Self-reported Total Physical Activity Research Articles

The effectiveness and acceptability of physical activity interventions amongst older adults with lower socioeconomic status: a mixed methods systematic review.

Older adults with lower socioeconomic status are less likely to be physically active than those with higher socioeconomic status. To inform future intervention development, this review explored: [i] how effective are physical activity interventions at increasing levels of physical activity amongst older adults with lower socioeconomic status?; [ii] what factors are associated with the acceptability of physical activity interventions amongst older adults with lower socioeconomic status?; [iii] what are the implications for developing physical activity interventions for older adults with lower socioeconomic status? This mixed methods systematic review followed PRISMA guidelines. MEDLINE, CENTRAL, Embase, Scopus, Web of Science, PsycINFO, CINAHL, ASSIA and Sports Medicine and Education Index were searched up to May 2023, to identify quantitative, qualitative and mixed methods primary research studies measuring the effectiveness of and/or experiences of physical activity interventions for older adults (aged ≥ 65 years) with lower socioeconomic status. No limits on country were applied. Included studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. Results were synthesised using a results-based convergent synthesis approach with narrative synthesis of quantitative findings and thematic synthesis of qualitative findings. Thirty studies were included. Mixed effects were found for the effectiveness of physical activity interventions, with positive effects for increases in utilitarian walking (i.e. for transport) but not for leisure, mixed effects for objectively measured physical activity and no effects for self-reported total physical activity or muscle strengthening and flexibility activities. Engaging in physical activity interventions was perceived as offering many benefits, social familiarity was important to intervention acceptability and interventions were seen as more acceptable when they were compatible with the lifestyles of older adults with lower socioeconomic status. Future development of physical activity interventions for older adults with lower socioeconomic status should foster social connections, emphasise health benefits of physical activity, hold interventions in locations that are accessible and familiar to older adults with lower socioeconomic status, minimise costs to participants, employ individuals who share participant characteristics to lead interventions, and combine physical activity with other activities older adults with lower socioeconomic status already do to make more efficient use of time. PROSPERO CRD42023417312; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=417312 .

The joint associations of physical activity and ultra-processed food consumption with depression: A cohort study in the UK Biobank

BackgroundDespite substantial evidence regarding independent associations between physical activity (PA) and ultra-processed foods (UPF) consumption with depression, the joint effects of these two factors remain unknown. MethodsThis study included 99,126 participants without depression in the UK Biobank at baseline. A 24-h recall method was used to assess UPF consumption, and self-reported total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were assessed by metabolic equivalent task (MET). A series of Cox proportional hazard regression models were used to explore the independent and joint effects of TPA, MVPA, VPA and UPF consumption on depression. ResultsThe incidence rate of depression was 1.94 % [95 % confidence interval (CI): 1.80 %–2.10 %] per 1000 person-years after an average follow-up of 12.10 years. We found that MVPA and UPF consumption had additive interactions on depression risk (p < 0.05). Participants in Q1 of TPA and Q4 of UPF consumption (HR: 1.83, 95%CI: 1.45–2.31) showed a higher risk for depression than those in Q4 of TPA and Q1 of UPF consumption. Compared with the participants with WHO guideline-recommended MVPA and the lowest UPF consumption, those below recommended MVPA (HR: 1.51, 95%CI: 1.20–1.89) or above recommended MVPA (HR: 1.40, 95%CI: 1.10–1.78) and with the highest UPF consumption had a higher risk for depression. LimitationsStudy limitations include use of self-reported data, observational study and concerns regarding generalizability. ConclusionHigher UPF consumption, accompanied by lower PA levels regardless of TPA, MVPA, and VPA, is associated with a higher risk of depression. Our study offers insights on public health priorities to decrease the risk of depression in the population by addressing both PA and UPF consumption together.

Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis.

Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. The literature search was conducted in 6 electronic databases-PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus-from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD -0.23, 95% CI -0.33 to -0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult-oriented research is needed to develop eHealth interventions that can change multiple behaviors. PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418.

Relevance of the anterior cingulate cortex volume and personality in motivated physical activity behaviors

Some recent theories about the origins and maintenance of regular physical activity focus on the rewards of the properties of practicing this activity. Animal and human studies have demonstrated that mesolimbic dopamine plays a crucial role in the involvement in voluntary physical activity. Here, we test this possible role in a sample of 66 right-handed healthy young adults by studying the influence of personality and the volume of reward-related brain areas on individual differences in voluntary physical activity, objectively measured by accelerometer and subjectively self-reported by questionnaire. Our results show that a smaller volume of the right anterior cingulate cortex and lower scores on reward sensitivity contributed to explaining low levels of daily physical activity. Moreover, the volume of the right anterior cingulate cortex correlates positively with self-reported total physical activity. Results are discussed by highlighting the need to use objective measures of daily physical activity, as well as the important role of the anterior cingulate cortex and personality in promoting effortful and invigorating actions to obtain rewards.

O.4.5-11 The association between health literacy and objectively measured physical activity in Norwegian young adult students

Abstract Background Insufficient physical activity (PA) is a significant public health challenge, with a drastic decline in activity levels observed in young adulthood likely contributing to increases in cardiometabolic risk factors with age. Recent research suggests that health literacy (HL) may be an important modifiable factor associated with reduced physical activity levels and poor health outcomes in elderly and disease-prone populations. However, limited research has focused on young adulthood when the drastic decline in PA is observed. Moreover, most previous studies have only assessed self-reported PA, which has limited accuracy. Therefore, the purpose of this study was to assess the relationship between HL and objectively measured PA levels in healthy young adults. Method 28 young adult (18-25 years) college students participated in the study (men: n = 7, women: n = 21). PA was measured objectively and subjectively using an accelerometer (Actigraph GT3X+) and the IPAQ questionnaire, respectively. The HLS19 instrument was used to assess HL, which was developed within “HLS19 – the International Health Literacy Population Survey 2019-2021” of M-POHL. Participants were categorized as having low or high health literacy based on the classification defined in the Norwegian HLS-19 report (2021). Additionally, each response was assigned a value (1-4) to calculate a summative health literacy point score, with a higher summative value indicating greater health literacy. Results In our cohort, 60% (n = 17) of the participants were categorized as having low and 39% (n = 11) as having high health literacy. There was no group difference in objective and subjective PA levels between those with low and high HL (all comparisons: p &amp;gt; 0.05). However, we observed a significant positive correlation between health literacy (point score) and objectively measured moderate to high-intensity PA (r = 0.52, p = 0.002). Likewise, there was a significant correlation between health literacy (point score) and self-reported total PA (r = 0.34, p = 0.03). Conclusion This is the first study to show a positive relationship between HL and PA in healthy young adult students, highlighting the potential role of HL in modulating PA in this population. Thus, further research is needed to determine whether targeting HL could effectively increase PA levels in young adults.

The impact of a meditative movement practice intervention on short- and long-term changes in physical activity among breast cancer survivors.

Tai Chi Easy (TCE) is a low-impact, meditative movement practice that is feasible for breast cancer survivors, even in the face of post-treatment symptoms, and may even serve as a gateway into developing an active lifestyle and improving overall physical activity (PA). In the context of a randomized controlled trial testing effects of an 8-week TCE intervention on breast cancer survivors' symptoms, we examined the short- (8-week) and long-term (9-month) impact on total PA compared to an educational control group. Participants were recruited from two hospital systems, local community organizations, and different media platforms. Eligible participants were predominant non-Hispanic White (82%), college educated (92%), and middle- to high-income (65%), and most commonly reported stage 1 (40%) or 2 breast cancer (38%). After baseline assessments, participants were randomized to the 8-week TCE intervention (N=51) or education control (N=53). Weekly intervention TCE classes were led by a trained instructor. Weekly educational control classes focused on a series of readings and group discussions. Total PA and steps were objectively measured via accelerometry, and the international physical activity questionnaire was used to measure self-reported total PA. Multilevel mixed-effects linear regression models revealed no significant short- or long-term changes in objectively measured total PA or steps in either group; however, participants in the intervention reported short- and long-term changes in self-reported total PA. TCE is an appropriate PA strategy for survivors that may lead to modest improvements in PA; however, more research is needed to examine the long-term impact on PA as well as other physical and psychological outcomes (i.e., flexibility, mobility, stress). Low-impact, low-intensity activities like meditative movement practices are needed to assist survivors in overcoming post-treatment physical and psychological limitations to initiate a more active lifestyle.

Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics.

To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity. Cross-sectional study. Rural Southeastern United States. Participants included 289 African American women with a mean age of 56years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6kg/m2; 35% (n = 102) were classified with Class 3 obesity. We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys. Chi-Square analysis for categorical variables and analysis of variance (ANOVA) - via multiple linear regression - for continuous variables. There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences - lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02). For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.

Deconstructing Fitbit to Specify the Effective Features in Promoting Physical Activity Among Inactive Adults: Pilot Randomized Controlled Trial.

Wearable activity trackers have become key players in mobile health practice as they offer various behavior change techniques (BCTs) to help improve physical activity (PA). Typically, multiple BCTs are implemented simultaneously in a device, making it difficult to identify which BCTs specifically improve PA. We investigated the effects of BCTs implemented on a smartwatch, the Fitbit, to determine how each technique promoted PA. This study was a single-blind, pilot randomized controlled trial, in which 70 adults (n=44, 63% women; mean age 40.5, SD 12.56 years; closed user group) were allocated to 1 of 3 BCT conditions: self-monitoring (feedback on participants' own steps), goal setting (providing daily step goals), and social comparison (displaying daily steps achieved by peers). Each intervention lasted for 4 weeks (fully automated), during which participants wore a Fitbit and responded to day-to-day questionnaires regarding motivation. At pre- and postintervention time points (in-person sessions), levels and readiness for PA as well as different aspects of motivation were assessed. Participants showed excellent adherence (mean valid-wear time of Fitbit=26.43/28 days, 94%), and no dropout was recorded. No significant changes were found in self-reported total PA (dz<0.28, P=.40 for the self-monitoring group, P=.58 for the goal setting group, and P=.19 for the social comparison group). Fitbit-assessed step count during the intervention period was slightly higher in the goal setting and social comparison groups than in the self-monitoring group, although the effects did not reach statistical significance (P=.052 and P=.06). However, more than half (27/46, 59%) of the participants in the precontemplation stage reported progress to a higher stage across the 3 conditions. Additionally, significant increases were detected for several aspects of motivation (ie, integrated and external regulation), and significant group differences were identified for the day-to-day changes in external regulation; that is, the self-monitoring group showed a significantly larger increase in the sense of pressure and tension (as part of external regulation) than the goal setting group (P=.04). Fitbit-implemented BCTs promote readiness and motivation for PA, although their effects on PA levels are marginal. The BCT-specific effects were unclear, but preliminary evidence showed that self-monitoring alone may be perceived demanding. Combining self-monitoring with another BCT (or goal setting, at least) may be important for enhancing continuous engagement in PA. Open Science Framework; https://osf.io/87qnb/?view_only=f7b72d48bb5044eca4b8ce729f6b403b.

Abstract P160: Sex-Differences in Physical Activity-Mediated Associations of Perceived Neighborhood Environments With Severity of Metabolic Syndrome Among Jackson Heart Study Participants

Introduction: Metabolic syndrome (MetS) can lead to harmful effects on cardiovascular health. Assessing whether links between perceived neighborhood social environment (PNSE) and MetS are mediated by physical activity (PA) levels will inform interventions to reduce population-level mortality attributed to MetS. Hypothesis: PNSE will be both directly and indirectly related to MetS severity via PA. Methods: This study utilized baseline data from the Jackson Heart Study, a prospective, community-based cohort of African American adults in Jackson, MS (total sample=3082; mean age 53.3 years; 64% female). PNSE variables included neighborhood violence, problems (higher value=more violence or problems), and social cohesion (higher value=more cohesion). MetS severity Z-score was the outcome (higher score indicates worse MetS). Validated self-reported total PA, based on active living, sports, and home/yard indices, was tested as the mediator. Linear regressions with bootstrap-generated 95% bias-corrected confidence intervals ( BC CIs ) were estimated to test for significant unstandardized indirect effects, controlling for covariates (age, education, smoking status, alcohol consumption, and diet). All analyses were stratified by sex. Results: In women, neighborhood violence, problems, and social cohesion were indirectly related to MetS via PA (B for indirect effects=.04, 95% BC CI =.01, .08; .03, 95% BC CI =.01, .06; and -.03, 95% BC CI =-.07, -.01, respectively). That is, higher violence and problems were related to lower PA (B=-1.06, 95%CI=-1.76, -.36; B=-.79, 95%CI=-1.26, -.32, respectively), while higher social cohesion was associated with higher PA (B=.86, 95%CI=.15, 1.58). In turn, higher PA was associated with lower MetS. All PNSE factors were directly related to MetS (p&lt;.05). In men, neighborhood violence, problems, and social cohesion were indirectly related to MetS via PA (B for indirect effects=.06, 95% BC CI =.02, .12; .04, 95% BC CI =.01, .08; and -.06, 95% BC CI =-.11, -.02, respectively). Again, higher violence and problems were related to lower PA (B=-1.65, 95%CI=-2.58, -.71; B=-1.02, 95%CI=-1.64, -.40, respectively), while higher social cohesion was associated with higher PA (B=1.58, 95%CI=.64, 2.52). In turn, higher PA was associated with lower MetS. No PNSEs were directly related to MetS. Conclusions: Consistent with what we expected, higher perceived neighborhood violence and problems were positively related to MetS, and vice versa for social cohesion. These associations may be explained in part by PA levels. The data showed that indirect effects by PA were more pronounced in men than women. Future interventions to reduce MetS attributed to neighborhood issues should consider PA promotion tailored to women and men in conjunction with community efforts to reduce neighborhood violence and problems and encourage cohesive neighborhoods.

Association between physical activity and major adverse cardiovascular events in northwest China: A cross-sectional analysis from the Regional Ethnic Cohort Study.

To examine the association between daily physical activity (PA) and major adverse cardiovascular events (MACEs) in northwest China. The data in this analysis were part of the baseline survey of the Regional Ethnic Cohort Study in Northwest China from June 2018 to May 2019 in Shaanxi Province. This study used standardized self-reported total physical activity (continuous and categorical variables) and self-reported outcomes of MACEs. All analyses were conducted using the logistic regression model and stratified by age, sex, body mass index (BMI), and region. The dose-response relationships were assessed with a restricted cubic spline. The average level of total PA was 17.60 MET hours per day (MET-h/d). Every increase of four MET-h/d of total PA was associated with a lower risk of MACEs [adjusted OR = 0.95 (95% CI, 0.93~0.98)]. Compared with participants in the bottom quartile of total PA, a lower risk of MACEs was observed in the top quartile group [≥23.3 MET-h/d, 0.68 (0.55~0.83)]. Stratified analyses showed similar results in males, females, participants over 45 years old, participants in the rural region, and normal weight range participants (BMI < 24 kg/m2). Total participants also observed a dose-response relationship after adjusting for socioeconomic and lifestyle factors. A higher level of PA was associated with a lower MACE risk. Future research should examine the longitudinal association of prospectively measured PA and the risk of MACEs.

Association of Genetic Predisposition and Physical Activity With Risk of Gestational Diabetes in Nulliparous Women

Polygenic risk scores (PRS) for type 2 diabetes (T2D) can improve risk prediction for gestational diabetes (GD), yet the strength of the association between genetic and lifestyle risk factors has not been quantified. To assess the association of PRS and physical activity in existing GD risk models and identify patient subgroups who may receive the most benefits from a PRS or physical activity intervention. The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort was established to study individuals without previous pregnancy lasting at least 20 weeks (nulliparous) and to elucidate factors associated with adverse pregnancy outcomes. A subcohort of 3533 participants with European ancestry was used for risk assessment and performance evaluation. Participants were enrolled from October 5, 2010, to December 3, 2013, and underwent genotyping between February 19, 2019, and February 28, 2020. Data were analyzed from September 15, 2020, to November 10, 2021. Self-reported total physical activity in early pregnancy was quantified as metabolic equivalents of task (METs). Polygenic risk scores were calculated for T2D using contributions of 84 single nucleotide variants, weighted by their association in the Diabetes Genetics Replication and Meta-analysis Consortium data. Estimation of the development of GD from clinical, genetic, and environmental variables collected in early pregnancy, assessed using measures of model discrimination. Odds ratios and positive likelihood ratios were used to evaluate the association of PRS and physical activity with GD risk. A total of 3533 women were included in this analysis (mean [SD] age, 28.6 [4.9] years). In high-risk population subgroups (body mass index ≥25 or aged ≥35 years), individuals with high PRS (top 25th percentile) or low activity levels (METs <450) had increased odds of a GD diagnosis of 25% to 75%. Compared with the general population, participants with both high PRS and low activity levels had higher odds of a GD diagnosis (odds ratio, 3.4 [95% CI, 2.3-5.3]), whereas participants with low PRS and high METs had significantly reduced risk of a GD diagnosis (odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .01). In this cohort study, the addition of PRS was associated with the stratified risk of GD diagnosis among high-risk patient subgroups, suggesting the benefits of targeted PRS ascertainment to encourage early intervention.

IMPACT: A Randomized Controlled Trial of an mHealth Physical Activity Intervention for Young Adult Cancer Survivors

Purpose: The IMPACT trial evaluated a theory-based mobile physical activity (PA) intervention on total PA (primary) and moderate-to-vigorous (MVPA) at 6 months in a nationwide sample of young adult cancer survivors (YACS). Methods: YACS (N=280) were randomized to either an intervention group or a self-help (control) group. All participants received digital tools (activity tracker, smart scale, Facebook group) and an individual videochat session. Intervention participants also received a 6-month mHealth program with components to promote increased PA (behavioral lessons, adaptive goal-setting, tailored feedback, tailored text messages, Facebook group prompts). PA was assessed via accelerometry and online questionnaire (Godin Leisure Time Exercise Questionnaire) at baseline and 6 months. Using linear mixed models and an intention-to-treat approach, we tested for group differences in changes from baseline to 6 months, adjusting for education, time since diagnosis, age, and accelerometer wear time. Results: Of 280 YACS (M=33.4 (SD 4.8) yrs, 81.8% women, 23.2% racial/ethnic minority individuals), 92.9% completed 6-month measures. Device-measured total PA min/wk (i.e., sum of light, moderate, and vigorous PA) increased from a mean of 1974.3 (SD=673.9) to 2024.3 (686.7) at 6 months in the intervention group (p=.26) and from 1814.9 (704.5) to 1877.7 (758.2) in the control group (p=.43), with no difference between groups (p=.84). Both groups increased MVPA min/wk over 6 months; increases were 24.7 min/wk (95% CI: 14.8, 34.6; p&amp;lt;.0001) in the intervention versus 11.4 min/wk (95% CI: 1.4, 21.4; p=.02) in the control (p=.07 between groups). Increases in MVPA were 99.7% and 41.6% over baseline in the intervention and control groups, respectively. Increases in self-reported total PA were significant; 123.3 min/wk (95 CI%: 94.5, 152.1; p&amp;lt;.0001) in the intervention versus 83.40 (95% CI: 49.30, 117.50; p&amp;lt;.0001) in the control (p=.08 between groups). Conclusions: While both groups increased total PA over 6 months, the intervention doubled the increase in MVPA min/wk relative to the control group, which is associated with important health benefits. Future research should examine moderators of effects to identify for whom, and under what conditions, the effectiveness varied.

Physical Activity during Pregnancy: Comparisons between Objective Measures and Self-Reports in Relation to Blood Glucose Levels.

Objective: to quantify pregnant women’s physical activity during pregnancy using wearable accelerometers and a self-reported scale and to examine the variation in these two physical activity measures in relation to fasting plasma glucose (FPG) levels and presence of gestational diabetes mellitus (GDM). Methods: this prospective observational study included 197 pregnant women from one of the largest regional hospitals in South China. Women with singleton pregnancy, absence of pre-existing comorbidities and pre-specified contraindications, wore an accelerometer on their waist for 7 consecutive days to objectively record their physical activity, followed by completing a past-7-day physical activity questionnaire, three times, respectively, in three trimesters. GDM was determined by 2-h 75 g oral glucose tolerance test (OGTT) in 24–28th week’s gestation and FPG was obtained in both 1st and 2nd trimesters following standard practice. Results: pregnant women engaged highest levels of various physical activity types in 2nd trimester, except accelerometer-based moderate-to-vigorous physical activity which gradually decreased in pregnancy. Pregnant women were more likely to walk in 3rd trimester. The relationship between objective total physical activity and self-reported total physical activity was non-linear. Increased trend of FPG from 1st trimester to 2nd trimester disappeared when adjusting for accelerometer-based light physical activity and attenuated when including walking. Self-reported moderate physical activity was surprisingly positively associated with GDM. Conclusions: different patterns in physical activity between objective measure and self-report in relation to gestational glucose levels were observed. Short-term increase in moderate physical activity prior to OGTT may not be necessary for reducing presence of GDM. Future glucose management for pregnant women may be targeted at lower intensity physical activity.

Abstract P132: Self-reported Recreational Physical Activity And Incident Venous Thromboembolism Risk In The Women’s Health Initiative

Introduction: The association between physical activity (PA) and incident venous thromboembolism (VTE) is inconsistent and incompletely characterized. Hypothesis: Higher amounts of self-reported total PA will be associated with a lower risk of incident VTE. Methods: Eligible women were Women’s Health Initiative (WHI) Hormone Therapy (HT) trial and Observational Study (OS) participants without prior VTE, able to walk at least one block, with baseline PA data (n=110,631). At multiple timepoints, women reported their current usual frequency and duration of walking and low, moderate, and strenuous intensity recreational PA, which were used to estimate energy expended. VTE, including deep vein thrombosis and pulmonary embolism, were validated in the WHI-HT and self-reported in the WHI-OS. Multivariable-adjusted (Table) Cox Proportional Hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of time-varying total PA and incident VTE risk, with women censored at death, loss to follow-up, and three years after their final PA measure. Results: At baseline, women were 64 years of age on average. Over an average of 9.9 years of follow-up, 1,403 women experienced incident VTE. In primary confounder-adjusted models, compared with women who reported no PA, higher tertiles of total PA were associated with a lower risk of incident VTE (high vs. no PA HR=0.60; 95% CI: 0.51, 0.71; p-trend&lt;0.001) (Table). Further adjustment for potential mediators on the causal pathway (physical function, self-reported health, body mass index [BMI], cardiovascular-related factors) attenuated but did not eliminate this association (high vs. no PA HR=0.81; 95% CI: 0.68, 0.97; p-trend=0.017). Conclusions: Compared to no PA, higher tertiles of total PA were associated with a lower risk of incident VTE, even after adjusting for potential mediators reflecting physical function, health, BMI, and cardiovascular risk. Our results add to the apparent health benefits of even moderate amounts of recreational PA.

Misreporting of Physical Activity and Sedentary Behavior in Parents-to-Be: A Validation Study across Sex

This study validated the International Physical Activity Questionnaire (IPAQ) and the Context-specific Sedentary Behavior Questionnaire (CSBQ) against accelerometry among parents-to-be. Sex-differences in potential misreporting of physical activity (PA) and sedentary behavior (SB) were also investigated. Self-reported total PA (TPA), light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate-to-vigorous-intensity PA (MVPA), and SB of 91 parents-to-be (41 men and 50 women) were compared with Actigraph data according to sex. Furthermore, the extent of misreporting was compared between sexes. Strong correlations for TPA and weak-to-moderate correlations for LPA, MPA, VPA, MVPA, and SB were observed. Participants underestimated TPA by 1068 min/week (=17.8 h/week; −50%), LPA by 1593 min/week (=26.6 h/week; −83%), and SB by 428 min/week (=7.1 h/week; −11%) and overestimated MPA by 384 min/week (=6.4 h/week; +176%) and MVPA by 525 min/week (=8.8 h/week; +224%). Males overreported VPA more than females in absolute minutes per week (238 min/week, i.e., 4.0 h/week vs. 62 min/week, i.e., 1.0 h/week), whereas, in relative terms, the opposite (+850% vs. +1033%) was true. The IPAQ and CSBQ can be used with caution to estimate TPA and SB among parents-to-be considering a strong correlation but low agreement for TPA and a weak-to-moderate correlation but acceptable agreement for SB. We disadvise using these self-reports to estimate PA on the distinct intensity levels.

Physical activity-mediated associations between perceived neighborhood social environment and depressive symptoms among Jackson Heart Study participants

BackgroundLittle is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA.MethodsWe used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates.ResultsOur participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms.ConclusionsWe found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.

Physical Activity, Sedentary Behavior, and White Matter Microstructure in Children with Overweight or Obesity.

This study aimed to investigate the associations of objectively measured and self-reported physical activity (PA) and sedentary behavior with white matter microstructure in children with overweight or obesity. In a sample of 103 participants (age, 10.02 ± 1.15 yr; 42 girls) from the ActiveBrains project, we assessed PA and sedentary behavior using accelerometers (GT3X+; ActiGraph, Pensacola, FL), and the Youth Activity Profile-Spain questionnaire. Objectively measured PA and sedentary behavior were classified into different intensities following the hip- and wrist-based cutoff points for the Euclidean Norm Minus One metric by Hildebrand et al., wrist-based cutoff points for counts metric by Chandler et al., and hip-based cutoff points for counts metric for Romanzini et al. and Evenson et al. Magnetic resonance imaging of white matter microstructure, fractional anisotropy (FA), and mean diffusivity (MD) were derived from diffusion tensor imaging. Linear regression models were used to examine the associations of objectively measured and self-reported PA and sedentary behavior with global and tract-specific FA and MD. Self-reported total PA was positively associated with global FA (β = 0.236, P = 0.038), whereas watching television was negatively associated with global FA (β = -0.270, P = 0.014). In regard to the objective measures, using single regression models, light PA (β = 0.273, P = 0.016), moderate-to-vigorous PA (β = 0.257, P = 0.035), and total PA (β = 0.294, P = 0.013) were positively associated with global FA only when Hildebrand-Euclidean Norm Minus One hip cut points were used for analyses. Lastly, no association was found between PA and sedentary behavior and FA and MD within individual tracts. Our results suggest that PA and watching television are related to white matter microstructure in children with overweight or obesity. However, longitudinal large-scale studies are needed to confirm and expand these findings.

Associations Between Neighborhood Recreation Environments and Adolescent Physical Activity.

To examine relations between parents' perceived neighborhood recreation environments and multiple measures of adolescent physical activity (PA). Participants (N = 928; age 14.1 [1.4]y, 50.4% girls, and 33.4% nonwhite/Hispanic) and their parents were recruited. Teen moderate to vigorous PA (MVPA) was assessed with 7-day accelerometry. Self-reported total PA, PA near home, and PA at recreation locations were also assessed. Proximity of home to 8 types of recreation facilities was reported by parents. Mixed-model linear regressions relating environments to various measures of PA were adjusted for demographics and neighborhood clustering. Perceiving more availability of recreation facilities around home was related to higher reports of days per week with 60+ minutes of PA (b = 0.153; P < .05), reported PA time near home (b = 0.152; P < .001), PA time at recreation facilities (b = 0.161; P < .001), accelerometer-measured total MVPA (b = 1.741; P < .05), and nonschool MVPA (b = 1.508; P < .01). Adolescents living in lowest quintile of recreation facility availability averaged 27.6 (3.2) minutes per day of total MVPA versus 49.8 (3.5) minutes per day for those living in highest quintile. Adolescents living in neighborhoods that parents reported having more availability of recreation facilities around homes had higher activity across 5 indicators of PA.

Efficacy of a Self-Regulation-Based Electronic and Mobile Health Intervention Targeting an Active Lifestyle in Adults Having Type 2 Diabetes and in Adults Aged 50 Years or Older: Two Randomized Controlled Trials.

BackgroundAdopting an active lifestyle plays a key role in the prevention and management of chronic diseases such as type 2 diabetes mellitus (T2DM). Web-based interventions are able to alter health behaviors and show stronger effects when they are informed by a behavior change theory. MyPlan 2.0 is a fully automated electronic health (eHealth) and mobile health (mHealth) intervention targeting physical activity (PA) and sedentary behavior (SB) based on the Health Action Process Approach (HAPA).ObjectiveThis study aimed to test the short-term effect of MyPlan 2.0 in altering levels of PA and SB and in changing personal determinants of behavior in adults with T2DM and in adults aged ≥50 years.MethodsThe study comprised two randomized controlled trials (RCTs) with an identical design. RCT 1 was conducted with adults with T2DM. RCT 2 was performed in adults aged ≥50 years. Data were collected via face-to-face assessments. The participants decided either to increase their level of PA or to decrease their level of SB. The participants were randomly allocated with a 2:1 ratio to the intervention group or the waiting-list control group. They were not blinded for their group allocation. The participants in the intervention group were instructed to go through MyPlan 2.0, comprising 5 sessions with an interval of 1 week between each session. The primary outcomes were objectively measured and self-reported PA (ie, light PA, moderate-to-vigorous PA, total PA, number of steps, and domain-specific [eg, transport-related] PA) and SB (ie, sitting time, number of breaks from sitting time, and length of sitting bouts). Secondary outcomes were self-reported behavioral determinants for PA and SB (eg, self-efficacy). Separate linear mixed models were performed to analyze the effects of MyPlan 2.0 in the two samples.ResultsIn RCT 1 (n=54), the PA intervention group showed, in contrast to the control group, a decrease in self-reported time spent sitting (P=.09) and an increase in accelerometer-measured moderate (P=.05) and moderate-to-vigorous PA (P=.049). The SB intervention group displayed an increase in accelerometer-assessed breaks from sedentary time in comparison with the control group (P=.005). A total of 14 participants of RCT 1 dropped out. In RCT 2 (n=63), the PA intervention group showed an increase for self-reported total PA in comparison with the control group (P=.003). Furthermore, in contrast to the control group, the SB intervention group decreased their self-reported time spent sitting (P=.08) and increased their accelerometer-assessed moderate (P=.06) and moderate-to-vigorous PA (P=.07). A total of 8 participants of RCT 2 dropped out.ConclusionsFor both the samples, the HAPA-based eHealth and mHealth intervention, MyPlan 2.0, was able to improve only some of the primary outcomes.Trial RegistrationClinicalTrials.gov NCT03291171; http://clinicaltrials.gov/ct2/show/NCT03291171. ClinicalTrials.gov NCT03799146; http://clinicaltrials.gov/ct2/show/NCT03799146.International Registered Report Identifier (IRRID)RR2-10.2196/12413

Physical activity, sedentary time and their associations with clustered metabolic risk among people with type 2 diabetes in Jiangsu province: a cross-sectional study

ObjectiveInvestigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China.DesignInterview-based cross-sectional...