Increase Physical Activity Levels Research Articles

141 Perspectives of key stakeholders on an adaptive physical activity mHealth intervention in the prevention of secondary stroke: a qualitative study

Abstract Background Engaging in regular Physical Activity (PA) is associated with lower mortality post-stroke, and PA reduces the chance of recurrent stroke. Despite recent guidelines to optimise PA post-stroke, people with stroke are known to be less active than their age-matched counterparts. Given the heterogenous nature of stroke, PA interventions, which are adaptive to individual performance, are recommended. Empirical data is lacking on the design and delivery of adaptive PA interventions post-stroke. Suggested strategies recommend the use of mobile health (mHealth) interventions. The aim of this study is to explore the perspectives of key stakeholders on the design and development of an adaptive mHealth PA intervention post-stroke. Methods People with stroke, healthcare professionals and carers participated in semi-structured one-to-one or focus group interviews. A reflexive thematic analysis was undertaken on transcribed interviews and key themes and sub-themes were developed. Results Twenty-eight interviews were conducted across stakeholder groups including people with stroke (n = 12, mean age 55 years), healthcare professionals (n = 10) and carers (n = 6, mean age 67 years). Three main themes relevant to the design and development of the intervention were identified: (1) Key features of a mHealth PA intervention, (2) Pragmatic intervention delivery, (3) Challenges to development and use. Conclusion There was widespread agreement across stakeholder groups that an adaptive mHealth PA intervention post-stroke would be beneficial following discharge from acute care. Our data supports the development of individually adapted programs, to increase PA post-stroke. These findings present new perspectives across stakeholder groups on the design and delivery of an adaptive, mHealth PA post-stroke. Taken together with existing quantitative evidence, these findings will inform the development of a feasibility trial, examining patient and process outcomes, to increase PA levels post-stroke.

O.4.5-11 The association between health literacy and objectively measured physical activity in Norwegian young adult students

Abstract Background Insufficient physical activity (PA) is a significant public health challenge, with a drastic decline in activity levels observed in young adulthood likely contributing to increases in cardiometabolic risk factors with age. Recent research suggests that health literacy (HL) may be an important modifiable factor associated with reduced physical activity levels and poor health outcomes in elderly and disease-prone populations. However, limited research has focused on young adulthood when the drastic decline in PA is observed. Moreover, most previous studies have only assessed self-reported PA, which has limited accuracy. Therefore, the purpose of this study was to assess the relationship between HL and objectively measured PA levels in healthy young adults. Method 28 young adult (18-25 years) college students participated in the study (men: n = 7, women: n = 21). PA was measured objectively and subjectively using an accelerometer (Actigraph GT3X+) and the IPAQ questionnaire, respectively. The HLS19 instrument was used to assess HL, which was developed within “HLS19 – the International Health Literacy Population Survey 2019-2021” of M-POHL. Participants were categorized as having low or high health literacy based on the classification defined in the Norwegian HLS-19 report (2021). Additionally, each response was assigned a value (1-4) to calculate a summative health literacy point score, with a higher summative value indicating greater health literacy. Results In our cohort, 60% (n = 17) of the participants were categorized as having low and 39% (n = 11) as having high health literacy. There was no group difference in objective and subjective PA levels between those with low and high HL (all comparisons: p > 0.05). However, we observed a significant positive correlation between health literacy (point score) and objectively measured moderate to high-intensity PA (r = 0.52, p = 0.002). Likewise, there was a significant correlation between health literacy (point score) and self-reported total PA (r = 0.34, p = 0.03). Conclusion This is the first study to show a positive relationship between HL and PA in healthy young adult students, highlighting the potential role of HL in modulating PA in this population. Thus, further research is needed to determine whether targeting HL could effectively increase PA levels in young adults.

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.

Facilitators and barriers to physical activity among English adolescents in secondary schools: a mixed method study.

It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated students' perceptions of barriers to PA among inactive English adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, the Behaviour Change Wheel (BCW), and Theoretical Domains Framework (TDF). The study compared barriers faced by inactive and active groups participating in sports and PA in secondary schools to identify sources of behaviour contributing to inactivity. A pre-intervention online survey was distributed to affiliated schools by 233 Teaching Schools Alliances (TSAs) as part of the monitoring and evaluation of the Secondary Teacher Training study. Data were cross-tabulated to analyse activity levels and behavioural barriers for active and inactive groups, using the COM-B domains. The research team followed a seven-step process to categorise barriers based on their relevant domain in the TDF mapped to the COM-B. The findings were derived from one of the most extensive surveys of adolescents ever undertaken involving 200,623 active and 8,231 inactive respondents. The study identified 52 barriers and 68 behaviours that prevent adolescents from participating in PA. Psychological and social barriers were found to affect all activity levels, genders, and ethnic groups, with a lack of confidence and self-consciousness being the most prevalent. Certain demographic groups, such as those from minority ethnic groups and disabled individuals, were found to be overrepresented among inactive populations. The finding of the study indicated that there were common barriers that affected both inactive and active groups, with further similarity when examining barriers between active and inactive girls. The study also found that girls were more likely to experience the main barriers compared to boys, while inactive boys were more likely to encounter these barriers compared to active boys. The findings suggest that common barriers could be addressed across the population, while recognising some differences in demographics, and the need to provide personalised support. Targeted interventions are also suggested for all girls and inactive boys. This study highlights the range of barriers that impact adolescents and provides insight into potential mechanisms for behaviour change, including intervention functions, policy categories, and evidence-based behaviour change tools. The study highlights the need for further research to address the barriers to PA among adolescents, particularly those who are inactive. Utilising the findings of this study, future research should investigate the effectiveness of novel digital exercise interventions and policies in increasing PA levels among children and adolescents. Complex digital exercise interventions, including conversational AI solutions, could provide personalised tools to identify and revolutionise support around the multitude of barriers that impact adolescents globally."For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission."

Healthy longevity: a systematic review of nutrological and lifestyle aspects

Introduction: In the context of healthy longevity, quality of life, genetic, environmental, and lifestyle factors can determine the life expectancy of human beings. Nutrition is a key component affecting our health, and several studies show that nutrition also has the potential to increase lifespan. Objective: It was to carry out a systematic review of the impacts of nutrology and lifestyle on the longevity of human beings, as well as to point out the main dietary and lifestyle care based on the results of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to July 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 311 articles were found, and 147 articles were evaluated and 47 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 51 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =87.3%>50%. There is scientific evidence that nutrients and natural substances of human physiology and biochemistry such as melatonin and coenzyme Q10 control the functions of the immune system. Many metabolic or chronic diseases have been implicated with poor diet and lifestyle. Improved diet quality is associated with reduced all-cause mortality, whereas multivitamins and multimineral supplements can improve life expectancy. Overall well-being is improved when sedentary but sufficiently physically active adults reduce sedentary time and increase physical activity levels. The results of the pandemic indicate there have been a variety of lifestyle changes, physical inactivity, and psychological issues. Still, adults over 40 years old, with children, unemployed, and those living in a macroeconomic region were shown to be more exposed to unhealthy behaviors. The maintenance of dietary intervention through telemedicine can reduce the negative impact of eating habits and physical activity patterns.

Analysis of association between childhood overweight/obesity with screen time, sedentary life style and low levels of physical activity

The escalating prevalence of childhood obesity, affecting nearly 40 million children under five globally, has become a pressing public health concern. The high incidence of obesity in this population can be attributed to numerous factors, such as unhealthy eating habits, lack of physical activity, sedentary lifestyle, and increased screen time, which were exacerbated by worldwide lockdowns during the Covid-19 pandemic. These factors, together with obesity, can potentially predispose these children to non-communicable diseases such as coronary artery disease, type 2 diabetes, and cancer, thereby increasing morbidity and mortality rates. This capstone project aims to globally assess the prevalence of obesity or overweight status in children, establish a relationship between screen usage, physical activity levels, and sedentary behavior, and examine the impact of Covid-19 lockdowns on these parameters. The study methodology includes a comprehensive literature review and data collection from global studies on childhood obesity. Findings from this study could be instrumental in identifying risk factors and developing interventions to mitigate the rising rates of childhood obesity, ultimately supporting the WHO's goal of "no rise in childhood overweight by 2025". Additionally, the study would provide valuable recommendations to decrease sedentary behavior in children and increase physical activity levels, promoting healthier lifestyle choices in children.

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Introduction: Many guidelines now recommend early rehabilitation for acute stroke patients. However, evidence remains lacking regarding the specific timings for initiation of various rehabilitation steps and management when complications are encountered in acute stroke rehabilitation. This survey aimed to investigate actual clinical situations in acute stroke rehabilitation in Japan and to improve the medical systems for rehabilitation and plan further studies. Methods: This nationwide, cross-sectional, web-based questionnaire survey was administered between February 7, 2022, and April 21, 2022, targeting all primary stroke centers (PSCs) in Japan. Among several components of the survey, this paper focused on the timing of the initiation of three rehabilitation steps (passive bed exercise; head elevation; and out-of-bed mobilization), along with the management of rehabilitation (continued or suspended) in the event of complications during acute stroke rehabilitation. We also investigated the influence of facility features on these contents. Results: Responses were obtained from 639 of the 959 PSCs surveyed (response rate: 66.6%). In cases of ischemic stroke and intracerebral hemorrhage, most PSCs initiated passive bed exercise on day 1, head elevation on day 1, and out-of-bed mobilization on day 2 (with day of admission defined as day 1). In cases with subarachnoid hemorrhage, rehabilitation steps were delayed compared to other stroke subtypes or showed wide variation depending on the facility. Passive bed exercise was accelerated by the presence of protocols for rehabilitation and weekend rehabilitation. Out-of-bed mobilization was accelerated by the presence of a stroke care unit. Facilities with board-certified rehabilitation doctors were cautious regarding the initiation of head elevation. Most PSCs suspended rehabilitation training in the event of symptomatic systemic/neurological complications. Conclusion: Our survey revealed the actual situation of acute stroke rehabilitation in Japan and indicated that some facility features appear to influence early increases in physical activity levels and early mobilization. Our survey provides fundamental data to improve the medical systems for acute stroke rehabilitation in the future.

#3388 ASSOCIATIONS BETWEEN PHYSICAL ACTIVITY, PHYSICAL FUNCTION AND BONE METABOLISM MARKERS IN HAEMODIALYSIS PATIENTS: A PRELIMINARY CROSS-SECTIONAL STUDY

Abstract Background and Aims Chronic kidney disease (CKD) patients suffering from end-stage renal disease often undergo dialysis treatment. Haemodialysis (HD) patients spend most of their time in sedentary behaviour, having therefore poor physical function, as well as frequently develop mineral and bone disorders due to disease-induced systemic alterations such as abnormally high bone resorption rates exceeding bone formation. In healthy individuals, there is considerable evidence highlighting the associations between physical activity (PA), physical function (PF), and bone health. In HD patients, however, evidence on the association between these variables is still scarce. Therefore, the present preliminary study seeks to characterise HD patients in terms of their PA and PF, and to identify any associations between these and markers of bone metabolism. Method A cross-sectional design study recruited 88 adult HD patients (males: 68%, age: 66±14 years, dialysis vintage: 42±52 months) from three clinics in Portugal. Resting blood samples were collected from the patients’ fistula at the start of the second dialysis session of the week. Plasma levels of the bone markers tartrate-resistant acid phosphatase 5b (TRAP-5b) (IDS, Tyne and Wear, UK), and sclerostin (SOST) and receptor activator of nuclear factor kappa-Β ligand (RANKL) (Biomedica Immunoassays, Vienna, Austria) were measured by commercially-available enzyme-linked immunosorbent assays (ELISA), and osteocalcin (OCN) (Biogen, Madrid, Spain) and osteoprotegerin (OPG) (R&D Systems, Abingdon, UK) via DuoSet ELISA kits. PF was assessed by completing the Sit to Stand 60 (STS60), the STS5, the Incremental Shuttle Walk Test (ISWT), the Timed Up and Go (TUG), and handgrip strength (HGS). All participants worn tri-axial accelerometers continuously for a week to estimate PA levels. Results Accelerometers were worn for an average 13±2h/day and data showed that 81±11% of the time was spent in sedentary behaviour, and 18±10% in light PA. Associations between PA, PF and markers of bone metabolism are described in Table 1. Weekly sedentary time was associated with reduced agility (TUG), muscle endurance (STS60, ISWT), and muscle power and strength (STS5), whereas light PA levels were associated with an increment in overall PF. Also, light PA levels were associated with decreased TRAP-5b and OPG, but elevated circulating OCN, supporting a potential modulatory effect of PA on bone turnover. Decreased overall PF were associated with increased concentrations of OPG, with muscle endurance and strength associated with increased circulating TRAP-5b. Conclusion Our data suggests that sedentarism may be responsible for a reduced PF, which in turn was associated with increased inhibition of osteoclastogenesis via OPG activity. Yet, a rather small increase in PA levels may lead to PF gains and could be a trigger for OCN activity and TRAP-5b inhibition. Therefore, increasing PA levels may modulate bone metabolism through mechanisms that favor bone formation.

Prevention of Poor Physical and Mental Health through the Green Social Prescribing Opening Doors to the Outdoors Programme: A Social Return on Investment Analysis.

There is growing interest in green social prescribing and connecting with nature-based activities to promote social cohesion along with improving levels of health, wealth and well-being. The Outdoor Partnership is a third sector organisation based in North Wales offering nature based social prescribing interventions. Individuals experiencing poor mental health and wellbeing are referred from GPs, community mental health services, and third sector organisations to the 'Opening the Doors to the Outdoors' (ODO) programme which is a 12-week outdoor walking and climbing green prescribing intervention. The purpose of the ODO programme is to provide a supportive environment to increase levels of physical activity among participants leading to improvements in overall health and mental wellbeing while promoting socialisation among peers. In this evaluation of a preventative green social prescribing intervention, a mixed method social return on investment (SROI) approach used quantitative and qualitative data from ODO participants. Data collection took place from April 2022-November 2022. Mental wellbeing data was collected at baseline and at 12 weeks using the Short Warwick Edinburgh Mental Wellbeing Scale, a social trust question, an overall health question, and the International Physical Activity Questionnaire- short form. Baseline and follow-up data was available for 52 ODO participants. Results indicate that for every £1 invested in the ODO programme, social values ranging from £4.90 to £5.36 were generated.

Applying the Socioecological Model to Map Factors Associated with Military Physical Activity Adherence.

Physical activity (PA) within the military can have large effects on the soldier's health, productivity, and ability to meet tasks. This study aims to identify the factors associated with PA adherence during military service, applying the socioecological model, which classifies the factors influencing health behaviors into individual, social, and environmental levels. This cross-sectional survey was carried out among 500 soldiers aged 18 to 49 years in the Israeli Defense Forces. Statistical analysis to assess associations between PA and individual, social, and environmental factors included correlations, variance analyses, and multivariable linear regression. PA rates were higher among men soldiers in combat positions. Individual level factors, such as intention to perform PA (β = 0.42, p < 0.001), and self-efficacy regarding PA (β = 0.20, p < 0.001) were associated with PA among men and women. However, social norms were associated with PA only among men (β = 0.24, p < 0.001). The physical environment was not associated with PA adherence (β = -0.04, p = 0.210). Conclusions: Developing interventions on the individual level for all military personnel and interventions on the social level, mainly for men, could help increase levels of PA in the military.

Potential of social engagement for overcoming barriers to physical activity in individuals with spinal cord injury.

Many barriers to physical activity (PA) exist for individuals with spinal cord injury (SCI). Social engagement may improve motivation to perform PA, which in turn may increase PA levels. This pilot study investigates how social engagement facilitated by mobile technology may reduce lack of motivation as a barrier to PA in individuals with SCI and demonstrates design implications for future technologies. A user-needs survey was conducted with participants in the community. We recruited 26 participants (16 individuals with SCI and 10 family members or peers). A participatory design process using semi-structured interviews was used to identify themes relating to PA barriers. One theme related to PA barriers was lack of PA-focused forums to connect with peers. Participants with SCI considered connecting with other individuals with SCI more motivating than connecting with their family members. Another key finding was that participants with SCI did not perceive that personal fitness trackers were targeted towards wheelchair-based activities. Engagement and communication with peers who have similar functional mobility levels and life experiences can potentially improve motivation for PA; however, PA-motivational platforms are not tailored towards wheelchair-users. Our preliminary findings show that some individuals with SCI are not satisfied with current mobile-technologies for wheelchair-based PA.

Association between physical activity, immune-related adverse events, and mortality in patients undergoing immune checkpoint inhibition.

2643 Background: Immune checkpoint inhibitors (ICIs) have improved prospects for some, but not all patients with cancer and frequently induce severe immune-related adverse events (irAEs). While physical activity (PA) has been associated with prolonged survival and diminished toxicity of chemotherapy, its association with ICI efficacy and toxicity is currently unknown. Hence, here we study the association between PA in patients undergoing ICI, and survival and severe irAE occurrence. Methods: Patients with advanced cancer receiving anti-PD-(L)1 based immunotherapy at our academic center were enrolled in the UNICIT cohort. All participants who completed the PA questionnaire (SQUASH) at ICI initiation between 10-2019 and 01-2022 were included in this study. PA was quantified by calculating Metabolic Equivalent Task (MET) hours per week and moderate to vigorous sport and leisure time activity. Association of PA with overall survival (OS) was assessed using Cox proportional hazard regression. Association of PA with occurrence of a severe irAE (grade 3 or higher) within one year was assessed using logistic regression in patients with at least one year follow-up. All analyses were adjusted for sex, age, tumor type, treatment intent and ICI type. Results: In total, 251 patients were included, with a median follow-up of 20 months and a median age of 64 years. The majority (153 patients) had melanoma. Median OS was not reached. Compared to low levels of total PA, intermediate and high levels of total MET-hours were associated with prolonged survival (adjusted hazard ratios: 0.56 (95%CI 0.31-1.02) and 0.47 (95%CI 0.26-0.86), respectively; table). Thirty eight out of 209 patients with at least one year of follow-up developed severe irAEs within the first year. Compared to patients with low total PA levels, patients with intermediate or high levels of total PA have a lower odds of developing severe irAEs (adjusted odds ratios: 0.35 (95%CI 0.12-0.90) and 0.19 (95%CI 0.06-0.56), respectively). Similar trends of prolonged OS and reduced odds of severe irAE occurrence were observed in patients who performed more moderate to vigorous sport and leisure time activity. Conclusions: Higher physical activity levels at start of ICI treatment are associated with prolonged survival and lower risk of severe irAEs. Future research needs to elucidate whether inactive patients benefit from increasing PA levels after diagnosis. [Table: see text]

Early integration of exercise into breast cancer care: The MSK healthy living program.

e24047 Background: In patients diagnosed with breast cancer, quality of life (QoL) has been reported to decrease during and after treatment. Physical activity (PA) mitigates adverse effects from treatment and improves QoL, and insufficient PA is associated with cancer recurrence and mortality. However, PA interventions are not included in standard cancer care. Early intervention to increase PA levels may improve QoL during active cancer therapy. The Healthy Living Program (HLP) at Memorial Sloan Kettering Cancer Center (MSK) is a lifestyle and survivorship program that engages early-stage breast cancer patients at the time of diagnosis using lifestyle risk stratification and matched referrals. We investigated whether early exercise intervention through the MSK HLP impacts QoL within the first months after cancer diagnosis. Methods: At the time of diagnosis, patients complete a lifestyle questionnaire (LQ), which is a composite of validated instruments, including the Godin Leisure Time Exercise Questionnaire (GLTEQ). Patients not meeting PA guidelines per the GLTEQ are offered a referral to an exercise physiologist (EP). The EP creates an individualized, home-based exercise program using the FITT Principle (Frequency, Intensity, Time, and Type). Patients meet with the EP every 4 weeks for 16 weeks; if exercise recommendations continue to be unmet, the program is extended. The Functional Assessment of Cancer Therapy-Breast (FACT-B) and 36-Item Short Form Survey Instrument (SF-36) were completed at baseline (BL) and follow-up (FU). Results: 206 patients enrolled between April 2020 – September 2022, of which 72 volunteered to complete the QoL assessments (median age 53 years [range 23-84]; 11.1% ductal carcinoma in situ, 69.4% Stage 1, 16.7% Stage 2, and 2.8% Stage 3). Among these patients, 30.6% received chemotherapy, 66.7% received radiation, 83.3% received hormone therapy, and 6% declined treatment. The mean baseline FACT scores were FACT-B: 116, FACT-G: 87, and FACT-B Trial Outcome Index (TOI): 72. At FU, scores were maintained with no significant changes (means FACT-B: 117, FACT-G: 88, and TOI: 74). Improvements were observed among the subscales of the SF-36 from BL to FU. The largest improvements were observed in physical and emotional role function scores, with 26% and 15% improvements from BL to FU, respectively. Conclusions: A clinically implemented exercise intervention embedded in standard of care prevented decreases in QoL and improved physical and emotional functioning during the initial course of adjuvant breast cancer therapy. These findings support early implementation of lifestyle modification after a breast cancer diagnosis.

Physical Activity Counselling Received Throughout Pregnancy and Effect on Behaviours: A Quasi-Experimental Study

ObjectivesThe objective was to examine the frequency of physical activity (PA) counselling for pregnant women over the course of their pregnancies and the effect on the women’s PA behaviour. MethodsA quasi-experimental study was conducted in the maternity unit of a hospital. In total, 72 pregnant women were randomized into a control or intervention group. Counselling about PA was dispensed to the women in the intervention group throughout pregnancy by health professionals who had been sensitized to its importance and the recommendations. The women in the control group received the usual consultation content. The PA behaviour of pregnant women in the intervention group who reported receiving PA counselling was evaluated. The counselling and PA levels were evaluated by chi-square tests and repeated measures analysis of variance, respectively. ResultsOverall, the women received little counselling in accordance with the recommendations, although the intervention group women received this counselling more frequently (P = 0.049). All women in the intervention group who reported receiving counselling throughout pregnancy limited their decline in PA compared with those in the control group. The decline in total PA among normal-weight and overweight pregnant women was reduced in the intervention group (respectively, P = 0.043 and P = 0.044). ConclusionOur intervention showed the effectiveness of counselling on PA behaviour, although the effect was observed at the end of pregnancy. Training and sensitizing for professionals should be strengthened to ensure that counselling in line with the recommendations to maintain or increase PA levels throughout pregnancy is provided.

Longitudinal relationships between habitual physical activity and pain tolerance in the general population.

Physical activity (PA) might influence the risk or progression of chronic pain through pain tolerance. Hence, we aimed to assess whether habitual leisure-time PA level and PA change affects pain tolerance longitudinally in the population. Our sample (n = 10,732; 51% women) was gathered from the sixth (Tromsø6, 2007-08) and seventh (Tromsø7, 2015-16) waves of the prospective population-based Tromsø Study, Norway. Level of leisure-time PA (sedentary, light, moderate, or vigorous) was derived from questionnaires; experimental pain tolerance was measured by the cold-pressor test (CPT). We used ordinary, and multiple-adjusted mixed, Tobit regression to assess 1) the effect of longitudinal PA change on CPT tolerance at follow-up, and 2) whether a change in pain tolerance over time varied with level of LTPA. We found that participants with high consistent PA levels over the two surveys (Tromsø6 and Tromsø7) had significantly higher tolerance than those staying sedentary (20.4 s. (95% CI: 13.7, 27.1)). Repeated measurements show that light (6.7 s. (CI 3.4, 10.0)), moderate (CI 14.1 s. (9.9, 18.3)), and vigorous (16.3 s. (CI 6.0, 26.5)) PA groups had higher pain tolerance than sedentary, with non-significant interaction showed slightly falling effects of PA over time. In conclusion, being physically active at either of two time points measured 7-8 years apart was associated with higher pain tolerance compared to being sedentary at both time-points. Pain tolerance increased with higher total activity levels, and more for those who increased their activity level during follow-up. This indicates that not only total PA amount matters but also the direction of change. PA did not significantly moderate pain tolerance change over time, though estimates suggested a slightly falling effect possibly due to ageing. These results support increased PA levels as a possible non-pharmacological pathway towards reducing or preventing chronic pain.

Physical Activity Trajectories and Functional Recovery After Acute Stroke Among Adults in Sweden

The optimum level and timing of poststroke physical activity interventions to enhance functional recovery remain unclear. To assess the level of physical activity in the first 6 months after stroke among individuals with similar physical activity patterns over time and to investigate the association between physical activity trajectories and functional recovery at 6 months after stroke. This cohort study obtained data from the Efficacy of Fluoxetine-a Randomized Controlled Trial in Stroke, which was conducted in 35 stroke and rehabilitation centers across Sweden from October 2014 to June 2019. Adult participants (aged >18 years) were recruited between 2 and 15 days after stroke onset and followed up for 6 months. Participants who withdrew or were lost to follow-up were excluded from the longitudinal analysis. Data analyses were performed between August 15 and October 28, 2022. Physical activity was assessed at 1 week, 1 month, 3 months, and 6 months. Multiple factors associated with physical activity trajectories were investigated. Association of the distinct trajectories with functional recovery was assessed in multivariable logistic regression. The primary outcomes were the distinct physical activity trajectories over time, which were identified using group-based trajectory modeling. The secondary outcome was the functional recovery at 6 months after stroke, which was assessed using the modified Rankin Scale. Of the 1367 included participants (median [IQR] age, 72 years [65-79] years; 844 males [62%]), 2 distinct trajectory groups were identified: increaser (n = 720 [53%]) and decreaser (647 [47%]). The increaser group demonstrated a significant increase in physical activity level (mean difference, 0.27; linear slope β1 = 0.46; P < .001) and sustained it at light intensity from 1 week to 6 months, whereas the decreaser group showed a decline in physical activity and eventually became inactive (mean difference, -0.26; linear slope β1 = 1.81; P < .001). Male participants and those with normal cognition had higher odds of being in the increaser group, regardless of stroke severity. Increasing physical activity and sustaining it at light intensity were associated with a good functional outcome at 6 months (adjusted odds ratio, 2.54; 99% CI, 1.72-3.75; P < .001). Results of this study suggest that increased physical activity was associated with functional recovery 6 months after stroke. Interventions targeting individuals with decreasing physical activity in the subacute phase of stroke may play a role in improved functional outcomes.

Longitudinal associations between physical activity and five risk factors of metabolic syndrome in middle-aged adults in Germany

BackgroundWe examined the longitudinal association between (change in) physical activity (PA) with new onset of five risk factors of metabolic syndrome among 657 middle-aged adults (mean age 44.1 (standard deviation (SD) 8.6) years) who were free of the respective outcome at baseline, in a longitudinal cohort study spanning over 29 years.MethodsLevels of habitual PA and sports-related PA were assessed by a self-reported questionnaire. Incident elevated waist circumference (WC), elevated triglycerides (TG), reduced high-density lipoprotein cholesterols (HDL), elevated blood pressure (BP), and elevated blood-glucose (BG) were assessed by physicians and by self-reported questionnaires. We calculated Cox proportional hazard ratio regressions and 95% confidence intervals.ResultsOver time, participants developed (cases of incident risk factor; mean (SD) follow-up time) elevated WC (234 cases; 12.3 (8.2) years), elevated TG (292 cases; 11.1 (7.8) years), reduced HDL (139 cases; 12.4 (8.1) years), elevated BP (185 cases; 11.4 (7.5) years), or elevated BG (47 cases; 14.2 (8.5) years). For PA variables at baseline, risk reductions ranging between 37 and 42% for reduced HDL levels were detected. Furthermore, higher levels of PA (≥ 16.6 METh per week) were associated with a 49% elevated risk for incident elevated BP. Participants who increased PA levels over time, had risk reductions ranging between 38 and 57% for elevated WC, elevated TG and reduced HDL. Participants with stable high amounts of PA from baseline to follow-up had risk reductions ranging between 45 and 87% for incident reduced HDL and elevated BG.ConclusionsPA at baseline, starting PA engagement, maintaining and increasing PA level over time are associated with favorable metabolic health outcomes.

Physical activity diminished adverse associations of obesity with lipid metabolism in the population of rural regions of China

ABSTRACT The interactive effects of obesity and physical inactivity on lipid metabolism and prevalent dyslipidemia are scarcely reported in rural regions. 39029 subjects were obtained from the Henan Rural Cohort, and their metabolic equivalents (METs) of physical activity (PA) were computed. Independent associations of the obesity indices and PA with either lipid indices or prevalent dyslipidemia were analyzed by generalized linear models, and additive effects of obesity and PA on prevalent dyslipidemia were further quantified. Each obesity index was positively associated with total cholesterol, triglyceride, low-density lipoprotein or prevalent dyslipidemia but negatively associated with high-density lipoprotein, whereas the opposite association of PA with either each lipid index or prevalent dyslipidemia was observed. Joint association of PA and each obesity index with each lipid index and prevalent dyslipidemia was observed. Furthermore, the association of each obesity index in association with each lipid index was attenuated by increased PA levels.

Mercury and Motion: The Influence of Seasonality on Off-School Hours High School Facility Use

Purpose: Grounded in the behavioral ecological model, and to address a lack of park space, this study looked at community members’ use of public high school physical activity (PA) facilities during nonschool hours while considering the effects of seasonality. Method: Data included 3,959 observation sweeps across 19 public high school campuses over 1 year (all seasons) in Arizona. Results: Differences in contextual supports were evident between seasons, with facilities being more accessible, usable, and lighted in spring than summer or fall. Accessible facilities were most often outside (68.6% of the time). The highest frequency of sedentary behavior was in summer. Conclusion: The present study expands our understanding about the influence of seasonality as related to community access to PA facilities. During times of extreme temperatures, it may be beneficial to find ways to make indoor PA facilities more accessible to support increased PA levels of community members.

Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial.

Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η2p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η2p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η2p=0.01, Δmean SBP -0.4, SD 1.4 mm Hg; η2p=0.02, Δmean DBP -2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η2p=0.01; SFII: η2p=0.03). The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted.