Insufficient physical activity (PA) and extensive sedentary behavior (SB) in adolescents has been related to adverse outcomes related to physical fitness, body weight as well as social and psychological health indicators. Furthermore, these behaviors tend to track from adolescence to adulthood, thereby affecting adult chronic disease risk. The knowledge of factors associated with PA and SB is needed particularly in adolescents, in order to plan public health strategies aiming at increasing PA and reducing SB. The aim of this Citizen Science project (conducted between February 2020 and June 2021) was to work together with young citizens on a school-based epidemiologic study assessing device-based measured PA and SB in students (grades 8 or higher) to identify associated factors based on both established as well as co-created questionnaires. In 12 school classes from Berlin and Brandenburg, students were as Citizen Scientists involved in the co-creation of class-specific questionnaires by collecting factors that may influence their PA and SB. Students participating in the study wore thigh-worn accelerometers (activPAL) for seven consecutive days and subsequently completed established as well as the newly developed class-specific questionnaires to ascertain potential influencing factors of PA and SB. Multilevel linear regression models were used to identify factors associated with time spent in moderate-to-vigorous physical activity (MVPA) and SB. Accelerometry data with at least four recorded days were available for 119 students (783 recorded days). In models adjusted for age, sex and parental socioeconomic status, high traffic safety around the school (14.8min/day, 95% CI 0.9, 28.7) and higher degree school type (10.7min/day, 95% CI 1.7; 19.8) were associated with more time spent in MVPA. From the class-specific questionnaires developed based on input from students, the feeling of being exhausted after school and homework was associated with less time spent in MVPA, while internal motivation to be physically active, active hobbies and working out regularly at a gym were associated with more time spent in MVPA. The potential influencing factors under investigation were not associated with sedentary time (except female sex, which was related to lower sedentary time). Although our findings warrant confirmation in larger samples, this Citizen Science study points to potential action points that may be targeted in public health interventions aimed at increasing PA to improve health in adolescents.

The present study aimed to analyze associations between device-measured physical activity and sedentary time during childhood with mental health-related outcomes throughout adolescence. Data from the Millennium Cohort Study were used. Device-measured physical activity (i.e., light and moderate-to-vigorous physical activity) and sedentary time were assessed at 7 years. Internalizing and externalizing symptoms were assessed at three time points (11 years, 14 years, and 17 years) via the Strengths and Difficulties Questionnaire. Depressive symptoms were estimated using the Mood and Feelings Questionnaire at 14 years. Psychological distress was assessed using the six-item Kessler psychological distress scale at 17 years. Negative binomial regression models, adjusting for potential confounders were used. Among boys, greater time spent in moderate-to-vigorous physical activity at 7 years was associated with higher hyperactivity and lower peer problems throughout adolescence. Higher moderate-to-vigorous (incidence rate ratio [IRR]: 0.95; 95% confidence interval [CI]: 0.93-0.98), light (0.90; 0.85-0.95), and total activity time (0.95; 0.93-0.98) at 7 years were associated with lower, while sedentary time was associated with higher (1.11; 1.07-1.16) psychological distress at 17 years in the adjusted models. Girls who spent more time in light physical activity at 7 years were more likely to have lower hyperactivity levels over adolescence, while higher sedentary time at the same age was associated with higher hyperactivity levels. Higher sedentary time at 7 years was associated with higher depressive symptoms at 14 years (1.06; 1.01-1.10), whereas light physical activity at 7 years (0.91; 0.85-0.97) was associated with lower depressive symptoms at 14 years in the adjusted models. Higher moderate-to-vigorous, light physical activity, and lower sedentary time were associated with lower peer problems, depressive symptoms, and psychological distress throughout adolescence.

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health burden globally, associated with multiple adverse outcomes and increased mortality. Sedentary behavior and systemic inflammation are independently linked to adverse outcomes, but their combined effects and potential interactions in the MASLD population remain unclear.MethodsWe used data from 10,778 U.S. adults with MASLD from NHANES 2007–2018. MASLD was identified using the Fatty Liver Index (FLI ≥ 60), a validated and widely applied noninvasive indicator of hepatic steatosis in NHANES-based epidemiologic studies, providing a reliable estimate of liver fat probability for population analyses. Sedentary time was assessed by questionnaire. The systemic inflammation response index (SIRI) was determined to be the most effective inflammatory marker among the 12 inflammatory indicators using time-dependent receiver operating characteristic curves. Weighted Cox proportional hazards models were used to evaluate associations with all-cause, cardiovascular disease (CVD), and cancer mortality. Restricted cubic spline (RCS) analysis was performed to assess nonlinear relationships. Joint associations and mediation analysis were conducted to explore joint effect and the mediating role of SIRI in the sedentary time–mortality relationship.ResultsA total of 1028 deaths occurred over the follow-up duration (median: 78 months), comprising 340 cardiovascular and 256 cancer-related. Longer sedentary time and elevated SIRI were independently associated with increased all-cause and CVD mortality. Compared with participants with low sedentary time and low SIRI, those with both high sedentary time (≥ 3.81 h/day) and high SIRI (≥ 0.81) had a 62% higher risk of all-cause mortality (HR 1.62, 95% CI 1.14–2.31) and a 137% higher risk of CVD mortality (HR 2.37, 95% CI 1.45–3.86). Mediation analysis showed that SIRI statistically explained 16.5% of the association between sedentary time and all-cause mortality and 14.7% of the association with CVD mortality.ConclusionsIn U.S. adults with a high probability of MASLD identified by the FLI, both longer sedentary time and elevated systemic inflammation level are linked to increased risks of all-cause and CVD mortality. Moreover, inflammation statistically explains part of this association. These findings highlight the importance of reducing sedentary time and managing systemic inflammation to improve outcomes in individuals with FLI-defined MASLD.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03486-3.

The association of maternal sedentary behaviour before and during pregnancy and offspring health outcomes: A systematic review and meta-analysis.

Background/Objectives: Children with visual impairments (VI) experience lower Quality of Life (QoL), higher sedentary time, and reduced motor competence as compared to their sighted peers, posing challenges to their health, well-being, and psychosocial development. While several QoL instruments have been developed internationally for children/youth with VI, none have been validated for use with U.S. pediatric populations. The purpose of this study was to evaluate the psychometric properties of the VISIONS QL assessment tool tailored for children/youth with VI, with a primary aim of variable/item reduction to develop a streamlined version of the instrument. Methods: This study featured a cross-sectional, descriptive analytic design with convenience sampling. Participants were children and youth with VI, aged 9–19 years, (N = 148; Boys = 71, Girls = 77; Mage = 14.49, SD = 3.36 years). A principal components analysis (PCA) with orthogonal varimax rotation was conducted to reduce dimensionality and identify components. Results: Results of the PCA yielded three components explaining 46% of the variance: Educational Opportunities = 7 items; Social and Familial Implications = 8 items; Communication = 5 items. Overall, the VISIONS QL Brief had a high level of internal consistency reliability (α = 0.857; Ω = 0.858) and test–retest reliability (ICC = 0.89, 95% CI = 0.84–0.92). The original 63-item version showed concurrent validity with the 20-item brief scale (r = 0.92, p < 0.0001). Conclusions: Findings affirm the multidimensional nature of QoL and support the usage of the VISIONS QL Brief and its utility in settings where time, accessibility, and cognitive load are critical considerations.

BackgroundThis cross-sectional study aims to describe the characteristics of physical activity, sedentary time, sleep quality, and resting EEG among college students with mild depressive symptoms, and further explore pairwise correlations between behavioral patterns, resting EEG, and mild depressive symptoms.MethodsThis study included 75 college students with mild depressive symptoms (MDS) and 75 college students without depressive symptoms (ND) as research subjects. Physical activity (vigorous physical activity (VPA), moderate physical activity (MPA), and low physical activity (LPA)) and sedentary time（ST） were measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Resting EEG power values were collected from subjects in a quiet, eyes-closed state using an electroencephalography (EEG) device.Results(1) Characteristic analysis revealed that compared with the ND group, the MDS group exhibited reduced MPA and VPA scores, elevated ST scores, and increased total PSQI scores along with elevated scores across its subdimensions. Their behavioral patterns (Moderate-to-Vigorous Physical Activity (MVPA), Sedentary Behavior (SB), Poor Sleep Quality (PSQ) may have changed, including a decrease in the proportion of MVPA, an increase in the proportion of SB, and an increase in the proportion of PSQ. Analysis of resting EEG revealed increased Alpha2 (α2) band power in the temporal regions (T3 and T5) and increased Beta1 (β1) band power in the frontal region (Fp1) in the MDS group (all pFDR < 0.01). (2) Exploratory analyses revealed that SB and PSQ behaviors may be positively correlated with mild depressive symptoms, while MVPA may be negatively correlated with mild depressive symptoms. The combination of certain EEG indicators (α2 at T3 and T5, β1 at Fp1) achieved an AUC of 0.659 (95% CI: 0.572 to 0.745, p = 0.001) for identifying mild depressive symptoms. Additionally, in the MDS group, sleep efficiency scores showed a negative correlation with Alpha1 (α1) band power at the frontal region (F4) electrode position, sleep disturbance scores showed a negative correlation with theta (θ) band power at the parietal region (P3), hypnotic medication scores showed a positive correlation with beta1 (β1) band power at the frontal region (F3), and total PSQI scores showed a negative correlation with θ band power at the temporal region (T3).ConclusionCollege students with mild depressive symptoms may exhibit altered behavioral patterns and abnormal neural activity in the frontal and temporal regions. Their changed behavioral patterns may correlate with mild depressive symptoms, and recognition models based on certain resting EEG indicators demonstrate preliminary application potential. The association between specific sleep issues and localized EEG activity in this population may provide evidence for further elucidating the mechanistic pathways linking their behavior and brain activity. Future longitudinal studies are recommended to explore causal relationships among these variables.

BackgroundDepression is a growing public health burden and is one of the leading causes of disability and illness in adolescents. Lifestyle factors are associated with depressive symptoms (DSs) in adolescents. This study aimed to estimate the prevalence of DSs and investigate the independent and combined associations between DSs and moderate-to-vigorous physical activity (MVPA), screen-based sedentary time (ST), and sleep duration (SLD) among Chinese adolescents aged 11–19 years.MethodsRepeated cross-sectional data were collected through questionnaires on health status and influencing factors for high school students in Ningbo, China, from a school-based study conducted from September to October in 2022 and in 2023. A multistage, stratified cluster sampling procedure was used to select target adolescents aged 11–19 years. DSs were assessed using the Centre for Epidemiological Studies Depression Scale. A multivariate analysis was used to assess the associations between independent lifestyle behaviours (MVPA, ST, and SLD) and the combined patterns of those lifestyle behaviours with DSs.ResultsThe prevalence of DSs amongst the adolescents was 16.3%. Low MVPA, excessive ST, and short SLD were independently associated with a greater likelihood of DSs (all p < 0.001). The unhealthiest combined pattern of low MVPA, excessive ST, and short SLD was associated with the highest odds of DSs (OR:4.2, 95% CI:3.3, 5.2, p < 0.001). In addition, the other combined patterns of MVPA, sleep duration, and ST were significantly associated with an increase in DSs compared with the healthy combined patterns of high MVPA, appropriate ST, and sufficient SLD.ConclusionOur results indicate that MVPA, ST, and SLD were independently and in combination associated with an increase in DSs. Effective school-based health education programmes aimed at promoting healthy lifestyles are necessary to protect the mental health of Chinese adolescents. Future longitudinal studies are needed to confirm causality between the combined lifestyle patterns and DSs in Chinese adolescents.

BackgroundUnderserved pregnant women have a greater risk of excessive or inadequate gestational weight gain (GWG) and adverse perinatal outcomes. In the United States, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental nutrition and is uniquely positioned to deliver equitable interventions that support recommended GWG. Yet to date, no randomized controlled trials have evaluated behavioral strategies for managing GWG in this setting.ObjectiveThe primary objective was to examine the effects of a statewide randomized multicomponent mobile eHealth lifestyle intervention trial on change in physical activity and sedentary time across pregnancy. The secondary objective was to explore associations between changes in physical activity, sedentary time, and GWG.MethodsA total of 351 pregnant women were recruited from the Louisiana WIC clinics and were randomly assigned to a multicomponent mobile eHealth intervention for GWG management (N=179) or usual care (N=172; standard in-person WIC care) prior to 16 weeks of gestation. The multicomponent mobile intervention included daily weighing, step tracking, counseling, exercise videos, health coach interactions, and social support. For the first objective, physical activity, including movement duration and movement context, and sedentary time were assessed at baseline (early pregnancy) and at the end of the intervention (late pregnancy) using accelerometry and the Pregnancy Physical Activity Questionnaire. For the second objective, GWG was determined based on weight collected at study visits in early and late pregnancy. Linear mixed models assessed intervention effects on physical activity and GWG.ResultsBoth the Intervention Group and the Usual Care Group significantly increased sedentary time from early to late pregnancy (adjusted effect estimate [95% CI] 62 minutes per day (42-83), P<.001 and 52 minutes per day (31-72), P<.001, respectively). Both the Intervention Group and the Usual Care Group significantly decreased moderate activity (–13 minutes per day (–20 to –6), P<.001 and –10 minutes per day (–17 to –3), P=.01, respectively) and total moderate to vigorous physical activity (–14 minutes per day (–21 to –7), P<.001 and –10 minutes per day (–18 to –3), P=.01, respectively) from early to late pregnancy. For the Pregnancy Physical Activity Questionnaire, the Intervention Group reported an increase in sports participation across pregnancy compared with the Usual Care Group (+4 metabolic equivalent task (MET)–hours per week (2-7); P=.002). There were no associations between physical activity (–7 g (–32 to 18), P=.57) or sedentary time measures (4 g (–4 to 12), P=.31) and GWG.ConclusionsThe first of its kind mobile eHealth multicomponent behavioral lifestyle intervention that included guidance to increase physical activity toward national guidelines did not meaningfully impact physical activity outcomes in pregnant women who were enrolled in Louisiana WIC.Trial RegistrationClinicalTrials.gov NCT04028843; https://www.clinicaltrials.gov/study/NCT04028843International Registered Report Identifier (IRRID)RR2-10.2196/18211

The majority of hepatocellular carcinoma (HCC) cases arise in patients with cirrhosis, with known major risk factors of hepatitis B (HBV) or C (HCV) infection, metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol-associated liver disease (ALD). However, the impact of additional risk factors that act independently or jointly on the pathogenesis of HCC in cirrhosis patients is unknown. The aim of this study was to determine whether sleep, sedentariness, or physical activity levels play a role in the progression of cirrhosis to HCC. We systematically collected data on sleep, sedentary time, and physical activity from the ongoing prospective study, the Texas HCC Consortium Cohort, which recruited patients with cirrhosis from December 2016 and followed up until HCC development, death, or May 2024. Hazard ratios (HRs) were calculated using Fine-Gray competing risk regression models to evaluate the independent association between sleep, sedentary, and physical activity levels with the risk of HCC overall and in groups stratified by major HCC risk factors. Of 3940 patients with cirrhosis (mean age = 59.9years, 39.1% women), 9.3% of patients had active HCV, 34.6% had MASLD, 41.5% had MetALD, and 3.2% had ALD only. In total, 208 patients developed incident HCC (annual incidence rate, 2.37% [95% CI 2.07, 2.72%]). After adjustment for demographic and clinical factors, absent levels of light physical activity (HR = 0.92 [0.57-1.47]), excessive sitting time (HR = 0.91 [0.57-1.44]), and reduced sleep duration (HR = 0.92 [0.65-1.29]) were not associated with an increased risk of HCC development. There were no associations with increased risk of HCC development across all sub-groups examined. In this study, the risk of HCC in patients with cirrhosis was not significantly affected by level of light physical activity, sedentariness, or sleep across all major etiologies of cirrhosis.

Chronic plantar heel pain is common and often recalcitrant yet understanding of modifiable risk factors that influence its trajectory of recovery is limited. The objective of this study was to describe associations of changes in physical and psychological measures and symptom descriptors over 12 months with changes in pain, function, and quality of life in people with chronic plantar heel pain. A prospective cohort with longitudinal follow-up was used. A community setting in southern Tasmania was used. The participants were 220 people with a clinical diagnosis of chronic plantar heel pain. The exposures were body mass index (kg/m2), waist circumference (centimeters), ankle plantarflexor strength (kilograms), ankle and first metatarsophalangeal joint dorsiflexion mobility (degrees), pain catastrophizing beliefs (Pain Catastrophizing Scale), depression (9-item Patient Health Questionnaire), multisite pain, morning stiffness, neuropathic symptoms (painDETECT), and physical activity (accelerometry). The Foot Health Status Questionnaire pain and function domains and the 6-dimension Assessment of Quality of Life Scale were used. Outcomes and exposures were assessed at baseline and 12 months. Data were analyzed using linear mixed-effects models with exposure × time interactions. Increasing pain catastrophizing and neuropathic painDETECT scores over 12 months were associated with a poorer trajectory of pain recovery (pain catastrophizing interaction β = -0.39 [95% CI = -0.01 to -0.77]; painDETECT interaction β = -0.79 [95% CI = -0.10 to -1.48]). In full multivariable models, there were no other significant associations between any other variable and pain. The only associations with foot function and quality of life were weak negative associations of steps per day and sedentary time with function and quality of life, respectively. Increasing pain catastrophizing and neuropathic symptoms were associated with poorer pain outcomes over 12 months in individuals with chronic plantar heel pain. These findings highlight the importance of pain beliefs and neurogenic factors in the prognosis of chronic plantar heel pain. Interventions targeting pain beliefs and neuropathic mechanisms may improve outcomes in subgroups with these characteristics.

Objective: Wearable devices that capture physical activity (PA) data offer valuable insights into the relationship between daily activity patterns and Type 2 Diabetes Mellitus (T2DM). However, the strength of these associations within larger, diverse populations remains unclear. This study examines associations between PA metrics and T2DM risk in a diverse cohort. Methods: We analyzed time-varying PA data from the All of Us Research Program (N=11,596), leveraging commercial Fitbit devices linked with electronic health records. We excluded patients with baseline T2DM. We explored the association between PA measures, namely number of daily steps, average daily sedentary time, average daily activity (lightly active: 1.5-3 metabolic equivalent tasks (MET) for &gt;10 mins, fairly active: 3-6 METs, very active: &gt;6 METs). Variables were modelled with Cox proportional hazard models with restricted cubic splines. Results: Over a median follow up of 3.6 years, 2.7% developed T2DM. Across all physical activity and sedentary behavior metrics, we observed clear non-linear relationships with incident T2DM, highlighting dose-dependent and threshold effects. For daily step count, there was a steep reduction in hazard up to approximately 8,000–10,000 steps, after which the curve plateaued, indicating diminishing returns with higher step volumes. A similar non-linear inverse pattern was seen for fairly active, lightly active, and very active minutes. In each case, the greatest risk reduction occurred within the initial increases from near-zero activity to moderate levels—around 20–30 minutes per day—after which benefits tapered or stabilized. Conversely, sedentary time exhibited a strong positive non-linear association with risk. Below 600 minutes/day (10 hours), increases in sedentary time were only modestly associated with elevated hazard, but above this threshold, risk escalated rapidly (figure). Conclusions: Our findings demonstrate robust non-linear associations between physical activity, sedentary behavior, and health risk, emphasizing that the greatest benefits are achieved by moving individuals from low to moderate activity levels and by reducing excessive sedentary time. These patterns highlight the importance of targeting minimal activity thresholds and limiting prolonged inactivity to effectively lower adverse health outcomes. Keywords: Physical activity, Type 2 Diabetes, Fitbit, longitudinal cohort, sedentary behavior, All of Us

Background: Despite evidence linking physical activity (PA) to improved cardiovascular outcomes, its impact on cardiovascular-kidney-metabolic syndrome (CKM) progression among women of reproductive age is unclear. The limited integration of data on gender-specific risk factors and behavioral patterns further exacerbates this. Objective: This study aims to assess the relationship between PA and the development of CKM in women of reproductive age using data from a population-based cohort. Methods: Using data from the National Institutes of Health All of Us Research Program, we categorized CKM stages as follows: stage 0 (no risk factors), stage 1 (excess/dysfunctional adiposity or prediabetes), stages 2-3 (metabolic risk factors, moderated-to-high risk kidney disease, or subclinical cardiovascular disease [CVD]), and stage 4 (clinical CVD; with stage 4b indicating kidney failure). PA was measured using Fitbit data or self-reported surveys and quantified as sedentary mins/week and moderate-to-vigorous PA (MVPA) metabolic equivalent task (MET)-mins/week. Associations between quintiles of PA measures and CKM stages were evaluated using multinomial logistic regression models, adjusting for demographics, socioeconomic status, health history, lifestyle factors and healthcare access. Results: Among 4,550 women of reproductive age, mean age was 36 (±5) years, 78% were White, and 49% had CKM syndrome. Mean (SD) of age entering stages 1, 2, 3, 4, and 4b were 28 (±6), 32 (±6), 35 (±5), 35 (±5), and 35 (±4) years, respectively ( Figure 1 ). Mean (SD) sedentary mins/week and MVPA MET-mins/week were 4,466 (2,060) and 1,368 (1,412). Mean sedentary time was 4,466±2,060 minutes/week, and MVPA was 1,368±1,412 MET-minutes/week. Compared to the lowest quintile, women in higher quintiles of sedentary time (&gt;4,446 vs. ≤3,000 minutes/week) showed reduced odds of CKM stages 2-3, while higher MVPA (&gt;1,194 vs. ≤402 MET-minutes/week) was associated with lower odds of CKM stages 2-3 ( Figure 2 ). Women with moderate MVPA levels (730-1,920 vs. ≤402 MET-minutes/week) demonstrated lower odds of stage 4 CKM syndrome. Conclusion: Among women of reproductive age, higher levels of physical activity than currently recommended were associated with reduced odds of developing advanced CKM stages. This suggests an opportunity to re-evaluate the existing physical activity guidelines for optimal CKM in this population, and the need for gender-specific recommendations to prevent early-onset CKM.

Background: Body mass index (BMI) masks physiologic lean mass versus pathologic fat mass effects on blood pressure (BP) in youth. Elevated BP in adolescents predicts premature cardiac damage. While dual-energy X-ray absorptiometry (DXA) is the gold standard for fat mass assessment, it is costly and inaccessible. BMI has 65% agreement with DXA-measured fat mass, while waist-to-height ratio (WHtR) demonstrates 89% agreement with DXA-measured total and trunk fat. New WHtR cutoffs predicting normal, high, and excess fat have been proposed in pediatrics (https://urfit-child.com/waist-height-calculator/). Whether these WHtR cutoffs predict elevated BP and hypertension risk in youth remains unclear. Methods: We included 1,886 multi-racial US participants (mean age 14.7±4.5 years) from NHANES 2021-2023 with complete data for three BP measurements, waist circumference, and height. WHtR categories: normal fat (0.40-&lt;0.50 males, 0.40-&lt;0.51 females), high fat (0.50-&lt;0.53 males, 0.51-&lt;0.54 females), excess fat (≥0.53 males, ≥0.54 females). Elevated BP (≥120/70 mmHg) and hypertension (≥140/90 mmHg) risk assessed using logistic regression, adjusted for age, sex, education, smoking, race, sedentary time, moderate physical activity, fasting total cholesterol, and high-sensitivity C-reactive protein. Results: Among 1,886 participants (47.9% non-Hispanic White, 17.0% other/multi-racial, 13.3% non-Hispanic Black, 12.0% Mexican American, 9.8% other Hispanic), mean WHtR was 0.51±0.1. Distribution: 607 (32.2%) excess fat, 184 (9.8%) high fat, 1,095 (58.1%) normal fat. Unadjusted analyses showed high fat and excess fat WHtR categories associated with higher SBP versus normal fat (high fat: 1.70 mmHg [95% CI 0.65-2.75], p=0.043; excess fat: 1.27 mmHg [0.22-2.32], p=0.02), attenuated after adjustment. Elevated BP prevalence was 27%; hypertension 1%. Relative to normal fat, high-fat WHtR predicted elevated BP risk (adjusted OR 1.66 [1.14-2.42], p=0.009); excess fat showed a stronger association (adjusted OR 1.98 [1.48-2.65], p&lt;0.001). Hypertension associations attenuated after adjustment due to low prevalence. Conclusions: New WHtR pediatric adiposity cutoffs effectively identified youth at increased risk of elevated BP who are likely to progress to hypertension. These findings support the utility of WHtR as a universal, cheap, and easily accessible preventive and clinical tool for cardiovascular risk stratification in youth.

Background: Functional limitations are common among U.S. adults and are established predictors of cardiovascular disease (CVD). However, it is unclear whether exposure to toxic metals modifies the association between functional limitation and CVD risk. Methods: We analyzed data on 6,337 U.S. adults (≥18 years) from the National Health and Nutrition Examination Survey 2021–2023. Functional status was assessed in three domains: cognition, mobility, and seeing. Toxic metal exposures (blood lead, cadmium, mercury, manganese, selenium) were measured as "high" (≥90th percentile) vs "low." The outcome was CVD, defined as any history of heart failure, coronary heart disease, angina, myocardial infarction, or stroke. Survey-weighted descriptive statistics, cross-tabulations, and survey-weighted, multiple-imputed logistic regression models (adjusted for age, sex, race, education, income, BMI, diet, physical activity, sedentary time, alcohol, and smoking) were used to estimate main and interaction effects. Results: Functional limitations were prevalent: cognitive—47.8%, mobility—32.8%, and seeing—40.3%. CVD prevalence was 12.8%. Each metal was "high" in ~10% of participants in the study population. Across all domains and metals, CVD rates were lowest among those with no functional limitation and low metal exposure (cognition × lead: 8.6%) and highest among those with both limitation and high metal (cognition × high lead: 23.8%; mobility × high lead: 32.8%; seeing × high lead: 26.3%). In multivariable regression, any difficulty in cognition was 1.52 times (aOR for CVD: 1.52, 95% CI: 1.28–1.80), mobility 2.22 times (aOR 2.22, 1.09–4.09), and seeing 1.59 times (aOR 1.59, 1.07–2.44) were independently associated with higher CVD risk, regardless of toxic metal exposure. No significant interaction was observed between high metal exposure and functional limitation. Conclusions: Functional limitation in cognition, mobility, and seeing is a strong, independent predictor of CVD in U.S. adults. Although CVD prevalence was highest among those with high toxic metals exposure and functional limitation, toxic metals exposure did not significantly modify the strength of this association in multivariable analysis in the study population.

Introduction: The “one-size-fits-all” recommendations in current physical activity (PA) guidelines have been challenged, and optimal PA patterns across individuals with varying predicted cardiovascular disease (CVD) risk remain unclear. Methods: We analyzed 72 884 UK Biobank participants (mean [SD] age, 56.0 [7.8] years; 57.1% female), with total volume of PA (TPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate-to-vigorous-intensity PA (MVPA), and sedentary time assessed by accelerometers. Participants were divided into low-to-moderate-, high-, or very high-risk groups by the updated Systemic Coronary Risk Estimation 2 (SCORE2), SCORE2-Older Persons, and SCORE2-Diabetes algorithms. Cox regression and compositional data analysis were used to estimate the association between PA and incident CVD events and the potential benefit of reallocating sedentary time to MVPA. Results: A total of 5695 incident CVD events occurred. Higher TPA and MVPA were associated with lower CVD risk, and the association was most pronounced among those from the very high-risk group ( Figures 1 and 2 ). For example, the hazard ratio (HR) was 0.80 (95% CI, 0.74-0.86), 0.84 (0.82-0.86) and 0.84 (0.81-0.87) per 1-SD increase in MVPA for individuals with very-high, high and low-to-moderate risk, respectively (P interaction &lt;0.001). In addition, individuals may benefit more from allocating sedentary time to active PA with the increased predicted CVD risk ( Figure 3A ). Further analyses revealed that current recommendations from PA guidelines (150-300 min/week of MPA or 75-150 min/week of VPA [or an equivalent combination]) should be refined according to individuals’ risk stratification. In low-to-moderate-risk individuals, any guideline-recommended combinations of MPA and VPA were beneficial. In high-risk individuals, VPA exceeding 60 min/week may attenuate benefits, while in very high-risk individuals, optimal benefits were observed at 42 min/week of VPA, beyond which benefits may decline ( Figure 3B ). Conclusions: Optimal PA pattern for cardiovascular health significantly varied across individuals at different risk, and the optimal VPA threshold should be underscored, especially for high- or very high-risk groups. This study calls for personalized PA recommendations by integrating risk assessment, and provides evidence for promoting the guidelines towards a more comprehensive and individualized development.

Previous research investigating sedentary behavior and breast cancer risk has shown mixed results. We investigated the association between sedentary time and breast cancer incidence overall and by time-dependent menopausal status. The Sister Study recruited 50,884 women aged 35 to 74 years from all 50 states and Puerto Rico who had not been diagnosed with breast cancer but had at least one affected sister. Sedentary time was collected at the first detailed follow-up from 2008 to 2012 and categorized as ≤5 hours/day (referent), 6 to 9 hours/day, and ≥10 hours/day. Breast cancer cases were reported annually. We used multivariable Cox proportional hazards regression to estimate the HR and 95% confidence intervals (CI) for the association of sedentary time with overall breast cancer incidence, with age as the primary time scale and adjusted for relevant covariates. Participants were followed through September 2021. We evaluated effect measure modification by menopausal status. Among the 39,111 eligible women with information on sedentary behavior and covariates, sedentary time [6-9 vs. ≤5 adjusted HR (aHR) = 1.18; 95% CI, 1.08-1.28; ≥10 vs. ≤5 aHR = 1.19; 95% CI, 1.07-1.32] was associated with higher breast cancer incidence. The association varied by menopausal status (P heterogeneity = 0.002), with sedentary time inversely associated with breast cancer among premenopausal women (≥10 vs. ≤5 aHR = 0.69; 95% CI, 0.50-0.95) and positively associated with breast cancer among postmenopausal women (6-9 vs. ≤5 aHR = 1.22; 95% CI, 1.11-1.33; ≥10 vs. ≤5 aHR = 1.28; 95% CI, 1.14-1.43). Increased sedentary time was associated with breast cancer incidence, but the direction of this association varied by time-dependent menopausal status. The impact of sedentary time on cancer risk may vary by menopausal status.

Feasibility of wearable technology for remote monitoring in high-risk adults with sickle cell disease: Baseline data from the SCD-carre trial

Modern police work has become increasingly sedentary due to technological advancements and administrative tasks, interspersed with occasional intense physical activity, and this study aims to assess Police officers (PO) usual PAL during police service. This is a cross-sectional study in which 32 PO (age 26.91±3.66 years) belonging to COMETLIS/PSP participated. ActiGraph model GT3X accelerometers were used to assess PA during police service, and the physical activity level (PAL) classification included the categories: sedentary, light, moderate, vigorous, and moderate to vigorous PA (MVPA). A total of 2584 hours of police activity were considered, corresponding to 323 8-hour shifts, of which 136 were morning shifts, 125 were afternoon shifts, and 62 were night shifts. It was observed that the time spent on sedentary (54.44%), light (15.57%), moderate (8.42%), vigorous (0.83%), and MVPA (9.25%) while performing police work underwent statistically significant differences. The day of the week, the shift of duty and the time of day had a statistically significant effect on the time spent on sedentary, light, moderate, vigorous and MVPA of police officers in the performance of police duty. Police work is primarily sedentary, with moderate to vigorous PA peaks corresponding to more demanding events. It seems relevant to counteract the excessive sedentary time associated with patrolling for professional and health reasons, as well as for quality of life, and to ensure the ability to act in an emergency scenario to resolve it because even though it represents a small percentage of working time, they are often linked to life-threatening situations.

While existing studies have linked declines in intrinsic capacity (IC) to adverse health outcomes, the role of potentially modifiable lifestyle factors in this pathway, especially sedentary behavior, remains critically underexplored. Using data from the Beijing Longitudinal Disability Survey in Community Elderly (BLINDSCE) cohort (2023-2024), this study investigated both cross-sectional and 1-year longitudinal associations between sedentary time and IC in community-dwelling older adults. Of the 2044 participants (≥ 65years) enrolled at baseline, 1576 completed 1-year follow-up assessments through face-to-face interviews. Multivariable linear regression analyses revealed that each additional hour of daily sedentary time was associated with a 1.18-point lower baseline IC score (95% CI: -1.38, -0.98) and an accelerated 0.48-point greater IC decline over 1 year (95% CI: -0.72, -0.24). Exposure-response analyses showed a linear relationship between sedentary time and 1-year IC change. Significant interaction effects were observed between sedentary time and baseline IC level, moderate-to-vigorous physical activity (MVPA), and daily internet use. These findings provide empirical support for reducing sedentary behavior, ensuring adequate MVPA, promoting moderate digital engagement, and implementing IC-stratified interventions to promote healthy aging-thereby operationalizing the WHO Integrated Care for Older People (ICOPE) framework through actionable public health measures.

Cognitive frailty in community-dwelling older adults is associated with decreased physical activity and limited life space. However, the association between cognitive frailty, physical activity, and life space in older patients undergoing hemodialysis (HD) is unknown. Here, we examined the association between cognitive frailty, physical activity, and range of life space mobility. We enrolled 236 patients undergoing HD aged > 65years [62% men, age 74 (70-79) years] in a multicenter prospective cohort study (REPnet-HD). Physical frailty was defined based on the revised Japanese version of the Cardiovascular Health Study criteria, and cognitive function was assessed using the Mini-Cog, with a score of < 3 points indicating cognitive impairment. Cognitive frailty was defined as the coexistence of physical frailty and cognitive impairment, whereas robustness was the absence of either. Life space was assessed using the Life Space Assessment (LSA), and physical activity and sedentary behavior time were assessed using the International Physical Activity Questionnaire (IPAQ)-Short Form. Low activity was defined based on the IPAQ results, sedentary was defined as median sedentary behavior time or longer, and low LSA was defined as an LSA < 40 points. Logistic regression analysis was performed using low activity, sedentary behavior, and a low LSA as dependent variables; the four groups based on physical frailty and cognitive impairment as independent variables (reference: robust); and age, sex, body mass index, comorbidities, albumin, and dialysis vintage as covariates. Physical and cognitive frailties were observed in 36.4% and 6.8% of the patients, respectively. Low activity was significantly associated with physical frailty [odds ratio (OR); 3.67, 95% confidence interval (CI); 1.85-7.26, p < 0.001] and cognitive frailty (OR; 6.23, 95% CI; 1.28-30.45, p = 0.023). Sedentary behavior was significantly associated with cognitive frailty (OR; 4.24, 95% CI; 1.20-14.86, p = 0.024). A low LSA was significantly associated with physical frailty (OR; 3.93, 95% CI; 1.94-7.93, p < 0.001) and cognitive frailty (OR; 7.82, 95% CI; 2.31-26.44, p < 0.001) with a higher OR for cognitive frailty. Cognitive frailty was associated with a sedentary lifestyle and a limited life space, and also showed a link to reduced physical activity, particularly in comparison to physical frailty alone.