Increases In Moderate Physical Activity Research Articles

Impact of the State of Emergency Declaration for Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic Suppression on Individuals with Type 1 Diabetes Mellitus.

Objective To examine the impact of lifestyle changes caused by the first emergency declaration issued in 2020 on glycemic control and body weight changes in Japanese individuals with type 1 diabetes mellitus. Methods This study included Japanese individuals with type 1 diabetes mellitus who visited Tokyo Women's Medical University Hospital between January 2019 and September 2020 (n=278). Seasonal changes in glycated hemoglobin (HbA1c) levels and the body mass index (BMI) were compared. A self-administered questionnaire regarding changes in treatment, diet, exercise, sleep, and telecommuting was used to assess lifestyle changes. Results Although HbA1c levels decreased from winter to summer in 2019 and 2020, the annual change was slightly but significantly greater in 2020 than in 2019. Seasonal changes in the BMI between 2019 and 2020 were also significantly different. An increase in the daily insulin dose, overall blood glucose level, diurnal change in blood glucose level, and food intake were significantly associated with increased HbA1c levels. Furthermore, HbA1c levels decreased with increasing moderate physical activity and sleep duration. The change in the BMI increased with increasing insulin dose, overall high blood glucose levels, and food intake. However, an increase in moderate physical activity was associated with a decrease in the BMI. HbA1c levels were significantly lower after the first emergency declaration in individuals with type 1 diabetes mellitus than that before the emergency declaration, even after accounting for seasonal variations. Conclusion Decreased HbA1c levels were associated with a decreased food intake, increased moderate exercise, and increased sleep duration during the state of emergency. The BMI remained relatively unchanged.

Hula as a physical activity and social support intervention for sustained activity in female breast and gynecologic cancer survivors

BackgroundPhysical activity improves health and psychosocial functioning for people who have been diagnosed with cancer. Native Hawaiians face disparities for some cancers, including breast cancer. Delivering culturally grounded interventions has the potential to improve enjoyment and adherence to the intervention. We sought to test the adherence and impact of a 6 month randomized wait-list controlled trial of hula.MethodsIn this randomized wait-list controlled design people who had been diagnosed with breast or gynecologic cancers were invited to participate with other cancer survivors in a group based setting. Participants were randomized to begin hula immediately or after six months. Attendance was collected and heart-rate measured three times per session. In addition, demographic data, self-report psychosocial data, and biological data (findings will be reported elsewhere) were collected at three time points: baseline, 6 months, and 12 months. The study included six months of hula, twice per week, 60 min each session. In addition, participants committed to practice 60 min per week at home.ResultsParticipants in the study (n = 42) attended, on average, 72% of the sessions. Significant increase in moderate physical activity (d = 0.50, p = 0.03) was observed in the intervention versus control group. For the measures of intra-individual changes pre-and post-intervention, an increase in total physical activity were seen in the intervention group (d = 0.69, p = 0.003), daily caloric intake decreased (d = −0.62, p = 0.007), and a reduction in waist circumference (d = −0.89, p = 0.0002) that was sustained six months after completion of the intervention. Psychosocially, cognitive functioning significantly declined from baseline to 12 months (d = −0.50, p = 0.03), with role functioning improving (d = 0.55, p = 0.02), social constraints increasing (d = 0.49, p = 0.03), and financial difficulties improving (d = −0.55, p = 0.02).ConclusionSustainable physical activity is crucial to improve both the survival and quality of life of cancer survivors. Culturally grounded interventions, such as hula have the potential to increase the maintenance of physical activity. In addition, they create a support group where the benefits of people who have all experienced cancer can gather and garner those benefits of social support, too. This study was registered as a clinical trial through the National Cancer Institute (NCT02351479).Clinical trial registrationClinicaltrails.gov, NCT02351479.

Impact of the COVID-19 Lockdown on Physical Activity Levels and Health Parameters in Young Adults with Cancer.

The lockdown of the COVID-19 pandemic impacted physical activity (PA) levels around the world, affecting health parameters in young adults with cancer (YAC). To our knowledge, there is no evidence of the impact of the lockdown on the Spanish YAC. To analyse the changes in PA levels before, during, and after the lockdown of the YAC and its impact on health metrics in Spain, in this study, we utilized a self-reported web survey. PA levels decreased during the lockdown, and a significant increase in PA was observed after the lockdown. Moderate PA had the largest reduction (49%). Significant increases in moderate PA were noted after the lockdown (85.2%). Participants self-reported more than 9 h of sitting per day. HQoL and fatigue levels were significantly worse during the lockdown. The impact of the COVID-19 pandemic in this cohort of Spanish YAC showed a decrease in PA levels during the lockdown, affecting sedentarism, fatigue and HQoL. After lockdown, PA levels partially recovered, while HQoL and fatigue levels remained altered. This may have long-term physical effects such as cardiovascular comorbidities associated with sedentarism and psychosocial effects. It is necessary to implement strategies such as cardio-oncology rehabilitation (CORE), an intervention that can be delivered online, potentially improving participants' health behaviours and outcomes.

Are changes in physical activity during COVID-19 associated with mental health among Danish university students?

The benefits associated with being physical active on mental health is well-established, but little is known on how rapid changes in physical activity are associated with mental health. This study investigated the association between changes in physical activity and mental health among Danish university students during the first COVID-19 lockdown. Online survey data were collected among 2,280 university students at the University of Southern Denmark and University of Copenhagen in May-June 2020 as part the "COVID-19 International Student Well-being Study." Multiple linear regressions were used to analyze associations between changes in physical activity and mental health (depression and stress scores) adjusted for potential socio-economic confounders. During the first COVID-19 lockdown, 40% decreased their moderate and 44% their vigorous physical activity, while 16% increased their moderate and 13% their vigorous physical activity. Overall, students with a stable physical activity level had the lowest mean depressive and stress scores. Adjusted analyses showed that a decrease in vigorous and moderate physical activity level was significantly associated with a higher depression score (mean difference (vigorous): 1.36, p < 0.001 and mean difference (moderate): 1.55, p < 0.001). A decrease in vigorous physical activity and an increase in moderate physical activity was associated with a 1-point increase in the PSS-4 stress score (p < 0.001). A substantial proportion of students changed their physical activity level during lockdown. Our findings emphasize the importance of staying physically active during COVID-19 lockdown. This knowledge might be important for relevant health authorities to bridle post-pandemic mental health challenges.

A hybrid type 2 effectiveness-implementation design to evaluate a community-based, heart-healthy intervention for women of low socio-economic status

BackgroundWomen of low socioeconomic status continue to experience a disproportionate burden of cardiovascular disease. To respond to their unique needs, we adapted the intervention and implementation strategy of an effective theory-based psychoeducational intervention for improving heart-healthy behaviors. Study aims were to evaluate implementation (i.e., reach, fidelity, acceptability, appropriateness) and effectiveness (i.e., perceived stress, common physical symptoms in primary care, physical activity, diet) of the adapted program we called mySTEPS. MethodWe used a hybrid type 2 effectiveness-implementation approach. To evaluate implementation, we conducted a process evaluation using data from research records, observation rubrics, and pre−/post-intervention surveys. To evaluate potential effectiveness, we used a one-group, pre−/post-test design with three, sequential offerings (16 weeks each) in unique settings, used standardized, quantitative measures at 8 weeks post-intervention, and calculated effect sizes. ResultsForty-two women were included in the evaluation. For reach, 66 % and 61 % of participants attended adequate numbers of educational and coaching sessions. Supporting fidelity of delivery, nurse implementers addressed 85–98 % of required criteria. Supporting fidelity of receipt, participants' pre- to post- knowledge scores increased and other scores revealed that nurse-implementers had interacted supportively throughout mySTEPS. Participants rated the acceptability and appropriateness of components positively. Effect-sizes revealed moderate decreases in stress, moderate increases in physical activity, and modest decreases in the number of physical symptoms. Dietary scores did not change. ConclusionsThe effectiveness and implementation of mySTEPS were positive overall. After strengthening the dietary component, more extensive evaluation of mySTEPS can be conducted to explain mechanisms of action. MeSH headingsHealth behavior, prevention, self-determination theory, self-regulation theory, cardiovascular diseases, implementation strategies.

The Effects Of The Web-based WeActive And WeMindful Interventions On Physical Activity And Resilience

PURPOSE: This study examined the effectiveness of an aerobic and resistance training (WeActive) and mindful exercise (WeMindful) web-based interventions in improving physical activity (PA) and resilience among college students. METHODS: Participants were randomly assigned to either an aerobic and resistance training group (WeActive; n = 31) or a mindful exercise group (WeMindful; n = 24). Each group attended two virtual 30-minute sessions per week for 8 weeks. All participants completed the International Physical Activity Questionnaire and the Connor-Davidson Resilience Scale (CD-RISC-10) via Qualtrics one week prior to (pretest), and after the intervention (posttest), and 6 weeks after the intervention (follow up). RESULTS: The repeated measures ANOVA yielded a significant main effect of time for total PA (F = 8.20, p = 0.001), vigorous PA (F = 3.90, p = 0.027), and walking (F = 8.67, p = 0.001) in both groups. The post-hoc tests indicated that the WeActive group showed a significant increase in vigorous PA from pretest to posttest (t = -2.5, p = 0.04) while the WeMindful group showed a significant decrease in total PA from pretest to follow-up (t = 3.6, p = 0.03) and from posttest to follow up (t = 2.5, p = 0.002). There was a significant interaction effect of time and group for moderate PA (F = 4.81 p = 0.01) and walking (F = 3.32 p = 0.047), indicating that the WeActive group showed a n increase in moderate PA and walking across all time points while the WeMindful group showed a decrease in moderate PA across all time points. The WeMindful group showed an increase in walking from pretest to posttest, then a decline from posttest to follow up. There was a significant main effect of time for resilience (F = 4.15, p = 0.024). The post-hoc tests revealed that both the WeActive and WeMindful groups showed a significant increase in resilience scores from pretest to follow up (t = -2.74, p = 0.02; t = -2.54, p = 0.04), respectively. The results showed no significant differences in resilience scores between the two groups regardless of time. CONCLUSION: Both interventions were effective in increasing resilience from pretest to 6-week follow up. Only the WeActive intervention was effective in increasing moderate PA and walking over time. These findings suggest that web-based PA interventions may strengthen the resilience of college students.

O3-8 A ban on smartphone usage during recess in increased 10-14 year old children's physical activity; a Danish school intervention study

BackgroundSchool recess provides a unique opportunity for children to be active. However, many children perceive smartphones as a key barrier for engaging in physical activity during recess. The aim was to investigate if a ban on smartphone usage during recess changed children's physical activity.MethodsDuring August-October 2020, children from grades 4-7 (10-14 yrs.) at six Danish schools were banned from using their smartphones during recess for a four-weeks period. Questionnaire and systematic observation (SOPLAY) data were collected from 814 children before intervention (baseline) and 828 during the last week of intervention (follow-up).ResultsThe mean frequency of physical activity significantly increased from baseline to follow-up (odds ratio = 1.370), as did physical activity on a moderate level (odds ratio = 1.387). Vigorous physical activity significantly decreased (odds ratio = 0.851). The increase in physical activity was found among both schools having outdoor and indoor recess, among both boys and girls and nearly equally among grades 4-7. Notably, we observed a much greater decrease in sedentary behavior and a slightly larger increase in moderate physical activity for girls than for boys and particularly boys decreased in vigorous physical activity. They might have changed their physical activity behavior in follow-up because more girls participated in physical activities, resulting in more children in the same space.ConclusionThis suggests that implementing a ban on smartphone usage during recess would, in line with the HEPA strategy, improve the everyday conditions for health among a broad range of children. To our knowledge, this is the first intervention study investigating if a ban on smartphone usage during recess changed schoolchildren's physical activity behavior. Thus, this study fills an important gap for researchers, school boards, teachers, health professionals, and politicians on how schoolchildren's physical activity during recess can be positively changed by policy.

The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis.

Background Healthy lifestyle is important to decrease health risks in individuals living with chronic pain. From an occupational therapy perspective, human health and lifestyle are linked to occupational engagement in meaningful everyday activities. This study is aimed at investigating the effect of including occupational engagement in chronic pain interventions on lifestyle. Methods In this systematic review (PROSPERO reg. CRD42020159279), we included randomized controlled trials (RCTs) on interventions involving occupational engagement (i.e., occupational performance based on involvement, choice, positive meaning, and commitment) and assessing modifiable lifestyle factors: physical activity, body anthropometrics, alcohol consumption, smoking, stress, and sleep. We sought the databases Ovid MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Scopus, Web of Science, OTseeker, ClinicalTrials.gov, OpenGrey, and the web engine Google Scholar and citations and references of relevant publications. We evaluated methodological quality with the Cochrane risk-of-bias tool 2.0, determined the overall evidence certainty using the GRADE methodology, and performed meta-analysis when two or more trials reported on the outcomes. Results Of the 9526 items identified, 286 were full text screened. We included twelve articles with eleven RCTs comprising 995 adults and assessing physical activity, sleep quality, stress, and Body Mass Index. Sufficient data for meta-analysis was only available for physical activity and sleep quality. The meta-analysis suggested a moderate increase in physical activity after behavioral interventions for fibromyalgia and musculoskeletal pain (SMD = 0.69 (0.29; 1.09)) and a small increase in sleep quality up to 6 months after multidisciplinary self-management of fibromyalgia (SMD = 0.35 (95% CI 0.08; 0.61)). The overall certainty of the evidence was deemed low. Conclusion Including occupational engagement in chronic pain interventions may increase short-term physical activity and long-term sleep quality. Due to the few available RCTs including occupational engagement in chronic pain treatment for adults living with chronic pain, further high-quality RCTs are needed and will likely change the conclusion.

EXERCISE CAPACITY AND ATRIAL FIBRILLATION RISK IN 459,592 HYPERTENSIVES: A COHORT STUDY

Objective: To assess the association between exercise capacity and the risk of developing atrial fibrillation (AF) in hypertensive patients. Design and method: We identified 459,675 hypertensives (63 ± 8.6 years, females: 4.9%), free of AF, who completed a normal Bruce exercise treadmill test (ETT). We established 5 fitness categories (quartiles) based on age-specific peak metabolic equivalents (METs) achieved: Least-fit (4.5 ± 1.22 METs; n = 107,593); Low-fit (6.9 ± 1.07; n = 119,433); Moderate-fit (8.3 ± 1.19; n = 88,923); Fit (10.3 ± 0.89; n = 106,921), and High-fit (13.1 ± 1.55; n = 36,722). Hazard regression models were adjusted for age, BMI, smoking (33.5%), DM (43.6%), dyslipidemia (69.8%) and CKD (5.8%). Results: During a median follow-up of 9.8 ± 5.0 years, 42,639 (9.6%) developed AF (9.6 per 1000 person-years). EXCP was inversely related to AF incidence. The risk was 11% lower (HR:0.89, 95% CI, 0.88–0.90) for each 1-MET increase in exercise capacity. Compared to the Least-fit category (Referent), the HRs were 0.72 (95% CI, 0.71–0.74) for Low-fit individuals, 0.61 (95% CI, 0.60–0.63) for Moderate-fit, 0.52 (95% CI, 0.50–0.54) for Fit, and 0.45 (95% CI, 0.43–0.47) for High- fit individuals. Similar trends for those &lt; 65 years &amp; &gt; 65 years of age. Conclusions: Our findings support that increased fitness offer a marked protection against AF. The association was inverse, independent, and graded. Significantly lower AF risk was evident in those with only modest increases in exercise capacity and declined by &gt; 50% for individuals in the High-fit category. These findings counter previous suggestions that even moderate increases in physical activity, (recommended by guidelines), increase the risk of AF.

663 BEHAVIOUR CHANGE INTERVENTIONS TO INCREASE PHYSICAL ACTIVITY IN HOSPITALISED PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Introduction Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. Methods: Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were searched from MEDLINE, EMBASE, PsychINFO, CINAHL, Cochrane Register of Controlled Trials and PEDr, supplemented by citation tracking. After application of selection criteria and data extraction, data were synthesised with random effects meta-analyses and pre-specified subgroup and meta-regression analyses. The primary outcome was Objectively measured physical activity. Secondary outcomes were patient-related outcomes (e.g. mobility), hospital-level outcomes (e.g. length of stay), adverse events and patient satisfaction. Results Eighteen randomised controlled trials (n = 2,197 participants) of behaviour change interventions were included and were associated with increased physical activity levels (SMD 0.36, 95% CI 0.15 to 0.57). Findings in relation to mobility and length of stay were inconclusive. Adverse events and patient satisfaction were poorly reported. Meta-regression found that the behaviour change technique of goal setting was independently associated with increased physical activity (SMD 0.35, 95% CI 0.11 to 0.60). Conclusion Targeted behaviour change interventions are associated with small to moderate increases in physical activity in hospitalised patients. Goal setting was the behaviour change technique that worked best in increasing physical activity.

The Effects of the BAILAMOSTM Dance Program on Physical Activity Levels and Cognition of Older Latino Adults: A Pilot Study.

Objective: To investigate the effects of the BAILAMOSTM dance program on physical activity (PA), cardiorespiratory, and cognitive health. Methods: A parallel, two-armed pilot study was conducted with 57 older Latinos randomized to the BAILAMOSTM dance program (n = 28) or health education (HE) (n = 29). We conducted two- and three-way repeated-measures ANOVAs. Results: BAILAMOSTM participants increased participation in leisure moderate-to-vigorous PA (LMVPA) (F[1,53] = 3.17, p = .048, η2G = .01) and performance in global cognition relative to HE participants (F[1,52] = 4.19, p = .045, η2G = .01). Attendance moderated increases in moderate PA, MVPA, LMVPA, and total PA (p < .05). Participants of both groups with ≥75% attendance increased participation in PA. Among participants with <75% attendance, BAILAMOSTM participants increased PA relative to HE. Discussion: BAILAMOSTM positively impacted self-reported PA and global cognition in older Latinos. Even smaller doses of dance appear to impact self-reported PA levels.

Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BackgroundMobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood.ObjectiveThe primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators.MethodsWe performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool.ResultsOf the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence.ConclusionsmHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.

Physical Activity and Adherence to the Mediterranean Diet among Spanish Employees in a Health-Promotion Program before and during the COVID-19 Pandemic: The Sanitas-Healthy Cities Challenge.

Physical activity and a healthy diet are key factors for avoiding major noncommunicable diseases. The aim of the present study was to analyze how physical activity (PA) and adherence to the Mediterranean diet among employees participating in the Healthy Cities program have been affected during confinement due to the COVID-19 pandemic. The sample was composed of 297 employees from 40 leading companies based in Spain, who participated in the 5th edition of the Sanitas “Healthy Cities” challenge. The participants (148 women and 149 men), aged between 24 and 63 years old (M = 42.76; SD = 7.79) completed the short form of the International Physical Activity Questionnaire (IPAQ) and the PREDIMED (Prevención con Dieta Mediterránea) questionnaire to measure adherence to the Mediterranean diet before and during the pandemic. Pearson χ2 tests revealed that workers were more likely to show sedentary behaviors during the pandemic than before (83.5% vs. 66.7%). Additionally, they were more likely to reach high levels of PA (51.2% vs. 64%), and Wilcoxon tests revealed that energy expenditure measured in Metabolic Equivalent of Task (MET) was higher during the pandemic (4199.03 METs) than before (3735.32 METs), due to an increase in moderate PA. Lastly, a higher adherence to a Mediterranean diet during the pandemic (76.4%) than before (54.5%) was reported. The findings of this investigation suggest a positive effect of working from home for employees involved in a health-promotion program, and highlight the relevance of this kind of action among this population.

Physical Inactivity from Youth to Adulthood and Risk of Impaired Glucose Metabolism.

Physical activity (PA) is important in the prevention and treatment of impaired glucose metabolism. However, association of physical inactivity during the transition between childhood and adulthood with glucose metabolism is unknown. Therefore, we studied the association of persistent physical inactivity since childhood with glucose metabolism in adulthood. Data were drawn from the ongoing, Cardiovascular Risk in Young Finns Study with repeated follow-ups between 1980 and 2011 (baseline age, 3-18 yr; n = 3596). Impaired glucose metabolism was defined as having impaired fasting glucose (6.1-6.9 mmol·L) or type 2 diabetes in adulthood. Leisure-time PA habits were repeatedly collected with a standardized questionnaire and expressed as a PA Index. Using PA Index, four groups were formed (n = 2000): 1) persistently low PA, 2) decreasingly active, 3) increasingly active, and 4) persistently active subjects. Poisson regression model was used to examine the association between PA groups and impaired glucose metabolism. The proportion of the sample with impaired glucose metabolism was 16.1% in individuals with persistently low PA, 14.5% in decreasingly active, 6.8% in increasingly active, and 11.1% in persistently active. Compared with individuals with persistently low PA, age and sex-adjusted risk for impaired glucose metabolism were lower in those who increased PA (relative risk [RR], 0.47; 95% confidence interval [CI], 0.29-0.76) and in those who were persistently active (RR, 0.70; 95% CI, 0.51-0.97), but similar in those who decreased PA (RR, 0.93; 95% CI, 0.66-1.36). Persistently physically inactive lifestyle from youth to adulthood is associated with increased risk of impaired glucose metabolism in adulthood. Importantly, a moderate increase in PA lowered the risk. The results highlight the importance of avoiding physically inactive lifestyle at all stages of life.

Use of text messages to increase positive affect and promote physical activity in patients with heart disease: The Promoting Activity in Cardiac Patients via Text Messages (PACT) pilot study.

Adherence to physical activity in patients with serious heart disease is critical to recovery and survival. In-person programs to promote activity in cardiac patients have been poorly attended, and increasingly patients are focused on mobile, self-management-based approaches to health. Accordingly, we completed a one-arm trial of a novel one-way 14-day text message intervention among 40 patients with a prior acute coronary syndrome (ACS). The two-pronged psychological-behavioral intervention alternated daily messages focused on promoting psychological well-being with messages providing specific education/advice regarding physical activity. All messages were successfully transmitted, and nearly all participants found the intervention to be helpful (n=37; 92.5%) and performed at least one specific health-related action in response to a text message (n=35; 87.5%). Post-intervention, participants had improvements in happiness (Cohen's d=0.25), determination (d=0.37), depression (d=-0.01), and anxiety (d=-0.13), though not optimism. Moreover, participants reported an increase in moderate physical activity of 105 minutes/week (baseline: 261 [SD 265] minutes/week, follow-up: 366 [SD 519]; d=0.25). These improvements were largely maintained two weeks later, with further increases in physical activity (414 [SD 570] minutes/week). Text messaging focused on well-being and physical activity was well-accepted and associated with improvements in activity and mental health in this high-risk clinical population.

Physical activity and change in fasting glucose and HbA1c: a quantitative meta-analysis of randomized trials.

A systematic review was conducted of randomized trials which evaluated the impact of physical activity on the change in fasting glucose and HbA1c. A literature search was conducted in PubMed until December 2015. Studies reporting glucose or HbA1c at baseline and at the end of study were included, and the change and its variance were estimated from studies with complete data. Mixed-effect random models were used to estimate the change of fasting glucose (mg/dl) and HbA1c (%) per additional minutes of physical activity per week. A total of 125 studies were included in the meta-analysis. Based on 105 studies, an increase of 100min in physical activity per week was associated with an average change of -2.75mg/dl of fasting glucose (95% CI -3.96; -1.55), although there was a high degree of heterogeneity (83.5%). When restricting the analysis on type 2 diabetes and prediabetes subjects (56 studies), the average change in fasting glucose was -4.71mg/dl (95% CI -7.42; -2.01). For HbA1c, among 76 studies included, an increase of 100min in physical activity per week was associated with an average change of -0.14% of HbA1c (95% CI -0.18; -0.09) with heterogeneity (73%). A large degree of publication bias was identified (Egger test p<0.001). When restricting the analysis on type 2 diabetes and prediabetes subjects (60 studies), the average change in HbA1c was -0.16% (95% CI -0.21; -0.11). This analysis demonstrates that moderate increases in physical activity are associated with significant reductions in both fasting glucose and HbA1c.

Validation and psychometric evaluation of physical activity belief scale among patients with type 2 diabetes mellitus: an application of health action process approach.

Background: Moderate increase in physical activity (PA) may be helpful in preventing or postponing the complications of type 2 diabetes mellitus (T2DM). The aim of this study was to assess the psychometric properties of a health action process approach (HAPA)-based PA inventory among T2DM patients. Methods: In 2015, this cross-sectional study was carried out on 203 participants recruited by convenience sampling in Isfahan, Iran. Content and face validity was confirmed by a panel of experts. The comments noted by 9 outpatients on the inventory were also investigated. Then,the items were administered to 203 T2DM patients. Construct validity was conducted using exploratory and structural equation modeling confirmatory factor analyses. Reliability was also assessed with Cronbach alpha and interclass correlation coefficient (ICC). Results: Content validity was acceptable (CVR = 0.62, CVI = 0.89). Exploratory factor analysis extracted seven factors (risk- perception, action self-efficacy, outcome expectancies, maintenance self-efficacy, action and coping planning, behavioral intention, and recovery self-efficacy) explaining 82.23% of the variation. The HAPA had an acceptable fit to the observations (χ2 = 3.21, df = 3, P = 0.38; RMSEA = 0.06; AGFI = 0.90; PGFI = 0.12). The range of Cronbach alpha and ICC for the scales was about 0.63 to 0.97 and 0.862 to 0.988, respectively. Conclusion: The findings of the present study provided an initial support for the reliability and validity of the HAPA-based PA inventory among patients with T2DM.

Exercise Capacity and Atrial Fibrillation Risk in Veterans: A Cohort Study

ObjectiveTo assess the association between exercise capacity and the risk of developing atrial fibrillation (AF). Patients and MethodsA symptom-limited exercise tolerance test was conducted to assess exercise capacity in 5962 veterans (mean age, 56.8±11.0 years) from the Veterans Affairs Medical Center, Washington, DC. None had evidence of AF or ischemia at the time of or before undergoing their exercise tolerance test. We established 4 fitness categories based on age-stratified quartiles of peak metabolic equivalent task (MET) achieved: least fit (4.9±1.10 METs; n=1446); moderately fit (6.7±1.0 METs; n=1490); fit (7.9±1.0 METs; n=1585), and highly fit (9.3±1.2 METs; n=1441). Multivariable Cox proportional hazards regression models were used to compare the AF-exercise capacity association between fitness categories. ResultsDuring a median follow-up period of 8.3 years, 722 (12.1%) individuals developed AF (14.5 per 1000 person-years; 95% CI, 13.9-15.9 per 1000 person-years). Exercise capacity was inversely related to AF incidence. The risk was 21% lower (hazard ratio, 0.79; 95% CI, 0.76-0.82) for each 1-MET increase in exercise capacity. Compared with the least fit individuals, hazard ratios were 0.80 (95% CI, 0.67-0.97) for moderately fit individuals, 0.55 (95% CI, 0.45-0.68) for fit individuals, and 0.37 (95% CI, 0.29-0.47) for highly fit individuals. Similar trends were observed in those younger than 65 years and those 65 years or older. ConclusionIncreased fitness is inversely and independently associated with the reduced risk of developing AF. The decrease in risk was graded and precipitous with only modest increases in exercise capacity. These findings counter previous suggestions that even moderate increases in physical activity, as recommended by national and international guidelines, increase the risk of AF, with marked protection against AF noted with increasing levels of fitness.

The effects of an enhanced quality Physical Education programme on the physical activity levels of Grade 7 learners in Potchefstroom, South Africa

Background: The absence of Physical Education (PE) from the South African school curriculum before its reintroduction in recent years contributed to health concerns regarding the low physical activity (PA) levels of children and adolescents in South Africa.Purpose: This study evaluated the effects of a once-a-week enhanced quality PE programme on the PA levels of South African Grade 7 learners.Methods: Using a pre-test and post-test control-group design, 110 Grade 7 learners aged 12–13 years (experimental school, n = 40; control schools, n = 70) from two primary schools in Potchefstroom, South Africa, were studied. They participated in a 12-week PE intervention programme based on the guidelines of the South African Curriculum and Assessment Policy Statement, which allocates one hour per week to PE teaching. The intervention included five quality-enhancing components, namely well-trained teachers, homework activities, a reward system, hand-made apparatus and the monitoring of activity intensity. In the experimental school, 40 learners were randomly assigned from the total Grade 7 class (n = 124) to the experimental group, while two control groups (n = 37 and n = 33) were used, one from the same school as the experimental school and the other from a different school. Additionally, to control for PE teacher interaction effect, the experimental group was divided into 4 experimental sub-groups of 10 learners each, which were taught by 4 different PE teachers, and the pre-test and post-test data of these experimental sub-groups were also analysed. Children's PA levels were measured before and after the intervention using a validated Children's Leisure Activities Study Survey questionnaire. The Kruskal–Wallis and Wilcoxon signed-rank tests were used to evaluate the effects of the intervention programme.Results: No significant differences were found within the experimental group between the 4 experimental sub-groups and between the 2 control groups at pre- and post-test measurements (p > .05). There was a significant effect for the experimental group as a whole, as results of the total experimental group showed statistically significant increases in moderate PA (ES = 0.47; p = .014), vigorous PA (ES = 0.48; p = .012) and total PA (ES = 0.51; p = .008) as well as decreases in sedentary behaviours (ES = 0.39; p = .041) after the 12-week intervention programme, whereas no significant changes were found in the control group. Statistically significant improvements were also found in all 4 experimental sub-groups between pre- and post-tests for the time spent in moderate PA (p = .028–.05; ES = 0.23–0.64), vigorous PA (p = .018–.036; ES = 0.23–0.63), total PA (p = .017–.05; ES = 0.30–0.68) and sedentary time (p = .014–.049; ES = 0.26–0.66), whereas no marked changes were observed among the two control groups, indicating no PE teacher interaction effect on the results.Conclusions: The enhanced quality PE programme can be used as a valuable framework for PE implementation targeted at promoting learners’ PA levels, even in the presence of restricted time allocation, and limited teaching and learning resources.

Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis.

To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-015-0203-7) contains supplementary material, which is available to authorized users.