Higher Physical Activity Energy Expenditure Research Articles

Physical activity volume, intensity, and incident cardiovascular disease.

The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. Data were from 88 412 UK Biobank middle-aged adults (58% women) without prevalent CVD who wore accelerometers on their dominant wrist for 7 days, from which we estimated total PA energy expenditure (PAEE) using population-specific validation. Cox proportional hazards regressions modelled associations between PAEE (kJ/kg/day) and PA intensity (%MVPA; the fraction of PAEE accumulated from moderate-to-vigorous-intensity PA) with incident CVD (ischaemic heart disease or cerebrovascular disease), adjusted for potential confounders. There were 4068 CVD events during 584 568 person-years of follow-up (median 6.8 years). Higher PAEE and higher %MVPA (adjusted for PAEE) were associated with lower rates of incident CVD. In interaction analyses, CVD rates were 14% (95% confidence interval: 5-23%) lower when MVPA accounted for 20% rather than 10% of 15 kJ/kg/d PAEE; equivalent to converting a 14 min stroll into a brisk 7 min walk. CVD rates did not differ significantly between values of PAEE when the %MVPA was fixed at 10%. However, the lowest CVD rates were observed for combinations of both higher PAEE and %MVPA. Reductions in CVD risk may be achievable through higher PA volume and intensity, with the role of moderately intense PA appearing particularly important. This supports multiple approaches or strategies to PA participation, some of which may be more practical or appealing to different individuals.

Effects of energy balance on appetite and physiological mediators of appetite during strenuous physical activity: secondary analysis of a randomised crossover trial.

Energy deficit is common during prolonged periods of strenuous physical activity and limited sleep, but the extent to which appetite suppression contributes is unclear. The aim of this randomised crossover study was to determine the effects of energy balance on appetite and physiological mediators of appetite during a 72-h period of high physical activity energy expenditure (about 9·6 MJ/d (2300 kcal/d)) and limited sleep designed to simulate military operations (SUSOPS). Ten men consumed an energy-balanced diet while sedentary for 1 d (REST) followed by energy-balanced (BAL) and energy-deficient (DEF) controlled diets during SUSOPS. Appetite ratings, gastric emptying time (GET) and appetite-mediating hormone concentrations were measured. Energy balance was positive during BAL (18 (sd 20) %) and negative during DEF (-43 (sd 9) %). Relative to REST, hunger, desire to eat and prospective consumption ratings were all higher during DEF (26 (sd 40) %, 56 (sd 71) %, 28 (sd 34) %, respectively) and lower during BAL (-55 (sd 25) %, -52 (sd 27) %, -54 (sd 21) %, respectively; Pcondition < 0·05). Fullness ratings did not differ from REST during DEF, but were 65 (sd 61) % higher during BAL (Pcondition < 0·05). Regression analyses predicted hunger and prospective consumption would be reduced and fullness increased if energy balance was maintained during SUSOPS, and energy deficits of ≥25 % would be required to elicit increases in appetite. Between-condition differences in GET and appetite-mediating hormones identified slowed gastric emptying, increased anorexigenic hormone concentrations and decreased fasting acylated ghrelin concentrations as potential mechanisms of appetite suppression. Findings suggest that physiological responses that suppress appetite may deter energy balance from being achieved during prolonged periods of strenuous activity and limited sleep.

Relationship between primary school healthy eating and physical activity promoting environments and children’s dietary intake, physical activity and weight status: a longitudinal study in the West Midlands, UK

ObjectiveWe aimed to examine the association between food and physical activity environments in primary schools and child anthropometric, healthy eating and physical activity measures.DesignObservational longitudinal study using data from a...

Wearable-device-measured physical activity and future health risk.

Use of wearable devices that monitor physical activity is projected to increase more than fivefold per half-decade1. We investigated how device-based physical activity energy expenditure (PAEE) and different intensity profiles were associated with all-cause mortality. We used a network harmonization approach to map dominant-wrist acceleration to PAEE in 96,476 UK Biobank participants (mean age 62 years, 56% female). We also calculated the fraction of PAEE accumulated from moderate-to-vigorous-intensity physical activity (MVPA). Over the median 3.1-year follow-up period (302,526 person-years), 732 deaths were recorded. Higher PAEE was associated with a lower hazard of all-cause mortality for a constant fraction of MVPA (for example, 21% (95% confidence interval 4-35%) lower hazard for 20 versus 15 kJ kg-1 d-1 PAEE with 10% from MVPA). Similarly, a higher MVPA fraction was associated with a lower hazard when PAEE remained constant (for example, 30% (8-47%) lower hazard when 20% versus 10% of a fixed 15 kJ kg-1 d-1 PAEE volume was from MVPA). Our results show that higher volumes of PAEE are associated with reduced mortality rates, and achieving the same volume through higher-intensity activity is associated with greater reductions than through lower-intensity activity. The linkage of device-measured activity to energy expenditure creates a framework for using wearables for personalized prevention.

Diurnal Profiles of Physical Activity and Postures Derived From Wrist-Worn Accelerometry in UK Adults

Background: Wrist-worn accelerometry is the commonest objective method for measuring physical activity in large-scale epidemiological studies. Research-grade devices capture raw triaxial acceleration which, in addition to quantifying movement, facilitates assessment of orientation relative to gravity. No population-based study has yet described the interrelationship and variation of these features by time and personal characteristics. Methods: 2,043 United Kingdom adults (35–65 years) wore an accelerometer on the non-dominant wrist and a chest-mounted combined heart-rate-and-movement sensor for 7 days free-living. From raw (60 Hz) wrist acceleration, we derived movement (non-gravity acceleration) and pitch and roll (forearm) angles relative to gravity. We inferred physical activity energy expenditure (PAEE) from combined sensing and sedentary time from approximate horizontal arm angle coupled with low movement. Results: Movement differences by time-of-day and day-of-week were associated with forearm angles; more movement in downward forearm positions. Mean (SD) movement was similar between sexes ∼31 (42) mg, despite higher PAEE in men. Women spent longer with the forearm pitched &gt;0°, above horizontal (53% vs 36%), and less time at &lt;0° (37% vs 53%). Diurnal pitch was 2.5–5° above and 0–7.5°below horizontal during night and daytime, respectively; corresponding roll angles were ∼0° (hand flat) and ∼20° (thumb-up). Differences were more pronounced in younger participants. All diurnal profiles indicated later wake-times on weekends. Daytime pitch was closer to horizontal on weekdays; roll was similar. Sedentary time was higher (17 vs 15 hours/day) in obese vs normal-weight individuals. Conclusions: More movement occurred in forearm positions below horizontal, commensurate with activities including walking. Findings suggest time-specific population differences in behaviors by age, sex, and BMI.

Fear of Physical Activity, Anxiety, and Depression

Abstract. Background: Physical activity (PA) is recommended by heart failure treatment guidelines. Adherence to exercise prescriptions is low and not much is known about everyday PA in this patient group. Aims: This study describes objectively assessed everyday PA/sedentary behavior in men and women with chronic heart failure and examines associations of potential barriers for engaging in PA, namely fear of physical activity (FoPA), general anxiety, and depression, with indicators of PA and sedentary behavior. Method: In 61 outpatients with heart failure (67.5 ± 10.7 years of age) the impact of FoPA, trait anxiety, and depression on 6-day accelerometer measures was evaluated using linear regression models. Results: Sedentary behavior was prevalent in men and women alike, with lying down and sitting/standing as predominant activity classes during daytime. Men had higher PA energy expenditure (726 vs. 585 kcal/d, Cohen’s effect size d = 0.74) and walked up/down more often (0.21% vs. 0.12% of total PA, d = 0.56) than women. FoPA did not differ between sexes. FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates (β-values between −0.26 and −0.44, p-values &lt; 0.024). Limitations: The self-selected sample included few women. Medical data were assessed via self-reports. Conclusion: FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates. These preliminary findings highlight FoPA as a barrier to everyday PA in patients with heart failure.

Associations of Sedentary Time with Energy Expenditure and Anthropometric Measures.

To investigate associations between accelerometer-determined sedentary time (ST) in prolonged (≥30 min) and nonprolonged (<30 min) bouts with physical activity energy expenditure (PAEE) from doubly labeled water. Additionally, associations between ST and body mass index (BMI) and waist circumference were examined. Data from 736 women and 655 men age 43 to 82 yr were analyzed. Participants wore the Actigraph GT3X for 7 d on two occasions approximately 6 months apart, and the average of the measurements was used. Physical activity energy expenditure was estimated by subtracting resting metabolic rate and the thermic effect of food from doubly labeled water estimates of total daily energy expenditure. Cross-sectional associations were analyzed using isotemporal substitution modeling. Reallocation of prolonged ST to nonprolonged was not associated with increased PAEE and only significantly associated with lower BMI (β = -0.57 kg·m; 95% confidence interval, -0.94 to -0.20) and waist circumference (β = -1.61 cm; 95% confidence interval, -2.61 to -0.60) in men. Replacing either type of ST with light or moderate-to-vigorous physical activity was significantly associated with higher PAEE, and lower BMI and waist circumference in both women and men. Limiting time spent sedentary as well as decreasing ST accumulated in prolonged bouts may have beneficial effects on BMI and waist circumference. Replacing any type of ST with activities of light or higher intensity may also have a substantial impact on PAEE.

Attaching metabolic expenditures to standard occupational classification systems: perspectives from time-use research

BackgroundTraditionally, time-use data have been used to inform a broad range of economic and sociological research topics. One of the new areas in time-use research is the study of physical activity (PA) and physical activity energy expenditure (PAEE). Time-use data can be used to study PAEE by assigning MET values to daily activities using the Ainsworth Compendium of Physical Activities. Although most diarists record their daily activities accurately and in detail, they are only required to record their paid working hours, not the job-specific tasks they undertake. This makes it difficult to assign MET values to paid work episodes.MethodsIn this methodological paper, we explain how we addressed this problem by using the detailed information about respondents’ occupational status included in time-use survey household and individual questionnaires. We used the 2008 ISCO manual, a lexicon of the International Labour Organization of occupational titles and their related job-specific tasks. We first assigned a MET value to job-specific tasks using the Ainsworth compendium (2011) then calculated MET values for each of the 436 occupations in the ISCO-08 manual by averaging all job-specific MET values for each occupation.ResultsThe ISCO-08 Major Groups of ‘elementary occupations’ and ‘craft and related trades workers’ are associated with high PAEE variation in terms of their job-specific MET values and together represented 21.6% of the Belgian working population in 2013. We recommend that these occupational categories should be prioritised for further in-depth research into occupational activity (OA).ConclusionsWe developed a clear and replicable procedure to calculate occupational activity for all ISCO-08 occupations. All of our calculations are attached to this manuscript which other researchers may use, replicate and refine.

Home and Work Physical Activity Environments: Associations with Cardiorespiratory Fitness and Physical Activity Level in French Women.

The influence of the physical activity environment in the home and at work on cardiorespiratory fitness (CRF) and objectively-measured physical activity has not been extensively studied. We recruited 147 women with a (mean ± SD) age of 54 ± 7 years and without evidence of chronic disease. The physical activity environment was assessed by self-report (Assessing Levels of PHysical Activity or ALPHA questionnaire), CRF using a submaximal step test, usual physical activity using combined heart rate and accelerometry, as well as by a validated questionnaire (Recent Physical Activity Questionnaire). Summary scores of the home environment and the work environment derived from the ALPHA questionnaire were positively correlated with CRF after adjustment for age (r = 0.18, p = 0.03 and r = 0.28, p < 0.01, respectively). Women owning a bicycle or having a garden (which may prompt physical activity) had higher CRF; those with a bicycle at home also had a higher physical activity energy expenditure. Similarly, women who had access to fitness equipment at work had higher CRF. In conclusion, these results provide new insights into potential environmental influences on physical capacity and physical activity that could inform the design of physical activity promotion strategies.

The Relationship Between Accelerometer-measured Sedentary Behaviors And Physical Activity Energy Expenditure Measured By Doubly-labeled Water

PURPOSE: The aim was to study the association between accelerometer determined total sedentary time (ST) and breaks in ST with physical activity energy expenditure (PAEE) from doubly-labeled water (DLW). Further, results based on accelerometer counts from only the vertical axis (VT) and from all three axes (VM3) were compared. METHODS: Data from 748 women and 659 men (43-83 years) were analyzed. Participants wore the Actigraph GT3X accelerometer on the hip during waking hours for seven days twice during the study about 6 months apart. Using the average of the two measurements, total ST was estimated using cut-points of 100 (VT) and 200 (VM3) counts/min. A break in ST was defined as at least one minute of a higher activity count within a sedentary bout. PAEE (kcal/day) was estimated by subtracting resting metabolic rate and the thermic effect of food from total energy expenditure derived from one DLW measurement, with a small subsample having a repeat. Partial Spearman correlations and linear regression models were used to determine associations between total ST and breaks per sedentary hour with PAEE. Correlations and models were adjusted for age, weight, fat free mass, accelerometer wear time and moderate-to-vigorous physical activity (MVPA). RESULTS: Mean total ST using VT and VM3 were 9.0 and 7.9 h/day of wear time, respectively, in women and 9.3 and 8.5 h/day in men. Corresponding mean breaks per sedentary hour were 10.4 and 11.0 in women and 9.2 and 9.4 in men. Partial Spearman correlation coefficients between ST and PAEE ranged from -0.34 to -0.44 and correlations between breaks per sedentary hour and PAEE from 0.27 to 0.34. After adjustment for within-person variation in PAEE, correlations for ST ranged from -0.38 to -0.68 and correlations for breaks per sedentary hour from 0.35 to 0.51. In adjusted models, each hour of ST was associated with lower PAEE (β= -66 to -103 kcal, p < .0001) and each break per sedentary hour was associated with higher PAEE (β= 21 to 39 kcal, p < .0001). Estimates were slightly higher for VT vs. VM3. CONCLUSIONS: This study found that total ST was inversely associated and breaks in ST was positively associated with PAEE in both men and women independent of body composition and MVPA. Replacing ST with light physical activity and more frequent movement throughout the day may have an impact on an individual’s PAEE.

Higher physical activity is associated with lower aortic stiffness but not with central blood pressure: the ADDITION-Pro Study.

Physical activity is associated with reduced cardiovascular disease risk. However, improvements in conventional risk factors due to physical activity do not explain its full benefit. Therefore, we examined associations of objectively measured physical activity energy expenditure and intensity with central hemodynamics to provide new insight into the link between physical activity and cardiovascular disease.We analyzed data from 1816 Danes (median age: 66 years) without cardiovascular disease. Physical activity was estimated using combined accelerometry and heart rate monitoring. Aortic stiffness was assessed by applanation tonometry, as aortic pulse wave velocity, and central blood pressure was estimated from radial waveforms. Associations between physical activity energy expenditure and central hemodynamics were examined by linear regression. Furthermore, the consequence of substituting 1 hour sedentary behavior with 1 hour light or moderate-to-vigorous physical activity on central hemodynamics was examined.Median physical activity energy expenditure was 28.0 kJ/kg/d (IQR: 19.8; 38.7). A 10 kJ/kg/d higher energy expenditure was associated with 0.75% lower aortic pulse wave velocity (CI: −1.47; −0.03). Associations with central systolic blood pressure and central pulse pressure were not statistically significant. We observed no difference in central hemodynamics when substituting 1 hour sedentary behavior with 1 hour light or moderate-to-vigorous physical activity.In this relatively inactive population, higher physical activity energy expenditure was associated with lower aortic stiffness, while there was no statistically significant association between substitution of activity intensity and central hemodynamics. This suggests that lower aortic stiffness is one of a number of health benefits attributed to higher habitual physical activity.

Physical activity across adulthood in relation to fat and lean body mass in early old age: findings from the Medical Research Council National Survey of Health and Development, 1946-2010.

Fat and lean body mass have important implications for health and physical functioning in older age, and physical activity is purported to be an important modifiable determinant. However, our evidence-based understanding of its role is limited. We examined the associations of physical activity, assessed both by self-report (using data on leisure time physical activity (LTPA) collected on 4 occasions over a 28-year period) and objectively (using 5-day heart rate and movement monitoring), with fat and lean mass at ages 60–64 years in 1,162 British participants from the Medical Research Council National Survey of Health and Development in 1946–2010. Higher objectively assessed physical activity energy expenditure (PAEE) at ages 60–64 years was associated with lower fat mass and android (abdominal):gynoid (hip) fat ratio (mean differences in fat mass per 1–standard deviation increase in PAEE were −0.79 kg/m1.2 in men (95% confidence interval: −1.08, −0.50) and −1.79 kg/m1.2 (95% confidence interval: −2.15, −1.42) in women). After adjustment for fat mass, higher PAEE was associated with higher appendicular lean mass. Both light and moderate-to-vigorous intensities of activity were associated with fat mass, and the latter was associated with lean mass. More frequent LTPA across adulthood was associated with lower fat mass (in women only) and higher appendicular lean mass (in both sexes, after adjustment for fat mass). These results support the promotion of LTPA across adulthood, as well as both light and moderate-to-vigorous intensities of activity among older adults.

Short Sleep Duration Is Associated with Higher Energy Intake and Expenditure among African-American and Non-Hispanic White Adults1,2

Habitual short sleep duration appears to increase the risk of obesity. The objective of this paper is to investigate the association of habitual sleep duration with objective measures of energy balance. One hundred twelve African-American and 111 non-Hispanic whites aged 21–69 y participated in a cross-sectional study of dietary assessment and biomarkers. Participants reported the mean number of hours per day spent sleeping over the past year. Short sleep duration was defined as ≤6 h/d of sleep. Energy intake (kilocalories) was objectively assessed using the 2-point doubly labeled water technique to determine total energy expenditure, which is approximately equal to energy intake. Physical activity energy expenditure (kilocalories) was estimated as total energy expenditure minus each participant’s calculated basal metabolic rate and the thermogenic effect of food. Compared with participants who slept ≤6 h, individuals who slept 8 h were significantly less likely to be obese (OR: 0.33; 95% CI: 0.14, 0.79). However, this association was not linear across 6–9 h of sleep (P-trend = 0.16). There was an inverse association between sleep and energy intake (P-trend = 0.07): compared with ≤6 h/d, adults who reported ≥9 h sleep consumed 178 fewer kcal/d. There was also an inverse association between sleep and physical activity (P-trend = 0.05): compared with ≤6 h/d of sleep, adults who reported 9 h of usual sleep expended 113 fewer kcal/d in physical activity. These data indicate that, compared with longer sleep duration, adults who report habitual short sleep duration have somewhat higher physical activity energy expenditure but considerably higher energy intake. Habitual short sleep duration appears to be 1 of the facets of modern life leading to a mismatch between energy intake and physical activity.

Abstract P022: Determinants of Energy Balance: Differences Related to Body Weight and Body Composition

Conversion, utilization and storage of energy in the regulation of energy balance is poorly understood. These misconceptions arise from confusion related to energy balance and its impact on body weight and composition, and can bias the interpretation of findings that are important for the development of policies addressing the obesity epidemic. PURPOSE: Our purpose was to examine the regulation of interactions between total daily energy intake (TDEI) and energy expenditure (TDEE) in healthy adults. METHODS: Adults not limited by gender, race or ethnicity (n=430; aged 21 to 40; BMI of 20 to 35) participated in a battery of physiological, anthropomorphic, behavioral and psychological measurements that are associated with energy balance regulation. The primary components of energy balance regulation (TDEI and TDEE) were measured by 3 random 24-hour dietary recalls and SenseWear accelerometry, respectively. Body composition was determined by dual x-ray absorptiometry (DXA). Absolute and relative resting metabolic rates (aRMR and rRMR) were determined through hooded indirect calorimetry. General linear modeling was used to examine the relationships of weight and body fatness with TDEI and macronutrient composition as well as the largest components of TDEE including aRMR, rRMR and physical activity energy expenditure (PAEE). In addition, data were compared between participants with a healthy body fat % (below 25; n=123) and obese (at or above 30%; n=241). RESULTS: All results were adjusted for age, gender and race. TDEE was positively associated (r=.47, p&lt;.001) with TDEI. There was a positive association between aRMR (L/min) and weight (r=.743, p&lt;.001). By contrast, rRMR (ml/kg/min) was inversely correlated with body weight (r= -.38; p&lt;.001). TDEI was significantly higher in the lean group (2465±66 to 1878±42, p&lt;.001) with no measureable differences in macronutrient percentages. The lean group had a higher TDEE and PAEE as compared to the obese group. CONCLUSIONS: There was a robust matching of TDEI and TDEE across weight and body composition ranges. Heavy people burned more calories than lighter people although the lighter individuals had a higher rRMR. The leaner group had a higher TDEI, reflecting a potential regulation based on the greater TDEE in this group. Further, the increased TDEE could be explained by the higher PAEE (approximately 500 kcal) in leaner individuals. These findings emphasize that energy expenditure is related to mass rather than body composition. The regulation of energy intake and body composition is multifactorial, with PAEE a significant determinant for energy storage. This study was funded through an unrestricted grant from The Coca-Cola Company.

Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia

Determine the relationship between diet and metabolic abnormalities among adult survivors of childhood acute lymphoblastic leukemia (ALL). We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral and subcutaneous adiposity were measured by abdominal CT. Adherence to a Mediterranean diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using multivariate analysis adjusted for age and gender. Greater adherence to a Mediterranean diet pattern was associated with lower visceral adiposity (p = 0.07), subcutaneous adiposity (p < 0.001), waist circumference (p = 0.005), and body mass index (p = 0.04). For each point higher on the Mediterranean Diet Score, the odds of having the metabolic syndrome fell by 31 % (OR 0.69; 95 % CI 0.50, 0.94; p = 0.019). Higher dairy intake was associated with higher HOMA-IR (p = 0.014), but other individual components of the Mediterranean diet, such as low intake of meat or high intake of fruits and vegetables, were not significant. PAEE was not independently associated with metabolic outcomes, although higher PAEE was associated with lower body mass index. Adherence to a Mediterranean diet pattern was associated with better metabolic and anthropometric parameters in this cross-sectional study of ALL survivors.

Cardiorespiratory fitness and physical activity in Luo, Kamba, and Maasai of rural Kenya

BackgroundAlthough habitual physical activity energy expenditure (PAEE) and cardio-respiratory fitness (CRF) are now well-established determinants of metabolic disease, there is scarcity of such data from Africa. The aim of this study was to describe objectively measured PAEE and CRF in different ethnic populations of rural Kenya.MethodsA cross-sectional study was done among 1,099 rural Luo, Kamba, and Maasai of Kenya. Participants were 17–68 years old and 60.9% were women. Individual heart rate (HR) response to a submaximal steptest was used to assess CRF (estimated VO2max). Habitual PAEE was measured with combined accelerometry and HR monitoring, with individual calibration of HR using information from the step test.ResultsMen had higher PAEE than women (∼78 vs. ∼67 kJ day−1 kg−1, respectively). CRF was similar in all three populations (∼38 and ∼43 mlO2·kg−1 min−1 in women and men, respectively), while habitual PAEE measures were generally highest in the Maasai and Kamba. About 59% of time was spent sedentary (<1.5 METs), with Maasai women spending significantly less (55%). Both CRF and PAEE were lower in older compared to younger rural Kenyans, a difference which was most pronounced for PAEE in Maasai (−6.0 and −11.9 kJ day−1 kg−1 per 10-year age difference in women and men, respectively) and for CRF in Maasai men (−4.4 mlO2·min−1 kg−1 per 10 years). Adjustment for hemoglobin did not materially change these associations.ConclusionPhysical activity levels among rural Kenyan adults are high, with highest levels observed in the Maasai and Kamba. The Kamba may be most resilient to age-related declines in physical activity. Am. J. Hum. Biol. 2012. © 2012 Wiley Periodicals, Inc.

Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia.

9552 Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity, insulin resistance and increased visceral adiposity. A history of cranial radiation therapy (CRT) worsens this risk. In non-cancer populations, adherence to a Mediterranean Diet has been shown to improve metabolic parameters and risk of diabetes mellitus. Whether diet may contribute to insulin resistance and increased adiposity in ALL survivors is not known. Methods: We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Fasting blood was obtained on all subjects and insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral adiposity was measured by abdominal CT. Adherence to a Mediterranean Diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using univariate analysis. Results: Subjects were majority female (56%); 25% were minority or Hispanic white. A history of CRT was present in 15 (29%) men and 25 (38%) women. Among all subjects, greater adherence to a Mediterranean diet pattern was associated with improved HOMA-IR (p=0.14), visceral adiposity (p=0.03), subcutaneous adiposity (p=0.005), waist circumference (p=0.02), and body mass index (p=0.03) (all unadjusted analyses). The effect of adherence to a Mediterranean diet on insulin resistance was especially notable in men who did not receive CRT (p=0.06). Higher dairy intake was found to worsen HOMA-IR (p=0.014), but other individual components of the Mediterranean diet, such as low intake of meat and high intake of fruits and vegetables, were not significant. Inclusion of PAEE did not alter our findings, although higher PAEE was associated with lower body mass index. Conclusions: Adherence to a Mediterranean diet pattern, especially low consumption of dairy products, may improve insulin resistance in survivors of childhood ALL. Further study is warranted.

Physical Activity Energy Expenditure in Dutch Adolescents: Contribution of Active Transport to School, Physical Education, and Leisure Time Activities

Detailed knowledge about physical activity energy expenditure (PAEE) can guide the development of school interventions aimed at reducing overweight in adolescents. However, relevant components of PAEE have never been objectively quantified in this population. This study investigated the contribution of active transport to and from school, physical education (PE), and leisure time activities to total PAEE during a regular school week in adolescents. Seventy-three adolescents (mean age: 15.7 years) wore an individually calibrated combined heart rate-acceleration monitor and kept an activity diary during a regular school week. Branched equation modeling was used to calculate PAEE of the specific activity categories, and their relative contribution to total PAEE was determined. Active transport and PE contributed 30.0% and 17.4%, respectively, to school-related PAEE. Active transport to and from school contributed 15% to total PAEE. Youth with a high physical activity level (PAL) spent 4 hours less in sedentary behavior than subjects with a medium or low PAL (F = 77.415 (2.70), p < .001) and had higher PAEE during leisure time sports (F = 9.135 (2.70), p < .001) and work-related activities (F = 10.583 (2.70), p < .001) than youth with medium or low PAL values. Active transport and PE contribute significantly to PAEE during school hours in adolescents. To achieve an increase in total PAEE in the least active group of adolescents, promising strategies might be to reduce inactive behavior, increase participation in leisure time sports, and possibly to replace inactive for active jobs.

Female boxers have high bone mineral density despite low body fat mass, high energy expenditure, and a high incidence of oligomenorrhea

Low body fat mass and menstrual irregularities have been associated with low bone mineral density (BMD). The aim of this study was to compare the relation between BMD, lean body mass, fat mass, physical activity energy expenditure (PAEE), and menstrual status in female boxers and in physically active females with low (C1) or average (C2) fat mass. Boxers (n = 11) and controls (C1, n = 16; C2, n = 17), aged 18-38 years, were assessed for BMD and body composition with dual-energy X-ray absorptiometry. Menstrual status and PAEE were determined from questionnaires. There was no difference in anthropometric measurements between boxers and C1 subjects, except that boxers had higher arm lean mass. However, both boxers and C1 subjects had a lower percentage of fat (p < 0.001) than C2 subjects (boxers, 14.6% +/- 2.0; C1, 15.5% +/- 4.2; C2, 25.8% +/- 3.4%), and boxers had a higher (p = 0.002) lean body mass index (lean body mass/height2, where lean body mass is measured in kilograms and height is measured in metres) than C2 subjects. The PAEE of boxers was higher (p < 0.007) than that of controls (boxers, 5748 +/- 2284 ; C1, 2966 +/- 2258 ; C2, 2714 +/- 1722 kcal.week-1). Oligomenorrhea was more common in boxers than in C1 and C2 subjects (boxers, 54.6%; C1, 18.8%; C2, 35.3%). Arm, leg, and spine BMD were higher (p < 0.008) in boxers than in C1 subjects, and arm BMD was higher in boxers than in C2 subjects. BMD Z scores were also higher (p < 0.05) in boxers (boxers, 1.1+/- 0.8, C1, 0.1 +/- 0.7; C2: 0.3 +/- 1.1). High BMD in boxers, despite low fat mass, high PAEE, and an increased incidence of oligomenorrhea suggest that boxing has a positive effect on BMD.

Relationship Between Very High Physical Activity Energy Expenditure, Heart Rate Variability and Self-Estimate of Health Status in Middle-Aged Individuals

In middle-aged persons, moderate physical activity energy expenditure (PAEE) has been shown to be associated with increased vagal-related heart rate variability (HRV) indexes and better health status. The purpose of this study was to determine whether a very high PAEE has greater effect on vagal-related HRV indexes and self-estimates of well-being in middle-aged subjects having distinct long-term physical activity profiles. Forty-four subjects were divided into three groups on the basis of the sport score of the Modified Baecke Questionnaire for Older Adults: sedentary (SED, n = 15), moderately-trained (MT, n = 16), and highly-trained subjects (HT, n = 13). PAEE was estimated by triaxial accelerometry during one week. Time and frequency domain HRV indexes were determined during quiet periods in the morning on 5-min R-R interval segments under controlled breathing. Quality of life was evaluated using the SF-36 health survey questionnaire. PAEE was significantly different for each group (374.5 +/- 13.8, 616.8 +/- 22.4, and 1086.6 +/- 43.2 kcal . day (-1) for SED, MT, and HT, respectively, p < 0.001). MT presented significantly higher vagal-related HRV indexes than SED and HT (p < 0.05). None of the HRV indexes was significantly greater in HT than in SED. MT and HT had similar health status scores, which were significantly higher than for SED. These results indicate that in middle-aged subjects, habitual moderate PAEE is associated with greater vagal tone and self-estimates of well-being compared to low PAEE. In contrast, very high PAEE is associated with similar vagal-related indexes as low PAEE, despite better overall health status.