Outdoor Walking Research Articles

Using a virtual reality power mobility device simulator to assess the driving skills of people with brain diseases.

No previous study has explored the effectiveness of current prescription standards for evaluating power mobility device (PMD) maneuverability. To verify the current prescription standards for PMDs using a virtual reality (VR)-based PMD simulator and to present the possibility of using a VR-based PMD simulator as an alternative to current evaluation standards. A total of 52 patients with brain diseases were enrolled. All participants were over 18 years old and had gait disturbance or limited outdoor walking ability. Participants performed a driving ability test using a VR PMD simulator. The driving ability test using the VR PMD simulator indicated that cognitive impairment, measured by the K-MMSE (p = 0.017), and unilateral neglect, measured by line bisection (p = 0.031), led to reduced driving ability and safety. In addition, patients with cognitive impairment or neglect presented driving stability problems, which were observed in the driving trajectory. There was also no correlation between driving scores and MBI subitems. In patients with brain lesions, a driving ability test using a VR PMD simulator can be a safe, objective method for comprehensively evaluating a driver's capacity, offering an alternative to the current prescription standards for PMDs.

A feasibility study to evaluate a purposeful walk intervention with a distance goal using a commercially available activity monitor in elderly people post total hip replacement surgery.

Total hip replacement (THR) is performed in an increasing number of individuals around the world and while improvements in pain reduction and long-term enhancement of muscle strength are well documented, the improvement in daily activity does not follow the same trend. This study aimed to determine the feasibility of a 5-week intervention where a personalised outdoor walking distance is monitored using a commercial activity monitor (Fitbit Charge 4). Data was collected on gait and activities of daily living using patient reported outcome measures. Following the completion of the intervention period, participants took part in a semi-structured interview to voice their opinion on the use of the activity monitor, their experiences, and any challenges in order to assess the feasibility of the intervention. All quantitative data were presented descriptively, using appropriate summary statistics. Interviews were analysed using thematic analysis. Five participants who had undergone total hip replacement surgery within the postoperative period of 3 to 6months were recruited from the local community. The findings suggest that the intervention was feasible and that it encouraged all participants to increase their daily activity. Therefore, it can be concluded that a follow-up effectiveness trial is warranted.

Commentary on: "Predicting Outdoor Walking 1 Year After Spinal Cord Injury: A Retrospective, Multisite External Validation Study".

Kandilakis, Casey PT, DPT; Hobbs, Sara PT, DPT; Rozwod, Meghan PT, DPT Author Information

Modified stepping behaviour during outdoor winter walking increases resistance to forward losses of stability

Healthy humans are proficient at maintaining stability when faced with diverse walking conditions, however, the control strategies that lead to this proficiency are unclear. Previous laboratory-based research has predominantly concluded that corrective stepping is the main strategy, but whether this finding holds when facing everyday obstacles outside of the laboratory is uncertain. We investigated changes in gait stability behaviour when walking outdoors in the summer and winter, hypothesizing that as ground conditions worsened in the winter, the stepping strategy would be hindered. Stability would then be maintained through compensatory strategies such as with ankle torques and trunk rotation. Data was collected in the summer and winter using inertial measurement units to collect kinematics and instrumented insoles to collect vertical ground reaction forces. Using the goodness of fit for a multivariate regression between the centre of mass state and foot placement we found that, counter to our hypothesis, stepping was not hindered by winter conditions. Instead, the stepping strategy was modified to increase the anterior-posterior margin of stability, increasing the resistance to a forward loss of stability. With stepping being unhindered, we did not observe any additional compensation from the ankle or trunk strategies.

Patients and Parents' Satisfaction and Self-Reported Evaluation After Single-Event Multilevel Surgery in Cerebral Palsy.

The aim of this study was to analyze the results of single-event multilevel surgery (SEMLS) in cerebral palsy (CP) based on objective gait outcomes and self-reported evaluations. In total, 258 patients with spastic diplegic CP, GMFCS I-III, who underwent SEMLS and with preoperative and postoperative gait analyses, were included in the SEMLS group (SG). The same database was used to compose the control group (CG) formed of 88 subjects who had performed at least 2 gait analyses and did not undergo surgical intervention between tests. Demographic data, Gait Deviation Index (GDI), and a self-reported questionnaire were analyzed, and results were compared between groups. The GDI decreased from 59.6 to 57.9 in the CG and increased from 51.3 to 58.4 in the SG ( P <0.001). There was no change in patients' walking ability in the CG. The number of patients who walk community distances increased after SEMLS in the group that had a GDI improvement >5 points (from 12.3% to 24.7%, P =0.008) and in patients GMFCS I and II (from 9.2% to 20.4%, P =0.028). According to patient and parental responses on satisfaction, the most significant improvements were reported in self-esteem, mobility, body image, and independence. In total, 51.1% of the patients were extremely satisfied or satisfied, while 3.9% were unsatisfied or extremely unsatisfied with the treatment results. Of the parents surveyed, 60.1% were extremely satisfied or satisfied, whereas just 5.0% were unsatisfied or extremely unsatisfied. In the studied group, an improvement in outdoor walking for community distances after SEMLS, as reported in questionnaires, was observed only when GDI increase was >5 points and in GMFCS I and II. Level III.

Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination

ObjectivesWe aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke. Materials and methodsThis study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination. ResultsCompared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043). ConclusionsThe ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.

Walking Behaviour of Individuals with Intermittent Claudication Compared to Matched Controls in Different Locations: An Exploratory Study.

Individuals with intermittent claudication (IC) are less physically active than their peers, but how this varies with location is unclear. Individuals with IC and matched controls [sex, age ±5 years, home < 5 miles] wore an activity monitor (activPAL) and carried a GPS device (AMOD-AGL3080) for 7 days. GPS data categorised walking events as occurring at home (<=50 m from home co-ordinates) or away from home, and indoors (signal to noise ratio <= 212 dB) or outdoors. Number of walking events, walking duration, steps and cadence were compared between groups and each location pair using mixed model ANOVAs. In addition, the locus of activity (distance from home) at which walking was conducted was compared between groups. Participants (n = 56) were mostly male (64%) and aged 54-89 years. Individuals with IC spent significantly less time walking and took fewer steps than their matched controls at all locations, including at home. Participants spent more time and took more steps away from home than at home, but were similar when walking indoors and outdoors. The locus of activity was significantly smaller for individuals with IC, suggesting that it is not just physical capacity that influences walking behaviour, and other factors (e.g., social isolation) may play a role.

Effect of low-calorie diet on psoriasis severity index, triglycerides, liver enzymes, and quality of life in psoriatic patients with non-alcoholic fatty liver disease.

Chronic-plaque psoriasis is a chronic inflammatory dermatological disease. Obesity comorbidities, including non-alcoholic fatty liver disease, are highly prevalent in patients with chronic-plaque psoriasis. Recently, weight loss has been a highly recommended intervention to improve the severity of psoriatic symptoms, psoriasis-induced chronic systemic inflammation, psoriasis-associated cardiovascular risk factors, quality of life, and the efficacy of anti-psoriatic drugs. This study was designed to assess the effect of a 12-week low-calorie-diet intervention on aspartate transaminase, psoriasis severity (assessed via Psoriasis Area and Severity Index - PASI), alanine transaminase, quality of life (assessed via Dermatology Life Quality Index - DLQI), triglycerides, waist circumference (WC), and body mass index (BMI) in class I obese men with chronic-plaque and non-alcoholic fatty liver disease. Sixty men with age ≥ 18 years with class I obesity and with chronic plaque psoriasis and non-alcoholic fatty liver disease were included in the study. All participants were randomly assigned to one of two groups: the first group as the low-calorie-diet group (30 men received immunosuppressive drugs, followed a low-calorie diet, and increased their energy expenditure through a daily 15,000-step outdoor walking program for 12 weeks) and the second as the control group (30 men received immunosuppressive drugs only). The primary outcome consisted of the results of the area and severity index. Weight, BMI, WC, laboratory results such as triglycerides, liver enzymes (alanine transaminase and aspartate transaminase) as well as DLQI were considered as secondary outcomes. While no significant improvements were achieved in the measured variables of the control group, the low-calorie-diet group demonstrated significant improvement in all the measured variables. The results of the present study confirmed that 12-week low-calorie-diet intervention controls BMI, increases the response of psoriasis to pharmacological agents and improves the quality of life. Diet interventions significantly control the elevated hepatic enzymes (aspartate and alanine transaminases) and triglycerides in male patients with chronic-plaque psoriasis and non-alcoholic fatty liver disease.

Abstract #1407112: Assessment of the Thyroid Eye Disease Specific Graves’ Ophthalmopathy Quality of Life Questionnaire in Non-Inflammatory or Inactive Thyroid Eye Disease Patients

Patients (pts) with inactive/non-inflammatory thyroid eye disease (TED) previously reported similar negative quality of life as those with active/inflammatory TED, using TED-specific Graves’ ophthalmopathy quality of life (GO-QOL) scores. Mean visual function and appearance scores of 58.6 and 62.3, respectively, indicated significant disease impact. Here we examined specific areas of quality of life affected by non-inflammatory TED. An online survey of pts with inactive TED, as assessed by pt healthcare provider, was conducted in January 2020. Questions from the GO-QOL evaluated TED impact on specific activities (reading, watching TV, hobby or pastime, driving, walking outdoors, moving around the house, and bicycling), appearance and social interactions on a 3-point scale: seriously or very much/a little/not at all limited, or not applicable. Caregiver assistance was also evaluated. 100 pts (47, 47% female) with inactive TED were identified (mean age 45.2 ± 7.6 yrs). Outside of individual symptoms, 28 (28%) reported that severe impact on quality of life was the major negative feature of TED. On specific GO-QOL items, watching TV and reading were the activities most affected, with 86 (86%) and 85 (85%) pts reporting some limitation, respectively, and 32 (32%) and 28 (28%) reporting serious limitation. 70 (70%) pts reported some difficulty driving, 59 (59%) reported some limitation walking outdoors, and 57 (57%) reported limitation with hobbies or pastimes. 58 (58%) reported hindrance to something they wanted to do in the past week. 77 (77%) pts felt like their appearance had changed because of TED with 11 (11%) reporting that their appearance had changed very much. 71 (71%) reported a negative influence on self-confidence with 25 (25%) reporting serious impact. 72 (72%) reported appearing less often in photos than before TED. 32 (32%) reported receiving caregiver (primarily partners) help for daily activities and 41% (13/32) of caregivers were extremely involved in communication with the pt’s healthcare provider. Among the tasks most necessitating aid from a caregiver, 69% (22/32) received help grocery shopping and cooking, 56% (18/32) received help with transportation, and 44% (14/32) received help with household tasks and general healthcare. This analysis indicates pts with inactive/non-inflammatory TED continue to feel the negative quality of life impact of TED after the acute/inflammatory presentation fades with many suffering from limitations of daily living activities. Pts also report that TED continues to affect their appearance and how they interact with people, with almost a third relying on caregiver help.

Distraction From Smartphones Changed Pedestrians' Walking Behaviors in Open Areas.

The prevalence of phone use has become a major concern for pedestrian safety. Using smartphones while walking reduces pedestrians' ability to perceive the environment by increasing their cognitive, manual, and visual demands. The purpose of this study was to investigate the effect of common phone tasks (i.e., reading, tapping, gaming) on walking behaviors during outdoor walking. Nineteen young adults were instructed to complete four walking conditions (walking only, walking-reading, walking-tapping, and walking-gaming) along an open corridor. Results showed that all three phone tasks increased participants' neck flexion (i.e.,neck kyphosis) during walking. Meanwhile, the reading task showed a greater influence on the temporal aspect during the early phases of a gait cycle. The tapping task lowered the flexion angles of the middle and lower back (i.e.,torso lordosis) and induced a longer terminal double support. And the gaming task resulted in a decrease in middle back flexion, a shorter stride length, and a longer terminal double support while walking. Findings from the study confirmed our hypothesis that phone tasks changed pedestrians' physical responses to smartphone distraction while walking. To avoid potential risks caused by the observed posture and gait adaptations, safety precautions (e.g.,roadside/electronic warning signals) might be imposed depending on the workload expected by different phone tasks.

Tracing recent outdoor geolocation by analyzing microbiota from shoe soles and shoeprints even after indoor walking

The microbial communities on shoe soles and shoeprints could carry microbial information about where someone walked. This is possible evidence to link a suspect in a crime case to a geographic location. A previous study had shown that the microbiota found on shoe soles depend on the microbiota of the soil on which people walk. However, there is a turnover of microbial communities on shoe soles during walking. The impact of microbial community turnover on tracing recent geolocation from shoe soles has not been adequately studied. In addition, it is still unclear whether the microbiota of shoeprints can be used to determine recent geolocation. In this preliminary study, we investigated whether the microbial characteristics of shoe soles and shoeprints can be used to trace geolocation and whether this information can be destroyed by walking on indoor floors. In this study, participants were asked to walk outdoors on exposed soil, then walk indoors on a hard wood floor. High-throughput sequencing of the 16S rRNA gene was performed to characterize the microbial communities of shoe soles, shoeprints, indoor dust, and outdoor soil. Samples of shoe soles and shoeprints were collected at steps 5, 20, and 50 while walking indoors. The PCoA result showed that the samples were clustered by geographic origin. The shoeprint showed a more rapid turnover of microbial community than the shoe sole during indoor walking. The result of FEAST showed that the microbial communities of shoe sole and shoeprint were mainly (shoe sole, 86.21∼92.34 %; shoeprint, 61.66∼90.41 %) from the soil of the outdoor ground where the individual recently walked, and a small portion (shoe sole, 0.68∼3.33 %; shoeprint, 1.43∼27.14 %) from the indoor dust. Based on the matching of microbial communities between geolocation and shoe sole or shoeprint, we were able to infer the recent geolocation of the individual with relatively high accuracy using the random forest prediction model (shoe sole: 100.00 %, shoeprint: 93.33∼100.00 %). Overall, we are able to accurately infer the geolocation of an individual’s most recent outdoor walk based on the microbiota of shoe sole and shoeprint, even though these microbiotas show a turnover when walking indoor floor. The pilot study was expected to provide a potential method for tracing recent geolocation of suspects.

Identifying Outdoor Winter Walking Programs and Resources for Older Adults: A Scoping Review of the Grey Literature

Purpose: The objective was to synthesize outdoor winter walking programs and resources for older adults, identified as a priority by the Winter Walk team comprised of older adults; and researchers and trainees from the rehabilitation and geography sciences. Method: A scoping review of web-based grey literature was conducted. Teams of two reviewers independently assessed eligibility and extracted data. Web-based resources were included if their content dealt with adults ≥65 years of age; an outdoor winter walking program, intervention, or general resource; and was written in English. Results: Twenty-seven website resources were eligible and included in the review. Resources were from Canada or the United States and included information provided by government, non-profit organizations, media and businesses. All resources focused on some aspect of winter walking safety and only one mentioned a winter walking program. Conclusions: Web-based resources for outdoor winter walking were synthesized to assist older adults and clinicians with access to safe outdoor winter walking information.

The context of outdoor walking: A classification of user‐generated routes

AbstractLeisure walking has known benefits to public health, from both physical and psychological viewpoints. Complementing traditional print information sources, dedicated online platforms and apps provide tools to search, discover, plan and share routes. While walking routes are highly heterogeneous in terms of their properties and geographical context, current platforms adopt simple representations of basic attributes. In this article, we report on a research project at the Ordnance Survey on the representation and recommendation of walking routes, which comprises the following contributions. Firstly, we outline a theoretical framework of leisure walking, intersecting its individual, social and environmental dimensions. Secondly, analysing about 4 million user‐generated walking routes produced in Great Britain, we characterise routes combining primary attributes and contextual information, including land cover and points of interest. Thirdly, by applying unsupervised learning to this data model, we produce the Walking Route Classification. This classification is methodologically similar to geo‐demographic classifications and identifies groups and supergroups of similar routes in a large multidimensional attribute space. This body of work is evaluated through a survey and a focus group with experts, showing encouraging results.

Does daily physical activity reflect claudication distance measured on a treadmill and in a community outdoor setting?

Low physical activity in patients with claudication is associated with lower walking abilities as assessed by the treadmill test. The impact of physical activity on the ability to walk in a natural environment is unknown. The study aimed to assess the level of daily physical activity among patients with claudication, as well as the relationship between the level of daily physical activity and claudication distance measured during the outdoor walking and treadmill tests. The study included 37 patients (24 males), aged 70.03±5.9, with intermittent claudication. Daily step count was assessed using the Garmin Vivofit activity monitor, worn on the non-dominant wrist for 7 consecutive days. Pain-free walking distance (PFWDTT) and maximal walking distance (MWDTT) were measured via the treadmill test. During 60-minute outdoor walking, the maximal walking distance (MWDGPS), total walking distance (TWDGPS), walking speed (WSGPS), number of stops (NSGPS) and stop durations (SDGPS) were assessed. Mean daily step count - 7,102±3,433. A significant correlation was observed between daily step count and MWDTT, TWDGPS (R=0.33, R=0.37, respectively (p<0.05). Furthermore, 51% of patients reached less than 7,500 steps/day and presented significantly shorter MWDTT, MWDGPS and TWDGPS, compared to the participants covering ≥7,500 steps (p<0.05). The daily step count reflects claudication distance measured on a treadmill and only partially in a community outdoor setting. The minimal daily step count that should be recommended for patients with claudication, allowing achievement of significantly better results with regard to walking abilities, both on the treadmill and in outdoor settings, is at least 7,500 steps per day.

Perceived Impact of the COVID-19 Pandemic on Playing Golf: A Qualitative Content Analysis Study

Golf is a very popular outdoor sport played worldwide by people from various socio-economic backgrounds. During the COVID-19 pandemic, lockdowns and quarantine restrictions led to closures of indoor and outdoor sport facilities and thus also affected the access to golf courses. This study aimed at elucidating perceptions of golfers regarding the impact of the crisis on their sport. We surveyed a sample of golfers in German-speaking countries (primarily Austria and Germany) from March to June 2021. A content analysis on golfers’ responses (n = 923) to an open-ended question on their feelings and engagement in alternative ways of physical activity in light of closed sport facilities was performed. More than 23% of the comments concerned negative feelings on how the pandemic impacted the surveyed golfers, especially due to reluctance to accept the closure of outdoor sports facilities. Almost all participants stated to perform alternative outdoor sports, mostly hiking, biking, walking, and running. In times of a pandemic, public spaces should be designed to allow for safe physical activity to maintain a mentally and physically fit population. In this context, policy makers should provide hygiene concepts that allow for minimal disturbance of sport routines, especially in regard to outdoor sports such as golf.

Dataset of Public Objects in Uncontrolled Environment for Navigation Aiding

Computer vision is a new approach to navigation aiding that assists visually impaired people to travel independently. A deep learning-based solution implemented on a portable device that uses a monocular camera to capture public objects could be a low-cost and handy navigation aid. By recognizing public objects in the street and estimating their distance from the user, visually impaired people are able to avoid obstacles in the outdoor environment and walk safely. In this paper, we created a dataset of public objects in an uncontrolled environment for navigation aiding. The dataset contains three classes of objects which commonly exist on pavements in the city. It was verified that the dataset was of high quality for object detection and distance estimation, and was ultimately utilized as a navigation aid solution.

Thermal responses of face-masked pedestrians during summer: An outdoor investigation under tree-shaded areas

During the SARS-CoV-2 (COVID-19) pandemic, most citizens were cooperative towards the face-masking policy; however, undeniably, face masking has increased complaints of thermal discomfort to varying degrees and resulted in potential health hazards during summer. Thus, a thermal comfort survey was conducted under tree-shaded areas generally preferred by pedestrians to explore the thermal response of face-masked pedestrians. Thirty-two subjects, with and without masks, participated in walking experiments, and their thermal parameters and physiological indicators were recorded; moreover, the subjects were asked to fill in subjective questionnaires. The results showed that although tree shades significantly reduced the average radiant temperature, dampness in the mask may cause some discomfort symptoms, among which intense sweating (54.55%) and tachycardia (42.18%) accounted for the largest proportion. Based on thermal indices, it could be concluded that face-masking does not significantly affect the thermal comfort of subjects walking in shaded areas. Notably, a 30-min walk in tree-shaded areas with face masking does not adversely affect human health or quality of life. Thus, the present assessment of the thermal safety of humans in shaded environments provides reference data for determining thermal comfort levels during outdoor walking with face masking.

Patch-Based Difference-in-Level Detection with Segmented Ground Mask

Difference-in-level detection in outdoor scenes has various possible applications, including walking assistance for blind people, robot walking assistance, and mapping the hazards of factory premises. It is difficult to detect all outdoor differences in level, such as RGB or RGB-D images, not only including road curbs, which are often targeted for detection in automated driving, but also differences in level on factory premises and sidewalks, because the pattern of outdoor differences in level is abundant and complex. This paper proposes a novel method for detecting differences in level from RGB-D images with segmented ground masks. First, image patches of differences in level were extracted from outdoor images to create the dataset. The change in the normal vector of the contour part on the detected plane is used to generate image patches of the difference in level, but this method strongly depends on the accuracy of planar detection, and it detects only some differences in level. Then, we created the dataset, consisting of image patches and including the extracted differences in level. The dataset is used for training a deep learning model for detecting differences in level in outdoor images without limitations. In addition, because the purpose of this paper is to detect differences in level in outdoor walking areas, regions in the image other than the target areas were excluded by the segmented ground mask. For the performance evaluation, we implemented our algorithm using a modern smartphone with a high-performance depth camera. To evaluate the effectiveness of the proposed method, the results from various inputs, such as RGB, depth, grayscale, normal, and combinations of them, were qualitatively and quantitatively evaluated, and Blender was used to generate synthetic test images for a quantitative evaluation of the difference in level. We confirm that the suggested method successfully detects various types of differences in level in outdoor images, even in complex scenes.

A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk

ObjectivesTo determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes.MethodThis was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures.ResultsForty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: − 38.7 mm [95% CI − 47.1 to − 30.3] versus usual care group: 4.3 mm [− 4.9 to 13.4]).ConclusionsThis study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial.Trial registration number12618001097235.Key Points• This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible.• The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone.• The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.

Vitamin D Knowledge and Awareness Is Associated with Physical Activity among Adults: A Cross-Sectional Survey.

The relation between knowledge and awareness of vitamin D (VD) and physical activity in adults has not been well studied. The present cross-sectional study aims to demonstrate this relation among adults living in Saudi Arabia. A total of 774 adults participated and were stratified based on self-reports of whether they were physically active (PA group, N = 562) or not (non-PA, N = 212). The prevalence of VD awareness and its health effects were significantly higher in the PA group compared with their counterparts (97 vs. 93.4%; p = 0.02 and 92.3 vs. 81.6%; p < 0.001, respectively). Sunlight was the preferred overall source of VD among the PA group (91.1%) followed by food, supplements, and fortified foods. Sardine, salmon, oily fish (63.7%) and eggs (54.6%) were reported as good dietary sources. Other positive attitudes, represented by taking supplement or multivitamins (51.2%), high sun exposure (33.1%), and daily duration of exposure to sunlight (15−30 min; 53.4%) were higher in the PA than the non-PA group (p values < 0.05). The body parts exposed to the sun among the PA group were arms (67.1%), hands (64.1%), face and hands (62.5%), legs (58.5%), and face (53.2%), while sunscreen cream (47.2%) was their preferred sun-protection method. High levels of knowledge and positive attitudes were reported by the PA group compared with the non-PA group in regard to walking outdoors for sun exposure (80.6 vs. 62.7%; p < 0.001). Information about good dietary sources, the role of VD in human health, associated diseases, positive attitudes to sun exposure, and the use of supplements or multivitamins were among the determinants of VD knowledge and awareness. In conclusion, VD knowledge and awareness are positively associated with self-reported physical activity in adults. Further objective classifications of PA may strengthen the results of the present investigation.