Physical Activity Outcome Measures Research Articles

Experience with Accelerometer Physical Activity Tracking in Adults and Adolescents with Hemophilia A: Tool Validation Using Results from the XTEND-1 Efanesoctocog Alfa Phase 3 Trial

Introduction Wearable physical activity trackers have become increasingly common within clinical studies, patient monitoring, and health assessments. Physical activity is a key endpoint of interest when evaluating treatments for hemophilia. The objective of this analysis was to describe the psychometric properties of five outcome measures of physical activity from the accelerometer activity monitor used in the XTEND-1 study. Methods XTEND-1 (NCT04161495) was a Phase 3, open-label, multicenter study of the efficacy, safety, and pharmacokinetics of efanesoctocog alfa in previously treated adults and adolescents aged ≥12 years with severe hemophilia A. Patients receiving prior standard-of-care prophylaxis factor VIII (FVIII) received once-weekly (qw) prophylactic efanesoctocog alfa for 52 weeks (Arm A); patients on prior on-demand FVIII treatment received efanesoctocog alfa on-demand for 26 weeks, then prophylactic efanesoctocog alfa qw for 26 weeks (Arm B). Patients wore a triaxial medical grade accelerometer activity monitor device for continuous monitoring during pre-specified intervals 8 consecutive days after (or before) scheduled visits (to collect data for a full 7-day week + 1 additional day): after the screening, baseline, Week 4, 13, 26, 39 visits, and before the Week 52 visit. Compliance was assessed based on number of monitoring intervals and number of days wearing the device, and number of minutes spent wearing the device within those days. Five outcomes were assessed: light physical activity (LPA), moderate-to-vigorous activity, sedentary behavior (minutes/day spent in these individual outcomes out of total number minutes wearing device while awake), steps (number of steps taken per day), and metabolic equivalent of a task (MET; total estimated metabolic rate per day). Psychometric analyses of these outcomes using data from Arm A were conducted to evaluate test-retest reliability (TRTR), concurrent validity, known-groups validity, ability to detect change, and meaningful within-patient change (MWPC) of physical activity measurements ( Table 1). An analysis to detect potential influential outlier patients for each outcome that could potentially bias results, was conducted. Results In total, 132 out of 133 patients in Arm A and 26 out of 26 patients in Arm B, distributed in 19 countries, had accelerometer data. Compliance was defined post-hoc as ≥12 consecutive wear hours/day and results are presented for days achieving this threshold; no meaningful differences in results were found when incorporating number of monitoring intervals or number of days within the interval in the compliance definition. Most patients maintained or improved physical activity as measured by the activity monitors, with an overall increase in mean (SD) minutes during each monitoring period for LPA (baseline: 636 [234]; Week 52: 653 [237]), though there were variable changes throughout the study period. Measurements of LPA demonstrated acceptable TRTR, concurrent validity with three validation criteria, and ability to detect change with all or most of the anchor variables, while demonstrating good separation for improvement and deterioration thresholds to provide for MWPC ( Table 1). Two patients were identified as influential outliers for LPA. For moderate-to-vigorous activity, the concurrent validity showed that two validators met the criteria, and for steps, four validators met the criteria. Sedentary behavior and MET did not meet criterion with any of the validators ( Table 1). Out of the outcomes assessed, LPA showed the best psychometric properties within the study. Conclusion These analyses show how physical activity tracking through wearables was used to assess outcomes in patients with severe hemophilia A, who switched to a FVIII replacement therapy that provided normal to near-normal FVIII activity for most of the weekly dosing interval, resulting in reduced pain and improved physical functioning as assessed by patient-reported outcome measures. Analyses of these results revealed limitations in the psychometric properties of the assessed outcomes. To further understand the personal motivation and barriers for improving physical activity, addition of goal-setting could be considered in future clinical studies.

Changes in Self-Reported and Device-Measured Physical Activity Before Abdominal Resection Surgery: A Meta-Analysis

Objective To determine the effect of interventions on physical activity levels of patients awaiting abdominal resection surgery using self-reported as well as device-measured outcome measures. Data source PubMed and EMBASE databases were searched on the 18th of April 2023 up to April 2023 for studies on interventions to promote physical activity during the preoperative phase. Review methods Studies were included if pre- and post-intervention physical activity was measured between diagnosis and abdominal surgery. Risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) assessment tool for trials. Meta-analyses were performed to assess the effect of the pre-surgery activity promoting interventions on self-reported and device-measured physical activity. Results Seventeen studies were included in the analysis with 452 subjects in the intervention groups. The random-effect meta-analysis showed a moderate improvement in intervention groups measures in pre-surgery physical activity levels compared to the baseline (SMD = 0.67, [CI = 0.30;1.03], I2 = 79%). The self-reported subgroup meta-analysis showed the largest increase in performed physical activity, (SMD = 0.78, [CI = 0.4;1.15], I2 = 79%) whilst non-significant increase was shown in the device-measured subgroup (SMD = 0.16, [CI = −0.64;0.97], I2 = 58%). Conclusion Increasing physical activity in the preoperative phase is feasible. Self-reported physical activity outcome measures show larger effects compared to device-measured outcome measures. More high-quality research should be performed utilizing objective measures.

Measurement properties of physical activity in adults with bronchiectasis: A systematic review protocol.

People with bronchiectasis reduce their physical activity (PA) due to muscle weakness, dyspnea, fatigue, reduced exercise capacity and frequent cough with expectoration. Patient-reported and objective physical assessment methods have been used to evaluate PA in people with bronchiectasis. In the literature, significant differences in the PA measured using patient-reported outcome measures when compared with the objective methods. Given the availability of many PA assessment tools, it is tedious for the clinician or researcher to choose an outcome measure for clinical practice or research. The evidence on validity and reliability in bronchiectasis are unclear. Objectives: To identify the PA assessment tools, describe and evaluate the literature on psychometric properties of instruments measuring and analyzing PA. Methods: The search will be conducted in PubMed/Medline, Cochrane Central Register of Controlled Studies, Scopus and EMBASE databases. The keywords, index terms and synonyms of the following words will be used: bronchiectasis, physical activity, and outcome measures. Published studies of adult with clinical and/ or radiologically diagnosed bronchiectasis, aged >18 years, any gender and studies that assessed PA and/or if there are reports on measurement properties of PA will be included in the review. Studies using qualitative research methods, narrative reviews, letters to editors and editorials will be excluded. The quality of the study will be assessed and data will be extracted. Any disagreement will be resolved in the presence of an author not involved in the screening or selecting studies. Discussion: By assessing the quality of studies on measurement properties, this review will help researchers choose the outcome measure to evaluate the effects of interventions on PA. This review will identify the suite of outcome measures of PA for people with bronchiectasis that can be used for research and clinical purpose.

Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD.

Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity levels following a programme of pulmonary rehabilitation (PR). The objective of the present study was to provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside physical activity behavioural modification strategies (BPA) during PR is more effective in improving physical activity outcomes compared to PR and CBT alone. 32 patients with COPD (mean±sd forced expiratory volume in 1 s 42±14% predicted) were assigned 1:1 to receive PR+CBT+BPA or PR+CBT. BPA comprised motivational interviews, step-count monitoring, feedback using a pedometer and goal setting. Assessments included accelerometer-derived steps per day, movement intensity, 6-min walk distance (6MWD) and Hospital Anxiety and Depression Scale (HADS) scores. The magnitude of improvement across physical activity outcomes was greater for the PR+CBT+BPA compared to the PR+CBT intervention (by 829 steps per day (p=0.029) and by 80±39 vector magnitude units (p=0.042), respectively). Compared to PR and CBT alone, the PR+CBT+BPA intervention induced greater clinically meaningful improvements in HADS anxiety scores (by -2 units, 95% CI -4-1 units) and 6MWD (by 33±20 m). Providing anxious and/or depressed patients with COPD with a combined intervention of CBT and BPA during PR presents more favourable improvements in physical activity outcome measures compared to CBT alone during PR.

A summary of the body of knowledge on physical activity for people following stroke: a scoping review

Background There are challenges implementing physical activity interventions for people across the stroke pathway of care. There is a need to understand the intervention content in addition to the effects. Objective This scoping review maps out the existing systematic review evidence in relation to five objectives. Design Intervention data were extracted to identify and clarify definitions of physical activity as well as key emerging themes, gaps and recommendations for implementation approaches and consensus. Results 50 systematic reviews fulfilled the predefined inclusion criteria. Most reviews (n = 31) focused on a subset of physical activity rather than day to day physical activity (n = 19). In addition, a description of theories underpinning the interventions were lacking. Only 11 reviews used a definition of physical activity. Physical activity outcome measures were reported in 22 reviews. Conclusions Better reporting of physical activity interventions is required to improve implementation. Research should include physical activity outcome measures across the stroke pathway. Determining which physical activity modes and parameters of each intervention would be useful in determining the optimal intervention for stroke survivors with different physical activity capacity levels.

CHoosing Active Role Models to INspire Girls (CHARMING): protocol for a cluster randomised feasibility trial of a school-based, community-linked programme to increase physical activity levels in 9\u201310-year-old girls

BackgroundIn the UK, there is evidence that girls’ physical activity tends to decline to a greater extent than boys as they enter adolescence. ‘Role models’ could play a vital role in inspiring girls to become or remain physically active. The CHARMING Programme is a primary school-based community linked role-model programme, co-developed in 2016, with children, parents, schools and wider stakeholders. It involves different types of physical activity delivered for 1-h each week by a community provider and peer role models (e.g. older girls from secondary schools) joining in with the sessions. The programme ultimately aims to increase and sustain physical activity levels among 9–10-year-old girls. This study aims to assess the feasibility and acceptability of the CHARMING Programme and of evaluating it using a randomised trial.MethodsThis study is a feasibility cluster randomised controlled trial, with embedded process evaluation and health economic evaluation. Approximately 90 Year 5 (i.e. 9–10-year-old) girls will be recruited across six primary schools in Mid-South Wales. Participating schools will be allocated to the programme: control on a 2:1 basis; four intervention schools will run the CHARMING Programme and two will continue with usual practice. A survey and accelerometer will be administered at baseline and repeated at 12 months. Interviews and focus groups will be conducted post-intervention delivery. The primary aim is to assess feasibility of a future randomised trial via the recruitment of schools, participants and role models; randomisation; retention; reach; data collection completion rates; programme adherence; and programme fidelity, views on intervention acceptability and programme barriers and facilitators. Secondary aims are to evaluate established physical activity outcome measures for children plus additional health economic outcomes for inclusion in a future full-scale trial.DiscussionThe results of this study will inform decisions on whether and how to proceed to a full-scale evaluation of the effectiveness and cost-effectiveness of the CHARMING Programme to improve or sustain physical activity.Trial registrationClinicalTrials.gov ISRCTN36223327. Registered March 29, 2021

A systematic review of physical activity in people with haemophilia and its relationship with bleeding phenotype and treatment regimen.

IntroductionAlthough the measurement of physical activity (PA) amongst people with haemophilia (PWH) has become increasingly widespread in recent years, the relationship between PA and bleeding phenotype remains poorly understood. In addition, the influence of various treatment regimens on this relationship has not been defined.AimThis review aimed to systematically assess the data that are available regarding PA levels amongst PWH, as well as the relationship between PA and bleeding.MethodsA systematic search of the online databases EMBASE, Cochrane, MEDLINE Ovid, CINAHL and Web of Science was conducted by two independent reviewers. Quality assessment was undertaken using the AXIS Critical Appraisal Tool for Cross‐sectional Studies and the STROBE checklist.ResultsOf 1902 sources identified overall, 36 articles were included. Low‐to‐moderate transparency of reporting and various sources of bias were identified. PA levels varied amongst heterogeneous samples of PWH. The relationship between PA and bleeds was inconclusive, although there was evidence that improvements in treatment over recent decades have appeared to enable PWH to become more physically active.ConclusionBased upon the limited available evidence, the relationship between PA and bleeding phenotype in PWH remains unclear. However, with the development of improved prophylaxis treatment regimens in recent years, there is evidence that PA levels have increased, especially amongst people with severe haemophilia. The use of validated outcome measures of PA and more robust reporting of bleeds and treatment regimen are warranted in future research, especially in a rapidly evolving era of new treatments for PWH.

The Use of a Smartphone App and an Activity Tracker to Promote Physical Activity in the Management of Chronic Obstructive Pulmonary Disease: Randomized Controlled Feasibility Study

BackgroundChronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR).ObjectiveThis study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness.MethodsWe conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity–based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology.ResultsOverall, 47% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation.ConclusionsmHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates.

Effectiveness of school-based health promotion interventions prioritized by stakeholders from health and education sectors: A systematic review and meta-analysis.

Childhood obesity and associated modifiable risk factors exert significant burden on the health care system. The goal of this systematic review and meta-analysis was to examine the effectiveness of school-based intervention types perceived by Canadian stakeholders in health and education as feasible, acceptable and sustainable in terms of improving physical activity (PA), fruit and vegetable intake, and body weight. We searched multiple databases for studies that evaluated school-based interventions to prevent obesity and associated risk factors (i.e., unhealthy diet, physical inactivity, sedentary behaviour) in children aged 4–18 years from January 1, 2012 to January 28, 2020. From 10,871 identified records, we included 83 and 80 studies in our systematic review and meta-analysis, respectively. Comprehensive School Health (CSH) and interventions which focused on modifications to school nutrition policies showed statistically significant positive effects on fruit intake of 0.13 (95% CI: 0.04, 0.23) and 0.30 (95% CI: 0.1, 0.51) servings per day, respectively. No intervention types showed statistically significant effect on vegetable intake. CSH, modifications to physical education (PE) curriculum, and multicomponent interventions showed statistically significant difference in BMI of −0.26 (95% CI: −0.40, −0.12), −0.16 (95% CI: −0.3, −0.02), and −0.18 (95% CI: −0.29, −0.07), respectively. CSH interventions showed positive effect on step-count per day, but no other types of interventions showed significant effect on any of PA outcome measures. Thus, the results of this systematic review and meta-analysis suggest that decision-makers should carefully consider CSH, multicomponent interventions, modifications to PE curricula and school nutrition policies to prevent childhood obesity.

Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review.

BackgroundIncreasing physical activity (PA) levels in adolescents aged 12 to 18 years is associated with prevention of unhealthy weight gain and improvement in cardiovascular fitness. The widespread availability of mobile health (mHealth) and wearable devices offers self-monitoring and motivational features for increasing PA levels and improving adherence to exercise programs.ObjectiveThe aim of this scoping review was to identify the efficacy or effectiveness of mHealth intervention strategies for facilitating PA among adolescents aged 12 to 18 years.MethodsWe conducted a systematic search for peer-reviewed studies published between 2008 and 2018 in the following electronic databases: PubMed, Google Scholar, PsychINFO, or SportDiscus. The search terms used included mHealth or “mobile health” or apps, “physical activity” or exercise, children or adolescents or teens or “young adults” or kids, and efficacy or effectiveness. Articles published outside of the date range (July 2008 to October 2018) and non-English articles were removed before abstract review. Three reviewers assessed all abstracts against the inclusion and exclusion criteria. Any uncertainties or differences in opinion were discussed as a group. The inclusion criteria were that the studies should (1) have an mHealth component, (2) target participants aged between 12 and 18 years, (3) have results on efficacy or effectiveness, and (4) assess PA-related outcomes. Reviews, abstracts only, protocols without results, and short message service text messaging–only interventions were excluded. We also extracted potentially relevant papers from reviews. At least 2 reviewers examined all full articles for fit with the criteria and extracted data for analysis. Data extracted from selected studies included study population, study type, components of PA intervention, and PA outcome results.ResultsOverall, 126 articles were initially identified. Reviewers pulled 18 additional articles from excluded review papers. Only 18 articles were passed onto full review, and 16 were kept for analysis. The included studies differed in the sizes of the study populations (11-607 participants), locations of the study sites (7 countries), study setting, and study design. Overall, 5 mHealth intervention categories were identified: website, website+wearable, app, wearable+app, and website+wearable+app. The most common measures reported were subjective weekly PA (4/13) and objective daily moderate-to-vigorous PA (5/13) of the 19 different PA outcomes assessed. Furthermore, 5 of 13 studies with a control or comparison group showed a significant improvement in PA outcomes between the intervention group and the control or comparison group. Of those 5 studies, 3 permitted isolation of mHealth intervention components in the analysis.ConclusionsPA outcomes for adolescents improved over time through mHealth intervention use; however, the lack of consistency in chosen PA outcome measures, paucity of significant outcomes via between-group analyses, and the various study designs that prevent separating the effects of intervention components calls into question their true effect.

The effect of school sports facilities on physical activity, health and socioeconomic status in adulthood

This paper focuses on the long-term impacts of attending a high school with inadequate sports facilities. We use prospective data from the British National Child Development Study, a continuing panel of a cohort of 17,634 children born in Great Britain during a single week of March 1958. Our empirical approach exploits the educational system they were exposed to: children were sorted by educational ability at age 11, but conditional on educational ability, attended their closest school. This produces quasi-random variation in the quality of the school sports facilities across respondents. We use this variation between cohort members residing within the same local authority area, and focus on outcome measures of physical activity, health, health-related lifestyle activities, and socioeconomic status, collected at ages between 33 and 50 years. We control for any potential links between the inadequacy of sports facilities and inadequacy of other facility types, and test that allocation to school type is random with respect to pre-high school observables. We find that attending a school with inadequate sports facilities led to a statistically significant, modest decrease in the likelihood of physical activity participation during adulthood. In contrast, we find no evidence that inadequate sports facilities worsened adulthood measures of physical and mental health, lifestyle or socioeconomic status.

A Control Theory-Based Pilot Intervention toIncrease Physical Activity in Patients WithHypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HC) is the most common genetic heart disease. Consensus guidelines recommend restriction from competitive and/or high-intensity physical activities; however, sufficient light-moderate intensity physical activity remains important for health and wellbeing. This study aimed to evaluate the effectiveness and appeal of a control theory-based intervention to increase physical activity levels in individuals with HC. A pre to post trial of HC participants (n = 25) recruited from May 2016 to April 2017 from a specialized, multidisciplinary clinic was conducted. A 12-week intervention based on principles of control theory was developed. The primary outcome measures were self-reported leisure and transport-related physical activity. The mean age of participants was 42 ± 13years and the majority were men (n = 15, 60%). Although both the primary (self-report) and secondary (objective) outcome measures of physical activity increased, such as leisure-time physical activity: 98 ± 132 minutes per week to 151 ± 218 minutes per week, these were not statistically significant. Secondary outcome measures improved, including physical health-related quality of life (HR-QoL; 43 ± 6 to 50 ± 8, p = 0.004), self-efficacy (14 ± 3 to 16 ± 4, p <0.001), and the number of barriers identified (4 ± 3 to 3 ± 2 barriers, p = 0.02). This simple, easy-to-administer intervention to promote physical activity in HC improved willingness to undertake physical activity, increased self-efficacy, and improved physical quality of life. This may help patients overcome perceived barriers and a lack of confidence regarding physical activity, with the ultimate goal to improve overall health outcomes in HC patients.

Does Pedestrian Danger Mediate the Relationship between Local Walkability and Active Travel to Work?

Environmental and policy factors play an important role in influencing people's lifestyles, physical activity (PA), and risks for developing obesity. Research suggests that more walkable communities are needed to sustain lifelong PA behavior, but there is a need to determine what local built environment features facilitate making being active the easy choice. This county-level study examined the association between local walkability (walkability and traffic calming scales), pedestrian danger, and the percent of adults who used active transport to work. Built environment and PA outcome measures were constructed for the 496 most populous counties representing 74% of the U.S. population. Geographic information system-based walkability scales were constructed and include a census of roads located within the counties using 2011 Navteq data. The pedestrian danger index (PDI) includes data collected from the Fatality Analysis Reporting System 2009-2011, and measures the likelihood of a pedestrian being hit and killed by a vehicle. Four continuous outcome measures were constructed using 2009-2013 American Community Survey county-level 5-year estimates. The measures represent the percentage of workers living in a county who worked away from home and (1) walked to work; (2) biked to work; (3) took public transit; and (4) used any form of active transport. Linear regression and mediation analyses were conducted to examine the association between walkability, PDI, and active transport. Models accounted for clustering within state with robust SEs, and controlled for median household income, families with children in poverty, race, ethnicity, urbanicity, and region. The walkability scale was significantly negatively associated with the PDI (β = -0.06, 95% CI = -0.111, -0.002). In all models, the PDI was significantly negatively associated with all active travel-related outcomes at the p < 0.01 level. The walkability scale was positively associated with all four outcomes at the p < 0.01 level. Results showed that the significant positive relationship between local walkability and the four active transport outcome measures was partially mediated by the PDI. We found no association between traffic calming, the PDI, and the active transport outcomes. Results from this study show that, at the county-level, walkability is associated with active travel, and this association is partially mediated by an index of pedestrian safety.

The Effects of Treadmill Obstacle-Stepping on Physical Activity in Ambulatory Patients After Stroke

Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.

The relationship between BMI and physical fitness of physically active girls at the age of 6–7 years old

Introduction: In an effort to curb rising levels of overweight and obesity, much attention has been given to understanding physical activity (PA) levels, in particular for adolescent females. Whilst general trends are often reported, it is important to understand the specific contexts of participation and how they may change over time. This studywas aimed at investigating changes in the contexts of moderate and vigorous physical activity (MVPA) for adolescent females, from Year 7 to post-secondary school. Methods: A 3-year longitudinal survey was conducted with females recruited in either Year 7 or Year 11. The questionnaire gathered demographic details, information about determinants of PA and PA outcome measures, including a Previous Day Physical Activity Recall (PDPAR) diary, from which self-reported total time spent in MVPA was calculated. An integrated cross-sectional and longitudinal analysis was conducted to investigate the duration and proportion of MVPA time occurring in the categories of sport, other (non-sport) PA and active transport, at six Year levels (7–9 and 11–13). Results: Analysis was based on participants who completed the relevant questions (n=Year 7: 381; Year 11: 211). The mean 24-hour total duration of MVPA increased significantly from Year 7 (mean±95% confidence interval: 45.8±8.0min) to Year 9 (65.5±8.5min) but the difference between the mean duration in Year 7 and the mean duration in Year 13 (53.1±14.1min) was not significant. There were, however, significant changes across time with respect to the form of MVPA undertaken. In Year 7, the mean proportion ofMVPA time associatedwith sport (59.2±7.8 percent) was significantly greater than themean proportion associatedwith other PA (35.7±7.8 percent), whereas for each of Years 12 and 13, the mean proportion of MVPA time associated with other PA (62.6±9.7 percent; 66.6±13.3 percent) was significantly greater than themeanproportionassociatedwith sport (34.0±9.7percent; 28.1±13.2 percent). The mean proportion of MVPA time undertaken in the form of active transport did not change significantly over time. Discussion: It is pleasing to see that total time spent in MVPA by this sample of adolescent girls did not significantly decrease over time.However, the context of participationdid change significantly over time, with sport playing a larger role than other PA in early adolescence and this role reversing during late adolescence. The sport sector could benefit from understanding why this transfer occurs, and perhaps reverse this trend by offering more genderand age-appropriate programs.

Longitudinal changes in the structure of moderate and vigorous physical activity across adolescence for females

Introduction: In an effort to curb rising levels of overweight and obesity, much attention has been given to understanding physical activity (PA) levels, in particular for adolescent females. Whilst general trends are often reported, it is important to understand the specific contexts of participation and how they may change over time. This studywas aimed at investigating changes in the contexts of moderate and vigorous physical activity (MVPA) for adolescent females, from Year 7 to post-secondary school. Methods: A 3-year longitudinal survey was conducted with females recruited in either Year 7 or Year 11. The questionnaire gathered demographic details, information about determinants of PA and PA outcome measures, including a Previous Day Physical Activity Recall (PDPAR) diary, from which self-reported total time spent in MVPA was calculated. An integrated cross-sectional and longitudinal analysis was conducted to investigate the duration and proportion of MVPA time occurring in the categories of sport, other (non-sport) PA and active transport, at six Year levels (7–9 and 11–13). Results: Analysis was based on participants who completed the relevant questions (n=Year 7: 381; Year 11: 211). The mean 24-hour total duration of MVPA increased significantly from Year 7 (mean±95% confidence interval: 45.8±8.0min) to Year 9 (65.5±8.5min) but the difference between the mean duration in Year 7 and the mean duration in Year 13 (53.1±14.1min) was not significant. There were, however, significant changes across time with respect to the form of MVPA undertaken. In Year 7, the mean proportion ofMVPA time associatedwith sport (59.2±7.8 percent) was significantly greater than themean proportion associatedwith other PA (35.7±7.8 percent), whereas for each of Years 12 and 13, the mean proportion of MVPA time associated with other PA (62.6±9.7 percent; 66.6±13.3 percent) was significantly greater than themeanproportionassociatedwith sport (34.0±9.7percent; 28.1±13.2 percent). The mean proportion of MVPA time undertaken in the form of active transport did not change significantly over time. Discussion: It is pleasing to see that total time spent in MVPA by this sample of adolescent girls did not significantly decrease over time.However, the context of participationdid change significantly over time, with sport playing a larger role than other PA in early adolescence and this role reversing during late adolescence. The sport sector could benefit from understanding why this transfer occurs, and perhaps reverse this trend by offering more genderand age-appropriate programs.

Quantifying Physical Activity in Physical Education via Pedometry: A Further Analysis of Steps/Min Guidelines

The validity of common pedometer steps/min guidelines for 1st-12th grade physical education physical activity (PA) recommendations (ie, 33% and 50% PA) was investigated. Data sets from previous research, where physical education PA was quantified via pedometry, were combined. Participants (1st-12th grade, N = 1152) with concurrent steps/min and observed %PA scores were included. Data were analyzed using correlation, regression, and receiver-operator-characteristic (ROC) statistics. Alpha was set at .05. Overall, by gender and school level group (ie, 1st-6th, 7th-12th) PA outcome measures were strongly correlated and significant (r = .85-.92). Steps/min₂, lesson time₃, stature₄, and BMI₅ were significant predictors (r₁₂.₃₄₅=.91) of %PA₁. Steps/min accounted for 85.4% of the variance for %PA; however, the other predictors only accounted for an additional 0.5%. ROC analyses indicated that steps/min was an excellent discriminator (AUC ≥ .90) of %PA guideline achievement. Steps/min values of 60.6 and 82.2 were the most accurate cut points overall for the 33% and 50% PA guidelines, respectively. Steps/min cut points for gender and school level demonstrated agreement with the overall steps/min cut points. These findings support the contention that common steps/min guidelines can be applied in the surveillance of physical education PA.

Effects of epoch length on outcome measures of physical activity with a triaxial accelerometer Active Style Pro

Effects of epoch length on outcome measures of physical activity with a triaxial accelerometer Active Style Pro

Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey

Lower-back pain (LBP) is a common secondary condition following lower-limb amputation. The purpose of this study was to investigate LBP prevalence and the relationship between LBP and physical activity (PA) levels in a national sample of persons with traumatic transfemoral amputation (TFA). Questionnaires were mailed to a random sample of people with traumatic TFA (n = 322) from the New Zealand Artificial Limb Board national database. Of the participants who completed the survey (55% response rate), 64.1% reported LBP and 39.1% reported restricted PA due to LBP. There was no relationship between the PA levels of persons with and without LBP (chi-square = 2.11, p > 0.05). There was an equal distribution of persons with LBP in low, medium, and high PA subgroups. However, persons who reported restricted PA due to LBP had lower PA scores than persons with LBP and no restricted PA (chi-square = 11.56, p < 0.05). Based on our results, LBP is prevalent in the traumatic TFA population. PA levels are not influenced by the presence or absence of LBP. However, future studies investigating LBP coping strategies and using objective PA outcome measures might further elucidate the relationship between PA and LBP in this population.

Social Cognitive Factors Associated With Moderate to Vigorous Physical Activity In Perimenopausal and Postmenopausal Women

Osteoporosis (OP) is a disease characterized by low bone mass and structural breakdown of the skeleton. The disease may be prevented through weight-bearing, moderate to vigorous physical activity (MVPA), which is important for periand postmenopausal women who are at great risk for OP. However, most women do not participate in activity according to guidelines, which can negatively impact bone health. A better understanding of multi-dimensional factors that influence MVPA may help inform physical activity interventions aiming for OP prevention. The purpose of this study was to utilize social cognitive theory (SCT) to understand the associations between social cognitive factors and MVPA among periand postmenopausal women. Eighty-seven periand postmenopausal women (aged 43 to 65) completed this cross-sectional study. Participants completed demographic, health, calcium, and SCT questionnaires. SCT variables assessed included task self-efficacy (SET) and barrier selfefficacy (SEB), perceived social support from friends (SSFR) and family (SSFA), and perceived access to facilities (ACF) and home equipment (ACH). Participants wore an NL-1000 pedometer for one week to assess total steps per day and minutes spent in MVPA. Past year MVPA, past week leisure MVPA, and past week occupational/ transport MVPA were assessed with the Modifiable Activity Questionnaire. Stepwise regression analysis was used to identify the direct relationships between cognitive variables and each of the physical activity outcome measures. Moderationmediation analysis was conducted to determine if significant interaction effects or confounding effects existed between social cognitive variables and each physical activity