Vigorous-intensity Physical Activity Research Articles

Men and women choose moderate-to-vigorous physical activity and sedentary behaviors with a “hot” mind rather than a “cold” one

BackgroundThe primary aim of our study is to explore how moderate-intensity physical activity (MPA), vigorous-intensity physical activity (VPA), moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) in men and women (ages 18–74; 4545 females and 1824 males) are associated with age, education, psychological factors (cognitive reflection/”cold” mind, emotional intelligence (E), impulsivity, perceived stress), health behaviors (overeating, breakfast consumption, smoking, alcohol use), body mass index (BMI), and sleep duration.MethodsThe information was collected by means of an online survey (https://docs.google.com/forms/) to ensure the anonymity of participation and confidentiality of data.ResultsMVPA and SB in men and women are significantly influenced by education, age, BMI, lifestyle, and psychological factors, with some gender differences. Higher education reduces MVPA and increases SB, while age lowers SB and raises MVPA in women. BMI inversely affects MVPA and VPA, and breakfast supports higher activity levels, while overeating and alcohol (in men) are linked to lower MVPA and higher SB. Sleep duration weakly affects activity structure but inversely relates to SB. While Cognitive Reflection Test (CRT) scores—an indicator of logical reasoning—do not show a significant positive impact on physical activity levels (MPA, VPA, or MVPA) in either gender, they are associated with increased sedentary behavior in women. Emotional Intelligence (EI), however, plays a clear and positive role: higher EI is strongly associated with increased VPA and MVPA in both men and women, especially in women, and inversely related to SB in both genders.ConclusionsThe results of our study suggest that enhancing EI (“hot” mind) may be more effective than reasoning skills (“cold” mind) in promoting physical activity and reducing sedentary behavior, particularly in women. These findings highlight EI’s potential as a key driver of active lifestyles, while logical reasoning appears to have a lesser impact.

Movement Mediates the Relationship Between Socioeconomic Position and Socioemotional Outcomes in Youth.

Youth from lower socioeconomic positions tend to have poorer socioemotional outcomes, be less physically active, have poorer sleep, and engage in more screen time than their peers from higher socioeconomic positions. The objective of this study was to test the hypothesis that movement behaviors (ie,physical activity, sedentary behavior, and sleep) and changes in combinations of movement behaviors over time (movement trajectories) mediate the relationship between socioeconomic position and socioemotional outcomes in youth. This study used socioeconomic position data, scores from Strengths and Difficulties Questionnaires, and time-use diaries from 980 females and 1014 males (2% Australian Indigenous) aged 10-14 from the Longitudinal Study of Australian Children from 2014 to 2018. Movement trajectories did not mediate the relationship between socioeconomic position and socioemotional outcomes. Least absolute shrinkage and selection operator-based mediation analyses found males from lower socioeconomic positions participated in less moderate- to vigorous-intensity physical activity than their peers from high socioeconomic positions, partially explaining (7%) more peer problems. Youth from lower socioeconomic positions participated in more recreational screen activities than their peers from higher socioeconomic positions, partially explaining (1%-3%) worse total socioemotional outcomes and conduct (females) and emotional problems (males). Future qualitative research should be considered to identify the best ways for youth from lower socioeconomic positions to decrease screen time and increase opportunities to participate in moderate- to vigorous-intensity physical activity in the community, at school, and at home. Other mediators explaining differences in socioemotional outcomes should be explored.

An Online Resource for Monitoring 24-Hour Activity in Children and Adolescents: Observational Analysis.

The Singapore integrated 24-hour activity guide for children and adolescents was introduced to promote healthy lifestyle behaviors, including physical activity, sedentary behavior, sleep, and diet, to enhance metabolic health and prevent noncommunicable diseases. To support the dissemination and implementation of these recommendations, a user-friendly online resource was created to help children and adolescents adopt these behaviors in Singapore. This study aimed to assess the acceptability of the online resource in the adoption of healthier lifestyle behaviors, and the change in the users' behaviors with the use of this online resource. Participants aged 7-17 years were required to log their activity levels of the past 7 days at the beginning and at the end of a 3-month period using the browser-based online resource, including information on the duration and frequency of moderate- to vigorous-intensity physical activity (MVPA), length of sedentary behavior, duration and regularity of sleep, and food portions. User satisfaction, on the length, ease of use, and relevance of the online resource, was also recorded using a 10-point Likert scale. Descriptive statistics and statistical analyses, including the Wilcoxon signed rank test and McNemar test, were carried out at baseline and at the end of 3 months. A total of 46 participants were included for analysis. For physical activity, the number of days of MVPA increased from a median of 3 (IQR 2-5) days to 4 (IQR 2-5) days (P=.01). For sedentary behavior, the median daily average screen time decreased from 106 (IQR 60-142.5) minutes to 90 (IQR 60-185) minutes. For sleep, 10% (5/46) more participants met the recommended duration, and the number of days with regular sleep increased from a median of 6 (IQR 5-7) days to 7 (IQR 5-7) days (P=.03). For diet, there was a decrease in the portion of carbohydrates consumed from a median of 42% (IQR 30-50) to 40% (IQR 30-48.5; P=.03), and the number of days of water and unsweetened beverage consumption remained stable at a median of 5 days but with a higher IQR of 4-7 days (P=.04). About 90% (39-41/46) of the participants reported that the online resource was relevant and easy to use, and the rating for user satisfaction remained favorable at a median of 8 with a higher IQR of 7-9 (P=.005). The findings support the development of a dedicated online resource to assist the implementation of healthy lifestyle behaviors based on the Singapore integrated 24-hour activity guide for children and adolescents. This resource received favorable ratings and its use showed the adoption of healthier behaviors, including increased physical activity and sleep, as well as decreased sedentary time and carbohydrate consumption, at the end of a 3-month period.

“Can physical activity reduce the risk of having tinnitus?”

Objective Tinnitus, the perception of sound without an external source, affects many adults, impacting quality of life. While factors like hearing loss and psychological distress are linked to tinnitus, the relationship with physical activity remains unclear. This study aimed to explore the association between physical activity, sedentary behaviour, and the presence of tinnitus. Design This study is a cross-sectional study. The participants completed the long form of the International Physical Activity Questionnaire. Adjusted logistic regression models were used to investigate associations between (components of) physical activity and the presence of tinnitus, and odds ratios (ORs) were calculated. Study Sample This study involved 3004 participants (2751 tinnitus patients, 253 healthy controls). Results Engaging in moderate or vigorous-intensity physical activity during leisure time for more than 2.5 hours per week was associated with a reduced risk of having tinnitus (OR = 0.515, p < 0.001). Conversely, individuals who reported sitting for more than 7 hours per day had a significantly higher risk of having tinnitus (OR = 2.366, p < 0.001). Conclusions The study suggests a potential protective effect of leisure-time physical activity against tinnitus and highlights the importance of reducing sedentary behaviour. Further research is needed to confirm these findings and to understand underlying mechanisms.

Physical activity interventions: an update on advancing sedentary time, technology, and dissemination and implementation research.

Approximately 28% of American adults meet both the physical activity (PA) and strength training guidelines despite the numerous health benefits associated with a physically active lifestyle. The purpose of this paper is to provide an update of the 2017 Society of Behavioral Medicine PA Special Interest Group article that outlined future directions in sedentary time reduction interventions, technology-based PA interventions, and the dissemination and implementation of PA interventions. Since the prior review, there has been significant progress on effective interventions for reducing sedentary time. However, there has been less progress for improving the specificity of sedentary time guidelines. There has been a dramatic increase in the number of studies examining PA mHealth interventions and support for mHealth intervention has generally been positive, though sustaining engagement in mHealth interventions remains a challenge. Promising newer technologies that have been explored more extensively since the prior review including artificial intelligence (AI). Knowledge of how to implement and scale-up effective PA interventions has also increased. Several current trends in PA intervention research that continue to advance the field include examining the moderating effect of the built environment on the effectiveness of behavioral interventions, cultural tailoring of interventions, Just in Time Adaptive Interventions (JITAIs), and exercise snacks (vigorous intensity PA sessions that are less than one minute). Overall, there has been significant progress in the PA intervention field but significant work remains for creating effective interventions that can be readily implemented into real world settings.

Chronotype and leisure-time physical activity among civil servants in Japan: a cross-sectional analysis of the Aichi workers’ cohort study

BackgroundThe association between chronotype and leisure-time physical activity (LTPA) remains unclear. We investigated the difference in regular LTPA and for a sufficient duration between those with evening-type (ET) and morning-type chronotypes (MT).MethodsWe conducted a cross-sectional analysis using the data of the Aichi Workers’ Cohort Study. It included 3,221 men (mean [standard deviation] age: 45.0 [11.6] years) and 1,294 women (39.8 [11.2] years). Chronotypes were determined with the reduced version of the Morningness-Eveningness Questionnaire. We calculated the metabolic equivalents (METs) consumed per week based on the four types of LTPA: strolling, brisk walking, light- and moderate-intensity PA, and vigorous-intensity PA. Regular LTPA and for a sufficient duration was defined as doing once or more per week and for 30 min or longer per session, respectively. Logistic regression analysis was conducted separately by sex to calculate odds ratios of ET for regular LTPA and for a sufficient duration, adjusted for age and other factors, for each type of LTPA.ResultsET men consumed fewer total METs per week than MT men (p < .001), although this pattern is not found in women. Compared to MT men, ET men were less likely to be engaged in regular LTPA in all types of LTPA (prevalence and adjusted odds ratio [95% confidence interval]: strolling: 39.1% vs. 28.7%, 0.685 [0.524–0.895]; brisk walking: 23.9% vs. 14.4%, 0.639 [0.454–0.899]; light- and moderate-intensity PA: 15.4% vs. 8.4%, 0.613 [0.404–0.929]; vigorous-intensity PA: 21.4% vs. 16.8%, 0.715 [0.518–0.989]). They were less likely to spend a sufficient duration in brisk walking (25.9% vs. 16.5%, 0.635 [0.461–0.875]), light- and moderate-intensity PA (37.1% vs. 26.8%, 0.684 [0.521–0.899]), and vigorous-intensity PA (35.3% vs. 35.8%, 0.741 [0.568–0.968]). Compared with MT women, ET women were less likely to be engaged in strolling (30.5% vs. 22.2%, 0.629 [0.398–0.995]), and less likely to spend a sufficient duration in light- and moderate-intensity PA (27.3% vs. 15.3%, 0.561 [0.335–0.937]).ConclusionsET was inversely associated with LTPA in men and partly in women.

A Systematic Review of the Long-term Efficacy of Physical Activity Interventions in Reducing Risk Factors for Obesity in Adults

Background: Regular physical activity (PA) provides numerous health advantages, including lowering mortality rates and preventing obesity. Despite well-established guidelines advising 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA weekly, sedentary lifestyles remain prevalent, especially in industrialised nations. This systematic review examines the long-term effectiveness (12-24 months) of PA interventions aimed at reducing obesity risk among adults, with a particular focus on identifying strategies that promote sustained adherence. Methods: A comprehensive literature search was performed using multiple databases, including Cochrane Library, PubMed, and Embase, focusing on studies published between January 2004 and January 2024. The inclusion criteria focused on randomised controlled trials and similar designs targeting healthy adults, with interventions promoting sustained PA. Primary outcomes assessed were long-term PA adherence, reductions in obesity rates, and improvements in physical and metabolic health. Results: Twenty-one studies met the inclusion criteria, covering a range of intervention strategies. Most interventions featured structured PA programmes, often with personalised components and ongoing support. Several high-quality studies demonstrated long-term PA adherence, increased weekly energy expenditure, and improvements in fitness. However, adherence rates varied, with participants meeting recommended PA levels ranging from 4.6% to 81%. The meta-analysis showed a small to moderate positive effect of PA interventions on outcomes like PA levels and weight loss, with an effect size of 0.37 (CI: 0.25-0.50). Discussion: The results highlight the need for tailored, culturally sensitive interventions, particularly for vulnerable populations. Long-term PA adherence is stronger in older adults than middle-aged ones, but the sustainability of these effects remains unclear, warranting further research

Fitness-related physical activity intensity explains most of the association between accelerometer data and cardiometabolic health in persons 50–64 years old

ObjectivesTo investigate the physical activity (PA) intensity associated with cardiometabolic health when considering the mediating role of cardiorespiratory fitness (CRF).MethodsA subsample of males and females aged 50–64 years from the...

Longitudinal Changes in Adolescents’ Sedentary, Light, Moderate and Vigorous Physical Activity Levels

Background and purpose: In recent years, sedentary behaviour (SB) has become a significant risk factor for health, alongside the decline of physical activity (PA) in the population. This study explored adolescents’ PA and SB using a longitudinal design, from the age of 13 to 15, to elucidate any changes and when they potentially occur. Method: The data material from the accelerometer measurements was analysed using the program SPSS, version 28. Repeated measures ANOVA (and follow-up test with Bonferroni corrections) were used to assess changes in the four activity levels during the three years. Independent t-tests were used to examine gender differences in each year and at each activity level and to determine differences in activity level between participants with valid data for all three years and those with valid data only at 13 and/or 14 years of age. Results: Statistical analyses of the accelerometer measurements revealed a significant increase in time in the lowest activity level and a decrease in light, moderate and vigorous intensity PA levels during the three years. These changes were larger from 13 to 14, than from 14 to 15, years of age. However, no significant interaction was found between time and gender. Analyses also showed a significantly higher time spent in SB and lower time spent in moderate activity among girls compared to boys at 13, but not at the age of 14 and 15. Conclusions: The findings, which indicate a reduction in PA and increased sedentary time with increasing age, are discussed, which we argue are important to increase and solidify involvement in PA among adolescents. Emphasized here is the importance of communicating the diverse possibilities of movement and challenging understandings of what PA can be for youth.

Effects of Sedentary Behavior Reduction on Blood Pressure in Desk Workers: Results From the RESET-BP Randomized Clinical Trial.

Sedentary behavior (SB) is observationally associated with cardiovascular disease risk. However, randomized clinical trials testing causation are limited. We hypothesized that reducing SB would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. This parallel-arm, 3-month randomized clinical trial recruited desk workers, age 18 to 65 years, with systolic BP 120 to 159 or diastolic BP (DBP) 80 to 99 mm Hg, off antihypertensive medications, and reporting <150 min/wk of moderate to vigorous intensity physical activity. Participants were randomized to a SB reduction intervention or a no-contact control group. The intervention sought to replace 2 to 4 h/d of SB with standing and stepping through coaching, a wrist-worn activity prompter, and a sit-stand desk. SB and physical activity were measured with a thigh-worn accelerometer and quantified during all waking hours and separately during work and nonwork times. Clinic-based resting systolic BP (primary outcome) and DBP, 24-hour ambulatory BP, and PWV were assessed by blinded technicians at baseline and 3 months. Participants (n=271) had a mean age of 45 years and systolic BP/DBP 129/83 mm Hg. Compared with controls, intervention participants reduced SB (-1.15±0.17 h/d), increased standing (0.94±0.14 h/d), and increased stepping (5.4±2.4 min/d; all P<0.05). SB and activity changes mainly occurred during work time and were below the goal. The intervention did not reduce BP or PWV in the intervention group compared with controls. Between-group differences in resting systolic BP and DBP changes were -0.22±0.90 (P=0.808) and 0.13±0.61 mm Hg (P=0.827), respectively. The findings were similarly null for ambulatory BP and PWV. Decreases in work-time SB were associated with favorable reductions in resting DBP (r=0.15, P=0.017). Contrary to our hypotheses, reductions in work-time SB (r=-0.19, P=0.006) and increases in work-time standing (r=0.17, P=0.011) were associated with unfavorable increases in carotid-femoral PWV. As expected, increases in nonwork-time standing were favorably associated with carotid-femoral PWV (r=-0.14, P=0.038). A 3-month intervention that decreased SB and increased standing by ≈1 hour during the work day was not effective for reducing BP. Future directions include examining effects of interventions reducing SB through activity other than work-time standing and clarifying association between standing and PWV in opposite directions for work and nonwork time. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03307343.

Compliance of physical activity among adults with metabolic syndrome with the WHO recommendations

Abstract Introduction Low physical activity is a leading factor in 6% of deaths worldwide. In Bulgaria, it contributes to the deterioration of the health status of the population and determines 4.3% of the global burden of diseases. Over 70% of Bulgarian adults have insufficient physical activity during their free time. The aim of the study is to measure and assess the level of physical activity among adults with metabolic syndrome with the World Health Organization (WHO) Global recommendations. Methods A comparative study of the physical activity of a representative sample of 200 individuals with metabolic syndrome aged 54.7±10.5 from Pleven region was made with the WHO Global recommendations on physical activity for people living with chronic conditions. Modified Physical activity Questionnaire (PAQ) for adults was used for assessment of the physical activity. Data were processed with IBM SPSS v. 25. Results The weekly frequency of the vigorous-intensity physical activity (VIPA) was 1,61 days with a weekly duration of 215 minutes, which met the WHO recommendations on physical activity for people living with chronic conditions, but 64% of the respondents had none and only 26% had VIPA on 2 and more days a week. More than half of the respondents (55%) had none moderate-intensity aerobic PA. From the remaining, 34% had this type of PA on 3 and more days a week with duration of 225 minutes, which met the WHO recommendations. Walking more than 10 minutes a day on 5 and more days a week had 69% of the respondents (40 minutes/day). Only 12% had none walking. Only 2% stated that the physical inactivity is the most important cause for the rise of many non-communicable diseases. Conclusions More than half of the respondents had none vigorous- and moderate-intensity PA but the PA of the remaining met the WHO recommendations. Although physical inactivity is among the risk factors for the rise of many non-communicable diseases, contributing to death, it was not recognised by the respondents. Key messages • Walking is the most important physical activity for the adults with metabolic syndrome. • Increasing the duration of walking should be encouraged and supported to manage the metabolic syndrome.

Clean-up actions as catalysts for sustainability and physical activity promotion

Abstract Issue The convergence of global sustainability and health promotion implies integrated policies and actions. Initiatives like the European Green Deal and the UN’s Sustainable Development Goals emphasize the urgent need to address climate change while promoting health through behaviours such as physical activity (PA). Description We explore the relationship between PA, sustainability, and health outcomes, highlighting the European Green Deal’s impact on PA promotion and the 2030 Agenda for Sustainable Development’s alignment with health behaviours. In addition, we further discuss the concept of “green exercise” and provide insights about how eco-friendly initiatives (e.g., plogging) may have dual benefits in both individual and environmental domains. Results Emerging eco-friendly activities, including plogging, plalking and pliking, directly benefit the environment, while holding the potential to contribute to PA accumulation. Walking while picking up litter (i.e., plalking) can represent up to 4-5 metabolic equivalents (METs), which corresponds to performing a moderate-intensity PA. If other activities - running or cycling - are performed while picking up litter, the number of METs (i.e., &amp;gt;6 METs) involved may correspond to performing a vigorous-intensity PA. Lessons The physiological impact of eco-friendly activities, such as litter picking, reveals their potential as moderate to vigorous-intensity PA, favouring compliance with WHO PA recommendations (i.e., 150 min/week). Integrated policies and actions are needed to address global challenges effectively, emphasizing the interconnectedness of PA promotion, sustainability efforts, and health outcomes. Key messages • Engaging in green initiatives fosters PA and supports the United Nations’ goals for health and sustainability. • Plogging and similar eco-activities offer dual benefits: cleaner environments and healthier lifestyles.

Agricultural activities reduce the risk of requiring long-term care among older Japanese

Abstract Introduction Controlling the risks that lead to requiring long-term care for the older adults is a crucial medical and socio-economic issue. This study investigated the impact of agricultural activities (AAs) on the risk of requiring long-term care. Methods A 5-year follow-up was conducted on 1,009 healthy individuals aged 65-80 years (mean age 72 years; 44% men) living in a rural area (Wakayama, Japan). Requiring long-term care was assessed as requiring support or nursing care (RSNC) according to the Japanese criteria. Health status including frailty and metabolic syndrome were also assessed using Japanese criteria. Work status and lifestyle habits were assessed using self-administered questionnaires. The main outcome was the probability of RSNC. COX proportional hazards regressions were performed, stratified by occupation (agricultural worker or other) or frequency of AAs (none, less than or &amp;gt;150 days/year), adjusted for sex, age, frailty, metabolic syndrome and household as possible confounding factors. Results Approximately 35% of the participants were in agriculture, forestry, and fisheries as occupation, and 78% engaged in AAs. A total of 85 participants RSNC and 39 deaths were observed during the follow-up. The cumulative survival probability did not differ according to occupation or frequency of AAs, whereas the probability of RSNC was significantly lower in participants engaged in AAs (hazard ratio 0.37 [95% CI 0.22, 0.62]; &amp;lt;150 days/year, 0.29 [95% CI 0.17, 0.50]; &amp;gt;150 days/year). Participants engaged in AAs were significantly more likely to engage in low- and vigorous-intensity physical activity, and to participate in industry and community organizations and relating events. Conclusions These findings suggest that AAs may promote a physically and socially active lifestyle, independent of frailty or metabolic syndrome, and reduce the risk of RSNC. Key messages • Prevention of long-term care is important in the older population. • A lifestyle associated with agricultural activities may contribute to healthy aging.

Evidence of the Long-Term Protective Effect of Moderate-Intensity Physical Activity on Cognitive Function in Middle-Aged and Elderly Individuals: A Predictive Analysis of Longitudinal Studies.

To investigate the effects of different intensities of physical activity (PA) on cognitive function in middle-aged and elderly individuals, and to predict future trends in cognitive ability using longitudinal data to assess the long-term role of PA in cognitive preservation. Data from the China Health and Retirement Longitudinal Study (CHARLS) were utilized. Mixed-effects models were employed to analyze the impacts of low-intensity PA (LPA), moderate-intensity PA (MPA), and vigorous-intensity PA (VPA) on overall cognition, episodic memory, and mental intactness. Random forest and XGBoost machine learning methods were employed to further validate the effects of PA. ARIMA models predicted future cognitive trends under the influence of PA. MPA demonstrated significant advantages in preserving cognitive function, particularly in overall cognition and episodic memory. While LPA had some protective effects, they were less significant than those of MPA, and VPA did not show advantages. Machine learning methods confirmed these findings. ARIMA model predictions indicated that the protective effects of MPA on cognitive function are likely to persist in the future. Moderate-intensity physical activity is associated with the preservation of cognitive ability in middle-aged and elderly individuals and may continue to provide this benefit in the future; however, further in-depth research is needed for confirmation.

Objectively measured levels of moderate to vigorous intensity physical activity are associated with cognitive impairment in diabetic hemodialysis patients: a cross-sectional study.

The purpose of this study was to observe the relationship between objectively measured levels of physical activity and cognitive impairment (CI) in the presence or absence of diabetes in middle-aged and elderly hemodialysis patients. In this multicenter cross-sectional study, 339 clinically stable hemodialysis patients (210 males; mean age: 67.38 ± 8.07 years) aged ≥55 years were included from 7 dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) was used to assess the CI. The duration of physical activity at different intensities, including moderate to vigorous physical activity (MVPA) as well as light physical activity (LPA), was measured using a triaxial accelerometer (ActiGraph GT3X+, Pensacola, FL, USA). Logistic regression and multiple linear regression were used for analyses. The prevalence of CI was higher in hemodialysis patients with comorbid diabetes (24.3%). In diabetic patients, MVPA (increase per 10 min/day) was negatively associated with CI after adjusting for covariates [(OR = 0.89, 95%CI = 0.79-0.99), p = 0.042]. However, no significant association between physical activity and CI was found in non-diabetic hemodialysis patients. Further analyses revealed that MVPA was positively associated with temporal orientation, attention and calculation and recall in diabetic hemodialysis patients. Physical activity was associated with CI in diabetic hemodialysis patients rather than the non-diabetes group. This study is important for early differential diagnosis of CI and improvement of cognitive status in hemodialysis patients.

School-level variation in children's moderate to vigorous intensity physical activity before and after COVID-19: a multilevel model analysis.

Schools play a crucial role in facilitating physical activity among children, but the COVID-19 pandemic has affected both children's physical activity and the school environment. It is essential to understand between-school differences in children's physical activity post lockdown, to determine if and how the role of schools has changed. Active-6 is a natural experiment comparing postlockdown accelerometer-estimated physical activity to a pre-COVID-19 comparator group. Accelerometer and individual data were collected on 1296 children aged 10-11 pre-COVID-19 (2017-8), with school characteristics collected from the 50 schools they attended. Post lockdown, we collected accelerometer, individual and school data from 393 children in 23 of the same schools and 436 children in 27 of the same schools in 2021 (Wave 1) and 2022 (Wave 2), respectively. Sources of variation (between-school, between-pupil and within-pupil) in child weekday moderate to vigorous physical activity at each wave were modelled using linear mixed-effects models with school-level wave random coefficients. We extended the model to estimate the proportion of between-school variation explained by school policy, curriculum and physical environment factors and school-aggregated pupil characteristics. We also explored the extent to which postlockdown differences in moderate to vigorous physical activity were mediated by individual or school factors. Between-school variation comprised 13% of the total variation pre-COVID-19, 7% in Wave 1 and 13% in Wave 2. School factors associated with moderate to vigorous physical activity were the following: whether physical education was compromised due to space (often: 9 minutes lower moderate to vigorous physical activity; sometimes: 5.4 minutes lower); high after-school club attendance (7 minutes higher moderate to vigorous physical activity for each additional club attended on average in the school); cycle training policy (4 minutes higher moderate to vigorous physical activity); and higher prevalence of active travel (1 minute higher moderate to vigorous physical activity for each 10% point increase in prevalence). These factors explained 22% of the between-school variation pre-COVID-19, and 72% at Wave 2. The relative importance changed, with cycle training policy and active travel being the most important pre-COVID-19 and cycle training policy, active after-school clubs and compromised physical education space most important in Wave 2. No factors were found to mediate the postlockdown differences in moderate to vigorous physical activity, except compromised physical education space, which had a suppressor effect in Wave 2. Only 27 of the initial 50 schools participated post lockdown, limiting our ability to make comparisons across waves. Sample sizes were additionally affected by missing data for some variables. While schools continue to play an important role in facilitating children's physical activity, the factors that contribute to this have changed post-COVID-19, with cycle training, active after-school clubs and ensuring physical education is prioritised even when space is limited now explaining nearly three-quarters of the between-school variation in children's moderate to vigorous physical activity. School-level interventions that focus on these areas, and policies that support them, may offer the potential to increase children's physical activity. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

Protective effect of regular physical activity against diabetes-related lower extremity amputation.

Foot ulcers are a major complication of diabetes mellitus that increase morbidity and mortality in patients with diabetes, affect their quality of life, and increase the overall social burden. A considerable number of patients with diabetic foot ulcers (DFUs) require amputations every year. This nation population-based study included 1 923 483 patients with diabetes who underwent regular health screening through the National Health Insurance Service during January 2009 and December 2012. We investigated the association between changes in physical activity (PA) status and the incidence of lower extremity amputation (LEA). Based on changes in PA status, participants were categorized into four groups: "remained inactive," "remained active," "active-to-inactive," and "inactive-to-active." Regular PA is an independent factor associated with a decreased risk of LEA in patients with diabetes. During the follow-up period, 0.23% (n = 4454) of the patients underwent LEA. Compared with the "remained inactive" group, the "remained active" group were at the lowest risk of LEA (adjusted hazard ratio 0.5888; 95% confidence interval 0.524-0.66). A protective effect of regular PA against LEA was observed in the "remaining active" group. Our findings suggest a protective role of PA against LEA in individuals with diabetes. This highlights the importance of recommending appropriate levels of PA for patients with diabetes. The study also showed a dose-response relationship, indicating that engaging in vigorous-intensity PA was most beneficial, and higher amounts of PA may provide additional benefits.

Aerobic Conditioning in Geriatric Rehabilitation

This article reviews the historical development of aerobic conditioning. The many physiological effects of aerobic conditioning are presented including the effects on cardiovascular, muscular, and neuromuscular health leading to increased physical endurance and increased lifespan. Aerobic exercise prescription follows the frequency, intensity, time, and type, as well as the volume and progression principles. Frequency recommendations are at least 3 d/wk and 3 to 5 d/wk appears to be conducive to meeting overall physical activity recommendations. Intensity determination is based on several methods that include heart rate methods, ratings of perceived exertion (Borg and OMNI), the talk test, and the counting talk test. Time recommendations include at least 150 to 300 minutes a week of moderate-intensity aerobic activity, 75 to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activities. Type recommendations include any aerobic activities involving major muscle groups used in a continuous or intermittent manner. Volume recommendations include ≥500 to 1000 metabolic equivalent minutes per week and approximately 150 min/wk of moderate-intensity activity. Progression recommendations include the gradual advancing of the exercise duration, frequency, and intensity, making sure that the progressions allows for the best adherence to aerobic exercise on an ongoing basis. The benefits of aerobic exercise have been shown to be important for every aspect of living a healthy lifestyle across the age span, particularly for aging adults, adults with chronic conditions, and adults with disabilities.

Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries

The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

Validity of the PROMIS® Early Childhood Physical Activity Scale among toddlers

BackgroundThe PROMIS® Early Childhood Physical Activity (PROMIS EC PA) scale is a recently developed PROMIS Early Childhood measure to assess PA among children aged 1–5 years. The purpose of this study was to examine test-retest reliability and convergent validity of the PROMIS EC PA scale among toddlers.MethodAn ancillary study was conducted in the toddler-mother dyad sample of the Child and Mother Physical Activity Study. Mothers completed the 7-item PROMIS EC PA scale twice: during a study visit (test) and on the last day when their child’s wore an ActiGraph accelerometer on the hip for 7 days (retest). The PROMIS EC PA summed score was calculated by totaling scores from items 1–5. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) for test and retest PROMIS EC PA. Convergent validity was assessed using rank correlation coefficients (rho) between PROMIS EC PA scores and accelerometer-measured moderate- and vigorous-intensity PA (MVPA).ResultsAmong 74 participants (56% female; 19 ± 4 months of mean age with range of 12–30 months), average accelerometer-measured MVPA was 76 ± 24 min/day. The median number of days between PROMIS EC PA test and retest was 8 days (IQR = 6 to 8), with an average PROMIS EC PA summed score of 11.0 ± 3.5 at test and 10.5 ± 3.4 at retest. ICC for the test-retest PROMIS EC PA summed scores was 0.72 (95% CI = 0.59–0.82). The rank correlation between the PROMIS EC PA summed score and accelerometer-measured MVPA was 0.13 (95% CI=-0.10 to 0.35; p = 0.28).ConclusionIn a sample of children aged 12–30 months, test-retest reliability for the PROMIS EC PA scale was moderate and its convergent validity against accelerometer-measured MVPA was poor. Prior to a widespread use of the PROMIS EC PA scale in large-scale research and clinical practice, the tool should be further refined and validated to elucidate how young children’s lived PA experience as measured in the PROMIS EC PA scale is relevant to their health and wellbeing outcomes.