two weekend days on a validated web-based assessment, My E-Diary for Activities and Lifestyle (MEDAL). Lifestyle patterns were derived using principal component analysis, and the correlations of these with multiple known determinants organised by distal, intermediate, and proximal levels of influence were studied.SettingChildren of the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort.ParticipantsTen-year-old children (n = 397).ResultsThree lifestyle patterns, “high snacks and processed food”, “balanced” and “mixed”, were identified. We focused on the more health-promoting “balanced” pattern, characterised by lower screen-viewing and higher consumption of fruits, vegetables, wholegrains, and dairy. Among the distal factors, girls were more adherent to the “balanced” pattern compared to boys, and children of parents with lower education levels were less adherent to this pattern. Among intermediate factors, children of mothers with higher diet quality were more adherent to the “balanced” pattern. Among the proximal factors, engagement in active transport, leisure sports, and educational activities outside of school were positively associated with the “balanced” pattern, whereas screen-viewing while travelling was negatively associated with this pattern. Having siblings, pet ownership, mother’s physical activity, parenting style, parental bonding, child’s outdoor time, and breakfast consumption were not associated with children’s lifestyle patterns.ConclusionsThese findings provide direction for future interventions by identifying vulnerable groups and contexts that should be prioritised.

Effective roles of exercise and diet adherence in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients. The associated pathogenic mechanism is not completely understood and there are no specific drugs for patients with NAFLD. Exercise and diet adherence are the best options for the management of NAFLD patients. Questionnaire associated analysis models of adherence to these interventions are used to assess their effectiveness in the management of NAFLD patients using specificity, sensitivity, and so on. Studies have indicated that the relative ratio of NAFLD can be reduced by physical activity with diet control. In the future, the pathogenesis of NAFLD should be clarified with stratified efforts to develop appropriate drugs, and both exercise and diet adherence should be optimized using better questionnaire design and evaluation models for patients with NAFLD.