Physical Activity Guidelines Research Articles

Abstract 2227: Physical activity at breast cancer diagnosis and incident cardiovascular disease in the Pathways Study

Abstract Background: Breast cancer survivors are at increased risk of cardiovascular disease (CVD) compared to women without a history of breast cancer. Although cardiotoxic cancer treatments influence these risks, lifestyles that are associated with both breast cancer and CVD also contribute. With the number of breast cancer survivors expected to increase, a growing need exists to identify modifiable risk factors that protect against the development of CVD after diagnosis. Physical activity at breast cancer diagnosis is associated with lower cancer recurrence and mortality risk. However, associations between physical activity at diagnosis and incident CVD have yet to be investigated in detail. Methods: The Pathways Study is a prospective cohort study of 4,504 women who were members of Kaiser Permanente Northern California (KPNC) when diagnosed with first primary invasive breast cancer between 2005 and 2013. At enrollment, women self-reported their frequency, duration, and intensity of physical activities during the previous six months using the Arizona Activity Frequency Questionnaire. This information was used to dichotomize the women’s physical activity levels by the CDC’s Physical Activity Guidelines for Americans (≥ 150 minutes of moderate-to-vigorous physical activity per week vs less). CVD events were obtained from electronic health records as part of the Pathways Heart Study and were defined as post-diagnostic incidence of ischemic heart disease, heart failure, cardiomyopathy, and stroke. Deaths were documented through several sources, including the National Death Index. Women were followed until the first of disenrollment from the KPNC health plan, death, or December 31, 2021. Competing risk Cox regression models were used to estimate associations between meeting CDC physical activity guidelines and CVD. Results: In this cohort of breast cancer survivors, women who self-reported meeting physical activity guidelines at diagnosis experienced lower rates of post-diagnostic CVD events (8.6% vs 13.1%). After adjustment for socio-demographic factors, meeting physical activity guidelines remained associated with lower risk of CVD (HR: 0.78, 95% CI: 0.61, 0.98); this association appeared to be driven by reduced risk of heart failure (HR: 0.68, 95% CI: 0.50, 0.93) and cardiomyopathy (HR: 0.51, 95% CI: 0.28, 0.92). Approximately 15% of the CVD risk reduction in Pathways Study participants can be attributed to meeting physical activity guidelines (population attributable risk percent: 14.5%, 95% CI: 8%, 21%). Conclusions: Compared to women who did not meet CDC physical activity guidelines, women who reported meeting guidelines near the time of their breast cancer diagnosis had decreased risk of future CVD, including heart failure and cardiomyopathy. Future studies investigating changes in post-diagnostic physical activity patterns and CVD risk are warranted. Citation Format: Jacob K. Kresovich, Alicia R. Richards, Isaac J. Ergas, Cecile A. Laurent, Rikki Cannioto, Jamal S. Rana, Janise M. Roh, Catherine Thomsen, Salma Shariff-Marco, Eileen Rillamas-Sun, Richard K. Cheng, Song Yao, Christine B. Ambrosone, Lawrence H. Kushi, Heather Greenlee, Marilyn L. Kwan. Physical activity at breast cancer diagnosis and incident cardiovascular disease in the Pathways Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2227.

Abstract 5403: Meeting the Physical Activity Guidelines is associated with increased CD8+ T-cell density in the tumor microenvironment of breast cancer patients

Abstract Background: Our current understanding of how physical activity (PA) is associated with immunity in breast cancer (BC) patients is based on pre-clinical evidence gleaned from mouse models or immune cells in the circulating blood, which may not be reflective of the tumor immune microenvironment (TIME). Whether self-reported PA is associated with immune cell infiltration in the breast TIME, the most relevant site for prognosis, remains a fundamental gap in knowledge. Herein, we examined the association of self-reported PA in the year before BC diagnosis with CD8+ T-cell density in the breast TIME. As prior evidence from healthy adults suggests the relationship between exercise and immunity is not linear, we hypothesized that patients reporting the highest PA level would not have the highest CD8+ T-cell density in their tumor. Methods: We leveraged data and tumor samples from 685 women with BC (548 self-identified Black and 137 self-identified White) enrolled in the Women’s Circle of Health Study and the Women’s Circle of Health Follow-Up Study. CD8+ T-cell density per square millimeter of tumor tissue was derived from IHC staining of tissue microarrays. Weekly PA in the year before diagnosis was categorized as inactive; low active (<7.5 MET hours/week); moderately active [7.5-14.9 MET hours/week, the equivalent of meeting the minimum PA Guidelines (PAG)]; or high active (≥15.0 MET-hours/week, exceeding the minimum PAG). Log transformed mean CD8+ T-cell densities were compared by PA level using t-tests and multivariable linear regression with adjustment for age, race, estrogen receptor status, and tumor grade. Results: Meeting the minimum PA Guidelines was associated with significantly higher CD8+ T-cell density in the breast TIME [120.4 (353.6)] in comparison to inactivity [62.0 (154.5), p=0.02]. Although there were also distinct differences in T-cell density between moderate and low-active patients [120.4 (353.6) versus 69.5 (172.6), p=0.10] and moderate and high-active patients [120.4 (353.6) versus 80.7 (223.3), p=0.051], associations were shy of significance. Multivariable linear regression analyses confirmed that moderately active patients had significantly higher CD8+ T-cell density in comparison to inactive patients, overall (p=0.029), and among Black patients (p=0.021). Conclusions: In comparison to inactivity, BC patients meeting the PAG (moderate activity) had significantly increased CD8+ T-cell density in their tumor, which is associated with better survival outcomes. This new translational knowledge suggests exercise-induced immunomodulation may be an important molecular mechanism underlying the association of PA with improved BC survival. As the immune system is a key player in treatment response and efficacy, further study of the role that PA ancillary to therapy may play in improving treatment and survival outcomes is warranted. Citation Format: Rikki Cannioto, Angela Omilian, Evan Davis, Lucas Mendicino, Scott Abrams, Bo Qin, Chi-Chen Hong, Elisa Bandera, Song Yao, Christine Ambrosone. Meeting the Physical Activity Guidelines is associated with increased CD8+ T-cell density in the tumor microenvironment of breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5403.

Abstract 2223: Cancer risk factors and nativity: Lifestyle and sociodemographic disparities among us-born and non-us-born residents and by length of residence in the US

Abstract Background: Previous studies have found racial/ethnic disparities in cancer and cancer-related risk factors. However, the relationship between US nativity status and cancer risk is not well understood. This study aimed to determine the relationship between cancer risk factors, including lifestyle behaviors, demographic characteristics, and nativity status, among US residents. Methods: We used data from the 2010 and 2015 National Health Interview Survey (NHIS). All analyses accounted for the NHIS complex survey design. Our sample consisted of 31,252 US-Born and non-US-born residents. Regression models were employed to assess the association of US nativity with various lifestyle and demographic variables, adjusting for potential confounders such as age, race, sex, education, income, and employment status. Results: In our sample, 25,153 (82.73%) were US-born. Among non-US-born respondents (n=6,099), 35.13% have resided in the US for less than 15 years, and 64.87% for greater than 15 years. 80.19% of US-born individuals identified as non-Hispanic White (NHW), followed by non-Hispanic Blacks (NHB) (11.71%), and Hispanics (8.10%). For non-US-born residents, 63.67% identified as Hispanic, followed by NHW (24.21%), and NHB (12.12%). Non-US-born individuals had lower odds of consuming red meat (aOR=0.60, 95% CI: 0.47-0.75), and processed meat (aOR=0.36, 95% CI: 0.31-0.43) compared to their US-born counterparts. Notably, non-US-born individuals had significantly higher odds of never smoking (aOR=1.58, 95% CI: 1.35-1.83), never drinking (aOR=2.45, 95% CI: 2.05-2.93), and consuming grains (aOR=1.45, 95% CI: 1.25-1.68) in comparison to US-born individuals. Conversely, non-US-born individuals had lower odds of meeting physical activity guidelines (aOR=0.77, 95% CI: 0.59-0.99), and consuming fruits (aOR=0.86, 95% CI: 0.74-0.99), and consuming vegetables (aOR=0.83, 95% CI: 0.71-0.97). Additionally, non-US-born respondents had higher odds of being overweight/obese compared to normal weight (aOR=1.36, 95% CI: 1.16-1.60) compared to US-born respondents. When considering the length of time in the US, non-US-born residents with greater than 15 years of residence had lower odds of being normal weight compared to overweight/obese (aOR=0.78, 95% CI: 0.63-0.97), and never drinking alcohol (aOR=0.73, 95% CI: 0.56-0.93). Discussion: These disparities highlight the association of nativity and length of residence on health-related behaviors and outcomes in the United States, and the need for targeted public health interventions considering nativity and residency duration to address these health disparities. Citation Format: LaShae D. Rolle, Melissa Lopez-Pentecost, Reanna Clavon, Atif Bhatti, Zuhair Khan, Tracy E. Crane. Cancer risk factors and nativity: Lifestyle and sociodemographic disparities among us-born and non-us-born residents and by length of residence in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2223.

Associations between levels of physical literacy and adherence to the 24-h movement guidelines among university students: A cross-sectional study

ObjectivesEmerging evidence indicates that the composition of movement behaviours within a 24-h period is associated with multiple health benefits across the lifespan. A concept that emphasises an individual's active lifestyle is physical literacy (PL), yet empirical research exploring the potential associations between PL and 24-h movement guidelines remains scarce. This study aimed to evaluate the associations between levels of PL and adherence to the guidelines among Chinese university students. Study designA cross-sectional study. MethodsSeven hundred and ninety-eight university students (390 male, 19.2 ± 1.2 years) completed all the measurements. Levels of PL and participants’ adherence to guidelines including physical activity, sedentary behaviour and sleep were self-reported through Perceived Physical Literacy Instrument, International Physical Activity Questionnaire and Pittsburgh Sleep Quality Index, respectively. Two-way ANOVA was conducted to determine the associations between the number of guidelines met (0, 1, 2, or 3) and levels of PL. ResultsThe results demonstrate that 36.5% (n = 291) of the participants met all the three guidelines, while 4.1% (n = 33) met none. Further analysis indicated that meeting physical activity or sedentary behaviour guidelines was associated with significantly higher total PL scores, and scores in the sub-domains of Confidence and Physical Competence and Motivation. ConclusionsThe findings provide evidence that young adults who obtained higher PL scores may meet more guidelines during a 24-h period. Future studies should incorporate accelerometer-based physical activity measurements and investigate the causal relationship between PL and adherence to the movement guidelines.

Abstract 13: Associations Between Leisure-Time Physical Activity and Mortality by Sociodemographic Factors in a Nationally Representative Sample of 567,483 US Adults

Introduction: The 2018 Physical Activity Guidelines Advisory Committee Scientific Report called for investigating whether the established health benefits of meeting physical activity guidelines (PAG) differ by sociodemographic factors. Guidelines for adults recommend engaging in muscle-strengthening activities (MSAs; ≥2 days per week) and moderate-to-vigorous aerobic physical activity (MVPA; ≥150 minutes per week at moderate intensity, ≥75 minutes per week at vigorous intensity, or an equivalent combination). Objective: To examine associations between meeting MVPA and MSA guidelines (combined PAG) in leisure time and all-cause and heart disease mortality across sociodemographic factors. Methods: We used nationally representative data on 567,483 adults from the 1998-2018 US National Health Interview Survey (NHIS) and 2019 public-use linked mortality files from the National Death Index. Median follow-up was 9.5 years (range=1-21.8 years). We classified participants into categories (met combined PAG, met MVPA only, met MSA only, met neither) based on reported leisure-time physical activity. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between meeting the combined PAG vs. meeting neither guideline and all-cause and heart disease mortality, overall and stratified by sex (women, men), race and ethnicity (six groups), or education (four levels). Models were adjusted for sociodemographic and health factors. We conducted pairwise comparisons (adjusted for multiple comparisons) to determine if associations differed across sociodemographic factors. Results: Compared to meeting neither PAG, meeting the combined PAG was associated with a reduced mortality risk between 14-36% for all-cause mortality and 25-52% for heart disease mortality across sociodemographic groups. Reductions in mortality risk were larger for some groups compared with others. For example, reduction in all-cause mortality was larger for non-Hispanic White compared with Hispanic or Latino adults (HR=0.66 [95% CI: 0.64-0.69] vs. 0.86 [0.75-0.99]; pairwise p <0.001) and for people with more vs. less education (college or more=0.64 [0.60-0.69] vs. less than high school=0.75 [0.69-0.82]; p <0.001). Reduction in heart disease mortality was larger for women compared with men (0.54 [0.48-0.62] vs. 0.66 [0.60-0.73]; p <0.001). Conclusions: Meeting the guidelines for MVPA and MSA generally provides a substantial reduction in risk of all-cause and heart disease mortality. There may be differences in the magnitude of benefit physical activity provides for health across sociodemographic groups. The reasons for these differences are unclear. Identifying factors contributing to these differences would further address research gaps identified in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.

Abstract P222: Prolonged Sitting Time Was Associated With Central Obesity-Related Parameters Among Hong Kong Chinese Women: A Cross-Sectional Study

Introduction: The evidence concerning the association between sitting time and central obesity in Hong Kong Chinese women was still scarce. Hypothesis: Prolonged sitting time was positively associated with increased waist circumference (WC), hip circumference, and trunk body fat percentage; and also larger waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) among Hong Kong Chinese women. Methods: Data were extracted from a cohort study named “Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women”. The baseline data (2019-2021) were used for analysis. Sitting time and physical activity level were measured by the International Physical Activity Questionnaire short form. Body weight, height, WC, hip circumference, and trunk body fat percentage were measured according to standard protocol. The WHR and WHtR were then calculated. Central obesity was defined as WC ≥80.0 cm. Subgroup analysis were conducted based on age (≥60 and <60 years) and whether participants met the recommended physical activity guidelines (≥75 minutes/week of vigorous physical activity or ≥150 minutes/week of moderate-intensity physical activity). Results: A total of 3,280 Hong Kong Chinese women aged 56.46±8.30 years were included. The overall prevalence of central obesity was 32.26% (1,058 of 3,280). Participants with central obesity had a longer sitting time compared to those without (8.01±3.27 vs. 7.60±3.25 hours/day, P =0.001). After adjusting for age, education, living alone or with family members, drink, smoking, and physical activity, each additional hour of daily sitting time was significantly correlated with 0.678 unit increase in hip circumference ( P <0.001), 0.003 unit increase in WHR ( P =0.004), 0.004 unit increase in WHtR ( P =0.002), and 5.485 unit increase in trunk body fat percentage ( P <0.001). With a one-unit augment in sitting time, the odds of being central obesity was 1.187-fold higher ( 95% CI= 1.108-1.587, P <0.001). In subgroup analysis, the sitting time-central obesity association was significant in women aged ≥60 years ( OR =1.192, 95% CI= 1.085-1.309, P <0.001). Whereas, such positive association existed both in women who did not meet the physical activity guidelines ( OR =1.413, 95% CI =1.011-1.977, P =0.043, 8+ vs. <8 hours/day) and those who adhered to the guidelines ( OR =1.326, 95% CI =1.108-1.587, P =0.002, 8+ vs. <8 hours/day). Conclusions: Longer sitting time exhibited a positive relationship with central obesity-related indices in terms of WC, hip circumference, trunk body fat percentage, WHR and WHtR. The significant association between sitting time and central obesity was only observed in older women, but it remained consistent and robust regardless of whether the subjects followed the recommended physical activity guidelines.

Abstract P213: Examining Sociodemographic Disparities in Physical Activity and Diabetes: Preliminary Findings From 2007-2020 National Health and Nutrition Examination Survey

Purpose: Physical activity (PA) plays a crucial role in preventing diabetes, but few studies have examined whether sociodemographic factors were associated to PA, and PA and sociodemographic factors were related to diabetes. We aimed to 1) examine associations between sociodemographic factors and PA, and 2) investigate whether PA and sociodemographic are related to the prevalence of diabetes. Methods: Data came from the 2007-2020 National Health and Nutrition Examination Survey (NHANES), a series of cross-sectional cohort studies (total sample=30,788, Female: 49.1%, mean age =49.6). Two binary outcomes included: 1) Meeting PA guidelines (≥500 MET minutes/week) and 2) diabetes (yes/no). Sociodemographic variables included age group (20-44 [referent], 45-64, 65-79), sex, race/ethnicity (White [referent], Black, Hispanic, and other adults), and poverty income ratio (low, middle, high-income [referent]). PA guideline was also considered as exposure for diabetes analysis. By accounting for the complex survey design, two weighted generalized Poisson models were used to conduct the analyses, adjusting for covariates. Results: Model 1 showed that participants aged 45-64 and 65-79 had 14% and 16% lower likelihood of meeting PA guidelines than those aged 20-44. Females had an 18 % lower likelihood of meeting PA guidelines than males. Furthermore, Black, Hispanic, and other racial/ethnic adults were 7%, 8%, and 12% less likely to meet the PA guidelines than White adults. Adults with low- and middle-income had 13% and 8% lower likelihood of meeting PA guidelines than those with high income. Model 2 showed that participants from 2017-2020 were 22% more likely to have diabetes (AOR = 1.22) than those from 2007-2008. Adults aged 45-64 and 65-79 years had a 4.35- and 7.36-times higher likelihood of having diabetes than those aged 20-44. Females had a 25% lower likelihood of having diabetes than males. Black, Hispanic, and other groups were 49%, 35%, and 73% more likely to have diabetes than White adults, respectively. Adults with low- and middle-income had a 52% and 32% higher likelihood of having diabetes than those with high income. Adults meeting PA guidelines had a 28% lower likelihood of having diabetes than those not meeting the PA guidelines. Conclusion: The study highlights persistent disparities in PA levels and diabetes across different sociodemographic groups within the U.S. population. Future interventions targeting diabetes should prioritize addressing these disparities among vulnerable populations who do not meet PA guidelines. Emphasis should be placed on promoting PA as an integral component of diabetes prevention.

Abstract MP77: Both Racial/Ethnic Residential Segregation and Exposure to Outdoor Artificial Light at Night May Impact Cardiovascular Health but Perhaps Not Through Self-Reported Sleep

Introduction: Due to structural racism, minoritized racial/ethnic groups are overrepresented in racially segregated areas of concentrated disadvantage in which residences may be less protective against outdoor artificial light at night (ALAN). Both racial/ethnic residential segregation (RRS) and ALAN are associated with disparities in both sleep duration, potentially through ALAN exposures in segregated areas disrupting melatonin production, and cardiovascular health (CVH). However, few studies have investigated pathways between RRS and ALAN, sleep, and CVH. We sought to investigate sleep duration as a potential mediator between RRS and ALAN exposures and CVH among US adults. Hypothesis: We hypothesized that (1) ALAN would disproportionately burden minoritized racial/ethnic groups, (2) sleep duration would mediate associations between both RRS and ALAN and CVH, and (3) associations would vary by race/ethnicity. Methods: We used data collected from 2011 National Health Interview Survey adult participants reporting sleep duration (short [<7 hours(h)]), recommended [7-9 h], long [>9 h]) and CVH (defined as yes vs. no to all: never/former smoking, BMI 18-<25 kg/m 2 , meets physical activity guidelines, and no prior diagnosis of dyslipidemia, hypertension, or pre-diabetes/diabetes). Participants’ home addresses were geographically linked to the 2012 American Community Survey 5-year estimates to assess RRS, measured by the local Getis-Ord G i * statistic (z-scores) categories: low (z<0), medium (0≤z≤1.96), and high (z>1.96). Quintiles of residential ALAN were estimated from 2010-2011 US Defense Meteorological Satellite Program’s Operational Linescan System values. We used robust Poisson regression adjusted for sociodemographic characteristics, estimated mediation through sleep duration with the Sobel’s test, and assessed effect modification by race/ethnicity. Results and Conclusions: Among 18,057 participants (mean age±SE =45±0.2 years); 35%, 44%, and 21% resided in low, medium, and highly segregated neighborhoods, respectively. ALAN was highest among non-Hispanic White adults. Prevalence of short and long sleep duration overall were 31% and 3% and highest among Black adults (39% and 4%). High (vs. low) RRS was associated with a higher prevalence of CVH (PR=1.13 [95% CI:1.01-1.26]). However, higher ALAN (Q5 vs. Q1) was associated with a lower prevalence of CVH (PR=0.79 [95% CI:0.66-0.95]). Sleep did not appear to mediate associations, which did not vary by race/ethnicity. In conclusion, self-reported sleep did not mediate associations between RRS or ALAN and CVH. Nonetheless, further study using objective measures is warranted given the biological plausibility. The findings/conclusions in this research are those of the authors and do not necessarily represent the views of the Research Data Center, National Center for Health Statistics, or CDC.

Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada

BackgroundPhysical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada.MethodsWe used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics.ResultsThree distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males.ConclusionsFindings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.

Abstract P362: Differences in Cardiovascular Health, Physical Activity Determinants, and Desired Intervention Components in Individuals With a History of Hypertensive Disorders of Pregnancy by Activity Level

Introduction: Hypertensive Disorders of Pregnancy (HDP) affects ~16% of pregnancies and is associated with a 2- to 4-fold greater risk of cardiovascular disease (CVD). Physical activity (PA) is a known modifiable risk factor for CVD; however, little is known about the CVD risk factors potentially related to postpartum PA after HDP. More research is also needed examining specific behavioral determinants influencing postpartum PA and a postpartum PA intervention would be desired. Purpose: To assess differences in CVD risk factors, behavioral determinants of PA, and desired PA intervention components among postpartum individuals with HDP, stratified by PA level. Hypothesis: Inactive individuals will have more CVD risk factors, different behavioral determinants and desired PA intervention components compared to active individuals after HDP. Methods: Individuals residing in Iowa who were <1 year postpartum and experienced a HDP were recruited to complete online surveys assessing demographics, PA, CVD risk factors, behavioral determinants of PA (e.g., barriers and facilitators of PA), and desired PA intervention components. Individuals were classified as active or inactive using the 2018 PA guidelines for Americans. Results: Participants (N=72) were 30±6 years old, mostly white (84%), and 54% were sufficiently active. Inactive individuals were more likely to be diagnosed with hypertension after delivery, had lower CVD knowledge, and were 2.9 times less likely to identify facilitators of PA compared to active individuals (Table; p<0.05). All indicated interest in a postpartum PA intervention, with inactive individuals expressing greater interest in information on postpartum PA safety, PA while breastfeeding, and social media interventions compared to active individuals (Table; p<0.05). Preferred communication included text, email, and video call. Conclusions: Development of PA interventions after HDP should consider the unique needs of individuals across current postpartum activity levels.

Abstract P215: Activity Behaviors and Cardiometabolic Health Outcomes in People Living With HIV

Introduction: Physical activity (PA) and sedentary behavior (SB) are independently associated with cardiometabolic health; data on activity behaviors and cardiometabolic health among people living with HIV (PWH) are limited. Hypothesis: Activity behaviors would differ by age and that not meeting PA Guidelines would be associated with an increased risk of cardiometabolic diseases among PWH. Methods: Using NHANES 2007-08 through 2017-18, PWH (n=125; age 44.3 yrs) were characterized as emerging (18-29 yrs), early (30-44 yrs) and middle (45-59 yrs) adulthood. Achieving Guidelines (≥150 min/wk) was derived from self-reported PA across three domains. SB was reported as time spent sitting. Chronic conditions were high cholesterol, obesity, hypertension, and chronic kidney disease. Prevalence estimates of joint high SB (≥8 h/day) and inactivity (<10 min/wk) were calculated, and regression models were used to estimate differences in behaviors by age and investigate the association between achieving Guidelines and chronic conditions. Results: PWH reported 395.8 min/day of SB with 37.5% spending over 8 h/day sitting. There was no significant difference in SB across lifestage. A total of 67.2% achieved Guidelines although 14% were jointly inactive and highly sedentary. Compared with early adult PWH, middle adult PWH spent more time performing transport-related PA (β= 102.7 min/wk, p =0.009) and less time performing leisure-time PA (β= -211 min/wk, p =0.044) ( Figure ). Compared with PWH meeting Guidelines , those that did not meet Guidelines had higher diastolic blood pressure (β= 6.1 mmHg [CI: 2.6, 9.6]) and higher odds of obesity (OR=2.5[CI: 1.0, 6.4]). Conclusions: Domain-specific differences occurred in transportation and leisure time PA among PWH - a high-risk group for cardiovascular disease. Not meeting the Guidelines resulted in greater odds of obesity and higher diastolic blood pressure. Future research should incorporate device-based measures of movement to understand its relation to chronic disease in PWH.

Association between meeting 24‐h movement guidelines and academic performance in a sample of 67,281 Chinese children and adolescents

AbstractThis study aimed to explore the association between meeting 24‐h movement guidelines and academic performance among Chinese children and adolescents. Cross‐sectional data on 67,281 Chinese children and adolescents were used for the analyses. Adherence to 24‐h movement guidelines and academic performance (i.e., grades in Chinese, Math, and English), as well as sociodemographic information, were measured using a self‐reported questionnaire. 24‐h movement guidelines recommend at least 60 min/day of moderate to vigorous physical activity (MVPA), no more than 2 h/day of recreational screen time (ST), and 9–11 h/night of sleep for ages 11–13 years or 8–10 h/night for ages 14–17 years. Multilevel generalized linear models were used to explore the associations between 24‐h movement guidelines and academic performance. Results indicated that compared to not meeting any of the three 24‐h movement guidelines, participants meeting one or more guidelines were more likely to report better academic performance in Chinese, Math, and English. Meeting all the three guidelines was associated with better academic performance in Chinese (odds ratio [OR] = 1.56), Math (OR = 1.51), and English (OR = 1.73). Additionally, meeting the physical activity (PA) guidelines only was associated with better academic performance in Chinese; meeting only the ST guidelines, both ST and sleep guidelines, and both ST and PA guidelines were associated with better academic performance in Chinese, Math, and English. Subgroup analyses indicated that the associations between 24‐h movement guidelines and academic performance varied across grade groups and course subjects. As such, in general, adherence to 24‐h movement guidelines was related to better self‐reported academic performance. Healthy movement behaviors should be promoted for health and academic achievement in Chinese children and adolescents.

Examining the relationship between meeting 24-hour movement behaviour guidelines and mental health in Chinese preschool children.

Limited research has explored the relationship between adhering to 24-h Movement Behaviour guidelines and mental health in Chinese preschool children. The objectives of this study encompassed two primary goals: (1) to investigate the adherence of preschool children in China to the 24-h Movement Behaviour guidelines; and (2) to analyze the relationship between fulfilling various combinations of these guidelines and mental health, identifying the most advantageous combination. Utilizing a convenience sampling approach, this study included 205 preschool children (117 boys and 88 girls, average age 4.8 ± 0.51 years) from five kindergartens in Hengyang, Hunan Province. The physical activity (PA) and sedentary behaviour of preschool children were objectively assessed using waist-worn accelerometers, while sleep duration and screen time were reported by the children's parents. To evaluate mental health, the parent version of the internationally validated Strength and Difficulties Questionnaire (SDQ) was employed, which measures externalizing problems, internalizing problems, and prosocial behaviour. Employing Mplus 8.0 for Structural Equation Modeling analysis, while controlling for demographic variables, the study explored the connection between preschool children's mental health and their adherence to the 24-h Movement Behaviour guidelines. Worryingly, merely 14.6% of preschoolers met the recommended guidelines for all three aspects (PA, sleep duration, and screen time). Positive correlations were identified between meeting PA guidelines and displaying prosocial behaviour (β = 0.184; p < 0.05), while screen time adherence exhibited a negative correlation with externalizing problems (β = -0.207; p < 0.05). Similarly, there was a negative association between sleep duration adherence and externalizing problems (β = -0.191; p < 0.05). Meeting all three recommended guidelines was notably linked to enhanced prosocial behaviour (β = 0.464; p < 0.05), while following the screen time and sleep duration guidelines was negatively associated with externalizing problems (β = -0.246; p < 0.05). This study underscores the limited adherence of Chinese preschoolers to the comprehensive 24-h Movement Behaviour guidelines. Noteworthy findings include the positive influence of PA on prosocial behaviour, alongside the significant roles that sleep duration and screen time play in mitigating externalizing problems within this age group. Alignment with the 24-h Movement Behaviour guidelines is associated with more favorable mental health indicators in preschoolers.

Development of a physical activity prescription course in a Doctor of Pharmacy program.

Pharmacists are increasingly becoming the healthcare professional who interacts most regularly with patients who have diseases or disorders for which exercise is an effective and recommended treatment. With the relative scarcity of clinical exercise physiologists in the United States, pharmacists are expected to provide lifestyle advice to their patients, especially in community (i.e. retail) pharmacy settings, but student pharmacists typically receive no formal or informal training in exercise physiology and prescription. To address this deficit, an elective course was developed to provide student pharmacists with the knowledge and skill set that will enable them to apply evidence-based physical activity guidelines in the pharmacy. The course utilized the Exercise is Medicine resources for chronic diseases and disorders that are routinely encountered in community pharmacies, in addition to analysis of interactions between exercise and medications commonly prescribed for these conditions. After completion of the course, students reported being significantly more comfortable discussing physical activity with their patients compared to the start of the course (P < 0.001). Similarly, at the end of the course, 99% of students reported that they felt confident in their ability to apply evidence-based recommendations of common diseases and disorders to their patients. Postcourse student evaluations clearly demonstrated that student pharmacists viewed the course positively and as essential in their professional training. These data highlight the feasibility and efficacy of improving self-perceptions for the provision of physical activity recommendations via an elective course in physical activity prescription in a Doctor of Pharmacy program.NEW & NOTEWORTHY This study describes a new elective course in physical activity prescription for Doctor of Pharmacy students. After completing the course, students reported improved self-perceptions for the provision of physical activity recommendations. This course fills a gap in pharmacy education and this study provides future directions to improve training in lifestyle modifications.

Associations between a paternal healthy lifestyle score and its individual components with childhood overweight and obesity.

Maternal healthy lifestyle behaviors during pregnancy have been associated with reduced risk of offspring overweight and obesity (OWOB). However, there has been little investigation, in the context of the Paternal Origins of Health and Disease (POHaD) paradigm, of the potential influence of the paternal lifestyle on offspring OWOB. To describe paternal healthy lifestyle factors around pregnancy and investigate their associations, individually and combined, with offspring risk of OWOB during childhood. Participants included 295 father-child pairs from the Lifeways Cross-Generation Cohort Study. A composite paternal healthy lifestyle score (HLS) based on having a high dietary quality (top 40% of the Healthy Eating Index-2015), meeting physical activity guidelines (≥450 MET-min/week of moderate-to-vigorous physical activity), having a healthy body mass index (BMI) (18.5-24.9kg/m2 ), being a non-smoker, and having no/moderate alcohol intake, was calculated (range 0-5). Paternal HLS (and individual components) associations with child BMI and waist-to-height ratio (WHtR) at age 5 and 9 years were assessed using linear (BMI z-scores and WHtR) and logistic (IOTF categories) regression analyses, adjusted for sociodemographic characteristics. At age 5 and 9 years, 23.5% and 16.9% of children were classified as living with OWOB, respectively. Of the 160 pairs with a complete HLS, 45.0% of the fathers had unfavorable lifestyle factors, determined by a low HLS between 0 and 2 points. Although a low paternal HLS was not significantly associated with a higher risk of childhood OWOB measured using either BMI z-scores and IOTF categories, it was associated with a greater child WHtR, an indicator of central adiposity, at 9 years of age (β [95% CI]=0.04 [0.01,0.07]). Almost half of the fathers had unfavorable lifestyle factors around pregnancy. A low paternal HLS was associated with a greater child WHtR at 9 years but not with a higher risk of childhood OWOB when measured by BMI z-scores or IOTF categories.

Pasos Hacia La Salud II: A Superiority RCT Utilizing Technology to Promote Physical Activity in Latinas

IntroductionLatinas face increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA. Study designThe researchers conducted a superiority randomized controlled trial (data collected 2018-2022, analyzed 2023). Setting/participantsParticipants were 195 Spanish-speaking Latinas ages 18-65 in the Providence, RI area. InterventionThe original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features. Main outcome measuresTotal weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months. ResultsParticipants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs. 70.18 (9.99)) and accelerometer-measured (66.21 (18.26) vs. 60.27 (16.00)) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 (23.35) vs. 81.44 (1.82)) and accelerometer-measured (63.76 (15.12) vs. 54.86 (14.59)) MVPA at 24 months. Baseline PA moderated the intervention effect. ConclusionsThis study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance. Trial registrationThis study is registered at www.clinicaltrial.gov (NCT03491592).

Validity, reliability, and readability of single-item and short physical activity questionnaires for use in surveillance: A systematic review.

Accurate and fast measurement of physical activity is important for surveillance. Even though many physical activity questionnaires (PAQ) are currently used in research, it is unclear which of them is the most reliable, valid, and easy to use. This systematic review aimed to identify existing brief PAQs, describe and compare their measurement properties, and assess their level of readability. We performed a systematic review based on the PRISMA statement. Literature searches were conducted in six scientific databases. Articles were included if they evaluated validity and/or reliability of brief (i.e., with a maximum of three questions) physical activity or exercise questionnaires intended for healthy adults. Due to the heterogeneity of studies, data were summarized narratively. The level of readability was calculated according to the Flesch-Kincaid formula. In total, 35 articles published in English or Spanish were included, evaluating 32 distinct brief PAQs. The studies indicated moderate to good levels of reliability for the PAQs. However, the majority of results showed weak validity when validated against device-based measurements and demonstrated weak to moderate validity when validated against other PAQs. Most of the assessed PAQs met the criterion of being "short," allowing respondents to complete them in less than one minute either by themselves or with an interviewer. However, only 17 questionnaires had a readability level that indicates that the PAQ is easy to understand for the majority of the population. This review identified a variety of brief PAQs, but most of them were evaluated in only a single study. Validity and reliability of short and long questionnaires are found to be at a comparable level, short PAQs can be recommended for use in surveillance systems. However, the methods used to assess measurement properties varied widely across studies, limiting the comparability between different PAQs and making it challenging to identify a single tool as the most suitable. None of the evaluated brief PAQs allowed for the measurement of whether a person fulfills current WHO physical activity guidelines. Future development or adaptation of PAQs should prioritize readability as an important factor to enhance their usability.

Independent and joint association of physical activity and adequate weekday sleep duration with metabolic dysfunction-associated steatotic liver disease

BackgroundThe independent and joint association of physical activity (PA) and weekday sleep duration with metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. Aims: We intended to explore this association in the United States. MethodsThis cross-sectional study recruited 4974 individuals from the National Health and Nutrition Examination Survey between 2017 and 2018. Information regarding PA and weekday sleep duration was obtained through questionnaires. Metabolic associated fatty liver disease (MAFLD) was diagnosed by transient elastography based on the consensus definitions. Multivariable logistic regression models were employed to investigate the independent and joint association of PA and weekday sleep duration with MAFLD. ResultsOf the 4974 subjects, engaging in active PA or sustaining adequate sleep duration was associated with decreased the odds of MAFLD (p < 0.05). Specifically, active leisure-time PA was linked to lower 37 % odds of MAFLD (OR, 0.63; 95 % CI, 0.55–0.73). Individuals who had one to twice times (150–299 min/week) or more than twice (≥300 min/week) the recommended amount of leisure-time PA by PA Guidelines had 19 % (OR, 0.81; 95 % CI, 0.67–0.99) and 45 % (OR, 0.55; 95 % CI, 0.47–0.65) lower odds of MAFLD, respectively (P for trend <0.001). Individuals with adequate weekday sleep duration was associated with 24 % lower odds of MAFLD (OR, 0.76;95 % CI,0.67–0.88). Notably, active PA combined with adequate weekday sleep duration significantly decreased the odds ratios for MAFLD by 35 % (OR: 0.65, 95 % CI, 0.52–0.80). However, in individuals with significant alcohol use, the joint effect of total PA and weekday sleep duration on MAFLD was not statistically significant. ConclusionsBoth active PA and adequate weekday sleep duration were inversely associated with the risk of MASLD independently, while combining them could further lower the risk of MASLD.

Previous Exercise Levels and Outcome in Patients with New Atrial Fibrillation: "Past Achievements Do Not Predict the Future".

Long-term endurance exercise is suspect to elevate the risk of atrial fibrillation (AF), but little is known about cardiovascular outcome and disease progression in this subgroup of AF patients. We investigated whether previous exercise level determines cardiovascular outcome. In this post hoc analysis of the RACE 4 randomized trial, we analyzed all patients with a completed questionnaire on sports participation. Three subgroups were made based on lifetime sports hours up to randomization and previous compliance to the international physical activity guidelines. High lifetime hours of high dynamic activity patients were defined as more than 150 min·wk -1 of high-intensity physical exercise. The primary endpoint was a composite of cardiovascular death and hospital admissions. A total of 879 patients were analyzed, divided in 203 high lifetime hours of high dynamic activity, 192 high lifetime hours of activity, and 484 low lifetime hours of activity patients. Over a mean follow-up of 36 months (±14), the primary endpoint occurred in 61 out of 203 (30%) high lifetime hours of high dynamic activity, 53 out of 192 (27%) high lifetime hours of activity, and 135 out of 484 (28%) low lifetime hours of activity patients ( P = 0.74). During follow-up, 42 high lifetime hours of high dynamic activity (35%), 43 high lifetime hours of activity (32%), and 104 low lifetime hours of activity patients (34%) with paroxysmal AF received electrical or chemical cardioversion or atrial ablation ( P = 0.90). In patients included in the RACE 4, there seems to be no relation between previous activity levels and cardiovascular outcome and the need for electrical or chemical cardioversion or atrial ablation. Cardiovascular outcome was driven by AF-related arrhythmic events.

Association of domain-specific physical activity with albuminuria among prediabetes and diabetes: a large cross-sectional study

BackgroundAlbuminuria, the presence of excess of protein in urine, is a well-known risk factor for early kidney damage among diabetic/prediabetic patients. There is a complex interaction between physical activity (PA) and albuminuria. However, the relationship of specific-domain PA and albuminuria remained obscure.MethodsAlbuminuria was defined as urinary albumin/creatinine ratio (ACR) > 30 mg/g. PA was self-reported by participants and classified into transportation-related PA (TPA), occupation-related PA (OPA), and leisure-time PA (LTPA). Weighted logistic regression was conducted to compute the odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) was used to evaluate the dose–response of PA domains with the risk of albuminuria.ResultsA total of 6739 diabetic/prediabetic patients (mean age: 56.52 ± 0.29 years) were enrolled in our study, including 3181 (47.20%) females and 3558 (52.80%) males. Of them, 1578 (23.42%) were identified with albuminuria, and 5161(76.58%) were without albuminuria. Diabetic/prediabetic patients who adhered the PA guidelines for total PA had a 22% decreased risk of albuminuria (OR = 0.78, 95%CI 0.64–0.95), and those met the PA guidelines for LTPA had a 28% decreased of albuminuria (OR = 0.72, 95%CI 0.57–0.92). However, OPA and TPA were both not associated with decreased risk of albuminuria. RCS showed linear relationship between the risk of albuminuria with LTPA.ConclusionsMeeting the PA guideline for LTPA, but not OPA and TPA, was inversely related to the risk of albuminuria among diabetic/prediabetic patients. Additionally, achieving more than 300 min/week of LTPA conferred the positive effects in reducing albuminuria among diabetic/prediabetic patients.