Regular PA Research Articles

The performance of physical activity and health-related quality of life in patients with heart failure: a cross-sectional study

Introduction: This study aimed to describe self-reported PA performance and determine predictors regarding health-related quality of life (HRQOL) among heart failure (HF) patients. Methods: A cross-sectional design was adopted, and data were collected using a questionnaire comprising demographic characteristics, illness-related factors, self-report health status (SRHS) questionnaire, international PA questionnaire, and Minnesota Living with Heart Failure questionnaire. Subsequently, data were analyzed using Pearson correlation coefficient, t-test, one-way ANOVA, and hierarchical multiple regression. Results: The mean age for the total participants of 180 HF patients was 59.92 ± 11.90 years, with 60% being male, and the mean HRQOL score was 42.96 ± 20.47. HRQOL had significant correlations with HF medication (r= 0.20, p< 0.01), health status (HS) (r= 0.35, p< 0.01), PA (r= -0.52, p< 0.01), and HRQOL was associated with the New York Heart Association (NYHA) classification (F= 94.57, p< 0.001). Meanwhile, age, gender, job, marital status, religion, level of education, hemoglobin, body mass index, length of diagnostic HF, and comorbidities did not have a significant relationship with HRQOL. Three variables were significant predictors of HRQOL, namely HS (β= 0.21, p< 0.01), NYHA Class III (β= 0.15, p< 0.05), and PA (β= -0.31, p< 0.001). Conclusions: Regular PA is crucial in improving HRQOL of HF patients. In addition, HS, HF medication, and NYHA Class should be considered in providing care for HF patients aimed at improving HRQOL.

Physical activity and sedentary behaviour in relation to body composition, estimated insulin sensitivity and arterial stiffness in adults with type 1 diabetes

AimsTo examine the association of daily PA levels and sedentary behaviour with body composition, estimated insulin sensitivity, and arterial stiffness in adults with type 1 diabetes (T1D). MethodsCross-sectional study in adults with T1D (n = 54). PA levels (daily steps, and time in moderate-to-vigorous intensity PA (MVPA)) and sedentary behaviour were measured using accelerometry for 7 days (McRoberts® DynaPort MoveMonitor). Cardiopulmonary exercise test for VO2max. Anthropometrics were collected, and body composition (total and % of fat mass (FMtot, FM%), total and % of lean mass (LMtot, LM%), and estimated visceral adipose tissue (VAT)) volume was assessed with dual energy X-ray-absorptiometry (DXA). Estimates of insulin sensitivity were determined (estimated glucose disposal rate (eGDR) and total daily insulin dose). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV (m/s); SphygmoCor®). ResultsLower 10-years HbA1c associated moderately with all PA measures. Favourable moderate associations were also found between PA measures and BMI, waist, VAT but not FM and LM. PA measures were favourably associated with a lower total daily insulin dose and higher eGDR. All PA parameters associated moderately with cf-PWV however not independent from traditional risk factors. VO2max was inversely associated with cf-PWV independent of age, T1D duration and 24-hour mean blood pressure. ConclusionsHigher levels of PA, lower sedentary behaviour and greater exercise capacity are favourably associated with long-term glycaemic control, body composition, insulin dosage, estimated insulin sensitivity and arterial stiffness in adults with T1D. Therefore, regular PA and limiting sedentary time should be encouraged to improve metabolic and cardiovascular health in this population. Future longitudinal studies should explore mutual interactions and synergistic effects of PA on these outcomes.

New parents’ sleep, movement, health, and well-being across the postpartum period

ABSTRACT Objective The aim of this study was to examine changes and the bi-directional relationship in sleep and movement, and health and well-being among new parents and differences by sex. Methods This secondary data analysis included both conditions from a randomized control trial to improve new parents’physical activity [PA] and recruited couples. Parents (n = 181, 117 couples represented 31.5 ± 4.4 years, 51.3% women, 83.3% White) completed questionnaires on regular overnight sleep duration, PA, mental health (perceived stress), physical health (physical quality of life [PQoL]), and well-being (life satisfaction) at 2-, 4-, 6-, and 8-month postpartum. Random-intercept cross-lagged panel models were stratified by sex to examine changes in sleep and PA with health and well-being across time. Results Sleep and stress were interrelated at different times for fathers (2 months), and mothers (8 months). Sleep and PQoL improved across time, with mothers reporting less sleep than fathers at 4 and 6 months. PQoL at 4 months was related to MVPA at 6-months. Life satisfaction and PA at 2 months was related to PA at 4 months. Conclusion Mothers and fathers experienced different sleep and stress trajectories. Mental health improved postpartum with early connections to PA. Supporting the 24-hour movement behavior cycle and mental health across the parenthood transition may benefit couples.

Exploring person-specific associations of situational motivation and readiness with leisure-time physical activity effort and experience.

Identifying determinants of leisure-time physical activity (LTPA) often relies on population-level (nomothetic) averages, potentially overlooking person-specific (idiographic) associations. This study uses an idiographic perspective to explore how subjective readiness and motives for LTPA relate to volitional effort (duration, intensity) and affective experience (pleasure, displeasure). We also highlight the potential for different interpretations when data are averaged within individuals and assessed using a variable-centered approach. Participants (N = 22, 25±8 years old, 54.5% women) were asked to continue their regular PA patterns for 10 weeks. Ecological momentary assessment procedures allowed participants to provide pre-activity reports (physical, cognitive, emotional readiness and situational motive for activity) and post-activity reports (activity type, duration, perceived exertion, ratings of affective valence). Spearman rank correlation was implemented to interpret within- and between-person associations. Data visualization approaches were used to showcase person-specific differences in associations. Participants provided 519 reports of LTPA (24±11 events/person), which displayed between- and within-person variety in type, duration, intensity, and affective experience. Exemplar cases highlight discrepancies in interpretation based on level of analysis, such that the nomothetic association (rho = .42, p = .05; 95% CI -.02, .72) between motive to replenish energy and LTPA duration was observed in only one within-person analysis (41% were weak-to-large inverse effects). Alternatively, the negligible nomothetic association (rho = .02, p = .93; 95% CI -.41, .44) between physical readiness and LTPA-related affect did not reflect the 59% of within-person analyses showing moderate-to-large, positive effects. Future research aiming to identify determinants of LTPA effort and experience should integrate contemporary, idiographic analyses in early-stage research for developing person-specific strategies for LTPA promotion.

The effect of regular running on body weight and fat tissue of individuals aged 18 to 65

BackgroundAge and reduction in performed physical activity cause physiological changes that include an increase in body fat (BF) and visceral fat (VF) during aging. These parameters, together with increased body mass (BM), are some of the risk factors of several noninfectious diseases. However, changes in body composition can be influenced by regular physical activity. Running is a suitable, accessible, and the most effective physical activity cultivating people. The objective of this study is to investigate the effects of long-term, regular PA, specifically recreational running, on changes in body composition among recreational adult runners covering a weekly distance of at least 10 km, compared with inactive adult individuals within the same age bracket.MethodsThe study included 1296 runners and inactive individuals (691 male and 605 female), divided into 5 age groups: 18–25, 26–35, 36–45, 46–55, and 56–65 years. Runners are as follows: ran ≥ 10 km/week, and inactive is as follows: did not follow the WHO 2020 physical activity recommendations. The measured parameters included BM, BF, and VF. To check statistical significance, the Mann–Whitney U-test was used. Practical significance was assessed using the effect of size.ResultsAll age groups of runners were selected to include individuals who run at least 10 km per week. In fact, they ran, on average, from 21.6 to 31.4 km per week in relation to age and showed significantly lower values of BM, BMI, BF, and VF (p < 0.05) than inactive individuals. Exceptions included insignificant differences (p > 0.05) in BM and BMI in males in the age category of 18–25 and in females in the age category of 18–25 and 26–35.ConclusionThe selected runners had to run at least 10 km per week. Their actual average volume was significantly higher (from 21.6 to 31.4 km/week), and the results showed that it could lead to significantly better body composition values. It may lead to significant changes in body mass, body fat, and visceral fat. It may meet the contemporary societal expectations for physical activities that are both achievable and effective at the lowest possible volume.

Physical activity and its fluctuations in relation to depressive symptoms: A national longitudinal study among Chinese adults

BackgroundPhysical activity (PA) may prevent depressive symptoms, however, PA fluctuations may have different effects. Using three waves of nationally representative data, this study aimed to examine the effects of PA fluctuations on depressive symptoms. MethodsParticipants comprised 7633 adults free of depressive symptoms at the first two waves (Mage = 45.26, 54.70 % males). They completed the China Family Panel Study in 2016 (T1), 2018 (T2), and 2020 (T3), respectively. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES–D) scale using a cutoff of 16. Participants' PA levels were split into regular PA or infrequent PA groups. Changes in PA levels between T1 and T2 were classified into four groups: maintained infrequent PA, initiated regular PA, ceased regular PA, and persisted regular PA. ResultsThe incidence of depressive symptoms was 20.22 % (19.05 % possible and 1.17 % severe depression). After multivariate adjustment, Poisson regression showed that persistent regular PA had 17.8 % (95 % CI: 0.724, 0.934) lower risks of incident depressive symptoms compared to maintained infrequent PA. And adults who ceased regular PA were more likely to experience depressive symptoms than those who persisted in regular PA (RR = 1.188, 95 % CI: 1.010, 1.398). LimitationsAll items were self-reported. CES–D only examined self-diagnosed depressive symptoms, not medical diagnoses. ConclusionAdults who persisted in regular PA may have a lower possibility of developing depressive symptoms. The finding might serve as an empirical reference to depression prevention.

Regular exercise delays microvascular endothelial dysfunction by regulating antioxidant capacity and cellular metabolism

Aging is the basis for several unfavorable conditions, including cardiovascular diseases (CVDs). In this sense, regular physical activity (regular PA) has been proven to delay cellular aging and prevent endothelial dysfunction related to CVDs. Despite numerous studies involving athletes, little is known about cellular and molecular mechanisms of regular PA among master athletes. The present study aimed at evaluating the effects of regular PA on local microcirculatory functions in elderly athletes as compared to age-matched sedentary controls. Moreover, molecular/epigenetic mechanisms (nitric oxide, oxidative stress, PGC-1α, SIRT1 and miR29) were also assessed. The results of the present study showed that regular PA significantly increased local blood flow in post-ischemia and post-heating conditions, as well as NO plasma concentrations, denoting a better endothelial function/microcirculatory efficiency. Moreover, athletes presented a greater plasma antioxidant and increased transcriptional levels of the metabolism regulator PGC-1α. Finally, regular PA enhanced plasma level of SIRT1 and miR29, suggested as epigenetic regulators of redox balance and cellular metabolism. In addition, stimulated local blood flow was directly related to plasma antioxidant capacity, and SIRT1 and miR29 levels. Overall, our data confirm the beneficial effects of regular PA on the cardiovascular profile in elderly athletes and shed light on molecular signals involved in the positive adaptations to exercise.

The associations of physical activity and lifetime depression with all-cause and cause-specific mortality: evidence from a prospective cohort study

This study aims to explore the joint associations of physical activity and lifetime depression with all-cause and cause-specific mortality. The present study using data from UK Biobank, included 316568 participants aged 37 to 73 years recruited from 22 centers between 2006 and 2010. Total physical activity (TPA), moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), assessed by metabolic equivalent task (MET) were used and Cox-proportional hazard models were performed in this study. The incidence rate of all-cause, CVD, and cancer mortality was 4.35(95%CI: 4.29-4.42), 0.69 (95%CI: 0.67-0.72), and 2.23 (95%CI: 2.19-2.28) per 1000 person-years after an average follow-up time of 12.49 years. Lower levels of TPA, MVPA, and VPA were all independently associated with elevated risk of all-cause and cancer mortality. Lifetime depression was significantly associated with increased risk of all-cause (HR=1.46, 95%CI: 1.40-1.52), CVD (HR=1.48, 95%CI: 1.33-1.64), and cancer mortality (HR=1.13, 95%CI: 1.06-1.21). Significant interactive effect of low levels of TPA, MVPA, and VPA and lifetime depression on all-cause mortality were found in this study. The risk of all-cause mortality associated with lifetime depression was deteriorated with low levels of physical activity. Relevant interventions for regular PA should be performed among depressed population.

Motives for physical activity participation among Lebanese adults aged 15 to 50 Years: A cross-sectional study

Background: Sports participation motivations can be intrinsic, extrinsic, or even amotivational. Few studies on adult participation in PA have been found in the Lebanese context. This study aims to: a) investigate significant differences in sports participation motivation across gender, age, occupation, and time of practice, and b) investigate sports participation motives that discriminated the best between those variables.Material and methods: The Arabic version of the Sport Motivation Scale was collected electronically from 568 volunteers practicing regular PA for the last six months. Gender, occupation, marital status, and time of practice were all analyzed using Mann-Whitney U test and the Kruskal Wallis Test with 0.05 as level of significance.Results: Internal motivation subscales (particularly the intention to accomplish) were the most influential motives for both genders. A significant difference across gender was reported in the extrinsic motivation and amotivation subscales. Furthermore, age, occupation, marital status, and time of practice show significant differences in motivation factors either dependent or regardless of gender distribution (p&lt;0.05).Conclusion: no significant differences in the intrinsic motivation for sports participation between genders. Other factors, on the other hand, had a substantial impact.Research contribution: these findings are intended to contribute to a better understanding of differences in motivation for participating in PA and to aid in its promotion among Lebanese adults.

Addressing Physical Activity among Adults 50+: An Ethnographic Study of Physical Therapists

Aims 1) Gain insight into PA prescription by United States-based physical therapists treating patients 50 years and older, and 2) Explore the contextual factors that impact PA prescription. Methods We integrated ethnographic study data, including a questionnaire, observations, and semi-structured interviews. Results Our nine participants with 24.7 years (SD= 11.6) of clinical experience completed frequent PA assessments, but PA prescription was inconsistent. The following themes helped explain the participants’ clinical decisions: 1) treatment prioritization; 2) physical therapists’ intentions of addressing PA; and 3) contextual factors that impact treatment and treatment prioritization (e.g., experience, beliefs, concerns related to PA prescription, and work environment). Conclusions Most participants did not address PA among adults 50 years and older. Due to the importance of performing regular PA, it is vital for physical therapists to reflect on their PA prescription. Organizations and health service researchers need to implement strategies that address the PA prescription barriers.

Do Physical Fitness and Executive Function Mediate the Relationship between Physical Activity and Academic Achievement? An Examination Using Structural Equation Modelling.

Background: Physical activity health benefits are widely known. However, the association between physical activity, physical fitness, executive function, and academic performance need further investigation. Additionally, one of the literature gaps reveals scarce and mixed findings on what mediators of physical activity may affect academic achievement. Purpose: This investigation aims to provide knowledge about the mediation role of physical fitness and executive function in the association of physical activity with academic achievement in a cohort of Spanish schoolchildren using a structural equation modelling approach. Methods: The data for this cross-sectional study were collected from a convenience sample of children from Spain (Balearic Islands) aged between 9 and 13 years. Physical activity levels were self-reported with the Physical Activity Questionnaire for Children; physical fitness was assessed using the International Fitness Scale; executive function was assessed with the Trail Making Test, and children’s achievements were collected from the school records. Structural equation modelling was used to explore the relationship between physical activity, physical fitness, executive function, and academic achievement. Findings: Statistically significant positive direct associations were observed between physical activity and physical fitness (β = 0.46, 95% CI [0.29, 0.64]), physical fitness and executive function (β = 0.28, 95% CI [0.04, 0.52]), and executive function and academic achievement (β = 0.46, 95% CI [0.28, 0.65]), while adjusting for the confounding effects of sex and body mass index. Furthermore, indirect associations were observed between physical activity and executive function mediated by physical fitness (β = 0.13, bias-corrected 95% CI [0.02, 0.31]) and between physical fitness and academic achievement through executive function (β = 0.13, bias-corrected 95% CI [0.03, 0.32]). Conclusions: This investigation adds to the literature with evidence supporting the idea that regular PA leads to improvements in physical fitness and may support cognitive skills and academic performance in children.

The COVID-19 Conundrum: Keeping safe while becoming inactive. A rapid review of physical activity, sedentary behaviour, and exercise in adults by gender and age.

BackgroundCoronavirus (COVID-19) has severely impacted lifestyles worldwide. Responses to COVID-19 have intentionally restricted the factors that encourage regular and frequent PA; opportunity, capability and motivation. However, the effects of these restrictions are likely to have differed by gender and age and different intensities of PA. This rapid review builds on previous evidence by synthesising the global impact of COVID-19 on adult PA through specific intensities and types of PA and evaluating this by gender and age.MethodsA rapid systematic search of seven electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, Academic Search Complete, APA PsycInfo, and APA PsycArticles) was performed from December 2019 to January 2021. Studies investigating adult change in PA, exercise or sedentary behaviour due to COVID-19 were included.ResultsFrom an initial database search identifying 3,863 articles, 66 remained for synthesis after applying eligibility criteria. Results demonstrate decreases among all intensities and types of PA—walking (6 out of 7 papers), moderate-only (5 out of 6 papers), vigorous-only (5 out of 6 papers) and MVPA (4 out of 5 papers); as well as overall PA (14–72% participants reported a decrease). Reflecting that COVID-19 responses were designed to have universal effects, they also achieved whole-society decreases in PA behaviour, accented in older age groups.ConclusionThere is a universal need to address the low levels of PA post-COVID-19. The consequences of decreased PA across all intensities has powerful, potentially recoverable, impacts. Universal declines have implications for public health officials and PA advocates for post-COVID-19 initiatives to promote PA.

Health Behaviors of Austrian Secondary Level Pupils at a Glance: First Results of the From Science 2 School Study Focusing on Sports Linked to Mixed, Vegetarian, and Vegan Diets.

Attaining healthy behaviors is essential at any life stage, particularly childhood, due to the strong link between children’s lifestyle and the subsequent adult state of health. This multidisciplinary study aimed to assess lifestyle behaviors of Austrian pupils of secondary schools I and II, with a specific focus on PA habits and diet types based on a large sample. In total, 8845 children/adolescents participated in the short standardized online survey on relevant health-related aspects nationwide. Valid and complete data was provided by 8799 pupils, including 1.14% of the eligible 771,525; 63% girls, 76% having a normal body weight, 70% attending secondary schools II, and more pupils/students living in rural vs. urban areas (3:1 ratio). Across the total sample, 11.8% were considered overweight/obese with a higher prevalence of overweight/obesity in boys than girls (15.5% vs. 9.6%) and urban vs. rural participants (13.9% vs. 10.8%; p < 0.05). The majority of participants (84.5%) reported a mixed diet, while 7.2% and 8.5% reported a vegan and vegetarian diet, respectively. Vegans reported a lesser alcohol intake (p < 0.05) compared to non-vegan pupils (no difference in dietary subgroups for smoking). Although overall PA and dietary behaviors suggest an appropriate health status among Austrian youth, attention should be focused on policies to increase healthy lifestyle habits at best through a dual approach to health permanently combining regular PA, sports, and exercise with a healthy diet, which would contribute to matching the current recommendations for improving individual and public health.

Physical Activity Promotion in a Safety-net Clinic: Does the Provider Make a Difference? A Pilot Study.

Despite the long-term health benefits of physical activity, many Americans across the lifespan do not meet the recommended levels. However, physical activity discussions in the clinic setting may hold promise. The purpose of this study aimed to understand health care providers' beliefs and practices about physical activity discussions being a part of patients' healthcare treatment. Semi-structured, audiotaped interviews were conducted to elicit narratives from ten health care providers. Interview data were transcribed verbatim, then coded and analyzed by two qualitative researchers using NVivo12. Three major themes emerged: importance of regular PA counseling for vulnerable populations, patients' lack of regular physical activity, including subthemes of lack of time, current health conditions, and social determinants of health, and healthcare provider's reflections about their own physical activity. Healthcare providers have an important role when it comes to promoting good health. Having physical activity discussions with patients at every clinic visit is a great opportunity to encourage patients to engage in healthy lifestyle behaviors such as regular physical activity. From this pilot study, implications for practice may include increased awareness of the healthcare providers to discuss physical activity at every visit, which may lead to improved provider-patient communications related to the benefits of daily physical activity behaviors. These discussions may even have a secondary gain of encouraging the providers themselves to adopt the healthy behavior and thereby serve as a role model for their patients.

The post 16 gap: how do young people conceptualise PE? An exploration of the barriers to participation in physical education, physical activity and sport in senior school pupils.

Previous studies have identified several key barriers to Physical Education, Physical activity and Sport (PEPAS). However, there is a paucity of qualitative evidence investigating why young people do and do not participate in PA and the relationship between their levels of participation at different stages of life. This study builds on a previous study and aims to investigate the barriers to PEPAS in adolescents at transition stage. The extant literature highlights that instilling regular PA throughout life strongly relies on developing physical literacy through participation in high quality physical education. Despite the understanding of the importance of high quality physical education, there is an over emphasis on the short term outcomes of physical education (PE) sessions which have been noted to overemphasise immediate physical activity rather than focus on educational outcomes important to physical literacy. Anecdotally, the recent Covid 19 Global pandemic and subsequent lockdown has resulted in a digitalisation of PE in schools and a subsequent reliance of PA programmes based on adult fitness classes, which may not necessarily be categorised as PE in its true sense. Twenty-four respondents aged 16-19 were divided into five focus groups. Data were analysed verbatim using NVivo following the guidelines by Braun and Clark (2006) on thematic analysis. The findings indicated that most respondents equated PE with team sports. Findings suggest that Physical Educators need to acknowledge how past and present experience of PE impacts young people's future motivation to continue PA beyond school. Delivery of traditional PE lessons, prioritising sporting ability, can act as a participation barrier to pupils who consider themselves"non-sporty". Accordingly, a shift towards inclusive pedagogical models with an emphasis on a holistic approach, may best promote the physical literacy necessary for the competence and confidence to continue movement in a lifelong capacity.

Physical activity and preschool children: Preschool teachers' perceptions

In this study, it is aimed to understand the perceptions of preschool teachers around the physical activity levels of children in preschool period and the factors that increase or limit their physical activity. The case study design, one of the qualitative research methods, was used in the study. In addition to maximum variation sampling from purposeful sampling types was used in the selection of the study group. A total of 102 teachers, out of 296 teachers, working in 85 schools were reached. The semi-structured interview form prepared by the researcher was used as the data collection tool. As a result of this study, it was seen that most of preschool teachers had positive opinions about physical activity, they gave importance to physical activity in their classroom activities, and they applied physical activity regularly and in a systematic plan. Preschool teachers are aware of the contribution and importance of physical activity to children, and it is thought that if arrangements are made in line with their suggestions to perform physical activity, children will be more physically active. Teachers made suggestions to improve physical conditions, to have regular PA, to direct them to sports, to ensure that children exercise at home with family education, and to plan the plans interesting so that they can include more PA and make children more physically active. Policy makers, healthcare providers, and teachers should take into account these recommendations and provide various supports to increase children's PA levels.

Physical Activity Together for People With Multiple Sclerosis and Their Care Partners: Protocol for a Feasibility Randomized Controlled Trial of a Dyadic Intervention.

BackgroundPhysical activity (PA) is beneficial for all people; however, people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with advanced disabilities and their care partners.ObjectiveThe objective of this study is to determine the feasibility of a dyadic PA intervention for people with advanced MS and their care partners.MethodsThis study is a randomized controlled feasibility trial of a 12-week intervention, with 1:1 allocation into an immediate intervention condition or delayed control condition. A target of 20 people with MS–care partner dyads will be included. The outcomes will be indicators of process, resources, management, and scientific feasibility. Participant satisfaction with the intervention components will be evaluated using a satisfaction survey. The subjective experience of participation in the study will be explored using semistructured interviews.ResultsThe project is funded by the Consortium of Multiple Sclerosis Centers. This protocol was approved by the Ottawa Hospital Research Ethics Board (20190329-01H) and the University of Ottawa Research Ethics Board (H-09-19-4886). The study protocol was registered with ClinicalTrials.gov in February 2020. The findings of this feasibility trial will be disseminated through presentations at community events to engage the MS population in the interpretation of our results and in the next steps. The results will also be published in peer-reviewed journals and presented to the scientific community at national and international MS conferences.ConclusionsThe data collected from this feasibility trial will be used to refine the intervention and materials in preparation for a pilot randomized controlled trial.Trial RegistrationClinicalTrials.gov NCT04267185; https://clinicaltrials.gov/ct2/show/NCT04267185.International Registered Report Identifier (IRRID)PRR1-10.2196/18410

HFrEF patient activity levels during COVID-19 lockdown: A comparison between physical activity questionnaires and implantable devices data

Funding AcknowledgementsType of funding sources: None.BackgroundThe ongoing COVID-19 pandemic is a major public health crisis of great risk to patients with cardiovascular comorbidities. Heart failure (HF) is a deadly chronic disease, a leading cause of hospitalizations worldwide and a great detriment to patients’ quality of life. HF therapy guidelines suggest prescribing physical activity to improve long-term outcomes. Self- or government- imposed behavioral modifications in response to COVID-19 ranging from avoiding social interactions to outright restrictions of movement (lockdowns) could compromise regular PA in HF patients, who constitute an extremely high-risk group.PurposeInvestigate the effect of the national lockdown in Greece 23rd March – 4th May 2020) on the PA levels of patients suffering from HF with reduced ejection fraction (HFrEF) and cardiac implantable electronic devices (CIEDs).MethodsHFrEF patients with CIEDs were included in the study. Participants answered the Physical Activity Questionnaire (PAQ) regarding the period before, during and after the 42-day national lockdown. CIED-derived daily activity levels for the corresponding periods were recorded through CIED telemetry. The differences in PAQ- and CIED-derived PA levels and sedentary time before, during and after the lockdown period were investigated.Results67 HFrEF patients participated in the study (mean age 69 ± 10.2y, 85% male). Activity levels fell in 55 (82%) of patients. The median PAQ-derived PA level decreased by 28% during lockdown, from 840.5 (944) METmin/week to 602 (1054) METmin/week during the lockdown (p = 0.01). A 53% increase was observed after the lockdown, to 924 (1214) METmin/week (p = 0.004). The CIED-derived activity level was 2.38 (1.3) hours/day pre-lockdown, 1.78 (1.1) hours/day during the lockdown (25% decrease, p < 0.001) and 2.69 (1.5) hours/day post-lockdown (51% increase, p < 0.001). Time spent on sedentary activities also increased to 9 (3) hours per day during the lockdown, up from 6.5 (4) hours before lockdown (p = 0.001).ConclusionsAll measures examined in this study indicate that the COVID-19 lockdown period was associated with a significant decrease in HFrEF patients’ PA. All efforts must be made on the part of clinicians and public health organizations to promote safe exercise in this subgroup of the population that is particularly vulnerable to the effects of a sedentary lifestyle. Figure. Patient activity around COVID lockdown

Editorial

There is consistent and strong scientific evidenceabout the numerous health benefits related to thephysical activity (PA). Regular PA can improve physicalfitness and health and assist in the prevention of variousdiseases. In general, physically active adults are healthierand present higher physical performance in comparisonwith inactive adults worldwide. Among some desirablebehaviors, PA can be considered as part of a healthy lifestyleand can be categorized into occupational, sports,conditioning, household, or other activities involvingmovement of the body generated by skeletal muscleswith energy expenditure. Aligned with that, it is undeniablethe relevance of the physical inactivity as a riskfactor for premature mortality and for cardiovasculardisease and a variety of other chronic diseases, includingdiabetes mellitus, cancer (colon and breast), obesity,hypertension, bone and joint diseases (osteoporosis andosteoarthritis), and depression. Moreover, exercise inpatients with hematologic cancer, like leukemia, couldimprove immune function.Due to the relevance of the PA, it is important to stimulatebehaviors involving the physical practice. There areseveral factors that can influence these behaviors, suchas: personal (biological, health and psychological attributes),social (family, affiliation group, and work factors),and environmental (contexts for different forms of PAand policy factors that could determine availability ofrelevant settings and opportunities).The outbreak of the coronavirus disease 19 (COVID--19) has interfered in different factors of the PA behaviors.Depending of the severity of the COVID-19 inan individual, there are limitations to performed PA.Furthermore, aiming to contain the COVID-19 infectionsand to reduce interaction between infected andnon-infected individuals, strategies and restrictivepolicies have been suggested, such as quarantine, localconfinement, lockdown and isolation. It is clear that,while the individuals are confined at home the levelof PA, in general, decreases, due to the reduction of (i)daily activities outside, (ii) the participation in socialevents and, (iii) sometimes, of laboral activities. Thismay have a negative impact in general heath becauseit can contribute to sedentary behaviors. Besides theconfinement, it is important to consider other actionsto protect against the COVID-19 infection that is theuniversal use of masks.In addition to those facts, as an environmental factor,in confinement, the sunlight exposure is reduced.The relevance of the ultraviolet B radiation present insunlight to the active production of vitamin D in theorganisms is well known. This vitamin has a relevantrole to metabolic responses and protection againstdiseases, including cancer. Vitamin D deficiency hasbeen recognized as an undesirable global public healthproblem and it plays a wide role in health and in theprevention of several diseases, including the COVID-19.As the reduction of the muscle strength is observedin the individuals that had COVID-19, PA or exercisescould be important for their rehabilitation. There aredifferent modalities of exercises that could be also usedfor them, including the whole-body vibration exercisesto improve the muscular performance.Putting together, people in the world is living, or istrying to live, in conditions to maintain a minimal, butconvenient level of PA to have health to contercousethe bad situation of the COVID-19 up to a definitiveand confident vaccin be available to the human beings.The researchers are working hard to aid the worldpopulation to win this fight against the COVID-19 andthe sedentary behaviors.Naturally, COVID-19 and the sedentarism are problemsfor the world, but the continuous education aboutthe importance of PA, the studies about the effects ofmedications that can be used in the treatments of diseases,the control of use of drugs, as the pesticides, andthe discussion about the biological and legal aspects ofreprocessing of medical-hospital material are welcometo contribute to improve the health.

Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis

BackgroundPhysical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the...