Moderate-intensity Activity Research Articles

The crowding-out effect of physical fitness activities on medical expenditure in the aged group

IntroductionChina is facing the challenge of “deep aging”, and promoting healthy aging has become a key research topic. Both medical care and physical exercise are important for health, but while medical services focus on treating illness, physical fitness activities focus on prevention, making them a more effective approach for promoting healthy aging.MethodsThis study uses data from the China Health and Retirement Longitudinal Study (CHARLS), focusing on individuals aged 60 to 80, to investigate the relationship between physical fitness activities and medical expenditures. A Tobit model was employed to analyze the data.Results(1) Active participation in physical fitness activities significantly improves the health of older adults, making physical activity an essential pathway to achieve healthy aging. (2) Participation in sports and fitness activities leads to a crowding-out effect on medical expenditures, significantly reducing healthcare costs for participants. (3) High-intensity physical activities are most suitable for individuals aged 60-65, moderate-intensity activities for those aged 66-70, and low-intensity activities for those aged 71–80.Discussion(1) Policies should focus on raising awareness of physical fitness benefits among older adults, encouraging regular physical activity to improve health and reduce medical costs. (2) A shift from treatment to prevention in health management is needed, promoting exercise as a cost-effective way to reduce healthcare spending. (3) Age-specific fitness guidelines should be developed to provide tailored exercise recommendations for different older aldult age groups.

Accuracy of Wrist-Worn Heart Rate Monitors: A Comprehensive Review of Smartwatches in Exercise Monitoring

Wrist-worn heart rate monitors have become integral in personal health monitoring, particularly during exercise and daily activities. This review evaluates the precision of various commercially available smartwatches in assessing heart rate, focusing on their accuracy across different physical activities, such as walking, running, cycling, and elliptical training. A systematic analysis of 29 peer-reviewed studies, encompassing over 900 participants, was conducted to compare devices like the Apple Watch, Fitbit, Garmin, and others. The results demonstrate significant variation in accuracy depending on the device, type of activity, and individual factors such as body mass index and skin tone. The Apple Watch consistently outperformed other devices, showing the lowest mean absolute percentage error (MAPE), particularly during moderate-intensity activities. In contrast, devices such as the Fitbit Blaze exhibited greater error rates, especially during high-intensity exercises or activities involving significant arm movement. Although wrist-worn heart rate monitors provide users with convenient real-time data, limitations such as motion artifacts, device placement, and external factors may affect their reliability.

Exercise Training in Patients With Hypertrophic Cardiomyopathy Without Left Ventricular Outflow Tract Obstruction: A Randomized Clinical Trial.

Patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction commonly experience reduced exercise capacity. Physical training improves exercise capacity in these patients, but whether the underlying effects of exercise are a result of central hemodynamic or peripheral improvement is unclear. This study assessed whether exercise training reduces left ventricular filling pressure measured during exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction. Between March 2019 and June 2022, patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction were randomly assigned (1:1) to a 12-week (3 h/wk) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure during mild exercise (25 W) from baseline to week 12. Pressure tracings were analyzed offline by a blinded investigator. Secondary outcomes included changes in peak oxygen consumption, cardiac index, quality of life, echocardiographic indices of diastolic function, and natriuretic peptides. Of 59 patients randomized (mean age, 58.1±12.2 years; 27% women), 51 (86%) completed all follow-up assessments. At week 12, the change in 25-W pulmonary capillary wedge pressure was -2.8±6.8 mm Hg in the exercise group, compared with +1.2±4.9 mm Hg in the usual-activity group (between-group difference, 4.0 mm Hg [95% CI, 0.7-7.3]; P=0.018). Peak oxygen consumption improved by +1.8±2.0 mL/kg/min in the exercise group versus -0.3±3.1 mL/kg/min in the usual-activity group (P=0.005). Exercise training improved the ventilatory efficiency (VE/VCO2) slope compared with usual activity (between-group difference, 2.0 [95% CI, 0.6-3.5]; P=0.006). Peak cardiac index improved by +0.38±1.38 L/min/m2 in exercise versus -0.85±1.20 L/min/m2 in the usual-activity group (P=0.002). Change in overall Kansas City Cardiomyopathy Questionnaire score was similar between groups. However, the change in physical limitation scores (+8.4±12.0 points in exercise versus +0.7±6.8 points in usual-activity group; P=0.034) and quality-of-life scores (+8.7±18.0 points in exercise versus 0.7±4.0 points in usual-activity group; P=0.01) differed significantly. There were no significant changes in diastolic function assessed by echocardiography or in natriuretic peptides. In patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction, a 12-week moderate-intensity exercise training program resulted in reduced left ventricular filling pressures at mild exertion and improved exercise performance. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03537183.

Relationship between physical activity and oral frailty among older adults in Korea

Objectives: This study aimed to investigate the effects of physical activity on oral frailty in older Korean adults. Methods: The data from 1,320 individuals aged 65 years and older, derived from the 8th Korean National Health and Nutrition Examination Survey (2019), were subjected to complex sample statistical analysis. Oral frailty was assessed based on the presence of one or more functional impairments according to the following five criteria: difficulty chewing, difficulty speaking, number of natural teeth, brushing frequency, and use of oral hygiene products. Results: Chewing discomfort and difficulty speaking were highest in the 76-80 age group at 44.5% and 18.1%, respectively (p<0.01). The proportion of patients with 20+ natural teeth decreased from 72.2% (65-70) to 45.3% (75-80) (p<0.001). The daily brushing rate was 50.2% in the 65-70 group. Chewing discomfort was reported by 26% of those who walked 4-6 days a week (p<0.01). Moderate-intensity activity was linked to lower chewing discomfort (22.9%) and speaking difficulty (7.4%) compared with higher levels in inactive individuals (30.4%, 14.9%) (p<0.01). Brushing three times daily was observed in 52.9% of walkers and 33.9% of non-walkers (p<0.001). Oral hygiene product use varied significantly according to activity level (p<0.05). Conclusions: Physical activity significantly affects oral frailty, highlighting the need for targeted training and policy development.

Role of physical training in cardiac rehabilitation in patients with congestive heart failure and type 2 diabetes mellitus

Introduction. Currently, the effectiveness of cardiac rehabilitation of patients with comorbid CHF using physical training when prescribing optimal drug therapy, including SGLT2 drugs, has not been studied.Aims. To study the effect of controlled physical training on the quality of life and prognosis of patients with CHF comorbid with type 2 diabetes mellitus against the background of rational pharmacotherapy.Materials and methods. The study included 74 patients with CHF against the background of type 2 diabetes mellitus, receiving optimal drug therapy, with mandatory intake of SGLT2 drugs. Two groups were formed using the simple randomization method: “Physical training” (n = 35) – basic drug therapy supplemented by a program of controlled physical training and “Standard drug therapy” (n = 37) – only basic drug therapy. Patients in the standard drug therapy group were recommended regular aerobic physical activity of moderate intensity for 30–60 minutes at least 5 days a week.Results. In the Physical Training group, after 12 months, an increase in the distance according to the results of the 6-minute walk test by 39.6% (on average 407.2 meters) was registered, in the Standard Drug Therapy group, physical tolerance increased by 12.2% (324.5 meters) (p = 0.002). According MLHFQ questionnaire in patients with CHF, the results were obtained that characterize the high social adaptation of patients during physical training in comparison with standard pathogenetic drug therapy. Thus, the MLHFQ indicator in the Physical Training group changed by an average of 25.2 points, and in the Standard Drug Therapy group – by 5.7 points, amounting to 37.3 ± 5.9 in the Physical Training group, and 58.2 ± 2.1 in the Standard Drug Therapy group (p = 0.001).Conclusions. Physical training in patients with CHF associated with type 2 diabetes mellitus against the background of optimal drug therapy leads to an increase in the distance according to the results of the 6-minute walk test and contributes to an improvement in the quality of life.

Accelerometer-measured physical activity pattern in older patients with frailty and heart failure

Abstract Background Physical activity (PA) assessed by accelerometers represents a novel method to understand the PA profile of older patients with heart failure (HF). We hypothesized that PA level and pattern vary in HF patients across the spectrum of frailty status. Aim To report the duration, intensity and volume of PA in older patients with HF according to frailty status. Methods We recruited 150 HF patients≥65 years from a hospital-based HF clinic between March and October 2023. Frailty was assessed using the Short Physical Performance Battery (SPPB); patients with SPPB 10-12, 7-9, 4-6 and ≤3 was classified as robust, mildly, moderately and severely frail respectively. To evaluate PA profile, all patients wore a wrist accelerometer on their non-dominant hand for 7 days (24 hours/ day). PA parameters including average acceleration over 24 hours (proxy of volume of activity); time spent in inactive, light, moderate and vigorous intensity activities; intensity gradient (more negative gradient equates to poorer intensity profile) and time of most active continuous bouts of PA, were compared amongst frailty groups. Results 146 participants with good quality accelerometer data were included in the analysis; median age 80 (range 65-94 years), 65% male. Thirty-eight percent had heart failure with reduced ejection fraction (HFrEF); 21% had NYHA class III/IV symptoms; median NT-proBNP was 2040 ng/L (IQR = 1110 - 4930). Frail patients were more likely to be older with more comorbidities; they also had more severe HF symptoms and higher NT-proBNP. Frail patients had lower volume of PA compared to robust patients, evidenced by lower average acceleration (milligravity-mg) over 24 hours [20.4 (robust); 16.0 (mildly frail); 13.5 (moderately frail); 13.2 (severely frail), p<0.001]. PA intensity profile was poorer in frail patients compared to robust patients [median intensity gradient: -2.72 (robust); -2.92 (mildly frail); -3.00 (moderately frail); -3.07 (severely frail), p<0.001]. (Table 1) Frail patients spent more time inactive compared to robust patients [median time spent inactive (minutes): 654 (robust); 689 (mildly frail); 780 (moderately frail); 720 (severely frail), p<0.001]. The median time (minutes) spent in light [225 (robust); 190 (mildly frail); 164 (moderately frail); 159 (severely frail)] and moderate to vigorous activity [62 (robust), 23 (mildly frail), 15 (moderately frail) and 13 (severely frail), p<0.001] were significantly shorter in frail compared to robust patients. (Figure 1) The most active continuous bout of PA of patients across the frailty spectrum appeared to between 10 AM to 2 PM. Conclusion The duration, volume and intensity of PA was generally low in older patients with HF. Worse frailty status was associated with longer duration of physical inactivity, shorter duration of light, moderate or vigorous activity, poorer PA intensity profile and lower volume of PA.

Measured obesity and overweight in adults: the Italian Health Examination Survey 2023-CUORE Project

Abstract Background The WHO recommends to halt the rise of obesity by 2025, considering 2010 as baseline. This analysis aims to assess if Italy can meet the WHO target in the general adult population using data measured in the periodic health examination surveys (HESs) conducted within the CUORE Project. Methods In the HES started in 2023, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI< 30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (727 men and 706 women), from 7 (of 20) Italian Regions, in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. Insufficient physical activity was defined as less than 150 minutes of moderate-intensity activity per week, or equivalent. The survey is funded by the Italian Ministry of Health-CCM. Results Prevalence of obesity was 23% (95% C.I. 16-29%) in men and 25% (19-31%) in women; prevalence of overweight was 47% (39-54%) in men and 30% (24-37%) in women. Mean level of BMI was 27.5 kg/m2 (27.2-27.8 kg/m2) in men and 26.9 kg/m2 (26.4-27.3 kg/m2) in women. Obesity resulted tendencially higher in persons with insufficient physical activity (27%, with 95% C.I. 17-36% in men; 28%, 19-37% in women) than among those without (19%, 11-27% in men; 21%, 12-30% in women), and in persons with primary or secondary school education (29%, 17-40% in men; 32%, 20-44% in women) than in those with higher educational level (20%, 12-27% in men; 21%, 14-28% in women). Conclusions Going in the direction of WHO target, preliminary data collected within 2023 showed a prevalence of obesity not statistically different in comparison to HES data of 15 and 5 years ago, both in men and women, however, 70% of men and 55% of women are in the overweight/obesity condition. Preventive actions at national and community level should be still massively implemented. Key messages • Prevalence of obesity and overweight resulted still at epidemic level in the Italian adult general population. • In the Italian adult population stable obesity prevalence trend was observed in comparison to 15 and 5 years ago.

Aerobic Conditioning in Geriatric Rehabilitation

This article reviews the historical development of aerobic conditioning. The many physiological effects of aerobic conditioning are presented including the effects on cardiovascular, muscular, and neuromuscular health leading to increased physical endurance and increased lifespan. Aerobic exercise prescription follows the frequency, intensity, time, and type, as well as the volume and progression principles. Frequency recommendations are at least 3 d/wk and 3 to 5 d/wk appears to be conducive to meeting overall physical activity recommendations. Intensity determination is based on several methods that include heart rate methods, ratings of perceived exertion (Borg and OMNI), the talk test, and the counting talk test. Time recommendations include at least 150 to 300 minutes a week of moderate-intensity aerobic activity, 75 to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activities. Type recommendations include any aerobic activities involving major muscle groups used in a continuous or intermittent manner. Volume recommendations include ≥500 to 1000 metabolic equivalent minutes per week and approximately 150 min/wk of moderate-intensity activity. Progression recommendations include the gradual advancing of the exercise duration, frequency, and intensity, making sure that the progressions allows for the best adherence to aerobic exercise on an ongoing basis. The benefits of aerobic exercise have been shown to be important for every aspect of living a healthy lifestyle across the age span, particularly for aging adults, adults with chronic conditions, and adults with disabilities.

Adult Sports Participation and Physical Activity: How About Curling?

Despite its well-documented physical and psychosocial benefits, sport remains the least engaged form of physical activity (PA) among adults. Many adults may lack the skills needed to play or continue to play sports and aging adults are more likely to avoid participation for fear of poor performance or injury. A sport that shows great promise for adults seeking new sports participation outlets is curling. Curling is a team sport comprised of four interchangeable positions working collectively to deliver granite stones across a sheet of ice in an effort to outscore the opponent team. While it seems reasonable that walking on ice, “throwing” a 44 lb granite stone across a sheet of ice, and periodically sweeping while walking on ice over a two-hour period would generate at least a moderate amount of physical activity, research to date is quite limited. Therefore, the purpose of this study was to objectively measure the amount and intensity of PA achieved by average recreational curling participants during a typical curling match. Methods Members of a curling club in NC were asked to wear Actigraph Accelerometers (model GT3X) while they participated in their regularly scheduled curling match. All participants had at least one year of curling experience. Curling matches lasted between 90 and 120 minutes. Participants were asked to indicate their age, gender, and curling position during the match (lead, second, vice, skip) which were matched with accelerometer data. Results Overall, 110 participants (37 female, 73 male, avg. age 50 yrs) spent most of their curling time in light or moderate-intensity activity (18.1% Sedentary; 49.5% light; 32.4% moderate; .03% vigorous). In terms of minutes, the average participant spent 35.9 minutes engaged in Moderate-to-Vigorous PA (MVPA) per curling experience. This represents 23.9% of the weekly 150min of MVPA suggested by the CDC. The second position had the highest percentage of moderate activity level and a small percentage of vigorous activity. No other position reached a vigorous level. The skip position had the highest amount of sedentary activity as well as light activity. Females had a higher level of moderate activity in comparison to males. However, males reached a small amount of vigorous activity. The age group of 18 - 36 had the highest amount of moderate activity and the lowest amount of sedentary activity. This age group reached an average of 41.0 minutes of MVPA per curling experience. The age group of > 58 had the highest amount of sedentary activity and the lowest amount of moderate activity. Conclusions Curling may be a good sports participation option for adults looking for alternatives to meet recommended weekly amounts of MVPA. Participants should consider playing in one of the first three positions to maximize the amount and intensity of PA achieved while playing. Furthermore, since curling also requires balance, coordination, muscular strength, multitasking, strategic reasoning, and can cater to most physical challenges without compromising the integrity of the game, it may be an ideal sport to promote for adults of all ages and sport abilities. Implications for Practice and Policy Findings should be used to inform strategies for promoting curling as an opportunity for team sport involvement that has the added value of contributing to daily physical activity. However, , access and opportunities to play, especially for underserved populations, are limited. Given that most curling clubs in America are private and require a membership to play. Partnership arrangements between existing clubs and public parks and recreation departments could increase both access and opportunities to play.

Physical activity and nutrient intake levels according to grip strength among single-household elderly in Korea: data from 2014 and 2019 Korea National Health and Nutrition Examination Survey (KNHANES).

We analyzed the differences in physical activity (PA) levels and nutrient intake based on grip strength among elderly men and women in single-person households (ESH) in Korea. Data were obtained from 1,581 ESH individuals (aged ≥65 years) from the Korean National Health and Nutrition Examination Survey (2014-2019). PA levels (occupational and recreational moderate-intensity activities, travel to and from places, walking, and strength training) and nutrient intake (including, total energy, carbohydrates, protein, and fat) were analyzed. Men exhibited no differences in PA related to grip strength, except for the number of strength training days (p=0.000). Women with higher grip strength engaged more in recreational activities, travel, and strength training (all, p=0.000). Men with higher grip strength consumed more protein, while women consumed greater amounts of total fat (p=0.030), monounsaturated fatty acids (MUFA) (p=0.024), and polyunsaturated fatty acids (PUFA) (p=0.011). Both sexes had increased Vitamin C intake (men: p=0.023, women: p=0.020). Sex-related differences in PA levels and nutrient intake based on grip strength were observed among older individuals in ESH. Women require programs to enhance diverse PA and balance fat intake, while men need interventions focused on strength training and protein intake.

The German version of the Pregnancy Physical Activity Questionnaire: a translation, cross-cultural adaptation, reliability and validity assessment

BackgroundValidated and internationally standardised measurement instruments are a prerequisite for ensuring that physical activity during pregnancy is comparable and for deriving physical activity recommendations. In Germany, there has been no adapted version of the internationally used Pregnancy Physical Activity Questionnaire (PPAQ) until now. This study’s aim centred around translating the original English version into German (PPAQ-G) and determining its reliability as well as validity in a German population.MethodsThe PPAQ was translated into German using the forward-backwards technique. Its reliability and validity were tested. Thirty-four correctly completed questionnaires were analysed. The test–retest reliability was presented using the intraclass correlation coefficient (ICC) and Spearman correlation coefficient. Validity was tested by using accelerometer (n = 23) and determined by Spearman correlation coefficient.ResultsIn the transcultural adjustment, two questions were amended to describe intensity more precisely, and two other questions were adapted to reflect the units of measurement used in Germany. The ICC indicated a reliability of r = 0.79 for total activity (without sitting), and the intensity subcategories ranged from r = 0.70 (moderate-intensity activities) to r = 0.90 (sitting). Although, validity assessment showed no significant correlation for sedentary, moderate or vigorous intensity, there were significant correlations for total activity (light and above; r = 0.49; p < 0.05) and for light activity (r = 0.65; p < 0.01).ConclusionsThe PPAQ-G showed good reliability for use on pregnant German women and a moderately accurate measurement of physical activity. It can be used nationally for epidemiological studies, and it also enables international comparisons of physical activity during pregnancy.Trial registrationDRKS00023426; Registration date 20 May 2021.

Cool mama: Temperature regulation during high-intensity interval running in pregnant elite and recreational athletes

BackgroundRegular exercise during pregnancy is beneficial, but athletes often exceed the recommended 150 min of moderate-intensity activity, incorporate high-intensity exercises. The upper limit for exercise intensity and duration on fetal and maternal safety remains uncertain. A concern is a maternal core body temperature of >39.0 °C, potentially increase the risk of heat-related fetal malformations and complications during pregnancy. Blood flow redirection for thermoregulation could compromise fetal cardiovascular function, increasing the risk of miscarriage and preterm labor. This study evaluated whether pregnant women (gestational weeks 25–35) were at risk of exceeding a core body temperature of 39.0 °C during high-intensity running. We also investigated effects on skin temperature, fluid loss, and thermal sensation, comparing pregnant athletes to non-pregnant controls. MethodsIn this comparative cross-sectional study, 30 elite and recreational athletes (pregnant n = 15) completed up to five high-intensity treadmill-intervals. Core and skin temperature were continuously measured. Body weight was utilized to calculate the amount of fluid loss. ResultsHighest core body temperature were 38.76 °C and 39.56 °C in one pregnant and non-pregnant participant, respectively. Pregnant participants had lower core body temperatures (mean difference −0.47 °C, p ≤ 0.001) initially and a smaller increase (0.10 °C, p ≤ 0.003) during later intervals compared with the non-pregnant controls. Pregnant participants also showed a greater increase in skin temperature (4.08 ± 0.72 °C vs. 3.25 ± 0.86 °C, p = 0.008) and fluid loss (0.81 ± 0.19 L vs. 0.50 ± 0.12 L, p˂0.001). ConclusionPhysiological changes in pregnancy may enhance thermoregulation, indicating that high-intensity interval runs are unlikely to pose a risk of exceeding a core body temperature of 39 °C for pregnant athletes.

Race, Ethnicity, and Geography as Determinants of Excessive Weight and Low Physical Activity in Pediatric Population: Protocol for Systematic Review and Meta-Analysis.

The rationale for the current study is the sparsity of data on the combined effect of the environmental and individual risks of obesity and sedentary lifestyle in children of different races/ethnicities from different regions. An effective weight management strategy is hard to design due to insufficient evidence. This work was initiated to study race, ethnicity, and geography as determinants of excessive weight and low physical activity in the pediatric population. To achieve this aim, we systematically review publications on daily length of physical activity of light, moderate, and vigorous intensity, as well as sedentary time and BMI and its dynamics in children of different races/ethnicities and geographies. The extracted data are stratified into six major geographic regions and six races/ethnicities. Then, a random-effects meta-analysis is used to calculate the pooled mean of each outcome measure. A ridge regression is constructed to explore age-related change in BMI. A Kruskal-Wallis H test is applied to compare the pooled duration of physical activity and sedentary time in the subgroups. Finally, we calculate paired correlation coefficients between BMI and physical activity/inactivity for each group. The findings can be further used in public health surveillance to clarify the epidemiology of obesity, to guide priority setting and planning, and to develop and evaluate public health policy and strategy.

Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial.

Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent-treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software ("Buddy Link"; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference -67, SD 23; 95% CI -113 to -21 min/d), which was represented by a medium to large effect size (d=-0.6). A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true.

Metabolic Changes Following Smoking Cessation in Patients with Type 2 Diabetes Mellitus.

Smoking cessation is crucial for reducing complications of type 2 diabetes mellitus (T2DM), but associated weight gain can worsen glycemic control, discouraging quitting attempts. Varenicline, a partial agonist of α4β2 nicotinic receptors, aids smoking cessation. This study examines the effects of varenicline on body weight and metabolic parameters in patients with T2DM and prediabetes. Fifty-three patients were enrolled, of which 32 successfully quit smoking after a three-month course of varenicline and were examined after an additional month with no medication. Measurements taken at baseline, 2.5 months, and 4 months included body weight, blood pressure, resting metabolic rate (RMR), glycated hemoglobin (HbA1c), fasting glucose, blood lipids, C-reactive protein (CRP), appetite-related hormones, and physical activity. Post-treatment, there were no significant changes in body weight, blood pressure, RMR, or glycemic control. Total (CHOL) and low-density lipoprotein (LDL-C) cholesterol decreased significantly at 4 months of the study (from 168 to 156 mg/dL, p = 0.013, and from 96 to 83 mg/dL, p = 0.013, respectively). Leptin levels increased (from 11 to 13.8 ng/dL, p = 0.004), as did glucagon-like peptide-1 (GLP-1) levels (from 39.6 to 45.8 pM, p = 0.016) at 4 months of follow-up. The percentage of participants who reported moderate-intensity activity increased from 28% to 56%, while those reporting high-intensity activity increased from 19% to 22%, respectively (p = 0.039). Our study showed that smoking cessation with varenicline in smokers with T2DM and prediabetes led to significant improvements in lipid profile, significant increase in plasma leptin and GLP-1 levels, and increased physical activity, without significant weight gain. Thus, smoking cessation without weight gain or deteriorated glycemic control is feasible for these smokers, with added benefits to lipid profiles, GLP-1 regulation, and physical activity.

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

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

The relationship between accelerometer-based physical activity, sedentary behavior, and seven common geriatric syndromes: a two-sample Mendelian randomization study.

To investigate the causal associations between accelerometer-based physical activity (PA), sedentary behavior (SB), and seven common geriatric syndromes (GSs) (frailty, falls, delirium, urinary incontinence, dysphagia, hearing loss, and visual impairment) by Mendelian randomization (MR) analysis. Instrumental variables from a genome-wide association study were used for MR analysis. The exposure factors were three PA phenotypes (average acceleration, overall activity, and moderate-intensity activity) and one SB phenotype (SB). The outcome variables were seven common GSs. The inverse variance weighted (IVW) method was utilized for the primary MR analysis. Additionally, sensitivity, pleiotropy, and heterogeneity analyses were subsequently conducted to assess the robustness of the present study's findings. According to the primary MR results obtained using the IVW method, genetically predicted PA (average acceleration) decreased the risk of two GSs (frailty, p = 0.01; dysphagia, p = 0.03). Similarly, overall activity decreased the risk of two GSs (frailty, p = 0.01; delirium, p = 0.03), and moderate-intensity activity reduced the risk of three GSs (urinary incontinence, p = 0.04; hearing loss, p = 0.02; visual impairment, p = 0.01). Furthermore, SB was causally correlated with a greater risk for three GSs (frailty, p = 0.03; fall, p = 0.01; dysphagia, p = 0.04). This study provided evidence that accelerometer-based PA may be causally associated with a lower risk of GSs, while SB may increase the risk of GSs.

Myokine secretion during moderate-intensity physical activity: Dose-response of interleukin 6 to walking duration.

During vigorous physical activity, contracting muscles secrete a variety of immunomodulatory and metabolic factors called myokines that perform a variety of functions. Foremost among these is interleukin 6 (IL-6), which increases fatty acid mobilization and stimulates anti-inflammatory cytokine release. Despite being well characterized in vigorous exercise contexts, whether IL-6 is secreted during moderate-intensity activities such as walking is unclear. This is especially pertinent as regular walking is one of the oldest and most common forms of physical activity and comes with a variety of health benefits, which may be coordinated in part by IL-6 signaling. To test the hypothesis that IL-6 release occurs during evolutionarily normal physical activity contexts like long distance walking, we performed a dose-response experiment to test the effect of walking duration on IL-6 secretion. Thirteen participants completed four moderate-intensity walking trials (55% HRmax) of varying durations (30 min, 1 h, 2 h, and 3 h) in a randomized order with intervening washout periods of at least 1 week. Using a linear mixed effects model, we found that IL-6 levels modestly increased during only the 2 hand 3 h walking trials. These results suggest that small frequent increases in IL-6 signaling may be an important mechanism underlying the health benefits of regular walking. Furthermore, this finding raises the possibility that IL-6 secretion is an adaptation to fuel physical activity, especially during periods of negative energy balance.

Relationship of Self-Reported Physical Activity with Cognition in Middle- Aged Adults.

The increasing prevalence of age-related cognitive decline highlights the importance of physical activity for cognitive health. Regular exercise has been associated with improved mental health and reduced risk of cognitive decline. This study investigated the connection between self-reported physical activity and cognitive function in middle-aged adults. This cross-sectional study included 56 Indian adults aged 30-55, selected based on a health screening questionnaire. Participants reported their physical activity using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), which categorized them into low, moderate, and high activity levels. Cognitive functions, including visual memory, executive function, and attention, were assessed using the Cambridge Neuropsychological Automated Testing Battery (CANTAB). Results were statistically analyzed for relationships between cognitive domains and physical activity parameters using Pearson's correlation and linear regression analysis. The study showed a significant positive correlation of attention with moderate and vigorous physical activity, while sedentary behavior negatively impacted attention. Linear regression showed that attention is affected by moderate-intensity activity whereas executive function and visual memory are affected by age. This study supports the view that moderate and vigorous intensity activities may positively affect attention in middle-aged adults highlighting the benefits of physical activity.

National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants

Insufficient physical activity increases the risk of non-communicable diseases, poor physical and cognitive function, weight gain, and mental ill-health. Global prevalence of adult insufficient physical activity was last published for 2016, with limited trend data. We aimed to estimate the prevalence of insufficient physical activity for 197 countries and territories, from 2000 to 2022. We collated physical activity reported by adults (aged ≥18 years) in population-based surveys. Insufficient physical activity was defined as not doing 150 minutes of moderate-intensity activity, 75 minutes of vigorous-intensity activity, or an equivalent combination per week. We used a Bayesian hierarchical model to compute estimates of insufficient physical activity by country or territory, year, age, and sex. We assessed whether countries or territories, regions, and the world would meet the global target of a 15% relative reduction of the prevalence of insufficient physical activity by 2030 if 2010-22 trends continue. We included 507 surveys across 163 countries and territories. The global age-standardised prevalence of insufficient physical activity was 31·3% (95% uncertainty interval 28·6-34·0) in 2022, an increase from 23·4% (21·1-26·0) in 2000 and 26·4% (24·8-27·9) in 2010. Prevalence was increasing in 103 (52%) of 197 countries and territories and six (67%) of nine regions, and was declining in the remainder. Prevalence was 5 percentage points higher among female (33·8% [29·9-37·7]) than male (28·7% [25·0-32·6]) individuals. Insufficient physical activity increased in people aged 60 years and older in all regions and both sexes, but age patterns differed for those younger than 60 years. If 2010-22 trends continue, the global target of a 15% relative reduction between 2010 and 2030 will not be met (posterior probability <0·01); however, two regions, Oceania and sub-Saharan Africa, were on track with considerable uncertainty (posterior probabilities 0·70-0·74). Concerted multi-sectoral efforts to reduce insufficient physical activity levels are needed to meet the 2030 target. Physical activity promotion should not exacerbate sex, age, or geographical inequalities. Ministry of Public Health, Qatar, and World Health Organization. For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.