Paffenbarger Physical Activity Questionnaire Research Articles

Replacement of watching television with physical activity and the change in gestational diabetes mellitus risk: A case-control study.

To evaluate the effect of replacing 1 h/week of watching television with 1 h/week of light to moderate (LMPA) or vigorous physical activity (VPA) before and during pregnancy on the risk of gestational diabetes mellitus (GDM). A case-control study was conducted in pregnant women. Physical activity and television watching before and during pregnancy were assessed using the Paffenbarger Physical Activity Questionnaire. Each type of activity was classified according to intensity (metabolic equivalent of task; MET): less than 6 METs is LMPA, 6 METs or more is VPA. The duration of physical activity and watching television was calculated, and logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals for their association with GDM risk. The isotemporal substitution model was used to calculate the effect of replacing 1 h/week of watching television with the same duration of physical activity. The GDM cases (n = 290) spent less time performing VPA than controls without GDM (n = 1175) and more time watching television during pregnancy (P < 0.05). During pregnancy, the risk of GDM increased for each hour of watching television (aOR = 1.02; 95% confidence interval 1.00-1.03). Women who spent more time watching television during pregnancy were likely to develop GDM (aOR>14 h/week vs. 0-6 h/week = 2.03; 95% confidence interval 1.35-3.08). Replacing 1 h/week of watching television with 1 h/week of VPA during pregnancy could decrease the chance of developing GDM (aOR = 0.66; 95% confidence interval 0.43-1.00). A simple change of 1 h/week of watching television for 1 h/week of VPA in pregnant women may reduce the risk of GDM considerably.

Effect of Severe Distal Tibia, Ankle, and Mid- to Hindfoot Trauma on Meeting Physical Activity Guidelines 18 Months After Injury

ObjectiveTo examine the effect of severe lower extremity trauma on meeting Physical Activity Guidelines for Americans (PAGA) 18 months after injury and perform an exploratory analysis to identify demographic, clinical, and psychosocial factors associated with meeting PAGA. DesignSecondary analysis of observational cohort study. SettingA total of 34 United States trauma centers ParticipantsA total of 328 adults with severe distal tibia, ankle and mid- to hindfoot injuries treated with limb reconstruction (N=328). InterventionsNone. Main Outcome MeasuresThe Paffenbarger Physical Activity Questionnaire was used to assess physical activity levels 18 months after injury. Meeting PAGA was defined as combined moderate- and vigorous-intensity activity ≥150 minutes per week or vigorous-intensity activity ≥75 minutes per week. ResultsFewer patients engaged in moderate- or vigorous-intensity activity after injury compared with before injury (moderate: 44% vs 66%, P<.001; vigorous: 18% vs 29%; P<.001). Patients spent 404±565 minutes per week in combined moderate- to vigorous-intensity activity before injury compared with 224±453 minutes postinjury (difference: 180min per week; 95% confidence interval [CI], 103-256). The adjusted odds of meeting PAGA were lower for patients with depression (adjusted odds ratio [AOR], 0.45; 95% CI, 0.28-0.73), women (AOR, 0.59; 95% CI, 0.35-1.00), and Black or Hispanic patients (AOR, 0.49; 95% CI, 0.28-0.85). Patients meeting PAGA prior to injury were more likely to meet PAGA after injury (odds ratio, 2.0; 95% CI, 1.20-3.31). ConclusionsPatients spend significantly less time in moderate- to vigorous-intensity physical activity after injury. Patients with depression are less likely to meet PAGA. Although the causal relationship is unclear, results highlight the importance of screening for depression.

The Moderating Effects of Genetic Variations on Changes in Physical Activity Level and Cardiorespiratory Fitness in Response to a Life-Style Intervention: A Randomized Controlled Trial.

Prior studies identified single nucleotide polymorphisms (SNPs) associated with physical activity (PA) level in a natural environment and intervention study: rs978656-DNAPTP6, rs10887741-PAPSS2, rs7279064-C18orf2, and rs6265-BDNF. Using the four SNPs' polygenic score (PGS), we examined whether PGS moderates a life-style intervention's effect on changes in PA level and cardiorespiratory fitness (CRF). This is a secondary analysis of Look AHEAD, a multicenter randomized controlled trial designed to test the health benefits of a life-style intervention among 2675 participants with overweight/obesity and type 2 diabetes (ages, 45-76 years). Using linear mixed-effects models, level of PA (Paffenbarger PA questionnaire) and treadmill-assessed CRF were each regressed on four SNPs' PGS, study time (baseline, year 1, and year 4), intervention arm, and interactions between the three. Models adjusted for age, sex, body mass index, ancestry principal components (population stratification), and study sites, with Bonferroni corrections for multiple testing (α < .005). Effect modification by age was examined. PGS was not predictive of change in CRF or PA level in response to intervention. In analyses without PGS by intervention by time, the relationships between PGS and PA phenotypes were modified by age (p interaction = .048 for CRF and .058 for PA), such that a 1-unit increase in PGS was associated with 24 kcal · wk-1 more in moderate-intensity PA and 0.004 MET higher CRF only among older groups (age >55 years for CRF, >60 years for PA level). The effects of the intervention on PA and CRF were not moderated by the four SNPs. Future studies with extended SNP list should confirm the findings on effect modification by age.

Sitting Time, Type, and Context Among Long‐Term Weight‐Loss Maintainers

This study aimed to investigate sitting time, the home sedentary environment, and physical activity among weight-loss maintainers in WW (formerly Weight Watchers). Participants were 4,305 weight-loss maintainers who had maintained≥9.1kg of weight loss (24.7kg on average) for 3.3years and had an average current BMI of 27.6kg/m2 . A control group of weight-stable individuals with obesity (n=619) had an average BMI of 38.9kg/m2 . The Multicontext Sitting Time Questionnaire and Paffenbarger physical activity questionnaire were administered. Weight-loss maintainers versus controls spent 3hours less per day sitting during the week (10.9 vs. 13.9; = 0.039; P=0.0001) and weekends (9.7 vs. 12.6; = 0.038). Weight-loss maintainers versus controls spent 1hour less per day in non-work-related sitting using a computer or video games during the week (1.4 vs. 2.3; = 0.03; P=0.0001) and weekends (1.5 vs. 2.5; = 0.03; P=0.0001). Weight-loss maintainers versus controls had similar numbers of sedentary-promoting devices (15.8 vs. 14.8) and expended significantly more calories per week in physical activity (1,835 vs. 785; = 0.036; P=0.0001). Weight-loss maintainers reported less time sitting than weight-stable individuals with obesity. Future research should test the efficacy of targeting sitting time to help promote long-term weight-loss maintenance.

Content validity and test–retest reliability with principal component analysis of the translated Malay four-item version of Paffenbarger physical activity questionnaire

PurposeThis study aimed to develop the construct validity for the Malay version of the Paffenbarger physical activity questionnaire (PPAQ) by adapting the original questionnaire to suit the local context.Design/methodology/approachThe PPAQ was adopted and translated into the Malay language and modified to reach good content agreement among a panel of experts. A total of 65 participants aged 22–55 years old, fluent and literate in the Malay language were selected. Principal component analysis (PCA) was used to investigate construct validity. Reliability of this adapted instrument was analyzed according to types of variables.FindingsThe panel of experts reached a consensus that the final four items chosen in the adapted Malay version of PPAQ were valid and supported by a good content validity index (CVI). In total, two domains consonant with the operational domain definition were identified by PCA. Based on scores from intensity and duration of exercise, the study further divided the group into who were physically active and those who chose the unstructured physical activity. Relative reliability after a 14-day interval demonstrated moderate strength of agreement with an acceptable range of measurement error.Research limitations/implicationsPPAQ has been used worldwide but was less familiar in the local context. The Malay-four item PPAQ will provide the locally validated version of physical activity questionnaire. In addition, the authors have improved the original PPAQ by dividing the question items into two distinct domains which will effectively identify those who are physically active and those who are involved in unplanned exercise. Nevertheless, further research is recommended in bigger and heterogeneous samples along with a number of reliability tests.Practical implicationsTo the authors’ knowledge, this is the first study to assess internal structure of the four-item version of PPAQ. This analysis successfully identified two components with eigenvalue more than one in the Malay four-item PPAQ. Based on this, the authors were able to separate pool of population into two groups, which are physically active and unplanned exercise (involved in unstructured exercise). The ability of the validated questionnaire to divide the population into various intensities of physical activity is a novel one, which may be useful in many public health studies where high intensity of physical activity; hence, greater energy expenditure is associated with increased longevity, better health benefit and improved cognitive function.Social implicationsIn addition, the second domain “unplanned exercise” was successfully grouped together. Implication of the unplanned exercise component is to identify pool of population with active lifestyle awareness and choose the unstructured exercise instead of vigorous and formal exercising. Even though the amount of intensity and duration of incidental exercise does not reach recommended public health recommendation, it has been proven that preferred healthier lifestyle is positively associated with better cognition in later life.Originality/valueThe adapted Malay version of PPAQ has sound psychometric properties and could assist in differentiating groups of population based on their physical activity.

Do Genetic Variations Predict Physical Activity Response To Lifestyle Intervention Among Obese Adults With Diabetes?

PURPOSE: Those who are prone to high physical activity (PA) in natural environments may respond better to a PA promotion intervention than those who are prone to low PA. A genome-wide association study (GWAS) and a candidate gene study identified 4 single nucleotide polymorphisms (SNPs) related to PA: rs978656 near DNAPTP6, rs10887741 near PAPSS2, rs7279064 near C18orf2, and rs6265 near BNDF. We hypothesized that the 4 SNPs will predict greater change in PA phenotypes in response to a lifestyle intervention. METHODS: This is a secondary analysis of Look AHEAD, a multi-center randomized controlled trial among participants who are overweight/obese and have type 2 diabetes (ages 45-76). Look AHEAD is designed to test the health benefits of an intensive lifestyle intervention (ILI), combining calorie restriction and PA promotion for weight loss, as compared to diabetes support and education alone. We examined the moderating effects of the 4 SNPs individually and in a weighted genetic score (GS). Of the 3649 participants who were successfully genotyped for all the 4 SNPs, we examined only those cases that also completed Paffenbarger PA questionnaire (PPAQ) and cardiorespiratory fitness (CRF) measures at baseline, year 1, and year 4 (n=2675). We used linear mixed effects models to regress PA phenotypes (PPAQ and CRF) on genetic variations, time, intervention, as well as interactions between the three. Models controlled for age, sex, body mass index, ancestry principal components (for population stratification), and study sites and included a Bonferroni correction for multiple testing. Additive, recessive, and dominant models were tested. RESULTS: None of the individual SNPs or the GS were associated with baseline CRF or PPAQ. The rs978656 interacted with time (year1) and intervention (p=0.04), such that the main effect of the intervention on CRF was significant (p=0.04) only among A allele carriers (less-PA-prone) at year 1; however, this finding did not persist following Bonferroni correction (alpha<0.006). GS was not predictive of change in CRF or PPAQ. Individual SNPs were not predictive of change in PPAQ. CONCLUSIONS: The ILI may have a more salient effect on CRF among A allele carriers of rs978656. Future intervention studies on the genetic basis of PA change are recommended to include more GWAS-identified SNPs.

THE EFFECTS OF A 16-DAY COURSE ON IMPROVEMENT IN ARMY PHYSICAL FITNESS TEST SCORES

Despite guidelines on the benefits of physical activity on improved quality of life and reduced levels of stress, an increasing number of adults do not meet the guidelines of at least 150-minutes of moderate physical activity per week. This may be a contributing factor relating to a growing population of military personnel who are unable to pass the Army Physical Fitness Test (APFT). PURPOSE: With this challenge in mind, we aimed to determine how attitudes, motivation, and knowledge of general health and wellness influenced a soldier’s ability to successfully pass the APFT. METHODS: Thirty-six national guard reservist men and women (age = 27 ± 5 yrs; weight = 91.2 ± 17.4 kg; height=1.7 ± 0.1 m) attended a 16-day course on health, wellness, and physical training. During the course, subjects had their body composition assessed via bioelectrical impedance. The APFT was completed five times over the course of four months with the first test occurring at the beginning of the course. At the start of the course and the final APFT, participants completed three questionnaires (BLOCK Fat Dietary Screener, Paffenbarger Physical Activity Questionnaire, and a modified Sports Motivation Scale-II). RESULTS: Passing rate in the APFT increased from 8.3% at the first test to a 22.7% passing rate after four months with the 2-mile run having the highest failure rate of the three events (push-ups, sit-ups, 2-mile run). On average, subjects lost 2.6 ± 3.9 kg which was statistically significant (p < 0.05) and saw a mean reduction of 1.6 ± 2% body fat percentage. There was no change in BLOCK Fat Dietary scores (31.8 ± 11.4 vs. 31.2 ± 12.5, p > 0.05) or the Paffenbarger physical activity index (2,184 ± 1548 vs. 2890 ± 1938 kcal/week, p > 0.05). Intrinsic motivation significantly increased pre to post-testing (12.9 ± 3.4 vs 16.6 ± 4.6, p < 0.001). CONCLUSION: The educational course was successful in increasing the passing rate of the APFT. More importantly, an increase in intrinsic motivation suggests a greater interest in the variety of training methods included in the curriculum which would decrease the monotony of the training and encourage their improvement in the APFT. Future studies need to explore the challenges of improving the two-mile run.

A Randomized Controlled Trial Comparing Two Different Approaches To Prescribe Exercise

The Physical Activity Guidelines for Americans (PAG) recommend 150min/wk of moderate intensity aerobic physical activity (PA) plus 2days of muscle strengthening PA for health. Yet, 26% of Americans and 36% of college students perform no leisure time PA, stressing the need to increase PA in these populations. PURPOSE: We conducted a randomized controlled trial (RCT) comparing two different exercise prescription (ExRx) approaches to increase PA among college students. The purpose of this interim analysis was to assess differences in the Transtheoretical Model stage of change (SOC) and drop-out (DO) rates at the 6wk mid-point (6W) of the RCT compared to baseline (BL) between the two ExRx approaches. METHODS: 60 sedentary, healthy college students >18yr were randomized to two groups: ExRx #1 emphasized meeting the PAG via the Frequency, Intensity, Time, and Type or FITT principle of ExRx; and ExRx #2 emphasized that all PA counts. Both ExRx approaches progressed students from being sedentary to meeting weekly PA goals over the 12wk PA intervention. The primary RCT outcome was the change in PA volume at 12wk, assessed via accelerometer and the Paffenbarger PA Questionnaire. At BL and 6W students completed the SOC to measure PA action transitions over time. Height (cm) and weight (kg) were measured to calculate the body mass index (BMI) at BL. DO was calculated as those who ceased participation at 6W divided by the total randomized sample x100. RMANOVA tested if SOC differed over time by group and Chi-Square tested if DO differed between groups. RESULTS: Subjects (n=32) were sedentary, overweight (BMI=26.0+4.2 m2/kg), healthy college students (24.7+5.2yo) with no differences in BL characteristics between ExRx groups or DO and completers (>0.05). At 6W DO was 28.1% for the total sample with no differences between ExRx groups (p>0.05). At 6W SOC increased from BL in both ExRx groups (p<0.001), but to a greater level in ExRx #1 of 3.6+1.2 indicating progression from the contemplation to action stage than ExRx #2 of 2.7+1.0 indicating progression from the contemplation to preparation stage (p=.045). DISCUSSION: Improvements in SOC suggest PA increased with both ExRx approaches at 6W. Whether these SOC improvements persist at 12wk and translate into greater increases in PA and lower DO remains to be determined.

Exercise and arrhythmic risk in TMEM43 p.S358L arrhythmogenic right ventricular cardiomyopathy

High-level exercise has been associated with a malignant phenotype in desmosomal and genotype-negative forms of arrhythmogenic right ventricular cardiomyopathy (ARVC). This is the first study to examine this issue with ARVC secondary to the TMEM43 p.S358L mutation. The purpose of this study was to evaluate the impact of exercise on arrhythmic risk and cardiac death in TMEM43 p.S358L ARVC. Individuals with the TMEM43 p.S358L mutation enrolled in a prospective registry who had received a primary prevention implantable cardioverter-defibrillator (ICD) were invited to complete the modified Paffenbarger Physical Activity Questionnaire to assess their physical activity in the year before their ICD implantation. Time-to-event analyses using unadjusted and adjusted Cox proportional hazards models evaluated associations between physical activity and first appropriate ICD discharge secondary to malignant ventricular arrhythmia or cardiac death. In 80 subjects with the TMEM43 p.S358L mutation, exercise ≥9.0 metabolic equivalent of task (MET)-hours/day (high level) in the year before ICD implantation was associated with an adjusted 9.1-fold increased hazard of first appropriate ICD discharge (there were no deaths) relative to physical activity <9.0 MET-hours/day (moderate level) (95% confidence interval [CI] 3.3-24.6 MET-hours/day; P < .001). The median age from birth to first appropriate ICD discharge was 58.5 years (95% CI 56.5-60.5 years) vs 35.8 years (95% CI 28.2-43.4 years) (P < .001) in subjects in moderate- and high-level exercise groups, respectively. Exercise ≥9.0 MET-hours/day is associated with an increased risk of malignant ventricular arrhythmias in the TMEM43 p.S358L subtype of ARVC. Extrapolating these data, we suggest molecular testing be offered in early childhood to inform exercise choices reflective of the genotype.

Muscle Size and Strengths and their Associations with Sports Participation among Young Adults

PURPOSE: A decision to participate in physical activity is heavily influenced by one’s self-efficacy related to exercise capacity, but it is not clear if muscle size and strength influence one’s decision to engage in sports and recreation. We examined this relationship and hypothesized that those with stronger and larger muscle would engage in more sports and recreation. METHODS: Subjects were young (23.4 ± 5.6yr), normal weight (24.4 ± 4.6 kg/m2) European-American women (n=227) and men (n=192). The Paffenbarger Physical Activity Questionnaire assessed self-reported weekly Kcal expended in sport and recreational physical activity. We obtained muscle size and strength on the dominant and non-dominant arms. Muscle strength was measured with the maximum voluntary contraction (MVC) and one repetition maximum (1RM), and muscle size by cross sectional area (CSA) using magnetic resonance imaging. Weekly sport and recreation participation was categorized by the median for purposes of statistical analysis. Logistic regression tested the associations among muscle size and strength and sport and recreation participation by gender adjusting for age and body mass index (BMI). Akaike Information Criterion was used to identify the most parsimonious model. RESULTS: On average, men spent about 1568.7±2397.5 kcal/wk and women spent 1732.2±2184.8kcal/wk in sports and recreation. Among men, a one-unit increase in dominant arm 1RM and MVC was associated with 16.9% (95%CI: 5.0-31.1%) and 2.3% (95%CI: 0.6-4.2%) higher odds of engaging in sports and recreation, respectively. Among women, a one-unit increase in non-dominant arm MVC was associated with 5.3% (95%CI = 2.2-8.7%) higher odds of engaging in sports and recreation, while a one- unit increase in non-dominant arm CSA was associated with 19.8 % (95%CI = 8.9-30.0%) lower odds of engaging in sports and recreation. CONCLUSIONS: As hypothesized, greater MVC predicted engaging in more sport and recreation for both men and women, but greater 1RM predicted engaging in more sport and recreation among men only. Contrary to our hypothesis, greater CSA (i.e., muscle size) predicted engaging in less sports and recreation among women only. The interactions among putative psychosocial mediators, muscle capacity, and sport and recreation participation warrants future investigation.

A genetic variant in IL-15Rα correlates with physical activity among European-American adults.

BackgroundInterleukin‐15 (IL‐15) is a myokine associated with muscle strength, possibly by attenuating protein breakdown. A variant in the alpha‐receptor (IL‐15Rα 1775 A>C, rs2228059) partially modulates the muscle strength and size response to resistance training. We examined if this polymorphism associated with habitual physical activity among European‐American adults.MethodsMen (n = 240, 23.7 ± 0.3 year, body mass index [BMI] 25.3 ± 0.3 kg/m2) and women (n = 292, 23.2 ± 0.3 year, 24.0 ± 0.3 kg/m2) were genotyped. Physical activity phenotypes were derived from the Paffenbarger Physical Activity Questionnaire. Analysis of covariance (ancova) tested log‐transformed differences between the IL‐15Rα genotype and physical activity phenotypes by gender with age and BMI as covariates.ResultsMen with the IL‐15Rα 1775AA genotype spent more time in light intensity physical activity (39.4 ± 2.4 hr/week) than men with the CC genotype (28.6 ± 2.3 hr/week, (p = .009).ConclusionFurther research is needed to confirm our finding and determine the possible mechanisms by which the IL‐15Rα variant modulates light intensity physical activity.

Comparing physical activity in individuals with overweight/obesity with and without binge eating disorder.

SummaryObjectiveDifferential participation in physical activity (PA) may partially explain the health discrepancies between individuals with or without binge‐eating disorder (BED). Yet, little is known about the PA habits of individuals with overweight/obesity and how those patterns may differ based on BED status. PA patterns and exercise self‐efficacy were examined in individuals with overweight/obesity, with and without BED.DesignNinety‐seven participants with overweight/obesity self‐reported their PA via the Godin Leisure‐Time Questionnaire and the Paffenbarger PA Questionnaire. Exercise self‐efficacy was assessed with the Marcus 5‐item Exercise Self‐Efficacy scale. Based on the Eating Disorder Examination, 27.8% (n = 27) of the participants met BED criteria. Participants were primarily female (n = 75, 77.3%), on average 47.5 years old (standard deviation = 10.4), and predominantly White/Not Hispanic (n = 67, 69.1%) or African–American/Not Hispanic (n = 18, 18.6%).ResultsHierarchical regressions, accounting for significant differences in body mass index between those with and without BED, showed that the Marcus 5‐item Exercise Self‐Efficacy Scale (but not BED status) was significantly related to PA. BED status also was unrelated to likelihood of reaching Centres for Disease Control PA guidelines, and 44.3% of all participants reported no participation in weekly sports/recreation activities.ConclusionsBoth groups participated in relatively little purposeful and moderate/strenuous PA. Exercise self‐efficacy may be important to assess and address among treatment seeking individuals with and without BED who struggle with excess weight.

Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial.

Background There is a significant health crisis with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs (SBWP). Mindfulness meditation (MM), with demonstrated benefits on physical, psychological health, and self-regulation behaviors was explored with SBWP. Methods Forty-six adults (BMI=32.5±3.7 kg/m2; age=45.2±8.2 years, 87 % female, 21.7 % African American) were randomly assigned to a 6-month SBWP only (n=24) or SBWP+MM (n=22) at a university-based physical activity and weight management research center in a northeastern US city. Participants were instructed to decrease intake (1200-1500 kcal/day), increase physical activity (300 min/wk), and attend weekly SBWP or SBWP+MM sessions. SBWP+MM had the same SBWP lessons with addition of focused MM training. Outcome measures collected at 0, 3, and 6 months included: weight, Block Food Frequency Questionnaire, Eating Behavior Inventory, Eating Inventory and Paffenbarger Physical Activity Questionnaire. Data were analyzed using linear mixed modeling for efficacy analysis of weight (primary) and eating, exercise and mindfulness (secondary outcomes). Results Retention rate was 76.1 % (n=35). A significant group by time interaction (p=0.03) was found for weight, with weight loss favoring SBWP+MM (-6.9 kg+2.9) over SBWP (-4.1 kg+2.8). Eating behaviors (p=0.02) and dietary restraint (p=0.02) improved significantly in SBWP+MM, compared to SBWP. MM enhanced weight loss by 2.8 kg potentially through greater improvements in eating behaviors and dietary restraint. Conclusions These findings support further study into the use of MM strategies with overweight and obese adults. The use of this low-cost, portable strategy with standard behavioral interventions could improve weight management outcomes.

Comparison of subjective and objective measures of office workers' sedentary time.

Sedentary behavior is an independent and prominent risk factor for chronic disease. Occupational sitting is likely to be the largest determinant of overall daily sitting time. Gathering accurate data on sedentary behaviors is essential to determine prevalence and effectiveness of interventions to reduce sedentary time. The purpose of this research was to determine whether self-reported sedentary time assessed by the Paffenbarger Physical Activity Questionnaire (PPAQ) and the Occupational Sitting and Physical Activity Questionnaire (OSPAQ) was related to objectively assessed sedentary time by the activPAL3 activity monitor. In the spring of 2015, 44 women employed full-time at Slippery Rock University participated in this study. Participants were predominantly Caucasian (95%), middle-aged (48 ± 10 years), and had an average BMI of 30.5 ± 8.2. A positive, weak correlation was found in sedentary time between the PPAQ (14.65 ± 2.77 h) and the activPAL3 (17.71 ± 1.46 h) over a 24 hour day (r = 0.253; p = 0.098; n = 44). Thirty-nine of the 44 participants significantly underestimated their sedentary time as compared to the activPAL3 (3.06 ± 2.76 h; p = 0.001). A positive, weak correlation was also found in sedentary time between the OSPAQ (5.96 ± 1.11 h) and the activPAL3 (5.69 ± 1.06 h) during the 8.5 hour work day (r = 0.100; p = 0.518; n = 44). Future studies examining sedentary behaviors should use caution when only considering the use of subjective recall surveys. This is especially true when self-reported behaviors are used to inform health promotion programs and create universal recommendations aimed to reduce sedentary time.

The angiotensin-converting enzyme insertion/deletion polymorphism rs4340 associates with habitual physical activity among European American adults.

BackgroundThe angiotensin‐converting enzyme (ACE) insertion/deletion (I/D) polymorphism (rs4340) (ACE DIP) accounts for half of the variability in plasma ACE concentrations. ACE has been widely studied for its influence on sports performance; however, research on its influence in physical activity is limited and inconsistent. We examined the influence of the ACE DIP on physical activity among 461 European Americans.MethodsSubjects completed the Paffenbarger Physical Activity Questionnaire for weekly walking distance. Multivariate analysis of covariance (MANCOVA) tested log‐transformed differences in weekly walking distance among ACE DIP genotypes (II, ID, DD) with gender as a fixed factor, and age and body mass index (BMI) as covariates. Because we found a significant ACE DIPxBMI interaction (P = 0.03), we categorized the sample by normal weight (NW: BMI<25.0 kg/m2) and overweight (OW: BMI ≥25.0 kg/m2) and repeated the MANCOVA with multiple comparison adjustments.Results NW adults with ACE II walked 15.8 ± 11.1 km/week, ID 13.2 ± 10.6 km/week, and DD 17.9 ± 13.0 km/week, with ID walking less than II (P = 0.03) and DD (P = 0.01). OW adults with ACE II walked 16.7 ± 12.6 km/week, ID 13.8 ± 11.6 km/week, and DD 9.7 ± 9.0 km/week, with DD walking less than II (P = 0.02). Weekly walking distance was 8.2 ± 2.4 km/week less among OW adults with ACE DD than NW (P = 0.02).Conclusion BMI interacted with ACE DD such that OW walked ~8.2 km/week less than NW, potentially equating to a body weight differential of ~3.5 kg annually.

Functional capacities of Polish adults of 60–87 years and risk of losing functional independence

Aim: To characterise the functional capacities of Polish men and women aged 60–87 years and evaluate their status relative to criteria for functional independence.Subjects and methods: Four hundred and thirty-one women and 125 men, aged 60–87 years, who were residents of Wrocław, southwestern Poland, were recruited. Height and weight were measured and BMI was calculated. The Fullerton Functional Fitness Test was administered to test upper and lower body strength, upper and lower body flexibility, agility-dynamic balance and aerobic endurance. The Paffenbarger physical activity questionnaire was completed. Characteristics of individuals classified by the number of tests which equalled or exceeded criterion-referenced standards for functional independence (excluding flexibility) were compared.Results: Polish older adults compared favourably to American reference values. Percentages meeting the criteria for all four, for two or three and for one or no tests were, respectively, 21%, 54% and 25% in women and 37%, 45% and 18% in men. Adults meeting the criteria for all four tests were lighter, with a lower BMI and more physically active than those meeting the criteria on two or three tests and on one or no tests.Conclusion: The majority of Polish older adults were not at risk for loss of physical independence. The most functionally independent adults of both sexes had a lower BMI and less obesity, and were physically more active; the converse was true for those not meeting the criteria.

Comparison of Objective and Subjective Sedentary Behavior

Physical activity decreases the risk of chronic disease, while sedentary behavior increases this risk. Questionnaires are an easy, inexpensive way to quantify sedentary behavior. However, there tends to be error with self-report. PURPOSE: To compare time in sedentary behaviors assessed via activity monitor (objective) with sedentary time assessed by self-report (subjective). METHODS: Office staff and administrators with a sedentary job description at a University were recruited. The activPAL3 activity monitor was placed on the participants’ (n=44) thigh and worn continuously for seven days. Participants completed the Occupational Sitting Questionnaire (OSPAQ) and Paffenbarger Physical Activity Questionnaire (PPAQ) for the timeframe that the activPAL3 was worn. Data were expressed in total time (hrs/day) spent sedentary over a typical work week. A Pearson Product Correlation was utilized to examine the relationship between the subjective sedentary time at work (OSPAQ) and over a 24 hr period (PPAQ) and objective (activPAL3) sedentary time. The agreement between the objective and subjective assessments was evaluated using a Bland-Altman analysis. Differences between objective and subjective scores for each individual were calculated and the mean error was determined. RESULTS: Participants were predominantly Caucasian (95%), middle-aged (48 y + 10), and had an average BMI (30. 5 + 8.2). A positive, weak correlation between sedentary time assessed subjectively from the OSPAQ (r = .100; p = .518) and PPAQ (r = .317; p = .036), and objectively by the activPAL3 activity monitor was found. The mean error of the sedentary time estimated during the workday was approximately one hour (1.07 + 1.02) and approximately four hours (3.52 + 2.31) for the entire day, with most participants underestimating sedentary time. The Bland Altman analysis found no systematic bias in the OSPAQ (p = .743), while a trend of proportional underestimation bias in the PPAQ (p = .001) was found relative to the activPAL3 measures. CONCLUSION: Self-reported sedentary time subjectively assessed by the PPAQ and OSPAQ was weakly correlated to sedentary time objectively assessed by the activPAL3 activity monitor over a 24 hour period and while at work. The lack of a relation demonstrated substantial error in self-reported assessment.

Outcomes of Amputations Versus Limb Salvages Following Military Lower Extremity Trauma

Objective: to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. Methods: this is a retrospective cohort study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, a complete compartment injury/compartment syndrome. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to measure overall function. Standard instruments were used to measure depression (the Center for Epidemiologic Studies Depression Scale), posttraumatic stress disorder (PTSD Checklist-military version), chronic pain (Chronic Pain Grade Scale), and engagement in sports and leisure activities (Paffenbarger Physical Activity Questionnaire). The outcomes of treatment were compared by using regression analysis with adjustment for age, time until the interview, military rank, upper-limb and bilateral injuries, social support, and intensity of combat experiences. Results: overall response rates were modest (59.2 %) and significantly different between those who underwent amputation (64.5 %) and those treated with limb salvage (55.4 %) (p = 0.02). Also, 38.3 % screened positive for depressive symptoms and 17.9 %, for posttraumatic stress disorder (PTSD). One-third (34.0 %) were not working, on active duty, or in school. After adjustment for covariates, participants with an amputation had better scores in all SMFA domains compared with those whose limbs had been salvaged (p &lt; 0.01). They also had a lower likelihood of PTSD and a higher likelihood of being engaged in vigorous sports. Conclusions: major lower-limb trauma sustained in the military results in significant disability. Service members who undergo amputation appear to have better functional outcomes than those who undergo limb salvage. Caution is needed in interpreting these results as there was a potential for selection bias.

The Angiotensin Converting Enzyme Insertion/Deletion Polymorphism Associates with Habitual Physical Activity among European-American Adults

PURPOSE: The angiotensin converting enzyme (ACE) insertion (I) deletion (D) polymorphism (ACE DIP) (rs4340) is a 287 base pair sequence within intron 16 of chromosome 17q23 that accounts for half of the variation in plasma ACE levels. Due to its influence on cardiovascular and renal function, the ACE DIP has been examined for its association with sport performance. The literature regarding associations with habitual physical activity is limited and inconsistent. We examined associations of the ACE DIP and physical activity among 461 European-American adults. METHODS: 203 men and 258 women with a body mass index (BMI) of 24.3±4.8 kg·m2 completed the Paffenbarger Physical Activity Questionnaire to determine weekly walking distance. ACE II (n=119), ID (n=213), and DD (n=129) genotypes were determined using TaqMan allele discrimination assays. Multivariate analysis of covariance (MANCOVA) determined logtransformed differences among ACE DIP genotypes and weekly walking distance with gender as a fixed factor and age and BMI as covariates. Because a significant ACE DIPxBMI interaction was found (p=0.03), we categorized the sample into normal weight (NW:BMI≤24.9 kg·m2) and overweight (OW:BMI>24.9 kg·m2). We repeated the MANCOVA with gender and BMI groups as fixed factors and age as a covariate. Bonferroni corrections were used to control for multiple comparison testing with alpha levels at p<.05. RESULTS: For NW (BMI=21.7±1.8 kg·m2), participants with the ACE II reported walking 1.4±1.0 mi/wk, ID 1.2±0.9 mi/wk, and DD 1.6±1.2 mi/wk, with ID walking less than II and DD (p<0.05). For OW (BMI=29.6±4.4 kg·m2), participants with the ACE II reported walking 1.5±1.1 mi/wk, ID 1.2±1.0 mi/wk, and DD 0.6±0.8 mi/wk, with DD walking less than II (p=0.02). For NW vs OW, weekly walking distance was 1.0±2.2 mi/wk less among OW with the ACE DD genotype than NW with this genotype (p=0.02); there were no other genotype-physical activity differences within or between NW and OW (p>0.05). CONCLUSIONS: BMI interacted with ACE DD to modulate habitual physical activity levels such that weekly walking distance was ~1.0 mi/wk greater among NW than OW with ACE DD. Our findings may provide insight into the discrepancies of this literature, and have public health significance equating to a body weight differential of ~1.4 lb/yr.

THE EFFECT OF EXERCISE ON TIME TO APPROPRIATE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR THERAPY OR DEATH IN SUBJECTS WITH ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY SECONDARY TO A TMEM43 P.S358L MUTATION

Arrhythmogenic right ventricular cardiomyopathy (ARVC) can lead to malignant ventricular arrhythmias, right ventricular and occasionally left ventricular dysfunction as well as sudden cardiac death (SCD). Competitive sports have been associated with SCD in ARVC presumably by accelerating the disease process and triggering terminal arrhythmias during the elevated adrenergic state. The purpose of this study was to assess the effect of exercise on expression of the disease phenotype in a genetically homogeneous cohort of ARVC patients with a TMEM43 p.S358L mutation. Subjects with implantable cardioverter-defibrillators (ICD) were identified from fifteen families shown to have ARVC caused by a p.S358L mutation in TMEM43. Consecutive patients with the p.S358L mutation were ascertained (n=110). Of these, 24 who received ICDs for secondary prevention were excluded; of the remaining 86 eligible patients, 83 were enrolled, following informed consent, in this study. All participants were administered the Paffenbarger Physical Activity Questionnaire to assess their level of physical activity in the 12 month period prior to receiving their ICD. This was used to estimate the number of MET-hours/day these participants were expending prior to ICD implantation. The primary outcome measure was a composite of first appropriate ICD discharge for VT/VF or death. Quartiles of physical activity were categorized as ≤9.9, 10-13.6 and ≥13.7 MET-hours/day. The mean times to first appropriate ICD discharge or death were 7.22, 5.08 and 2.63 years respectively (p=0.003). Survival curves are shown in Figure 1. This study demonstrates a clear dose-response relationship between level of physical activity in the year preceding ICD implantation for ARVC caused by TMEM43 p.S358L and progression to first appropriate ICD shock or death. This is consistent with with the hypothesis that exercise modifies the phenotype expression in ARVC patients. Data from others assessing the effects of physical activity on ARVC studied heterogeneous desmosomal mutations patient cohorts and demonstrated increased phenotypic expression of Task Force Criteria in “endurance athletes”. Our study demonstrates the novel finding of increased arrhythmic burden in a genetically homogeneous group of ARVC ICD patients associated with increased physical activity level. These results should inform physicians when advising subjects with this mutation on appropriate levels of physical activity.