Baseline Physical Activity Levels Research Articles

Alterations in energy balance from an exercise intervention with ad libitum food intake

Better understanding is needed regarding the effects of exercise alone, without any imposed dietary regimens, as a single tool for body-weight regulation. Thus, we evaluated the effects of an 8-week increase in activity energy expenditure (AEE) on ad libitum energy intake (EI), body mass and composition in healthy participants with baseline physical activity levels (PAL) in line with international recommendations. Forty-six male adults (BMI=19·7-29·3kg/m(2)) participated in an intervention group, and ten (BMI=21·0-28·4kg/m(2)) in a control group. Anthropometric measures, cardiorespiratory fitness, EI, AEE and exercise intensity were recorded at baseline and during the 1st, 5th and 8th intervention weeks, and movement was recorded throughout. Body composition was measured at the beginning and at the end of the study, and resting energy expenditure was measured after the study. The intervention group increased PAL from 1·74 (se 0·03) to 1·93 (se 0·03) (P<0·0001) and cardiorespiratory fitness from 41·4 (se 0·9) to 45·7 (se 1·1)ml O2/kg per min (P=0·001) while decreasing body mass (-1·36 (se 0·2)kg; P=0·001) through adipose tissue mass loss (ATM) (-1·61 (se 0·2)kg; P=0·0001) compared with baseline. The control group did not show any significant changes in activity, body mass or ATM. EI was unchanged in both groups. The results indicate that in normal-weight and overweight men, increasing PAL from 1·7 to 1·9 while keeping EI ad libitum over an 8-week period produces a prolonged negative energy balance. Replication using a longer period (and/or more intense increase in PAL) is needed to investigate if and at what body composition the increase in AEE is met by an equivalent increase in EI.

The Effects of "Physical Activity on Prescription" in Persons With Transient Ischemic Attack: A Randomized Controlled Study.

Transient ischemic attack (TIA) is a strong predictor of stroke, and physical inactivity is one risk factor for TIA/stroke. "Physical activity on Prescription" (PaP) can increase physical activity, but the effect of PaP after TIA has not been described. Our goal was to objectively measure the effect of PaP on physical activity and physical capacity, as well as self-rated health at 3 and 6 months after TIA. The primary outcome was moderate to vigorous intensities of physical activity objectively assessed by accelerometry. Secondary outcomes were steps per day assessed by accelerometry, physical capacity assessed by the 6-minute walk test, and self-rated health assessed by EQ-5D VAS. Eighty-eight individuals with TIA were randomized to an intervention group (n = 44) that received conventional treatment and PaP or to a control group (n = 44) that received conventional treatment alone. There was a 30% dropout among the participants at 6 months. No significant differences between groups were found in physical activity at 3 and 6 months. At 6 months, participants in the intervention group were significantly more likely to have improved their physical capacity than the control group. There was no significant difference between groups in self-rated health. PaP did not increase physical activity after TIA; however, there was an increase in physical capacity. The nonsignificant results for physical activity may be the result of a relatively high baseline physical activity level. The results may also indicate that prior studies suggesting that PaP increases physical activity overestimated effects because of the self-reported nature of the previous outcomes.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A134).

The effects of a low-carbohydrate diet on appetite: A randomized controlled trial

Background and aimsThe relationship between dietary macronutrient composition and appetite is controversial. We examined the effects of a year-long low-carbohydrate diet compared to a low-fat diet on appetite-related hormones and self-reported change in appetite. Methods and resultsA total of 148 adults with a body mass index 30–45 kg/m2, who were free of diabetes, cardiovascular disease and chronic kidney disease at baseline were randomly assigned to either a low-carbohydrate diet (carbohydrate [excluding dietary fiber]<40 g/day; N = 75) or a low-fat diet (<30% energy from fat, <7% from saturated fat; N = 73). Participants in both groups attended individual and group dietary counseling sessions where they were provided the same behavioral curriculum and advised to maintain baseline levels of physical activity. Appetite and appetite-related hormones were measured at 0, 3, 6 and 12 months of intervention. At 12 months, mean changes (95% CI) in peptide YY were −34.8 pg/mL (−41.0 to −28.6) and in the low-carbohydrate group and −44.2 pg/mL (−50.4 to −38.0) in the low-fat group (net change: 9.54 pg/mL [0.6 to 18.2]; p = 0.036). Approximately 99% of dietary effects on peptide YY are explained by differences in dietary macronutrient content. There was no difference in change in ghrelin or self-reported change in appetite between the groups. ConclusionsA low-fat diet reduced peptide YY more than a low-carbohydrate diet. These findings suggest that satiety may be better preserved on a low-carbohydrate diet, as compared to a low fat diet.Trial Registration: clinicaltrials.gov Identifier: NCT00609271.

Abstract 15066: Low Physical Activity and Short Sleep predict Cardiovascular Mortality in Former Male Athletes and Their Controls

Background: Both short and long sleep associate with mortality, and physical activity potentially influences these associations. Former athletes are often physically more active and have a healthier lifestyle also later in life than non-athletic peers. Our aim was to study the interrelationship between sleep, physical activity and mortality in a cohort of former athletes and their healthy controls. Methods: The prospective cohort consists of male athletes who competed at national team-level between 1920-1965 and their healthy controls. A baseline health questionnaire was sent to all subjects alive in 1985. The cohort was followed for mortality from national registers until December 31, 2011. Hazard ratios (HR) and 95 % confidence intervals (CI) for all-cause and cardiovascular mortality were estimated by Cox proportional hazards models with age as the time variable and age at baseline in 1985 as the entry. Sleep duration, sleep quality and physical activity level in 1985 were the main predictive variables. Results: At baseline, 2141 cohort members answered to the questionnaire, and 1388 (871 former athletes, 517 controls) provided adequate information for the analyses. Former athletes and controls differed in baseline sleep duration, sleep quality and physical activity level. However, these behaviors did not predict mortality neither in athletes or controls after adjustment for baseline socioeconomic status, BMI, smoking, alcohol use, chronotype and history of disease. A significant interaction between sleep duration and physical activity predicting all-cause and cardiovascular mortality was detected. After full adjustments, those sleeping less than 6 hours and having less than 450 MET-hours per week of physical activity had a higher risk for cardiovascular mortality (HR 1.78, 95% CI 1.06-3.00) than those sleeping 6.5 to 8.5 hours and having at least 450 MET-hours physical activity. Conclusions: We found a combination of short sleep and low physical activity to be predictive of cardiovascular mortality irrespective of a previous sports career. Neither sleep duration nor sleep quality alone predicted mortality in former athletes or controls, suggesting important clustering of health behaviors.

Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis.

Prior studies have reported an inverse association between physical activity (PA) and risk of heart failure (HF). However, a comprehensive assessment of the quantitative dose-response association between PA and HF risk has not been reported previously. Prospective cohort studies with participants >18 years of age that reported association of baseline PA levels and incident HF were included. Categorical dose-response relationships between PA and HF risk were assessed with random-effects models. Generalized least-squares regression models were used to assess the quantitative relationship between PA (metabolic equivalent [MET]-min/wk) and HF risk across studies reporting quantitative PA estimates. Twelve prospective cohort studies with 20 203 HF events among 370 460 participants (53.5% women; median follow-up, 13 years) were included. The highest levels of PA were associated with significantly reduced risk of HF (pooled hazard ratio for highest versus lowest PA, 0.70; 95% confidence interval, 0.67-0.73). Compared with participants reporting no leisure-time PA, those who engaged in guideline-recommended minimum levels of PA (500 MET-min/wk; 2008 US federal guidelines) had modest reductions in HF risk (pooled hazard ratio, 0.90; 95% confidence interval, 0.87-0.92). In contrast, a substantial risk reduction was observed among individuals who engaged in PA at twice (hazard ratio for 1000 MET-min/wk, 0.81; 95% confidence interval, 0.77-0.86) and 4 times (hazard ratio for 2000 MET-min/wk, 0.65; 95% confidence interval, 0.58-0.73) the minimum guideline-recommended levels. There is an inverse dose-response relationship between PA and HF risk. Doses of PA in excess of the guideline-recommended minimum PA levels may be required for more substantial reductions in HF risk.

Physical Activity Is Associated With Reduced Risk of Executive Function Impairment in Older Women.

To examine whether baseline levels of physical activity, measured by total caloric expenditure, predicted domain-specific cognitive impairments over a 9-year period. Participants included 376 community-dwelling older women aged 70 to 80 years at baseline from the Women's Health and Aging Study II. Cox proportional hazard models were used to evaluate the associations between self-reported physical activity and risk of cognitive impairments in psychomotor speed, executive function, and verbal memory. Models were adjusted for age, race, education, number of chronic illnesses, and number of depressive symptoms at baseline. Greater baseline levels of caloric expenditure were associated with better executive function in the most active quintile of adults compared with the least active quintile. Caloric expenditure was not associated with improved scores for any of the other domains assessed. The results of this study suggest that higher levels of physical activity modified risk of incident impairment in executive function.

Self-Reduction of Displaced Bucket-Handle Medial Meniscal Tear in a 71-Year-Old Patient: A Case Report.

Background:Bucket-handle meniscal tears are rare in geriatric patients. Displaced bucket-handle meniscal tears are usually treated operatively. Due to the rarity of these tears in elderly patients and conflicting evidence regarding the use of arthroscopy versus conservative treatment, it is valuable to report the clinical presentation, treatment, and outcome of these injuries in elderly patients.Case Description:We describe a 71-year-old man who presented with an acute, displaced, magnetic resonance imaging (MRI)-confirmed right medial meniscal bucket-handle tear with mild effusion and no signs of degenerative joint disease. On physical examination, the patient was unable to fully extend the right leg due to locking of the knee. At 2-month follow-up, MRI showed mild degenerative changes and an anatomically reduced tear. At 6-month follow-up, the patient reported normal, pain-free knee function, and MRI showed the tear healing in anatomic position with minimal inferior surface changes and no effusion. He returned to his pain-free baseline level of physical activity.Literature Review:Upon review of the English literature, this 71-year-old patient is an exceptional case and one of the oldest patients reported to have sustained a displaced medial meniscal bucket-handle tear treated successfully with nonoperative means. Two reported cases of spontaneously reduced meniscal bucket-handle tears were found in the English literature, although both cases were seen in much younger males and involved the lateral meniscus.Clinical Relevance:This case suggests that in elderly patients with displaced medial meniscus bucket-handle tears that reduce spontaneously, the physician can safely and efficaciously use conservative, nonoperative management to achieve restoration of baseline knee function and anatomic meniscal healing while avoiding the risks of arthroscopic surgery. Surgical intervention for reduction without repair may be an available option, but no literature is present to direct care; however, complete documentation as in the current case would be instructive. Katz et al have reported that physical therapy was as efficacious as surgical intervention, although the specific displaced bucket-handle tear was not reported.

A53 Cycling health and climate: what are the circumstances under which cycling can contribute to substantive greenhouse gas emission reductions and whose travel should be targeted to achieve the biggest health and climate benefits?

Abstract Background Co-benefits are defined as the health and other benefits that can accompany greenhouse gas emission reductions. Modelling studies have identified the potential for large health co-benefits in the transport sector from a mode shift to physically active transport. Findings on emission reductions from active travel have been less clear. Cycling is usually an option for shorter trips, typically exhibiting a strong distance decay function, whilst in most settings the majority of emissions come from longer trips. Despite this there has been little systematic investigation of the circumstances under which active travel can achieve emission reductions and how such scenarios would relate to the size of the health benefits. Health and carbon benefits vary according to who is changing their behaviour and the kind of trips they make and policy goals may not always be aligned. Methods In this study we will fill this gap using a microsimulation model based on individual level travel survey data from England combined with the ITHIM health model. The ITHIM model estimates health impacts from transport scenarios using a comparative risk assessment approach and incorporates variation in disease risk and baseline physical activity levels both between and within age and gender groups. Changes to distributions of physical activity are applied to multiple diseases, using WHO Global Burden of Disease data. The microsimulation model has been implemented in R and parameterised with the English National Travel Survey. In the model four parameters are allowed to vary: 1) the cycling mode split, 2) the distribution of travel distances, 3) the distance decay function for cycling (based on electric bikes), 4) the proportion of multimodal trips amongst longer trips. The potential for trip distance reduction from changing destinations will be allowed to vary by trip purpose, with more individual level latitude for changing non-commuting trips. Results We will search the output of the model to identify those combinations of strategies that would achieve substantive emissions reductions and investigate how these correlate with health benefits. Using person level data we will investigate the top population groups to target for mode shift from a health, a carbon, and a co-benefits perspective. Conclusions The results of this study will guide policy on the extent on urban planning and inform development of cycling policies that can achieve multiple societal benefits.

Walkability And Change In Physical Activity In A Large Sample Of Middle-aged And Older Australians

PURPOSE: To analyze the prospective relationship between perceived aspects of walkability and changes in walking and physical activity. METHODS: We used three-year longitudinal data (2006/07-2009/10) of adults 45 and older living in metropolitan areas (n=24,341; 62.9±11.3 years) in New South Wales, Australia. Neighborhood environment attributes were measured using the validated Physical Activity Neighborhood Environment Survey and physical activity was measured using the validated Active Australia Survey. General linear regression was used with each individual attribute of the residential neighborhood as the exposure, change in walking and total physical activity time as the outcome, adjusted for a range of socio-demographic and health covariates and baseline physical activity levels. RESULTS: During the follow-up period (3.3±0.94 years), the average change in total walking time was an increase of 6.3 min/week (SD=1.4, 95%CI: 3.4-9.1), the average change in total physical activity (VPA weighted by 2) was +6.0 min/week (SD=3.3, 95%CI: -0.34-12.42). There were significant differences in changes in walking and physical activity by perceptions of walkability. Participants who reported having shops (+14.59 min/week, 95%CI: 11.46, 17.71, p<0.001), public transport stops (+7.60, 95%CI: 5.14, 10.06, p<0.001) and recreation facilities (+7.97, 95%CI: 5.41, 10.53, p=0.004) within walking distance, and those who perceived their neighborhood as safe from crime during the day (+7.34, 95%CI: 4.89, 9.79, p=0.017) increased their walking, compared to those with negative perceptions of these attributes who walked less over time. There were no differences in changes of walking by availability of sidewalks and safety at night. Participants who reported shops nearby (+17.6, 95%CI: 10.64, 24.65, p<0.001), and those who perceived their neighborhood as safe at night (+14.54, 95%CI: 8.15, 20.83, p<0.001) increased their overall physical activity, compared to those with negative perceptions of these attributes who decreased their activity levels. CONCLUSIONS: Having access to shops, public transport stops, and recreation facilities, and safety from crime may help with maintenance of walking and physical activity in middle-aged and older adults.

‘Fitness for princess’—a study to improve physical fitness among school going children in western India

Background: At present there are significant disparities in the gender distribution in India with a clear preponderance for males. At this juncture the government is taking all steps to improve the scenario. But the fact remains that there are very few initiatives being implemented to make the girl child stronger and healthier. Physical activity is important for everybody, including all teenagers, but especially for girlswhoare generally less active than boys the same age. As teens juggle the transition from primary school to high school there are other pressures that come with it – socially, at home, and at school. Issues such as body image, the onset of menstruation, and general feelings of insecurity about the changing body can surface in these years. Physical activity sometimes takes a back seat to other priorities. However, physical activity is an important part of health and well being, and girls should remain active as they grow up. Purpose: This project is a part of a broader initiative aiming at developing physical fitness among school going girls of Vallabh Vidyanagar and Anand. Methods: 103 participants in the age group of 11 to 13 years were selected from Anandalaya School, SSR Vidya Mandir, St. Mary’s School, GJ Sharda School and recruited for the study. Consentwas taken from the parents before commencing the intervention. The participants were screened for any cardiac, pulmonary or orthopaedic problems and then recruited in the study. Outcome measures included Rockport one mile walk test and Vo2 max. Physical Activity Questionnaire for Adolescents was administered to know the baseline physical activity level of participants. Participants were assessed prior to intervention. Structured exercise program was administered for one month. The tailor made intervention program included jogging, skipping, DBE and suryanamaskar was executed by physical training teachers at the school. Participants were asked to play any outdoor sports of their choice for a minimum of 30minutes. Checklist for the exercise program for each student was maintained to check the adherence. Participants were re-assessed after the completion of intervention. Results: Paired ‘t’ test was used to analyze the data. Significant improvement was shown in terms of Vo2max and duration taken to complete Rockport one mile walk test. Conclusion(s):Structured exercise program improved the physical fitness among the girl children. Implications: The benefits of regularly participating in sports and physical activity is unequivocal.

The effects of physical activity on sleep: a meta-analytic review.

A significant body of research has investigated the effects of physical activity on sleep, yet this research has not been systematically aggregated in over a decade. As a result, the magnitude and moderators of these effects are unclear. This meta-analytical review examines the effects of acute and regular exercise on sleep, incorporating a range of outcome and moderator variables. PubMed and PsycINFO were used to identify 66 studies for inclusion in the analysis that were published through May 2013. Analyses reveal that acute exercise has small beneficial effects on total sleep time, sleep onset latency, sleep efficiency, stage 1 sleep, and slow wave sleep, a moderate beneficial effect on wake time after sleep onset, and a small effect on rapid eye movement sleep. Regular exercise has small beneficial effects on total sleep time and sleep efficiency, small-to-medium beneficial effects on sleep onset latency, and moderate beneficial effects on sleep quality. Effects were moderated by sex, age, baseline physical activity level of participants, as well as exercise type, time of day, duration, and adherence. Significant moderation was not found for exercise intensity, aerobic/anaerobic classification, or publication date. Results were discussed with regards to future avenues of research and clinical application to the treatment of insomnia.

Atorvastatin Treatment Does Not Alter Pulse Wave Velocity in Healthy Adults.

Introduction. Both statins and regular physical activity (PA) reduce arterial stiffness. The present post hoc analysis examined if arterial stiffness was improved with high-dose atorvastatin treatment in healthy adults and whether PA levels magnified this response. We utilized data from a double-blind, random-assignment clinical trial investigating the effects of atorvastatin 80 mg/d for 6 mo on skeletal muscle symptoms. Methods. Central and peripheral arterial pulse wave velocity (PWV) were measured and PA levels assessed at baseline and 6 mo in subjects randomized to atorvastatin (n = 21, 9 men) or placebo (n = 29, 16 men). Results. Baseline participant characteristics, PWV, and PA levels were not different between treatments. Central (means ± SD; 8.7 ± 2.6 to 9.0 ± 2.5 m/sec) and peripheral PWV (9.9 ± 1.3 to 9.8 ± 1.6 m/sec) were unchanged from baseline following atorvastatin treatment (time × drug interaction: P ≥ 0.13). Similarly, PA levels were unaffected by time or treatment. In sex and age adjusted models, baseline levels of PA were not related to changes in PWV with atorvastatin treatment. Conclusion. These data indicate that high-dose atorvastatin treatment for 6 mo does not influence arterial stiffness in healthy adults. Participation in habitual PA did not magnify the vascular effects of statin therapy. This study was registered with ClinicalTrials.gov NCT00609063.

Vitamin d and physical activity status: associations with five-year changes in body composition and muscle function in community-dwelling older adults.

High vitamin D and physical activity (PA) levels are independently associated with improved body composition and muscle function in older adults. The objective of this study was to investigate the interaction of 25-hydroxyvitamin D (25OHD) and PA status in maintenance of body composition and muscle function in older adults. This was a 5-year prospective population-based study of Australian community-dwelling older adults. Participants in the study included 615 community-dwelling volunteers aged 50 years old or older [61.4 ± 6.9 (mean ± SD) y; 48% female] randomly selected from electoral rolls and categorized according to baseline serum 25OHD (≥ or <50 nmol/L) and PA (≥ or <10,000 pedometer determined steps/d) levels as follows: high 25OHD and high PA (VitD+PA+); high 25OHD and low PA (VitD+PA-); low 25OHD and high PA (VitD-PA+); and low 25OHD and low PA (VitD-PA-). A subset of 518 participants completed accelerometer assessments during follow-up. Changes in dual-energy X-ray absorptiometry-assessed body composition and lower-limb muscle function were measured. VitD+PA+ had significantly smaller increases in body fat over 5 years compared with other groups (all P < .05). Higher baseline pedometer-determined PA resulted in declines in total body fat (β = -.23 kg per 100 steps/d, P = .001) over 5 years for participants with high 25OHD but not those with low 25OHD (P > .05). Among participants with accelerometer data, these associations were generally mediated by higher levels of moderate/vigorous PA. High vitamin D status appears to enhance PA-related declines in body fat during aging, but the mechanism may be greater amounts of outdoor moderate/vigorous PA rather than a direct effect of 25OHD.

Smoking and Physical Activity: Examining Health Behaviors and 15-Year Mortality Among Individuals With Multiple Sclerosis

ObjectivesTo examine 2 modifiable health behaviors—smoking and physical activity—and their relationship to mortality among individuals with multiple sclerosis (MS). DesignSecondary analysis of Large Health Survey. SettingData were obtained from a linkage of the Veterans Affairs (VA) MS National Data Repository, containing information on service provision to all individuals with MS receiving health services within the U.S. Department of Veterans Affairs; the VA 1999 Large Health Survey, containing information on smoking and physical activity; and the VA Vital Status File. All-cause mortality was examined for the 15-year period from 1999 through 2013. ParticipantsParticipants (N=2994) with MS who completed the Large Health Survey containing information on smoking and physical activity. InterventionsNot applicable. Main Outcome MeasureSurvival. ResultsThere were 1500 deaths (50.1%) during the study period. Cox proportional hazard analyses were conducted to examine the association between smoking and physical activity and 15-year mortality. After adjusting for demographic factors, physical functioning, mental health, and comorbid medical conditions, baseline smoking was associated with greater mortality (hazard ratio [HR]=1.38; 95% confidence interval [CI], 1.184–1.60). Higher levels of baseline physical activity were associated with lower mortality (activity 1–2 times/wk: HR=.64; 95% CI, .518–.798; activity ≥3 times/wk: HR=.53; 95% CI, .388–.715). ConclusionsResults suggest that modifiable health behaviors represent a promising opportunity for intervention to improve the lives of individuals with MS.

Telephone-delivered physical activity intervention for individuals with serious mental illness: a feasibility study.

Obesity is prevalent in individuals with serious mental illness (SMI). The purpose of this study is to examine the feasibility of a telephone-delivered physical activity (PA) intervention for outpatients with serious mental illness to maintain PA and to explore the preliminary efficacy of the intervention on health status. This study used a randomized experimental design. The treatment group received pedometers and eight weekly phone calls; the control group received written information regarding PA. Descriptive statistics were used to analyze data collected at baseline and 8 weeks. Twenty-two subjects with SMI (mean age = 44.09 ± 7.6 years; 54.5% were male) were recruited and 16 subjects completed the study in 8 weeks. PA (z = -2.37, p = .02) increased in the treatment group (n = 8) whereas the control group (n = 8) maintained baseline PA level (z = -1.61, p = .11). Health outcomes were not changed (ps > .05). Telephone-delivered intervention is feasible and has the potential to improve PA in individuals with SMI.

Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care

Regular physical activity (PA) reduces the risk of falls and hip fractures, and mortality from all causes. However, PA levels are low in the older population and previous intervention studies have demonstrated only modest, short-term improvements. To evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years. The ProAct65+ study was a pragmatic, three-arm parallel design, cluster randomised controlled trial of class-based exercise [Falls Management Exercise (FaME) programme], home-based exercise [Otago Exercise Programme (OEP)] and usual care among older people (aged ≥ 65 years) in primary care. Forty-three UK-based general practices in London and Nottingham/Derby. A total of 1256 people ≥ 65 years were recruited through their general practices to take part in the trial. The FaME programme and OEP. FaME included weekly classes plus home exercises for 24 weeks and encouraged walking. OEP included home exercises supported by peer mentors (PMs) for 24 weeks, and encouraged walking. The primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity (MVPA) per week, 12 months after cessation of the intervention. Secondary outcomes included functional assessments of balance and falls risk, the incidence of falls, fear of falling, quality of life, social networks and self-efficacy. An economic evaluation including participant and NHS costs was embedded in the clinical trial. In total, 20,507 patients from 43 general practices were invited to participate. Expressions of interest were received from 2752 (13%) and 1256 (6%) consented to join the trial; 387 were allocated to the FaME arm, 411 to the OEP arm and 458 to usual care. Primary outcome data were available at 12 months after the end of the intervention period for 830 (66%) of the study participants. The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40% to 49% in the FaME arm, from 41% to 43% in the OEP arm and from 37.5% to 38.0% in the usual-care arm. A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [adjusted odds ratio (AOR) 1.78, 95% confidence interval (CI) 1.11 to 2.87; p = 0.02]. There was no significant difference in MVPA between OEP and usual care (AOR 1.17, 95% CI 0.72 to 1.92; p = 0.52). Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level. In the 12 months after the close of the intervention phase, there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm (incidence rate ratio 0.74, 95% CI 0.55 to 0.99; p = 0.042). Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care, as did perceptions of benefits from exercise. Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm. There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes, including quality-adjusted life-years. FaME is more expensive than OEP delivered with PMs (£269 vs. £88 per participant in London; £218 vs. £117 in Nottingham). The cost per extra person exercising at, or above, target was £1919.64 in London and £1560.21 in Nottingham (mean £1739.93). The FaME intervention increased self-reported PA levels among community-dwelling older adults 12 months after the intervention, and significantly reduced falls. Both the FaME and OEP interventions appeared to be safe, with no significant differences in adverse reactions between study arms. This trial is registered as ISRCTN43453770. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 49. See the NIHR Journals Library website for further project information.

Changes in physical activity and all-cause mortality in COPD.

Little is known about changes in physical activity in subjects with chronic obstructive pulmonary disease (COPD) and its impact on mortality. Therefore, we aimed to study changes in physical activity in subjects with and without COPD and the impact of physical activity on mortality risk. Subjects from the Copenhagen City Heart Study with at least two consecutive examinations were selected. Each examination included a self-administered questionnaire and clinical examination. 1270 COPD subjects and 8734 subjects without COPD (forced expiratory volume in 1 s 67±18 and 91±15% predicted, respectively) were included. COPD subjects with moderate or high baseline physical activity who reported low physical activity level at follow-up had the highest hazard ratios of mortality (1.73 and 2.35, respectively; both p<0.001). In COPD subjects with low baseline physical activity, no differences were found in survival between unchanged or increased physical activity at follow-up. In addition, subjects without COPD with low physical activity at follow-up had the highest hazard ratio of mortality, irrespective of baseline physical activity level (p≤0.05). A decline to low physical activity at follow-up was associated with an increased mortality risk in subjects with and without COPD. These observational data suggest that it is important to assess and encourage physical activity in the earliest stages of COPD in order to maintain a physical activity level that is as high as possible, as this is associated with better prognosis.

Changes in physical activity during the transition from primary to secondary school in Belgian children: what is the role of the school environment?

BackgroundKey life periods have been associated with changes in physical activity (PA). This study investigated (1) how PA changes when primary school children transfer to secondary school, (2) if school environmental characteristics differ between primary and secondary schools and (3) if changes in school environmental characteristics can predict changes in PA in Belgian schoolchildren. Moderating effects of gender and the baseline level of PA were investigated for the first and third research question.MethodsIn total, 736 children (10–13 years) of the last year of primary school participated in the first phase of this longitudinal study. Two years later, 502 of these children (68.2%) agreed to participate in the second phase. Accelerometers, pedometers and the Flemish Physical Activity Questionnaire were used to measure PA. School environmental characteristics were reported by the school principals. Cross-classified regression models were conducted to analyze the data.Results S elf-reported active transport to school and accelerometer weekday moderate to vigorous PA (MVPA) increased after the transition to secondary school while self-reported extracurricular PA and total PA decreased. Pedometer weekday step counts decreased, but this decrease was only apparent among those who achieved the PA guidelines in primary school.Secondary schools scored higher on the school environmental characteristics: provision of sports and PA during lunch break, active schoolyards and playgrounds and health education policy but lower on sports and PA after-school than primary schools.Changes in the school environmental characteristics: active commuting to school, active schoolyards and playgrounds and health education policy resulted in changes in self-reported extracurricular PA, total PA , pedometer/accelerometer determined step counts and accelerometer determined MVPA. Moderating effects were found for baseline PA and gender.ConclusionPA changed after the transition to secondary school. In general, secondary schools seem more likely to foster strategies to promote PA during school hours than primary schools who seem more likely to foster strategies to promote PA after school. Changes in school environmental characteristics may contribute to changes in PA. Thus, if confirmed in future studies, efforts are needed to implement these components in schools as early as possible to positively affect the change in PA.

Short-stay surgery: What really happens after discharge?

Although duration of hospital stay commonly is used as a surrogate outcome for surgical recovery, it is not applicable in the setting of short-stay surgery (<24 hours). The objective of our study was to describe the trajectory of recovery after short-stay abdominal surgery by using measures of physical activity and health-related quality of life (HRQL) and identify predictors of prolonged, postdischarge recovery. Patients undergoing short-stay abdominal surgery were evaluated preoperatively and at 3 weeks and 2 months postoperatively. Physical activity was assessed with a validated questionnaire (Community Health Activities Model Program for Seniors, ie, CHAMPS) in which patients report physical activity for the previous week; responses estimate total weekly caloric expenditure (kcal/kg/wk). The Medical Outcomes Study 36-Item Short-Form Health survey (SF-36) was used to assess HRQL. Multivariate logistic regression was performed to determine which variables were predictive of recovery to baseline physical activity levels. A total of 132 patients (71% male, 53 [15] years) participated; 91% were discharged on the day of surgery. The most common procedures were open inguinal herniorrhaphy (40%) and laparoscopic cholecystectomy (30%). As a group, total, self-reported physical activity and most domains of HRQL were recovered to or greater than baseline at 3 weeks postoperatively and were above baseline levels at 2 months (P < .01). Patients who were older, had a complication, low baseline physical HRQL, or greater baseline physical activity were less likely to be recovered to their preoperative levels of physical activity at 3 weeks. At 2 months, 33% remained below preoperative levels; only high baseline physical activity was an important predictor of prolonged recovery. Despite uniformly early discharge, a substantial proportion of patients (∼33%) had suboptimal recovery 2 months after short-stay surgery. Measures of physical activity and HRQOL provide complementary information and reflect the variability in trajectories of recovery after surgery.

Effect of supplemental vitamin D and calcium on serum sclerostin levels

Serum sclerostin levels have been reported to be inversely associated with serum 25OHD levels, but the effect of vitamin D and calcium supplementation on serum sclerostin levels is unknown. This study was carried out to determine whether vitamin D and calcium supplementation altered serum sclerostin levels in healthy older adults. We measured serum sclerostin levels at baseline and after 2 years in 279 men and women who participated in a placebo-controlled vitamin D (700 IU/day) and calcium (500 mg/day) intervention trial carried out in men and women aged ≥65 years. Serum sclerostin levels were measured using the MesoScale Discovery chemiluminescence assay. In the men, sclerostin levels increased over 2 years by 4.11±1.81 ng/l (13.1%) in the vitamin D plus calcium-supplemented group and decreased by 3.16±1.78 ng/l (10.9%) in the placebo group (P=0.005 for difference in change). Adjustments for the season of measurement, baseline physical activity levels, baseline serum sclerostin levels, and total body bone mineral content did not substantially alter the changes. In the women, there was no significant group difference in change in serum sclerostin levels either before or after the above-mentioned adjustments. In both the sexes, vitamin D and calcium supplementation significantly increased serum ionized calcium levels and decreased parathyroid hormone levels. Men and women appear to have different serum sclerostin responses to vitamin D and calcium supplementation. The reason for this difference remains to be determined.