Physical Inactivity Research Articles

An Analysis of the Health Effects of Physical Activity due to Active Travel Policies in Rennes, France

Background Rennes, a midsize city in France, features many opportunities for active travel. City officials seek to increase walking and cycling by 2030 to improve public health. Physical inactivity, a leading risk factor for premature mortality around the globe, has been shown to be associated with many chronic diseases including heart disease, type 2 diabetes, and cancer. Methods Using the 2018 household travel survey of Rennes residents, we apply the Health-Oriented Transportation statistical model to assess health impacts associated with population-level rates of walking and cycling. We consider two proposed mobility and climate objectives which outline sustainable transportation goals by 2030. These include a shift in transportation mode share to increase walking and cycling trips, as well as a broad reduction in vehicle miles traveled (VMT) across the metropolitan area. Results Our regression analysis demonstrated that factors of household car access and inner-city residency were predictors of prevalence (observed one-day proportion engaging in walking or cycling), participation (weekly proportion), and intensity (mean individual physical activity achieved through walking/cycling) of active travel. Age and education were additionally associated with prevalence. The 2030 mobility objective (mode share: 9% cycle, 35% walk) was associated with a reduction of 1,051 DALYs (disability-adjusted life-years), translating to $73 million USD ($23-$177) in averted costs. The climate objective (10% reduction in VMT) was associated with a reduction of 369 DALYs when replaced entirely by walking and 714 DALYs with cycling, translating to $26 million ($8-$62) and $50 million ($15-$121) saved, respectively. Conclusions Rennes residents experience high participation in active travel, particularly those in the inner city. If residents achieve the city’s active travel goals for 2030, there is potential for a large reduction in health burden and subsequent costs. Reaching these goals may require significant investment in transportation programming and infrastructure to improve active travel opportunities.

Women and Cardiovascular Health: Unraveling Gender-Specific Factors, Risks, and Therapeutic Approaches in Contemporary Medicine.

Background and objective Cardiovascular diseases (CVDs) constitute a significant global health challenge,causing millions of deaths annually and straining healthcare systems worldwide. This study aimed to investigate and elucidate gender-specific factors, risks, and therapeutic approaches related to cardiovascular health in women within the context of contemporary medicine. Methodology We conducted a prospective observational study spanning one year (November 2022 to October 2023)at the Peshawar Medical Complex Hospital, to meticulously explore the field of women's cardiovascular health. With a diverse cohort of 435 women (age range: 18-55 years), representing various socioeconomic backgrounds and geographic locations, our study aimed to elicit comprehensive insights. Through structured interviews covering reproductive history, lifestyle, and psychosocial aspects, coupled with clinical assessments, we gathered multifaceted data. Statistical analysis was done using SPSS Statisticsversion 23.0 (IBM Corp., Armonk, NY). By employing descriptive and t-tests for quantitative analysisand by thematically analyzing qualitative insights, our approach ultimately sought to provide a nuanced understanding of gender-specific factors impacting women's cardiovascular health. Results The study, involving 435 women, revealed various prevalent cardiovascular risk factors. Notable findings include a high incidence of a family history of CVD (n=213, 48.96%, p=0.013), hypertension (n=207, 47.58%), hypercholesterolemia (n=114, 26.21%), elevated triglycerides (n=162, 37.24%), and diabetes (n=64, 14.71%). Physical inactivity was also significantly more common (53.56%, p=0.004) compared to those engaging in regular activity. Women-specific risk factors comprised miscarriage (n=191, 43.91%). Therapeutic preferences varied, with a majority opting for lifestyle modifications (n=263, 60.39%) and pharmacological interventions (n=331, 76.33%). Conclusions This study provides a comprehensive understanding of prevalent cardiovascular risk factors, distinctive women-specific contributors, and diverse therapeutic preferences, highlighting the importance of personalized and targeted interventions to optimize women's cardiovascular health outcomes in contemporary medicine.

Abstract MP61: Independent, Joint-Aerobic, and Dose-Response Associations of Resistance Exercise With Cardiovascular Disease Mortality: A Living Meta-Analysis

Introduction: Cardiovascular diseases (CVDs) account for ~33% of all deaths globally. Aerobic exercise (AE) is a well-established modifiable risk factor for lowering the risk of CVD mortality, but the global prevalence of meeting the World Health Organization’s (WHO’s) recommendation for weekly AE in adults is only ~25%. Given the rapidly growing body of evidence indicating resistance exercise (RE) confers numerous health benefits independent of AE, and may also lower the risk of CVD mortality, we conducted a living meta-analysis (PROSPERO ID: CRD42022356528) to determine: 1) if RE is associated with lower CVD mortality risk independent of, and jointly with, AE; and 2) whether there is a dose-response pattern of CVD mortality by amount of RE. Methods: We searched MEDLINE, Embase, SPORTDiscus, The Cochrane Library, and SCOPUS from inception to October 10, 2023. We included prospective cohort studies in which: 1) AE and RE were the exposures and CVD mortality the outcome; and 2) nonclinical adult populations (aged ≥18 years) were sampled. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were pooled using random effects meta-analysis models. The independent effect of RE from AE was based on models with AE as a covariate. A random effects dose-response meta-analysis characterized the association between the RE dose (sessions/week) and CVD mortality risk. Results: Ten cohort studies from 5 countries (Mean follow-up time = 10.1 years) were included (9, 8, and 5 examined independent, joint, and dose-response associations, respectively). Relative to no RE, meeting the WHO guideline for RE (1-2 sessions/week), independent of meeting the AE guideline (≥150 minutes/week at moderate to vigorous intensities), was associated with a lower risk of CVD mortality (HR: 0.90, 95% CI: 0.85-0.95). A sensitivity analysis removing a highly weighted study (53%) yielded consistent results. Compared to meeting neither guideline, meeting the joint AE-RE guideline was associated with a larger difference in CVD mortality risk (HR: 0.60, 95% CI: 0.45-0.81). The dose-response meta-analysis showed evidence of a non-linear, U-shaped relationship between the amount of RE (independent of AE) and risk of CVD mortality. In detail, relative to no RE, participating in 1-2 sessions/week of RE was associated with a lower risk of CVD mortality (HR: 0.81; 95% CI: 0.72, 0.91), but there was no difference in CVD mortality risk between those who exceeded the guideline and those who participated in no RE (HR: 1.00, 95% CI: 0.89, 1.12). Conclusion: With the increasing global prevalence of obesity and physical inactivity, RE—a more movement-varied, lower-impact exercise modality—should receive more attention in public health policy to help alleviate the global burden of CVD mortality. Public health surveillance instruments capturing RE volume (sets, repetitions) are needed to improve prescription.

Abstract P223: Long Term Impact of COVID19 Pandemic on Estimated Cardiorespiratory Fitness and Physical Activity Level in South American Adults: Results From the Lown Scholars PAFIT Network Online Survey

Background: While restriction measures helped to control the further transmission of the SARS-cov2 virus, they also produced undesirable repercussions on physical activity level (PAL) and, potentially, cardiorespiratory fitness (CRF). However, the extent to which CRF has returned to pre-pandemic levels in the current time has yet to be consistently evaluated, especially in South America. Objective: We aimed to assess changes in PAL and estimated CRF (eCRF) from before the COVID-19 pandemic until the current time using an online survey with validated questionnaires and identifying the determinants of the observed changes. Methods: We conducted a cross-sectional online survey using Global Physical Activity Questionnaire (GPAQ) to assess physical activity and sedentary time on a convenience sample of 1934 adults (68.7% women) from Argentina (n = 484), Brazil (n = 405), Chile (n = 279), Colombia (n = 343) and Uruguay (n = 423). We asked participants questions regarding their physical activity, body weight, socioeconomic status, education and cardiovascular risk factors before the start of the pandemic (Feb/Mar 2020) and at the time of the survey (Jul-Sep 2022). We calculated the eCRF before the pandemic and at the current time using a Brazilian equation including age, sex, body mass index, arterial hypertension, hyperlipidemia, current smoking, physical inactivity, and diabetes. To adjust for age, we also calculated eCRF using only the current time age. Results: The participants reported a significant increase in the prevalence of self reported hypertension (12.9% to 16.5%), diabetes (6.8% to 9.8%), dyslipidemia (18.9% to 24%), and obesity (15.4% to 18.2%) comparing pre-COVID-19 period to the time of the survey. In contrast, they reported a significant decrease in PAL at work (median 936.5 to 864.6 METs/min/week; p < 0.032) and within active transportation domains (median 502.6 to 460.3 METs/min/week; p < 0.008). No significant changes were reported in leisure time physical activity. The median sedentary time on weekdays increased by 60 minutes (360 to 420; p < 0.001) post pandemic and eCRF was reduced (mean difference, -1.17 mL/min/kg; p < 0.001). When adjusted for age, the differences remained statistically significant. (-0.50; mL/min/kgmL/min/kg; p 0.001). Conclusion: Social restriction policies aimed at controlling pandemics may lead to reduction in physical activity level and cardiorespiratory fitness in the long term.

Abstract P466: A Culturally Tailored mHealth Lifestyle Intervention Improves Diet and Physical Activity Self-Regulation Among African Americans

Background: Physical inactivity and poor adherence to healthy eating guidelines impact cardiovascular health (CVH) outcomes in African American (AAs). Our randomized controlled trial (RCT) testing the FAITH! App, an mHealth lifestyle intervention, showed efficacy in promoting ideal CVH, particularly diet and physical activity (PA) among AAs, warranting exploration of underlying factors. Psychosocial factors (e.g., self-regulation, self-efficacy, social support) are key to healthy behavior adoption. Hypothesis: The intervention group would have greater improvements in diet and PA-related psychosocial factors than the control group after using the FAITH! App. Methods: A 2-arm cluster RCT was conducted among AAs from 16 churches in Minnesota comparing the FAITH! App intervention to a delayed intervention control group. The FAITH! App included culturally relevant, CVH-focused education modules, diet/PA self-monitoring and a sharing board. The outcomes were change in diet and PA self-regulation and self-efficacy (primary) and social support and barriers (secondary) at 6 months post-intervention. The intervention effect was assessed using linear regression. Results: Sixty-eight participants were included (71% female; mean age [SD]: 54.7 [12.6] years) ( Table 1 ). The intervention group showed a significantly greater increase in diet self-regulation [planning/tracking nutrition] (+0.66, p<.03) and PA self-regulation [step count strategies] (+0.47, p=.003) than the control group. Within groups, the intervention group demonstrated significant improvements across diet and PA self-regulation measures, while the control group showed an improvement only in fruit/vegetable and grain intake. No effect was observed in self-efficacy, social support, or barriers. Conclusions: Our culturally tailored mHealth lifestyle intervention was associated with notable increases in diet and PA self-regulation, suggesting a potential mechanism by which the FAITH! App improves healthy eating and PA among AAs.

Abstract 46: Midlife and Late-Life Population Attributable Fractions of Dementia Risk Factors in the United States: A Cohort Study From the Dementia Risk Pooling Project

Introduction: Dementia cases in the US are projected to nearly double from 5.3 million in 2019 to 10.5 million by 2050. Research has suggested that 41% of US dementia cases may be prevented by eliminating several specific modifiable risk factors. Still, few studies examine risk factor variation between midlife and late-life. Previous studies have also been limited by sample diversity and size. The Dementia Risk Pooling Project (DRPP) is a consortium of longitudinal cohorts including several underrepresented racial/ethnic groups pooled at the individual level. Methods: We estimated individual and combined population attributable fractions (PAF) for seven modifiable risk factors in midlife (aged 45-64) and late-life (aged 65+), using data from six US cohorts in DRPP. We also used potential impact fractions (PIF) to estimate dementia cases that could be prevented due to risk factor reduction in midlife and late-life based upon the National Alzheimer’s Advisory Council goal of a 15% reduction in dementia risk factors by 2030. Results: In a sample of 41,432 unique participants (ppts), risk factor exposure was measured in midlife for 29,983 ppts (60% female, 77% white) and in late-life for 30,633 ppts (56% female, 70% white). During follow-up, 4,186 midlife ppts and 4,893 late-life ppts developed dementia. We found that eliminating midlife risk factors could prevent a greater proportion of dementia cases [PAF 41.3%, 27.9%-54.6%] compared to late-life risk factors [23.1%, 12.4%-33.7%]. Midlife physical inactivity [18.8%, 15.1%-22.4%] appeared to be the greatest contributor. Late-life hypertension and depression appeared to contribute to 9.8% [5.5%-13.9%] and 4.2% [3.5%-5.0%] of cases, respectively. Given the US prevalence of dementia in 2020, we estimate that a 15% reduction in physical inactivity alone could prevent 148,339 dementia cases. Conclusion: The importance of modifiable risk factors for dementia may vary with age. These estimates could inform the timing of public health interventions for dementia prevention.

Abstract MP13: Association Between Visceral Adiposity Index and Non-Alcoholic Liver Fibrosis Among United States Adults With Prediabetes

Background: Although type 2 diabetes is a well-established risk factor for non-alcoholic fatty liver disease (NAFLD) and downstream liver fibrosis, little is known about the risk factors associated with NAFLD fibrosis in adults with prediabetes. We aimed to understand whether visceral adiposity was associated with liver fibrosis, independent of insulin resistance, among participants with prediabetes. Methods: In this nationally representative, cross-sectional study, we selected non-pregnant adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 with prediabetes, defined as HbA1c of 5.7-6.4%, fasting blood glucose of 100-125 mg/dl, or a self-reported diagnosis of prediabetes. We excluded those with acute transaminitis (aspartate or alanine aminotransferase >500 IU/L), excessive alcohol consumption (>1 drinks/day for females, > 2 drinks/day for males), iron overload (transferrin saturation >50%), and positive hepatitis serology. Visceral adiposity was estimated using the validated Visceral Adiposity Index (VAI) and categorized into tertiles (<1.17, 1.17-2.19, >2.19). Our primary outcome was clinically significant liver fibrosis, defined dichotomously as median Fibroscan vibration controlled transient elastography liver stiffness measurements of 7.9 kPa or greater (≥F2). We used survey design-adjusted logistic regression, adjusting for covariates determined a priori (age, sex, race/ethnicity, income, education, smoking status, physical inactivity, hypertension, hemoglobin A1c (HbA1c), total caloric intake, and Homeostatic Model Assessment for Insulin Resistance [HOMA]) to estimate odds of fibrosis. Results: Among 1,290 prediabetic adults (mean age 62y [SD, 10], 44% female, 62% non-Hispanic White, representing 37,401,474 adults across the U.S.), 121 (10%) had NAFLD fibrosis. Participants in the highest tertile of VAI were more likely to be female, older, have higher waist circumference, and have comorbid cardiac conditions. The highest tertile of VAI was associated with three times higher odds of fibrosis (highest vs. lowest tertile; OR [95% CI], 3.81 [1.65, 8.79], middle vs. lowest tertile: 4.93 [1.74, 13.34]). There was no significant multiplicative interaction between VAI and HOMA (p=0.44). The highest tertile was also associated with 170% higher odds of F1 (mild) liver fibrosis (2.70 [1.10, 6.63], middle vs. lowest tertile: 2.69 [1.26, 5.77]). Conclusion: Nearly 1 in 10 adults with prediabetes have clinically significant liver fibrosis. High visceral adiposity was associated with more than 3 times the likelihood of fibrosis, independent of insulin resistance and traditional risk factors.

Abstract P256: Rationale, Development, and Implementation of a Multidisciplinary Digital Lifestyle Health Education Program for Older Adults With Cardiovascular Disease and Osteoarthritis

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. Globally, osteoarthritis (OA) affects 654 million. In 2018, of the 1.2 million Australians who had CVD, half also had arthritis, with the most common form in Australia being OA. Ongoing pain and physical limitations from OA can affect lifestyle choices, contributing to the shared risk factor profile of CVD and OA (physical inactivity, overweight/obesity, poor diet, high medication use). This contributes further to the burden of both diseases including reduced 6-minute walk (6MW) performance, which is directly related to increased CVD mortality. This project outlines the rationale for and development of a multidisciplinary digital lifestyle health education program for the treatment and secondary prevention of CVD and its common comorbidity of OA. Methods: This study is a cross-sectional analysis of older adults in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, muscle strength, and 6MW measurements were assessed. Differences between those with and without OA were determined via one-way analysis of variance. Simple linear regressions assessed potential relationships. Results: In a cohort of 532 adults; n=341 (64.1%) had diagnosed CVD; 48.4% of which had OA (mean age 66±12 years; 73.3% female). Socioeconomic index was deemed high. In the OA cohort mean BMI and waist were above healthy heart recommendations according to the World Health Organisation. There were no significant differences between those with OA and those without for cardiovascular risk factors of body weight, BMI, waist measurement, blood pressure, 6MW, or muscle strength. However, in those with CVD and OA, the relationship between age and 6MW was stronger and age accounted for more of the variance in performance (r=-0.44; r 2 =0.19; p<0.001) than those without OA (r=-0.37; r 2 =0.17; p<0.001), indicating a greater reduction in walking ability in those with OA as they get older. Conclusion: With 6MW performance being related to CVD mortality, interventions are needed to improve health and fitness in this cohort. International guidelines for CVD and OA recommend treatment should prioritise lifestyle changes, including a healthy diet, regular physical activity, and interventions that address all risk factors. Lifestyle LIFEMAP will assess the efficacy of a widely translatable multidisciplinary digital evidence-based 10-module lifestyle, food, exercise, medication, and park prescription education program for adults with the comorbidity of CVD and OA. We expect this program to improve knowledge, and healthy lifestyle choices, thereby improving physical activity and health outcomes in this highly vulnerable population.

Abstract P285: Relationship Between Body Mass Index, Waist Measurement, Six-Minute Walk Performance and Whole-Body Strength in Adults With Cardiovascular Disease: Findings From the Lifestyle Heart Health Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death, killing 17.9 million people annually worldwide. Key risk factors include physical inactivity, overweight/obesity, high blood pressure, high cholesterol which worsen with age, and smoking and excessive alcohol intake. Six-minute walk (6MW) performance and whole-body muscle strength are both related to cardiovascular mortality and also worsen with age, particularly in the absence of physical activity. The aims of this study were to understand levels of cardiovascular risk and compliance to usual medical treatment (medication, lifestyle modifications) in a high socioeconomic Australian population, and to identify relationships between key risk factors, 6MW and muscle strength. A secondary aim was to help inform development of the Lifestyle Heart Health Education Program. Methods: This was a cross-sectional study of 473 people with CVD in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, whole-body muscle strength and 6MW measurements were assessed. Simple linear and stepwise regressions were used to assess potential relationships. Results: Mean age of the cohort was 66.8±11.6; range 21-94 yrs; 68.5% female; socioeconomic index was deemed high. All participants had CVD, of which 25% were on aspirin. Hypertension was prevalent in 65% (38% on anti-hypertensives); 65% had dyslipidaemia (40% on a statin); 91% had a BMI over 26.0; and 85% of males and 80% of females had a waist measurement over gender-specific heart health recommendations. Less than 3% of the cohort smoked, and less than 10% consumed alcohol at a level deemed high-risk. Almost 20% of the cohort were at risk of CV mortality according to 6MW performance with scores less than 350 metres. Waist measurement, BMI, and blood pressure were the greatest risk factors across the cohort. Muscle strength (r=-0.34; r 2 =0.17; p<0.001) and 6MW performance (r=-0.37; r 2 =0.17; p<0.001) both decreased with age. BMI and age were the most significant predictors of 6MW (r=-0.45; r 2 =0.20; p=0.004) and whole-body strength (r=0.49; r 2 =0.24; p<0.001) in females; waist and age were the most significant predictors of 6MW (r=-0.38; r 2 =0.14; p=0.11) and whole-body strength (r=0.41; r 2 =0.17; p=0.04) in males. Conclusion: Whilst alcohol and smoking campaigns are working to reduce consumption of these harmful substances, low cardiorespiratory and muscular fitness and overweight/obesity remain highly prevalent. Population-level interventions such as the Lifestyle Heart Health Program that aim to reduce weight and waist and improve physical activity, walking ability and muscle strength are urgently needed to reduce cardiovascular risk and mortality.

Age-period-cohort analysis of ischemic stroke deaths attributable to physical inactivity in different income regions

This study assessed the global and regional burden of IS (ischemic stroke) deaths due to LPA (low physical activity) from 1990 to 2019, analyzed regional, sex, and age differences in ASMR (age-standardized mortality rate), and provided a comprehensive understanding of the impact of age, period, and cohort on low physical activity related ischemic stroke ASMR. We conducted an APC (age-period-cohort) analysis of the global and four World Bank income level regions’ IS mortality data attributed to LPA from 1990 to 2019, using the GBD2019 database, and the results showed that the global net drift of the Ischemic stroke age-standardized mortality attributable to low physical activity was − 1.085%[95% CI: − 1.168, − 1.003].The ASMR drop is most pronounced in the high-income zone, with a net drift of − 2.473% [95% CI: − 2.759, − 2.187] across the four income groups. The influence of age on mortality is increasing in the worldwide old population, while the period and cohort effects are decreasing. We also performed a Joinpoint regression analysis, which revealed that the specific time of considerable drop in ASMR of IS in the global LPA population was 2002–2007, with an APC of -2.628%. The specific period of considerable drop in ASMR in high-income regions with the highest variation was 1999–2007, with an APC = − 4.726%. The global burden of public health deaths caused by LPA is diminishing, with the most notable progress observed in high-income regions. However, in low and lower-middle income areas, the situation continues to deteriorate. Within the global elderly population, the effects of age on mortality is increasing, while the effects of period and cohort are diminishing. These trends vary across income levels, highlighting the necessity for enhanced international collaboration to formulate context-specific public health strategies aimed at enhancing cardiovascular health on a global, regional, and national scale.

Co-occurrence of and factors associated with health risk behaviors among adolescents: a multi-center study in sub-Saharan Africa, China, and India

Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs-physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05). The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study.

Promoting Return to Work After Vocational Rehabilitation Using a Work-Related Fitness App: Protocol for a Cluster-Randomized Controlled Trial.

Retraining programs in vocational rehabilitation are often characterized by a low level of physical activity, even when targeting jobs with primarily physical demands. They might therefore be accompanied by a decline in functional capacity if the lack of physical activity is not compensated by increased activity during leisure time. The implementation of a work-related exercise app might be a promising approach to promoting a return to work in vocational rehabilitation. We developed the "WORKout-app" which provides exercise plans based on a comparison of the physical demands of the retraining profession and the current functional capacity. The aim of this study is to examine the effects of app-based exercise during vocational rehabilitation on perceived work ability (primary outcome), occupational self-efficacy, days of sick leave, and return to work (secondary outcomes). We conducted a cluster-randomized controlled trial with 2 arms (intervention: WORKout-app vs control: treatment as usual) in 4 cohorts of 5 vocational rehabilitation centers in Germany. Participants are nested within retraining classes per vocational rehabilitation center and per cohort assigned to either the intervention condition or the control condition. The target sample size at the participant level is 598. Measurement time points include baseline, the end of rehabilitation, 3 months after the end of rehabilitation, and 6 months after the end of rehabilitation. Linear and generalized linear mixed-effects models are performed to test for treatment differences in outcomes. This study is funded by the German Federal Pension Insurance. The trial is registered with the German Clinical Trials Register (DRKS00030775) and approved by the Ethics Committee of the German Sport University Cologne (145/2022). The findings of the study will inform researchers and practitioners about the effectiveness of an exercise app developed to counteract the effects of physical inactivity during vocational rehabilitation. DERR1-10.2196/50200.

Chronic obstructive pulmonary disease: Signs and symptoms, diagnosis, treatments, lifestyle risk factors and management

Chronic Obstructive Pulmonary Disease (COPD) is associated with increased health complications, leading to a rise in mortality rates. COPD remains a significant global health issue, underscoring the importance of recognizing symptoms, facilitating diagnosis, and implementing effective treatment strategies. However, information on lifestyle risk factors and the management of COPD remains fragmented. This review paper aims to understand the clinical pathophysiologic changes triggered by lifestyle practices and their management strategies. It is important to understand its symptoms, diagnostics criteria, and treatment to correlate with lifestyle risk factors and to identify effective lifestyle interventions. Lifestyle practices as defined by dietary practices such being anorexia and low fruit and vegetable intake, smoking habits, alcohol consumption, and physical inactivity have increased the risk of COPD. This review suggested lifestyle approaches for COPD treatment such as regular exercise, a healthy diet, and avoiding smoking. In this case, the development of the guided improved intervention is important for a better understanding of the mechanisms between COPD and its associated lifestyle practices. This information may help clinicians, health practitioners, and dietitians to guide patients to implement improved dietary interventions. To avoid the progression of COPD, lifestyle practice therapy could be the most effective strategies that aid with medications as prescribed by the physicians.

Sex differences in modifiable risk factors for stroke incidence and recurrence: the UCC-SMART study.

Risk factors for stroke differ between women and men in general populations. However, little is known about sex differences in secondary prevention. We investigated if sex interacted with modifiable risk factors for stroke in a large arterial disease cohort. Within the prospective UCC-SMART study, 13,898 patients (35% women) with atherosclerotic disease or high-risk factor profile were followed up to 23years for stroke incidence or recurrence. Hypertension, smoking, diabetes, overweight, dyslipidemia, high alcohol use, and physical inactivity were studied as risk factors. Association between these factors and ischemic and hemorrhagic stroke incidence or recurrence was studied in women and men using Cox proportional hazard models and Poisson regression models. Women-to-men relative hazard ratios (RHR) and rate differences (RD) were estimated for each risk factor. Left-truncated age was used as timescale. The age-adjusted stroke incidence rate was lower in women than men (3.9 vs 4.4 per 1000 person-years), as was the age-adjusted stroke recurrence rate (10.0 vs 11.7). Hypertension and smoking were associated with stroke risk in both sexes. HDL cholesterol was associated with lower stroke incidence in women but not in men (RHR 0.49; CI 0.27-0.88; and RD 1.39; CI - 1.31 to 4.10). Overweight was associated with a lower stroke recurrence in women but not in men (RHR 0.42; CI 0.23-0.80; and RD 9.05; CI 2.78-15.32). In high-risk population, sex modifies the association of HDL cholesterol on stroke incidence, and the association of overweight on stroke recurrence. Our findings highlight the importance of sex-specific secondary prevention.

Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults

BackgroundOver- and undernutrition coexist in many African countries and pose a threat to metabolic health. This study assessed the associations between relationship satisfaction and Body Mass Index (BMI), waist circumference (WC), and glycated hemoglobin (HbA1c), in a rural population of older adults in Burkina Faso. It also explored potential gender differences and the mediating role of depressive symptoms.MethodsData from the “Centre de Recherche en Santé de Nouna (CRSN) Heidelberg Aging Study (CHAS),” a cross-sectional population-based study conducted in 2018 in Burkina Faso, were used in our study. Hierarchical linear regression models were applied for each of the three outcome variables. Among 2291 participants aged 40 years or older who provided data on relationship satisfaction, 2221, 2223, and 2145 participants had BMI, waist circumference (WC), and HbA1c values respectively.ResultsHigher relationship satisfaction (CSI-4 score) was associated with increased BMI (β = 0.05, p = 0.031) and WC (β = 0.12, p = 0.039). However, the association of CSI-4 and BMI became non-significant after controlling for depressive symptoms (PHQ-9 score) and physical inactivity (BMI: β = 0.04, p = 0.073). Depressive symptoms fully mediated the relationship between relationship satisfaction and BMI (β = -0.07, p = 0.005). There was no significant association between relationship satisfaction and HbA1c. These results were consistent across genders and age groups.ConclusionHigher relationship satisfaction may lead to increased body weight among Burkinabe adults aged 40 years and older, and depressive symptoms may be a mediator in this association.

Pharmacological models of liver iron overload

Iron deposits in tissues (hemosiderosis) accompany various diseases of the liver and pancreas. Overload of the liver with iron occurs due to (1) a diet with excess saturated fats, which provoke inflammation of the liver, (2) slowdown and stagnation of blood flow in the area of the portal vein (physical inactivity, obesity, alcoholism, etc), (3) uncontrolled and long-term use of iron supplements (primarily based on inorganic forms - sulfates, oxides, hydroxides of iron, etc.), (4) hereditary diseases (hemochromatosis). Patients with liver overload with iron require not only correction of diet and lifestyle (including physical activity), but also special therapy using effective and safe drugs. To study the effect of excess iron on the body and search for the most appropriate therapy for hemosiderosis, special models of liver overload with iron have been developed in pharmacology. The degree of iron overload and the rate of hemosiderosis formation in models can be slowed down by the addition of micronutrients with hepatoprotective properties (vitamins A, C) and accelerated by the addition of saturated fat and/or fructose to the diet.

Effects of short-term upper extremity exercise training in office workers during COVID-19 restrictions: A randomized controlled trial.

During COVID-19 pandemic, physical inactivity and inactivity-related health problems have deepened in many individuals, including office workers. It is not yet known whether there are exercise programs through telerehabilitation that will provide rapid relief in a short time in office workers who apply part or full-time teleworking system. To comparatively investigate influences of short-term upper extremity exercise trainings (UEET) on pain, musculoskeletal discomforts (MSD), physical activity (PA), mood, and quality of life (QOL) in office workers during COVID-19 restrictions. Thirty office workers were divided into exercise (EG) (UEET and walking advice) and control (CG) (walking advice) groups. The UEET was applied for at least 20-40 minutes/day, 5-7 days/week for a one week between February 2022 and June 2022. Office workers' pain, MSD, PA level, mood and QOL were measured. Baseline characteristics of groups (EG: 37.8±7.04 years, CG: 41.6±7.97 years) were similar (p > 0.05). Following UEET, scores of office workers in EG on total step count, vigorous PA, moderate-intensity PA, walking, total PA, physical functioning, and body pain subscales of QOL significantly increased compared to scores of office workers in CG, while scores on neck, back and hip discomforts and anxiety and depression significantly decreased (p < 0.05). One-week UEET and walking advice can improve office workers' daily step counts, MSD, PA levels, mood, and QOL. Office workers who have a busy work schedule may do these UEET and walking exercises in break times to relieve perception of discomfort.

Physical Fitness and Physical Self-Perception of Children in Relation to BMI: An Observational Study in Southern Italy

Introduction. Despite international literature has well recognized the rule of physical education in primary school for the promotion of children’s educational process and the mediating effects on cognitive, emotional and social development, in many European countries sedentary lifestyles in children have increased involving all age groups and social classes. Moreover, in Italy the prevalence of children’s overweight and obesity is linked to increased physical inactivity and reduced opportunities for physical activity expenditure. The present study aims to assess physical fitness and self-perception in children involved in SBAM Project in Apulia (Southern Italy), according to gender and BMI. The assessment involved four physical fitness tests (SLJ, MBT, 10x4 and 6mWT) and a self-report to assess physical self-perception. A 3x2 ANOVA was carried out to assess the main and interaction effect of gender and BMI on considered variables. Results showed (a) better motor performances and self-perception in normal weight children compared to overweight and obese peers, (b) male were stronger and faster than female, and (c) physical self-perception didn’t change between obese male and female. Methodological interventions aimed at increasing time spent in motor activity and develop physical fitness are needed in primary school to promote health-oriented physical education. Keywords: health promotion; motor development; physical education; children; self-perception.

Higher Learning as a Conduit to Healthy Living: A Review of Physical Activity and Health Education Courses Offered and Required at Historically Black Colleges and Universities

ABSTRACT Most college students do not engage in adequate physical activity. Physical education requirements (PERs) are often viewed as a potential solution to physical inactivity within this population as these courses provide opportunities for students to be physically active and/or become educated about healthy lifestyles. The potential benefits of these courses are particularly salient for Black college students who face many health disparities. The purpose of this study was to examine the health education and physical activity course offerings and requirements at Historically Black College and Universities (HBCUs). We examined the online course catalogs of all four-year accredited HBCUs in the United States (N = 86) to determine if they 1) offered and/or 2) required their students to take any health education or physical activity courses. Overall, 81 of the four-year HBCUs in this study (94%) at least offered their students a physical activity or health education course, although only 42 schools (48.8%) required either course for graduation. The remaining 44 institutions (51.1%) did not require their students to take a health education or physical activity course for graduation. PERs appear to be more prevalent at HBCUs compared to non-HBCUs; however, there has been a reduction in PERs across all institutions alike over the past few decades. Future studies should explore whether higher PERs at HBCUs are associated with Black students’ actual physical activity behaviors. HBCUs are presented with a unique opportunity to support the health behaviors and knowledge of Black college students.

Bridging the gap: Unveiling the crisis of physical inactivity in inflammatory bowel diseases

In this editorial we comment on the article titled “Inflammatory bowel diseases patients suffer from significant low levels and barriers to physical activity: The BE-FIT-IBD study” published in a recent issue of the World Journal of Gastroenterology 2023; 29 (41): 5668-5682. Inflammatory bowel diseases (IBD) are emerging as a significant global health concern as their incidence continues to rise on a global scale, with detrimental impacts on quality of life. While many advances have been made regarding the management of the disease, physical inactivity in these patients represents an underexplored issue that may hold the key for further and better understanding the ramifications of IBD. Chronic pain, fatigue, and fear of exacerbating symptoms promotes physical inactivity among IBD patients, while the lack of clear guidelines on safe exercise regimens contributes to a norm of physical inactivity. Physical activity (PA) is accepted to have a positive effect on disease outcomes and quality of life, while inactivity exacerbates comorbidities like cardiovascular disease and mental health disorders. The “BE-FIT-IBD” study, focusing on PA levels and barriers in IBD patients of Southern Italy, revealed that a significant proportion (42.9%) were physically inactive. This lack of PA is attributed to barriers such as fear of flare-ups and misconceptions about exercise exacerbating the disease. The study also highlighted the need for better communication between healthcare providers and patients regarding the benefits of PA and safe incorporation into lifestyles. Moreover, physical inactivity may also contribute to disability in IBD patients, having a great impact on employment status. Of note is the fact that IBD also comes with an important psychological burden with relevant evidence suggesting that regular PA can improve mood, reduce anxiety, and enhance mental health. The “BE-FIT-IBD” study advocated for the integration of PA into IBD management, emphasizing the bidirectional link between PA and IBD. Regular exercise can influence the course of IBD, potentially reducing symptom severity and prolonging remission periods. As such, it is mandatory that healthcare providers actively educate patients, dispel misconceptions, and tailor exercise recommendations to improve the quality of life and reduce IBD-related complications.