Physical Activity Recommendations Research Articles

Feedback Collection and Nearest-Neighbor Profiling for Recommendation Systems in Healthcare Scenarios

The rise in the dimension and complexity of information generated in the clinical field has motivated research on the automation of tasks in personalized healthcare. Recommendation systems are a filtering method that utilizes patterns and data relationships to generate items of interest for a particular user. In healthcare, these systems can be used to potentiate physical therapy by providing the user with specific exercises for rehabilitation, albeit facing issues pertaining to low accuracy in earlier iterations (cold-start) and a lack of gradual optimization. In this study, we propose a physical activity recommendation system that utilizes a K-nearest neighbor (KNN) sampling strategy and feedback collection modules to improve the adequacy of recommendations at different stages of a rehabilitation period when compared to traditional collaborative filtering (CF) or human-constrained methods. The results from a trial show significant improvements in the quality of initial recommendations, achieving 81.2% accuracy before optimization. Moreover, the introduction of short-term adjustments based on frequent player feedback can be an efficient manner of improving recommendation accuracy over time, achieving overall better convergence periods than those of human-based systems, topping at a measured 98.1% accuracy at K = 7 cycles.

Effects of a digital intervention on physical activity in adults: A randomized controlled trial in a large-scale sample

BackgroundPhysical inactivity is associated with health risks, contributing to various diseases and all-cause mortality. Despite recommendations for regular physical activity (PA), many adults remain inactive, influenced by socioeconomic and environmental factors. Digital interventions, particularly web-based PA programs, offer promising possibilities to promote PA across populations. These programs vary in their effectiveness, reflecting differences in design, user engagement, and behavior change techniques employed. ObjectiveThis study evaluates the effectiveness of the 12-week multimodal web-based TKFitnessCoach. The PA online program is part of the TK-HealthCoach. This study investigates the program's impact on self-reported PA levels, goal attainment, healthrelated quality of life, body weight, and eating behavior, comparing an interactive personalized web-based intervention and non-interactive web-based health information. MethodsIn a randomized controlled trial (RCT), participants were allocated to either the intervention group (IG), receiving access to the interactive TK-FitnessCoach, or the control group (CG) that was provided a static website with evidence-based information on PA. The study targeted a German-speaking adult population interested in improving health behavior. Data was assessed at T0 (beginning of the study), T1 (postintervention), T2, 6 months, and T3, 12 months follow-ups, focusing on self-reported PA at T3 and on various secondary outcomes. ResultsWe achieved equally distributed sociodemographics in both the IG and the CG with a mean age of 42.8 (IG), resp. 43.1 years (CG), and female participants of 76.1 % (IG), resp. 74.7 % (CG). PA at baseline was 277.9 min/week in the IG and 273.3 min/week in the CG. Both, the IG (n = 1153 in the Intention-to-treat (ITT) dataset) and CG (n = 1177 in the ITT dataset) exhibited significant increases in PA over time (IG(T3-T0) = 72.92 min/week; CG(T3-T0) = 74.12 min/week).However, the study did not find significant differences in the effectiveness of the interactive TK-FitnessCoach compared to the non-interactive control in terms of improving PA and related health outcomes. The intensity of using the TK-FitnessCoach was not associated with PA. ConclusionsBoth programs were effective in promoting PA among adults, with no significant differences observed between the two RCT groups. This highlights the potential of digital interventions in addressing physical inactivity, suggesting that the effectiveness of such programs may not solely depend on their interactivity but also on the quality and relevance of the information provided. Further research is needed to explore optimization strategies for such interventions, especially for persons with low PA, including user engagement, behavior change techniques, and the integration of objective PA tracking methods. Trial registrationGerman Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249.

Adherence to physical activity and screen time recommendations of youth: Demographic differences from National Health and Nutrition Examination Survey 2017-2018.

Engaging in physical activity (PA) and reducing sedentary behaviors among youth are linked to improved mental and physical health. This study aimed to examine demographic differences among youth adhering to PA and Screen Time (ST) recommendations. The present study utilized data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). The NHANES survey employed a cross-sectional design and gathered information on the daily duration of moderate-to-vigorous PA lasting 60min or more, as well as the maximum daily ST not exceeding 2h. The analysis encompassed a total of 1697 youth aged between 6 and 17years. Overall, 36.3% of participants adhered to PA recommendations, 20.9% adhered to ST recommendations and 10.8% of youth met both recommendations. The odds of meeting PA, ST and both recommendations were inversely associated with obesity (obese vs. normal: aOR, 0.56 [95% CI, 0.42-0.75]), (aOR, 0.67 [95% CI, 0.48-0.94]) and (aOR, 0.51 [95% CI, 0.32-0.82]) respectively, and age (14-17years vs. 6-9years: aOR, 0.2 [95% CI, 0.15-0.27]), (aOR, 0.33 [95% CI, 0.23-0.47]) and (aOR, 0.16 [95% CI, 0.09-0.3]) respectively. A small portion of the youth met PA and ST recommendations. Older youth, youth with obesity, and youth with a parent or guardian who had not completed a high school education were particularly at risk.

Physical Activity and Perceived Support among Adolescents According to Sex and Municipality

A cross-sectional study was conducted with three aims: (1) to determine the degree of compliance with physical activity recommendations among adolescents according to sex and place of residence, (2) to determine the perceived support of family and friends for physical activity among adolescents according to sex and place of residence, and (3) to analyse the influence of family and friends support on compliance with physical activity recommendations among adolescents according to sex and place of residence. A total of 694 adolescents from an inland area of Spain (14.06 ± 1.27 years) participated. Four one-day physical activity questionnaires were administered to assess physical activity and the Parental Support Scale and Peer Support to measure perceived support from family and friends regarding physical activity. Chi-square, Crammer’s V and Student’s tests were calculated to identify differences between variables according to sex and municipality of residence. Moreover, the initial binary logistic regression model was constructed to predict the physical activity compliance. Differences in adherence to physical activity recommendations were found according to the sex of the students (rural area: x2 = 4.192, p < 0.05; V = 0.106, p < 0.05; urban area: x2 = 8.999, p < 0.05; V = 0.167, p < 0.01). There were also sex differences in rural areas on items related to families providing transport (t = 3.878, p ≤ 0.001; d = 0.40) and doing physical activity together (t = 4.974, p ≤ 0.001; d = 0.50). It is concluded that most adolescents do not comply with physical activity recommendations. In addition, 30.4% of urban girls’ compliance was predicted by the perception that their family members saw them doing physical activity and doing it with friends.

Artificial intelligence chatbots for the nutrition management of diabetes and the metabolic syndrome.

Recently, there has been a growing interest in exploring AI-driven chatbots, such as ChatGPT, as a resource for disease management and education. The study aims to evaluate ChatGPT's accuracy and quality/clarity in providing nutritional management for Type 2 Diabetes (T2DM), the Metabolic syndrome (MetS) and its components, in accordance with the Academy of Nutrition and Dietetics' guidelines. Three nutrition management-related domains were considered: (1) Dietary management, (2) Nutrition care process (NCP) and (3) Menu planning (1500 kcal). A total of 63 prompts were used. Two experienced dietitians evaluated the chatbot output's concordance with the guidelines. Both dietitians provided similar assessments for most conditions examined in the study. Gaps in the ChatGPT-derived outputs were identified and included weight loss recommendations, energy deficit, anthropometric assessment, specific nutrients of concern and the adoption of specific dietary interventions. Gaps in physical activity recommendations were also observed, highlighting ChatGPT's limitations in providing holistic lifestyle interventions. Within the NCP, the generated output provided incomplete examples of diagnostic documentation statements and had significant gaps in the monitoring and evaluation step. In the 1500 kcal one-day menus, the amounts of carbohydrates, fat, vitamin D and calcium were discordant with dietary recommendations. Regarding clarity, dietitians rated the output as either good or excellent. Although ChatGPT is an increasingly available resource for practitioners, users are encouraged to consider the gaps identified in this study in the dietary management of T2DM and the MetS.

Distribution and determinants of healthcare costs for self-care behaviours among patients with type 2 diabetes across low-resource communities in Nepal

BackgroundType 2 diabetes mellitus (T2DM) is a global public health problem, imposing significant financial burden on its’ management and care. Patients’ self-care behaviours can help to reduce the financial burden on healthcare resources. However, no studies have examined the distribution of healthcare costs related to self-care behaviours in low and lower middle-income countries. Therefore, this study aimed to explore the distribution and associated determinants of healthcare expenses incurred on self-care behaviours among patients with T2DM in low-resource communities in Nepal.MethodsWe conducted a cross-sectional study, collecting data from 481 patients with T2DM across low-resource communities in the Kavrepalanchok and Nuwakot districts of Nepal. We applied micro-costing with a bottom-up approach to estimate the healthcare costs for 6 month periods. Self-care behaviours were assessed using a self-reported questionnaire. The relationship between healthcare expenses and self-care behaviours was modelled by using a generalised linear model with an identity-link function and 10,000 bootstrapping resampling techniques.ResultsThe average healthcare cost for managing T2DM is US $22.87 per patient for 6 months. Patients who engaged in footcare had the highest total expenses at US $71.98, followed by those who regularly conducted glucose monitoring (US $29.55), met physical activity recommendations (US $23.68), adhered to prescribed medication intake (US $23.59) and adhered to recommended dietary habits (US $22.98). Those patients who met the physical activity guidelines, regularly conducted glucose monitoring, and engaged in footcare had 18%, 32%, and 102% higher expenses respectively, compared to their counterparts.ConclusionsFootcare was the most expensive and least practised component of self-care behaviour for managing T2DM, followed by glucose monitoring and physical activity, underscoring the significance of making these behaviours affordable and accessible in diabetes management. This provides valuable insight for decision-makers to prioritise and ensure these behaviours are affordable for patients with diabetes.Graphical

Acute Effects of Cadence-Controlled Walking on Cognition and Vascular Function in Physically Inactive Older Adults: A Randomized Crossover Study.

Cadence-controlled walking may be a desirable approach for older adults to self-monitor exercise intensity and achieve physical activity guidelines. We examined the acute effects of cadence-controlled walking on cognition and vascular function in physically inactive older adults. In a randomized crossover design, 26 participants (65% females, 67.8 ± 11.3years) underwent 30-min acute exercise (walking at 100steps/min) and control (sitting) conditions. We measured cognition, central blood pressure (BP), and arterial stiffness before, and immediately, after each condition. We observed significant Time × Condition interactions in the Flanker Inhibitory Control and Attention (Flanker) test and Dimensional Change Card Sort (DCCS) test scores, and in central systolic BP, central pulse pressure, and carotid to femoral pulse wave velocity (p < .05). The Flanker and DCCS scores significantly increased after walking (d = 0.4 and 0.5, respectively), but not after sitting. Central systolic BP, central pulse pressure, and carotid to femoral pulse wave velocity significantly increased after sitting but remained unchanged after acute walking (d = 0.4-0.2), with p-values < .05. After walking, significant correlations were observed between DCCS and diastolic BP and central pulse pressure change scores and change scores in central pulse wave velocity,Flanker, and DCCS (rs = -0.45 to -0.52). These findings suggest that a single bout of cadence-controlled walking elicited an immediate improvement in cognition and might have mitigated increases in arterial stiffness and central BP observed in the seated control condition. Further research is needed to examine the association between cognition and vascular function following acute exercise compared to control conditions. Our findings may have practical implications for developing daily physical activity recommendations for improving the cognitive health for successful aging.

Effect of physical activity on the severity of irritable bowel syndrome (IBS) symptoms

Irritable bowel syndrome is a chronic gastrointestinal disease whose symptoms affect patients' daily lives. Exacerbation of symptoms can worsen patients' quality of life and lead to depressive-anxiety and somatoform disorders. The associated costs burden not only the patients, but also those around them. The etiology of IBS is multifactorial and not fully understood. The brain-gut axis remains a subject of research, which may involve the development of new, effective therapies for the treatment of IBS in the future. Pharmacological and non-pharmacological methods are used to treat IBS. In order to provide the patient with the best possible treatment results in the absence of significant side effects, research is being conducted on the possibilities of non-pharmacological patient management. Currently, there are numerous studies on the effect of physical activity on the severity of symptoms in IBS patients. The results show that the introduction of moderate-intensity physical activity has positive effects in terms of alleviating gastrointestinal symptoms, reducing the severity of psychological and somatoform symptoms, and improving patients' well-being as well as quality of life. Appropriate physical activity is acceptable to patients and rated by them as positive and having a beneficial effect on IBS symptoms. The lack of patient-reported significant side effects is important. Given the results of the study, it seems beneficial to recommend that IBS patients perform moderate physical activity to alleviate and control symptoms. It is necessary to educate patients and individualize physical activity recommendations to match the type of activity to patients' abilities and needs.

User-centered design of a mobile app for physical activity advice in cancer care: preliminary study in Morocco at the National Institute of Oncology

ContextUtilizing mobile apps to increase physical activity levels is now standard practice in cancer care. The study’s objective was to provide patients with precise physical activity recommendations and/or initiate self-directed exercise programs.MethodsA multidisciplinary group directed the design procedure. We adhered to the self-determination approach,and accompanying behavior modification strategies, as well as international guidelines in the field of physical activity in cancer care. The design process was user-centered and involved three steps: Understanding the user and the context, conceptualization, and evaluation of the prototype. The testing was carried out by the beneficiaries, healthcare professionals, and two experts. Three criteria were evaluated in the designed solution: usability, quality, and potential for behavior change.ResultsThe evaluation results of the designed solution showed good perception by both beneficiaries and healthcare professionals. The average system usability scale score was 90,6 (SD: 7.33) for beneficiaries, and 92.75 (SD: 3.83) for healthcare professionals. The first expert received a mean overall quality score of 4.51 on the mobile app rating scale, while the second received a score of 4.27. The results of the app behavior change scale gave the first expert a score of 17/21 and the second a score of 15/21.ConclusionBased on the criteria of usability, quality, and potential for behavior change, the designed app demonstrated positive results. This is a preliminary evaluation, which will be followed by additional, in-depth evaluations with larger sample sizes.

User-centered design of a mobile app for physical activity advice in cancer care: preliminary study in Morocco at the National Institute of Oncology

ContextUtilizing mobile apps to increase physical activity levels is now standard practice in cancer care. The study’s objective was to provide patients with precise physical activity recommendations and/or initiate self-directed exercise programs.MethodsA multidisciplinary group directed the design procedure. We adhered to the self-determination approach,and accompanying behavior modification strategies, as well as international guidelines in the field of physical activity in cancer care. The design process was user-centered and involved three steps: Understanding the user and the context, conceptualization, and evaluation of the prototype. The testing was carried out by the beneficiaries, healthcare professionals, and two experts. Three criteria were evaluated in the designed solution: usability, quality, and potential for behavior change.ResultsThe evaluation results of the designed solution showed good perception by both beneficiaries and healthcare professionals. The average system usability scale score was 90,6 (SD: 7.33) for beneficiaries, and 92.75 (SD: 3.83) for healthcare professionals. The first expert received a mean overall quality score of 4.51 on the mobile app rating scale, while the second received a score of 4.27. The results of the app behavior change scale gave the first expert a score of 17/21 and the second a score of 15/21.ConclusionBased on the criteria of usability, quality, and potential for behavior change, the designed app demonstrated positive results. This is a preliminary evaluation, which will be followed by additional, in-depth evaluations with larger sample sizes.

Cardiometabolic Health in Adolescents with Obesity: The Role of Protein Intake, Diet Quality, and Physical Activity.

Background: Although adolescents with obesity have an increased risk of cardiometabolic disease, a subset maintains a healthy cardiometabolic profile. Unhealthy lifestyle behaviors may determine cardiometabolic risk. We aimed to characterize the lifestyle behaviors of adolescents with obesity, compare differences between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and assess associations between lifestyle behaviors and cardiometabolic profiles. Methods: Participants aged 10-18 years with body mass index (BMI) ≥ 95th percentile were included. Dietary intake (DI) was estimated from 3-day food records, and diet quality (DQ) was assessed using the Healthy Eating Index-Canadian Adaptation. Physical activity (PA), body composition, anthropometrics, blood markers, and blood pressure (BP) were objectively measured. MUO was defined as having high triglycerides, BP, glucose, or low high-density lipoprotein. Regression analyses were performed between lifestyle behaviors and cardiometabolic markers. Results: Thirty-nine participants (BMI z-score 2.8 [2.5-3.5], age 12.5 [10.9-13.5] years, 56.4% female) were included. A high proportion of participants failed to meet lifestyle recommendations, particularly for DQ (94.7%, n = 36), fiber (94.7%, n = 36), and PA (90.9%, n = 30). No differences in lifestyle behaviors were found between MUO (59.0%, n = 22) and MHO (41.0%, n = 16). Protein intake was negatively associated with BMI and waist circumference z-scores, fat mass index, insulin resistance, low-density lipoprotein, and C-reactive protein, whereas higher DQ was associated with lower C-reactive protein. Higher light PA levels were associated with lower total cholesterol and triglycerides. Conclusion: Adolescents with either MUO or MHO displayed low adherence to DQ, DI, and PA recommendations; no differences in lifestyle behaviors were found. Protein intake, DQ, and PA were associated with a healthier cardiometabolic profile.

Cardiometabolic Health in Adolescents with Obesity: The Role of Protein Intake, Diet Quality, and Physical Activity.

Background: Although adolescents with obesity have an increased risk of cardiometabolic disease, a subset maintains a healthy cardiometabolic profile. Unhealthy lifestyle behaviors may determine cardiometabolic risk. We aimed to characterize the lifestyle behaviors of adolescents with obesity, compare differences between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and assess associations between lifestyle behaviors and cardiometabolic profiles. Methods: Participants aged 10-18 years with body mass index (BMI) ≥ 95th percentile were included. Dietary intake (DI) was estimated from 3-day food records, and diet quality (DQ) was assessed using the Healthy Eating Index-Canadian Adaptation. Physical activity (PA), body composition, anthropometrics, blood markers, and blood pressure (BP) were objectively measured. MUO was defined as having high triglycerides, BP, glucose, or low high-density lipoprotein. Regression analyses were performed between lifestyle behaviors and cardiometabolic markers. Results: Thirty-nine participants (BMI z-score 2.8 [2.5-3.5], age 12.5 [10.9-13.5] years, 56.4% female) were included. A high proportion of participants failed to meet lifestyle recommendations, particularly for DQ (94.7%, n = 36), fiber (94.7%, n = 36), and PA (90.9%, n = 30). No differences in lifestyle behaviors were found between MUO (59.0%, n = 22) and MHO (41.0%, n = 16). Protein intake was negatively associated with BMI and waist circumference z-scores, fat mass index, insulin resistance, low-density lipoprotein, and C-reactive protein, whereas higher DQ was associated with lower C-reactive protein. Higher light PA levels were associated with lower total cholesterol and triglycerides. Conclusion: Adolescents with either MUO or MHO displayed low adherence to DQ, DI, and PA recommendations; no differences in lifestyle behaviors were found. Protein intake, DQ, and PA were associated with a healthier cardiometabolic profile.

Physical Activity Interventions in People with Diabetes: A Systematic Review of The Qualitative Evidence.

The aim of this systematic review is to summarize the results of qualitative research into people with type 2 diabetes mellitus (T2DM) and their propensity to engage in physical activity (PA), and to identify and analyse their experiences and opinions of interventions and programs designed to increase their adherence to PA recommendations. Systematic review of qualitative studies extracted from databases using the SPIDER systematic search method. The review included studies that combined qualitative and mixed methods research and compiled the experiences and opinions of people with T2DM who had participated in interventions to increase their levels of PA. A thematic summary of qualitative data was performed. The review comprised nine studies published between 2017 and 2021, which included 170 people. Four themes and ten subthemes were identified. The four themes include: (1) factors related to PA, (2) factors related to the program, (3) factors related to the support the participants received and (4) factors related to the person. The support patients receive, both from family/friends and from health providers, is key to consolidating changes in habits and in promoting individualized health education. Future interventions and health policies should reinforce programs designed to promote PA that prioritize the experiences of people in order to increase their adherence to PA programs.

Evaluating recommendation-based dietary and physical activity strategies for prostate cancer prevention: a target trial emulation in the Health Professionals Follow-up Study.

The 2018 World Cancer Research Fund/American Institute for Cancer Research recommends sustained strategies of physical activity and diet for cancer prevention, but evidence for long-term prostate cancer risk is limited. Using observational data from 27,859 men in the Health Professionals Follow-up Study, we emulated a target trial of recommendation-based physical activity and dietary strategies and 26-year risks of prostate cancer, adjusting for risk factors via the parametric g-formula. Compared with no intervention, limiting sugar-sweetened beverages showed a 0.4% (0.0-0.9%) lower risk of lethal (metastatic or fatal) disease and 0.5% (0.1-0.9%) lower risk of fatal disease. Restricting consumption of processed foods showed a 0.4-0.9% higher risk of all prostate cancer outcomes. Estimated risk differences for clinically significant disease were close to null for strategies involving fruits and non-starchy vegetables, whole grains and legumes, red meat, and processed meat, as well as under a joint strategy of physical activity and diet. Compared with a "low adherence" strategy, maintaining recommended physical activity levels showed a 0.4% (0.1-0.8%) lower risk of lethal and 0.5% (0.2-0.8%) lower risk of fatal disease. Adhering to specific components of current physical activity and dietary recommendations may help to prevent lethal and fatal prostate cancer over 26 years.

Psychological distress and health behaviours in people living with and beyond cancer: a cross-sectional study

This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (< 500 g/week), processed meat (0 g/day), high calorie food (fat ≤ 33% of total daily energy intake and free sugar ≤ 5% of total daily energy intake), alcohol (≤ 14 units/week) and smoking (non-smoking). A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0–9). Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI 0.55, 0.97), but not for any other health behaviour. Psychological distress is associated with lower adherence to WCRF recommendations for physical activity in people living with and beyond cancer. Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.

Associations of 24-hour movement behaviors with emotional and behavioral problems among Chinese adolescents.

The role of adherence to the recommendations for 24-hour movement behaviors (24-HMB), including physical activity (PA), screen time (ST), and sleep duration (SLP), in relation to emotional and behavioral problems in Chinese adolescents remains uncertain. This study aimed to investigate these associations and explore potential sex differences. This school-based cross-sectional study included 15,071 Chinese adolescents with a mean age of 14.53 (SD: 1.65) years. Data on emotional and behavioral problems and 24-HMB (including PA, ST, and SLP) were collected. Analysis was performed using general linear mixed models, with additional sex-stratified analyses conducted. The number of 24-HMB recommendations met was negatively associated with total difficulties (β estimate=-0.96, 95% CI: -1.07 to -0.85) and positively related to prosocial behavior (β estimate = 0.41, 95% CI: 0.37 to 0.46) among adolescents. Compared with none of the recommendations met, meeting all recommendations (total difficulties: β estimate=-2.98, 95% CI: -3.41 to -2.55; prosocial behaviors: β estimate = 1.05, 95%CI: 0.87 to 1.24) demonstrated the strongest association with both difficulties and prosocial behaviors, followed by meeting recommendations for PA + ST (total difficulties: β estimate=-2.15, 95% CI: -2.41 to -1.90; prosocial behaviors: β estimate = 0.98, 95% CI: 0.87 to 1.09). These associations were consistently significant in both boys and girls. Adherence to more 24-HMB recommendations, particularly meeting all recommendations or combined PA + ST recommendations, could improve emotional and behavioral well-being among adolescent girls and boys. The significance of balanced movement behaviors for promoting adolescent mental health merits increased attention.

Lifestyle as a Modulator of the Effects on Fitness of an Integrated Neuromuscular Training in Primary Education.

The objective was to evaluate changes in fitness after an integrated neuromuscular training (INT) intervention in primary school children and to evaluate how lifestyle behaviors and parental education modulate these changes. One hundred and seventy children (7.45 ± 0.34 years; 52% girls) were included. Cardiorespiratory fitness (half-mile run test), a 10 × 5 m shuttle run test, standing broad jump (SBJ), handgrip dynamometer, body mass index (BMI) and fat mass percentage (FM%) were assessed before and after the 3-month intervention (20 min of INT in the physical education class, twice per week). The Mediterranean diet (MD), sleep time and parental education level (PEL) were evaluated by questionnaires, and adherence to physical activity (PA) recommendations was measured with a triaxial accelerometer before the intervention. After the intervention, there were improvements in the 10 × 5 test and the SBJ. Only girls had improvements in the handgrip test, BMI SDS and FM%. After correcting for confounding variables, only BMI was significantly improved whereas strength improved in the participants non-compliant with the PA recommendations or pertaining to families of high PEL. The INT produced improvements in fitness in a brief period and in different subgroups of pupils (inactive and with diverse sociocultural environments).

Physical activity and exercise motivation of multiple myeloma patients: a prospective cross-sectional study.

Multiple myeloma (MM) is the second most common hematological malignancy with its prevalence increasing. Patients with symptomatic MM can show numerous comorbidities, affecting their quality of life (QoL). Physical activity (PA) may improve QoL but is not a standardized intervention of comprehensive cancer centers (CCCs). Since data on the PA of patients with MM are scarce, we aimed to prospectively assess fitness levels and patients' motivation to join PA-interventions at our CCC. We generated an exercise questionnaire to interview consecutive patients MM. We prospectively collected data on (a) past and current PA, defined by the World Health Organization (WHO) recommendations, (b) knowledge on exercise effects, (c) exercise motivation, and (d) willingness to participate in PA-interventions. Demographics, comorbidities, response, progression-free survival (PFS), and overall survival (OS) were assessed in 211 symptomatic patients MM. While our patients were elderly and most showed bone involvement, their PA was similar to healthy individuals. Aerobic PA (≥ 60 minutes/week) was performed by 65%, and 25% exercised ≥ 150 minutes/week. WHO PA recommendations were fulfilled by 17% of patients. No sport activities or complete physical inactivity were observed in 35% and 16%, respectively. Notably, 38% were motivated to join MM-specific sport interventions. Self-reported knowledge of PA-induced benefits for patients cancer was high (82%), but only 27% knew which exercises were safe to perform. This study provides an overview of the PA of patients MM. Our results suggest that the PA of patients MM might not be much lower than in the age-matched general population.

Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study.

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.

Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population.

The haemodialysis (HD) population is sedentary, with substantial cardiovascular disease risk. In the general population, small increases in daily step count associate with significant reductions in cardiovascular mortality. This study explores the relationship between daily step count and surrogate markers of cardiovascular disease, including left ventricular ejection fraction (LVEF) and native T1 (a marker of diffuse myocardial fibrosis), within the HD population. This was a post hoc analysis of the association between daily step count and metabolic equivalent of task (MET) and prognostically important cardiac magnetic resonance imaging parameters from the CYCLE-HD study (ISRCTN11299707). Unadjusted linear regression and multiple linear regression adjusted for age, body mass index, dialysis vintage, haemoglobin, hypertension and ultrafiltration volume were performed. Significant relationships were explored with natural cubic spline models with four degrees of freedom (five knots). A total of 107 participants were included [age 56.3±14.1years, 79 (73.8%) males]. The median daily step count was 2558 (interquartile range 1054-4352). There were significant associations between steps and LVEF (β=0.292; P=.009) and steps and native T1 (β=-0.245; P=.035). Further modelling demonstrated most of the increase in LVEF occurred at up to 2000 steps/day and there was an inverse dose-response relationship between steps and native T1, with the most pronounced reduction in native T1 between ≈2500 and 6000 steps/day. The results suggest an association between daily step count and parameters of cardiovascular health in the HD population. These findings support the recommendations for encouraging physical activity but are not the justification. Further research should evaluate whether a simple physical activity intervention improves cardiovascular outcomes in individuals receiving maintenance HD.