Latina breast cancer survivors experience health disparities. Effective lifestyle interventions are sparse. This trial tested the effectiveness of a culturally tailored diet and physical activity (PA) intervention in Latina breast cancer survivors. Using a 2 × 2 factorial design, women were randomized to receive 4 weekly in-person group sessions; 11 months of eHealth communications, in-person sessions, and eHealth; or control. Follow-up data were collected at months 6 and 12. Eligibility criteria were self-identification as Latina, post-treatment for early-stage breast cancer, and consuming <5 daily servings of fruits and vegetables (F/V) and/or engaging in <150 min/wk of moderate-to-vigorous PA (MVPA). A total of 167 women from New York City were enrolled from July 2016 to October 2018, with 93.4% retention at 12-month follow-up (n = 156). All participants received a Fitbit for self-monitoring and a 1-on-1 health coaching session. In-person group sessions included nutrition and PA education, cooking classes, fitness classes or a grocery store visit, and social activities. The eHealth communications included motivational text messaging, e-mailed newsletters, and study website access. Activities were conducted in Spanish and English. Primary outcomes were 12-month change in F/V servings/d and energy density of food. Secondary outcomes were 12-month change in MVPA and anthropometry. Outcomes comparing intervention arms with the control were examined using generalized estimating equations. At baseline (n = 167), mean age was 56.7 years; 82.3% had overweight or obesity. At month 12, daily F/V intake for women in the in-person sessions increased by 10% and decreased by 44% for women in the control group, a +96% group difference (P = .01); no other between-group differences were observed. At month 12, women in the control group had a 53% increase in minutes per week of MVPA, and women in the in-person plus eHealth group had a 34% decrease, a -57% group difference (P = .01); no other between-group differences were noted. No changes in energy density or weight between groups were observed. Women randomized to the in-person ¡Mi Vida Saludable! classes modestly increased F/V intake at 12 months relative to control. Those receiving eHealth communication did not have diet, MVPA, or weight change relative to control. More research is needed to understand how to support Latina breast cancer survivors in making sustained diet and PA changes.

Evidence supports the benefits of physical activity (PA); however, many adults do not achieve recommended PA levels. Identity theories have been used to understand PA, but the antecedents of PA identity remain less clear. This study presents an exploratory test of a conceptual model predicting PA identity strength using candidate antecedents identified in a recent narrative review. A three-week prospective survey was administered to 570 Canadian adults. Time 1 recorded weekly self-reported minutes of moderate-to-vigorous physical activity (MVPA), self-regulation domains and five candidate antecedents-social relatedness, personal investment, perceived capability, PA alignment and priority. PA identity was measured 3 weeks later (Time 2). Using a structural equation modelling approach, we explored the proposed pattern of direct and indirect paths. The model fit the data adequately, χ2 = 795.92, df = 324, CFI = .95, TLI = .95, RMSEA = .05 (90% CI = .05-.06) and SRMR = .07. Significant direct paths to Time 2 identity were observed for Time 1 MVPA, reactive regulation, self-monitoring, relatedness, perceived capability, alignment and priority (β = .11-.34, ps ≤ .04). Indirect paths from Time 1 relatedness, personal investment and priority to Time 2 identity-operating via Time 1 MVPA and self-regulation strategies (especially reactive regulation and self-monitoring)-were also significant (β = .09-.18, ps ≤ .01). PA identity may have multivariate inputs. These findings provide preliminary evidence for the proposed conceptual model and experimental work is needed to determine whether modifying these inputs changes PA identity.

This study explored the interplay between actual and perceived motor competence and their associations with physical activity and fitness among children with and without risk of developmental coordination disorder (DCD). Utilizing data from 479 children aged 7-9 years from the CATCH cohort, latent profile analysis identified four distinct profiles based on Movement Assessment Battery for Children (MABC-2) and the Perceived Efficacy and Goals Setting System (PEGS). Moderate-to-vigorous physical activity was assessed through waist worn accelerometers, and fitness was assessed using the Bruce protocol, Wingate anaerobic cycling test, and standing long jump. Four latent profiles were identified including low-aligned (7.1%; low actual and perceived competence), over-perceivers (53.0%; low actual but above-average perceived competence), average-aligned (20.0%), and high-aligned (19.8%). Children in the low-aligned profile engaged in significantly less moderate-to-vigorous physical activity (MVPA) and demonstrated poorer physical fitness than children in all other profiles. Notably, over-perceivers exhibited MVPA levels comparable to children with average and high motor competence, despite their low actual competence. However, fitness levels remained lower among all children with reduced actual motor competence, regardless of perceived competence. These findings suggest that perceived motor competence may buffer against low motor competence-related declines in physical activity, though not in physical fitness. Findings highlight the potential utility of targeting perceived competence in motor skill interventions, particularly among children at risk of DCD, to enhance physical activity engagement. Interventions that simultaneously address actual and perceived competence may offer a promising strategy to support physical development in this population.

Contemporary cardiac rehabilitation (CR) has amoderate effect on physical activity (PA), whereas novel technologies offer promise for enhancing PA levels. Therefore, we assessed the effect of ahome-based smartphone training program in addition to center-based CR on PA levels in patients with coronary artery disease (CAD). CAD patients participating in CR were included in this randomized controlled trial (1:1, stratified for index diagnosis). The control group received usual care CR, whereas the intervention group additionally received a6-week remote smartphone program. The primary outcome was the change in accelerometer-derived moderate-to-vigorous PA (MVPA) from baseline to post-CR. Secondary outcomes included changes in light intensity PA, step count, sedentary time, functional parameters, quality of life, and cardiac anxiety. Abaseline-adjusted linear mixed model was used. Participants (16% female, intervention n = 44, control n = 49) were 63 [56-69] years old and had abaseline MVPA of1.0 (95% Confidence interval (CI):0.9;1.1) h/day. Changes in MVPA did not differ between the intervention (0.1 (95% CI: -0.0; 0.2) h/day) and control group post-CR (0.1 (95% CI: -0.0; 0.2) h/day, p-interaction = 0.75). Also, no differences between the groups were observed for light intensity PA (0.5 (95% CI: 0.2; 0.8) versus 0.4 (95% CI: 0.1; 0.8) h/day, p-interaction = 0.79). Similarly, changes in other secondary outcomes did not differ among groups. Asmartphone training program on top of the usual CR did not yield additional benefits. Amore elaborate mHealth intervention seems needed to change PA during CR in active patients with CAD.

Background Physical activity (PA) exerts a significant impact on global health and has been associated with a reduced risk of common cold. This study aims to examine the correlation between PA and the frequency of colds among middle school students in China. Methods A cross-sectional study was conducted among 356 middle school students aged 12–13 in Wuhan, Hubei Province, China. The 24-hour movement behaviors were measured using ActiGraph wGT3X-BT accelerometer, and participants reported the number of the frequency of cold s over the past year. Compositional linear regression and isotemporal substitution models were employed to analyze the association between time allocation to 24-hour movement behaviors and the frequency of colds, and to predict changes in frequency of colds following time reallocation among these behaviors. Results (1) The time spent in moderate-to-vigorous physical activity (MVPA) was the most stable component of 24-hour movement behaviors among middle school students. When activity patterns changed, the highest probability of time reallocation occurred with light physical activity (LPA). (2) A significant association was observed between 24-hour movement behaviors and the frequency of colds among middle school students. Specifically, the proportion of MVPA time was negatively correlated with the frequency of colds among middle school students. The proportion of time spent in sleep (SP) was positively associated with the frequency of colds, No significant associations were observed between time allocation in sedentary behavior (SB) or light physical activity (LPA) and the frequency of colds. (3) The 15-minute isotemporal substitution model predicted significant reductions in the frequency of colds when replacing both sedentary behavior (SB) and sleep (SP) with MVPA. Conversely, when MVPA was replaced by either SB or SP, the frequency of colds increased significantly. Notably, the substitution of SP with MVPA demonstrated the most substantial effect in reducing the frequency of colds. (4) The dose-response relationship (ranging from −30 to +30 minutes) revealed asymmetric effects on the frequency of colds when mutually substituting MVPA with either SB or SP. Conclusion To reduce the frequency of colds among middle school students in the future, educators and parents should focus on the overall framework of 24-hour movement behaviors, increasing MVPA and reducing SB are effective strategies to achieve this goal.

Breast cancer survivors often experience physical and mental side effects posttreatment, compromising their quality of life (QoL). The increasing number of survivors coping with long-term side effects creates public health concerns, emphasizing the need for supportive interventions. Although physical activity (PA) benefits cancer survivors, few studies examine the effect that cancer-related factors have on the relationship between PA levels and QoL among breast cancer survivors. Understanding the associations that cancer-related factors may have on the QoL response to PA is crucial for developing effective interventions. Baseline data from 341 postprimary treatment breast cancer survivors enrolled in a web-based diet and/or exercise intervention randomized controlled trial were analyzed. PA measures included accelerometry and self-reported moderate to vigorous PA (MVPA). QoL was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) global QoL and EuroQOL-5D-5L questionnaires. Pearson correlation coefficient tests and multiple linear regression assessed associations between MVPA and QoL and whether cancer-related factors moderated these associations. The EuroQOL-5D-5L QoL index (and 4 out of 5 domains) showed statistically significant associations with self-reported MVPA. PROMIS physical health was correlated with both MVPA measures. Survivors > 24months postdiagnosis had stronger associations between accelerometry-measured MVPA levels and EuroQOL-5D-5L QoL index (β = 0.0004, P = .003). Survivors receiving hormone therapy exhibited stronger associations between self-reported MVPA levels and PROMIS-physical health QoL domain compared with those not (β = 0.0121, P = .028). Greater MVPA was modestly associated with better QoL, with stronger associations observed in survivors receiving hormone therapy or >24months postdiagnosis. There are potential QoL benefits in implementing interventions immediately postdiagnosis and tailoring to treatment histories.

University students have been noted to have a drop in their levels of physical activity due to their academic transitions. When it comes to moderate-to-vigorous physical activity (MVPA), digital methods have shown to work inconsistently. This randomized controlled trial aimed to find out if a digital intervention that is gamified promotes more behavioral and motivational changes than a digital intervention that is prompt-based and if statistically motivational changes of an autonomous nature explain the differences. PATHFIT2 students (N=180) from the Philippines were assigned to either a gamified digital intervention or a non-gamified, standard digital intervention for a duration of eight weeks. Both conditions were directed to use MyFitnessPal to log their exercise and were given daily activity prompts. The gamified condition was given additional stimulation in the form of rewards for points, streaks, bonus badges, and leaderboard feedback. At pretest and posttest, MVPA (verified activity logs for MVPA) and motivational regulation (using the BREQ-3) and cardiovascular endurance (3-minute step test), muscular endurance (a push-up test), and body mass index were assessed. The mixed-design ANOVA showed significant changes in MVPA over time with the gamified condition resulting in the more pronounced changes (η²p = .11, d = 0.67). The gamified condition showed significant increases in both identified and intrinsic regulation. Improvement of both cardiovascular and muscular endurance were noted to be more substantial in the gamified condition although the changes in BMI were quite mild. Changes in intrinsic regulation were shown through bootstrapped mediation analyses to statistically account for part of the relationship between intervention condition and MVPA (indirect effect β = .15, 95% CI [.07, .27]). This means that gamified digital interventions improve the level of physical activity participants engage in, beyond increasing it through digital prompts, and that alterations in autonomous motivation account for a large portion of the relationship. A university program that includes autonomy-supportive gamification may be an effective and widely applicable method for enhancing participants' behavioral and functional health.

PurposeThis study examined associations between adherence to the 24-hour movement guidelines (moderate-to-vigorous physical activity (MVPA), screen time, and sleep) and academic achievement in school-aged children.DesignCross-sectional study.SettingElementary schools in Hangzhou, China.SampleSample of 268 children aged 8-12 years (52% boys).MeasuresMVPA and sleep duration were measured using accelerometers, while screen time was self-reported. Academic achievement was assessed through grades in Chinese, Math, and English, standardized into Z-scores. Covariates included age, sex, school location, and body mass index z-score.AnalysisMultiple linear regression was conducted to assess associations between combinations of adherence to the 24-hour movement guidelines and academic achievement.ResultsMeeting two or more recommendations was significantly associated with higher overall academic achievement compared to those meeting none (P < 0.05). Specifically, adherence to the screen time guideline only (β = 0.39, 95% CI: 0.14, 0.64) and combined adherence to both screen time and sleep guidelines (β = 0.37, 95% CI: 0.04, 0.69) were positively associated with overall academic achievement. For subject-specific Z-scores, meeting at least two guidelines was linked to higher achievement in Chinese and Math (P < 0.05).ConclusionAdherence to multiple 24-hour movement guidelines, particularly limiting recreational screen time, is associated with higher academic achievement in school-aged children. These findings highlight the potential value of integrated movement behavior strategies for educational outcomes and underscore the need for longitudinal research to clarify underlying mechanisms.

This study aimed to collect survey data on physical activity and organized sport participation among children across different weight categories. Using online data collection, 906 parents provided information about 1002 children (age = 10.9 ± 2.5 years, body height = 150.2 ± 16.4 cm, and body mass = 42.4 ± 15.8 kg). Most children (79%) achieved the recommended 60 min. of moderate-to-vigorous physical activity (MVPA) per day; 50% participated in club sports; and 41% took part in organized sports. Most of them (69%) were in the healthy weight category, 7% were underweight, and 22% of the children were overweight or obese. Participation in sports activities among overweight and obese children was nearly as high as among their peers. Achieving 60 min. of MVPA/day was associated with significantly lower odds (OR = 0.51 CI: 0.30-0.85; p < 0.01) of childhood obesity in the total sample. Football was the most popular club and organized sport among boys, while dancing was most preferred among girls. The preferred sports were generally well-suited to the respective weight categories. The relatively high levels of physical activity observed may be explained by daily physical education (PE) classes in schools and governmental support for sports. Our findings suggest that further research is needed to support effective obesity prevention, particularly those examining dietary habits and other lifestyle factors.

To examine whether diurnal timing patterns of moderate-to-vigorous physical activity (MVPA) are associated with mortality risk independent of activity volume, and whether these associations differ by chronotype and sleep midpoint. and results This prospective cohort study included 75,509 UK Biobank participants (aged 40-73 years) with wrist-worn accelerometry and a median follow-up of 8.7 years. Participants not meeting the WHO MVPA guideline (<150 min/week) were classified as inactive; among guideline-adherent participants, K-means clustering of hourly MVPA distribution identified four active timing patterns (early-morning, consistently active, midday, and evening). Cox proportional hazards models were fitted for all-cause mortality (primary outcome) and cancer and CVD mortality (secondary outcomes). In the primary analysis restricted to guideline-adherent participants (reference = consistently active) and additionally adjusted for total MVPA volume, the midday-active pattern remained associated with a lower risk of all-cause mortality (HR 0.79, 95% CI 0.65-0.97; P=0.022), whereas associations with cancer and CVD mortality were attenuated and not statistically significant. Fine-Gray competing-risk models produced similar estimates for cause-specific mortality. In secondary analyses comparing active patterns with the inactive group, all active patterns were associated with substantially lower mortality risk, with the midday-active pattern showing the largest risk reductions. Stratified analyses by chronotype and sleep midpoint suggested that associations of timing patterns with mortality were less consistent in evening chronotype and later sleep midpoint strata. Among adults meeting MVPA guidelines, a midday-active pattern was associated with lower all-cause mortality independent of MVPA volume. Secondary comparisons confirm the broad benefit of meeting MVPA guidelines regardless of timing. These findings support considering both activity volume and timing when tailoring physical-activity guidance.

Cancer-related cognitive impairment (CRCI) is a common concern among breast cancer (BC) patients receiving chemotherapy, yet predictors of short-term cognitive change remain unclear. This study examined whether baseline cardiorespiratory fitness (CRF) and moderate-to-vigorous physical activity (MVPA) moderate changes in objectively assessed cognitive function from pre- to post-chemotherapy in BC patients, compared with age-matched healthy controls. This prospective study included assessments at baseline (pre-chemotherapy) and approximately a five-month follow-up (post-chemotherapy). Participants were BC patients with stage I-III disease initiating chemotherapy and age-matched healthy controls. Cognitive function was assessed using the NIH Remote Cognition Toolbox (episodic memory, working memory, language/reading, verbal learning). CRF was measured using a remotely administered 6-min walk test, and MVPA was assessed via accelerometry. Linear mixed-effects models tested group × time × predictor (baseline CRF or MVPA) effects, adjusting for anxiety, depression, and menopausal status. Fifty-five participants were included (BC: n = 32; controls: n = 23). Episodic memory improved over time in both groups (β = 4.69, p = 0.031). Higher baseline CRF was associated with better verbal learning (β = 0.02, p = 0.023), but neither CRF nor MVPA predicted cognitive change over time (all three-way interactions p ≥ 0.05). BC patients scored lower than controls at baseline on working memory and language/reading, while verbal learning improved more in BC patients. BC patients also showed greater declines in MVPA over time. No short-term cognitive decline was observed from pre-chemotherapy to approximately 5months post-chemotherapy. Higher baseline fitness and physical activity were associated with better cognitive performance but did not predict cognitive change. Longer follow-up is needed to clarify treatment-related cognitive trajectories.

Plasma proteins mediate the protective association between physical activity and osteoporosis risk: A prospective study in the UK biobank.

The weekend warrior pattern, characterized by infrequent but sufficient bouts of moderate-to-vigorous physical activity (MVPA), has become increasingly common. Its association with the risk of osteoporosis and fracture remains unclear. We aimed to examine the association between the weekend warrior pattern and bone outcomes, identify related metabolites, and assess the modifying role of genetic susceptibility. We included 14,069 UK Biobank (UKB) participants with accelerometer and metabolomic data. Metabolomic signatures corresponding to weekend warrior and regular physical activity patterns were identified using elastic net regression. Cox proportional hazards models were used to examine the associations of physical activity patterns and metabolomic profiles with osteoporosis and fracture risk. Stratified analyses by polygenic risk scores (PRS) for osteoporosis and fracture were conducted to evaluate the potential effect modification by genetic susceptibility. During a median follow-up of 7.8 years, 267 cases of osteoporosis and 554 fracture events were documented. In comparison with the inactive group, the weekend warrior pattern was significantly associated with reduced risks of osteoporosis (HR: 0.59; 95% CI: 0.44-0.79) and fracture (HR: 0.77; 95% CI: 0.63-0.95). Using elastic net regression, we identified 51 metabolites characterizing the weekend warrior pattern and 62 metabolites representing regular physical activity. Each standard deviation (SD) increase in the weekend warrior-related metabolomic signature corresponded to a 27% lower risk of osteoporosis (HR: 0.73; 95% CI: 0.62-0.85) and a 12% lower risk of fracture (HR: 0.88; 95% CI: 0.79-0.99). These associations were not significantly modified by genetic susceptibility to osteoporosis (P = 0.429) or fracture (P = 0.221). The weekend warrior pattern was associated with lower risks of osteoporosis and fracture. We further identified distinct metabolomic signature characterizing this pattern, providing potential mechanistic insights into its protective effects.

Background The transition from middle to high school is characterized by surging academic stress, a precipitous decline in moderate-to-vigorous physical activity (MVPA), and alarming increases in sedentary time (ST). While family support is known to buffer stress, the specific types of support required may shift dramatically across developmental stages. Guided by Stage-Environment Fit Theory and the Stress-Buffering Hypothesis, this study investigated whether the buffering effects of family tangible support versus emotional support on device-measured MVPA and ST differ between middle and high school students. Methods A stratified sample of 523 adolescents (298 middle school, 225 high school) from diverse regions in China was recruited. MVPA and ST were objectively measured using ActiGraph GT3X+ accelerometers over seven consecutive days. Self-reported questionnaires assessed chronic academic stress and family support types. Multi-Group Structural Equation Modeling (MG-SEM) was employed to test the moderated effects. Results Academic stress robustly predicted decreased MVPA and increased ST across the entire sample. However, the buffering mechanisms exhibited profound developmental heterogeneity. For middle school students, family tangible support significantly buffered the detrimental effects of stress on both MVPA ( β = 0.21, p &amp;lt; 0.01) and ST ( β = −0.18, p &amp;lt; 0.01). Conversely, for high school students, tangible support became entirely ineffective. Instead, family emotional support emerged as the sole significant buffer against stress-induced physical inactivity ( β = 0.24, p &amp;lt; 0.001) and excessive sitting ( β = −0.22, p &amp;lt; 0.01). Conclusion The efficacy of family interventions is heavily contingent upon developmental timing. Combatting the dual burden of physical inactivity and sedentary behavior in high-pressure educational systems requires a transition from tangible parental involvement in early adolescence to autonomy-respecting emotional support in late adolescence.

To explore the associations between accelerometer-measured physical activity patterns and cardiovascular diseases (CVD), CVD-cause mortality, and all-cause mortality in people with osteoarthritis (OA). OA participants from the UK biobank with ≥36 h of accelerometer data, collected over one-week, were analyzed. Moderate to vigorous physical activity (MVPA) patterns were classified as: 'weekend warriors' (≥150 min/week, >50% on 1-2 days), active regular (>150 min/week), or inactive (<150 min/week). Mean min per week of light physical activity (LPA) were categorized into quartiles based on the distribution in the analytical sample. Among 10 210 study participants (mean age 58.1 ± 7.1 years; 64.5% female) followed for a median of 6.9 years, there were 1,538 incident cases of CVD, and 358 deaths, including 90 from CVD. Compared with inactive MVPA, both weekend warrior (adjusted hazard ratio, aHR (95% CIs); 0.73 (0.64-0.82)) and active regular MVPA (0.75 (0.65-0.87)) significantly lowered the risks of incident CVD. Notably, only the weekend warrior group showed significant reductions in CVD-cause mortality (0.55, 0.33-0.92), and all-cause mortality (0.75 (0.59-0.96)). Higher levels of LPA may link to lower CVD, CVD-cause mortality, and all-cause mortality risks in a dose-response manner. Subgroup analysis indicated that more prominent associations were found in individuals with a body mass index >30 or those aged over 60. Engaging in a weekend warrior pattern may confer unique survival benefits for OA patients, especially among older adults and those with obesity. LPA may have dose-dependent protective effects for CVD and mortality risk in OA patients.

Sufficient physical activity has the potential to mitigate the late effects of cancer, but objective data of activity levels in patients after pediatric bone cancer are scarce. This study aimed to objectively assess physical activity levels in this population and explore differences based on patient- and treatment-related factors. As part of a cross-sectional study of a nationwide cohort of patients treated for pediatric bone sarcoma, we assessed physical activity using an accelerometer, the ActiGraph GT9X Link. Physical intensity levels were categorized as sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and compared between subgroups stratified by sex, age, tumor location, type of surgery for tumors around the knee, and time since local therapy. Among 79 participants, 47% were female, and median age at evaluation was 19.8years (IQR 17.5-23.9) with a median of 5.9years (IQR 2.9-11.7) since local therapy. Mean daily sedentary time was 643min (SD = 104), 127min per day (SD = 58) was spent in LPA, and 63min per day (SD = 35) in MVPA. Seventy-eight percent of participants met the World Health Organization's recommended level of MVPA. No significant differences in intensity levels were found between the various subgroups. Pediatric bone sarcoma patients seem to regain participation in higher-intensity activities post-treatment, with physical activity levels comparable to the general population. No surgical approach is superior in terms of physical activity. Implications for Cancer Survivors Shared decision-making is important in guiding the choice of local therapy and should be informed by lifestyle and individual preferences. High sedentary time suggests scope for improvement in survivorship care.

Investigating Beliefs towards Physical Activity in Pregnancy among Women with and without Gestational Diabetes Mellitus.

Most children in the United States do not meet the recommended daily physical activity (PA) and sleep guidelines. This study described the contribution of after-school programs to children's daily moderate-to-vigorous PA (MVPA), the prevalence of meeting the U.S. MVPA guidelines (60min daily), sleep duration (9-12h daily), and sleep efficiency (≥ 85% daily) guidelines, and differences by gender, age, and school-level income. This cross-sectional study included 72 children (8-12years, grades 3-6) attending after-school programs at 14 elementary schools in a public school district in Arizona. The children wore ActiGraph GT3X + accelerometers for at least three weekdays and one weekend day for 10h/day to measure PA and sleep. The time spent in MVPA intensity was calculated during after-school programming, and overall MVPA and sleep were averaged across all daily hours. Fisher's exact test was used to examine differences in the prevalence of meeting MVPA and sleep guidelines. After-school programs contributed an average of 35min of daily MVPA among participants. Nearly all (99%) of the children met the PA guidelines, 40% met the sleep efficiency guidelines, and none met the sleep duration recommendations. No statistically significant differences were observed by age, gender, or school-level income (p > 0.05). Although after-school programs effectively support PA, adherence to sleep guidelines remains challenging. After-school programs alone may not be sufficient to improve sleep outcomes. Future studies should explore potential differences in sleep habits between days children attend and do not attend after-school programs.

Total hip arthroplasty (THA) effectively alleviates pain and improves quality of life in patients with severe hip osteoarthritis (OA). However, comprehensive longitudinal data regarding physical function and objectively measured physical activity patterns following THA are limited. To establish the test-retest reliability of physical fitness measures in hip OA patients and assess longitudinal changes in physical fitness and activity following THA. Seventy-eight OA patients (mean age 73.7 ± 4.2 years, 81% women) scheduled for THA underwent comprehensive physical fitness testing and accelerometry-based physical activity monitoring. Assessments were conducted at two preoperative time points and at 4-month (n = 57) and 1-year postoperative follow-up (n = 48). The test battery included measures of muscle strength, motor fitness, and cardiorespiratory fitness. Physical activity was objectively measured using hip-worn triaxial accelerometers. Self-reported Hip disability and Osteoarthritis Outcome Score (HOOS) were collected pre- and post-operatively. Good to excellent test-retest reliability was demonstrated across 23 of 24 fitness parameters. At 1-year post-op, significant improvements were observed in 23 of 45 measured parameters, including functional mobility (Timed Up and Go: -29%), walking distance (Six-Minute Walk Test: +16%), trunk endurance-strength (+71-82%), shoulder-press (+32%), various leg strength tests (+13-42%), 4m max walking-speed (+42%), moderate-to vigorous-physical activity (+63%) and daily step count, from 6004 to 7558 steps/day, (+26%). Ipsilateral-to-contralateral step height asymmetry decreased from 27% pre-operatively to 8% at 1-year follow-up. VO₂peak demonstrated a modest but significant improvement from 22.7 to 23.6 mL/kg/min (+4%) one year postoperatively. This study revealed low fitness and activity levels in patients with severe hip osteoarthritis before surgery, with marked improvements in physical fitness and activity measurements one year after surgery. The high reliability of the comprehensive assessment battery supports its usefulness for both research and clinical practice. These findings contribute to the existing evidence on simple, field-based fitness tests for patients with hip osteoarthritis, while also offering methodological insights and recovery trajectories.

Wearable smartwatches enable objective quantification of physical activity. This study evaluated the association of extravalvular cardiac damage in aortic stenosis with smartwatch-recorded physical activity before and after transcatheter aortic valve implantation (TAVI). Patients with severe symptomatic aortic stenosis were dichotomized into cardiac damage stages 0 to 2 (left-heart dysfunction) and stages 3 to 4 (pulmonary/right-heart dysfunction) by echocardiography. All patients received a Fitbit smartwatch for 7 days of continuous monitoring before transcatheter aortic valve implantation and at 6-month follow-up. Regression models determined significant predictors of total daily step count and moderate to vigorous physical activity (MVPA). Within the study cohort (stages 0-2: 43 [50.6%]; stages 3-4: 42 [49.4%]), all patients showed significant improvement in physical activity from baseline to follow-up (all P<0.001). Patients in stages 3 to 4 had significantly lower total daily step count and MVPA at baseline and follow-up, as well as a smaller improvement in MVPA (all P<0.05). Relative to stages 0 to 2, stages 3 to 4 were significantly associated with lower step count and MVPA at baseline (step count: β=-1453.8 [95% CI, -2351.3 to -554.2], P=0.002; MVPA: β=-12.9 [95% CI, -24.3 to -1.5], P=0.027) and follow-up (step count: β=-1438.1 [95% CI, -2453.9 to -422.3], P=0.006; MVPA: β=-27.4 [95% CI, -47.7 to -7.1], P=0.009), as well as less improvement in MVPA (β=-14.5 [95% CI, -28.4 to -0.48], P=0.043) after transcatheter aortic valve implantation. The extent of cardiac damage before transcatheter aortic valve implantation has an important impact on physical activity, both at baseline and following intervention. Future studies should examine whether smartwatch-measured activity predicts death across cardiac damage stages and whether cardiac rehabilitation improves outcomes in aortic stenosis with advanced remodeling.