US Physical Activity Guidelines Research Articles

Feasibility and acceptability of a parent-child intervention to improve step count in childhood cancer survivors exposed to cardiotoxic therapy: The STEP UP for FAMILIES Study.

Late morbidity after childhood cancer may be mitigated by healthy lifestyle behaviors. We piloted a game-based, parent-child digital intervention to increase activity in sedentary survivors. Survivors aged 10-16 treated with cardiotoxic therapy and not meeting US physical activity guidelines were enrolled in a single-arm study with a parent. Following a 14-day run-in, participants chose a prespecified step goal and wore an accelerometer daily for 24weeks (12-week game-based intervention; 12-week follow-up). Participants completed the Acceptability of Intervention Measure (AIM) at 24weeks; a subset of dyads completed qualitative interviews. Among 129 eligible survivors, 27 enrolled (20.9% participation rate) with a parent. Four dyads were removed during the 14-day run-in period due to noncompliance. Among the 23 dyads who continued to the study, the tracker was worn for 95% of days during the 12-week intervention (95% confidence interval [CI]: 94-96) and 81% during the 12-week follow-up (95% CI: 79-82). Overall, the prespecified step goal was met for 64% (95% CI: 63-66) of days during the intervention and 37% (95% CI: 35-38) during the follow-up. At the end of study, 17/23 dyads responded to AIM; 82% of survivors and 94% of parents reported the intervention as acceptable. During qualitative interviews (n=5), dyads noted that they liked the accountability of the "buddy system," but would have liked more personalized goal-setting. Despite high ratings of acceptability among participants, difficulties with sustained adherence and retention were encountered in this parent-child gamification intervention. Alternate, tailored designs should be considered in the future.

Time- vs Step-Based Physical Activity Metrics for Health

Current US physical activity (PA) guidelines prescribe moderate to vigorous PA (MVPA) time of at least 150 minutes per week for health. An analogous step-based recommendation has not been issued due to insufficient evidence. To examine the associations of MVPA time and step counts with all-cause mortality and cardiovascular disease (CVD). This cohort study analyzed data from an ongoing follow-up study of surviving participants of the Women's Health Study, a randomized clinical trial conducted from 1992 to 2004 in the US to evaluate use of low-dose aspirin and vitamin E for preventing cancer and CVD. Participants were 62 years or older who were free from CVD and cancer, completed annual questionnaires, and agreed to measure their PA with an accelerometer as part of a 2011-2015 ancillary study. Participants were followed up through December 31, 2022. Time spent in MVPA and step counts, measured with an accelerometer for 7 consecutive days. The associations of MVPA time and step counts with all-cause mortality and CVD (composite of myocardial infarction, stroke, and CVD mortality) adjusted for confounders. Cox proportional hazards regression models, restricted mean survival time differences, and area under the receiver operating characteristic curve (AUC) were used to evaluate the associations. A total of 14 399 women (mean [SD] age, 71.8 [5.6] years) were included. The median (IQR) MVPA time and step counts were 62 (20-149) minutes per week and 5183 (3691-7001) steps per day, respectively. During a median (IQR) follow-up of 9.0 (8.0-9.9) years, the hazard ratios (HR) per SD for all-cause mortality were 0.82 (95% CI, 0.75-0.90) for MVPA time and 0.74 (95% CI, 0.69-0.80) for step counts. Greater MVPA time and step counts (top 3 quartiles vs bottom quartile) were associated with a longer period free from death: 2.22 (95% CI, 1.58-2.85) months and 2.36 (95% CI, 1.73-2.99) months at 9 years follow-up, respectively. The AUCs for all-cause mortality from MVPA time and step counts were similar: 0.55 (95% CI, 0.52-0.57) for both metrics. Similar associations of these 2 metrics with CVD were observed. Results of this study suggest that among females 62 years or older, MVPA time and step counts were qualitatively similar in their associations with all-cause mortality and CVD. Step count-based goals should be considered for future guidelines along with time-based goals, allowing for the accommodation of personal preferences.

The Prostate Cancer Active Lifestyle Study (PALS): A randomized controlled trial of diet and exercise in overweight and obese men on active surveillance.

Active surveillance (AS) is increasingly used to monitor patients with lower risk prostate cancer (PCa). The Prostate Cancer Active Lifestyle Study (PALS) was a randomized controlled trial to determine whether weight loss improves obesity biomarkers on the causal pathway to progression in patients with PCa on AS. Overweight/obese men (body mass index >25kg/m2) diagnosed with PCa who elected AS were recruited. The intervention was a 6-month, individually delivered, structured diet and exercise program adapted from the Diabetes Prevention Program with a 7% weight loss goal from baseline. Control participants attended one session reviewing the US Dietary and Physical Activity Guidelines. The primary outcome was change in glucose regulation from baseline to the end of the 6-month intervention, which was measured by fasting plasma glucose, C-peptide, insulin, insulin-like growth factor 1, insulin-like growth factor binding protein-3, adiponectin, and homeostatic model assessment for insulin resistance. Among 117 men who were randomized, 100 completed the trial. The mean percentage weight loss was 7.1% and 1.8% in the intervention and control arms, respectively (adjusted between-group mean difference, -6.0kg; 95% confidence interval, -8.0, -4.0). Mean percentage changes from baseline for insulin, C-peptide, and homeostatic model assessment for insulin resistance in the intervention arm were -23%, -16%, and -25%, respectively, compared with +6.9%, +7.5%, and +6.4%, respectively, in the control arm (all p for intervention effects ≤ .003). No significant between-arm differences were detected for the other biomarkers. Overweight/obese men with PCa undergoing AS who participated in a lifestyle-based weight loss intervention successfully met weight loss goals with this reproducible lifestyle intervention and experienced improvements in glucose-regulation biomarkers associated with PCa progression.

A cross-sectional examination of post-myocardial infarction physical activity levels among US rural and urban residents: Findings from the 2017-2019 Behavioral Risk Factor Surveillance System.

This study sought to examine the relationship between rural residence and physical activity levels among US myocardial infarction (MI) survivors. We conducted a cross-sectional study using nationally representative Behavioral Risk Factor Surveillance System surveys from 2017 and 2019. We determined the survey-weighted percentage of rural and urban MI survivors meeting US physical activity guidelines. Logistic regression models were used to examine the relationship between rural/urban residence and meeting physical activity guidelines, accounting for sociodemographic factors. Our study included 22,732 MI survivors (37.3% rural residents). The percentage of rural MI survivors meeting physical activity guidelines (37.4%, 95% CI: 35.1%-39.7%) was significantly less than their urban counterparts (45.6%, 95% CI: 44.0%-47.2%). Rural residence was associated with a 28.8% (95% CI: 20.0%-36.7%) lower odds of meeting physical activity guidelines, with this changing to a 19.3% (95% CI: 9.3%-28.3%) lower odds after adjustment for sociodemographic factors. A significant rural/urban disparity in physical activity levels exists among US MI survivors. Our findings support the need for further efforts to improve physical activity levels among rural MI survivors as part of successful secondary prevention in US high-MI burden rural areas.

Physical activity is inversely associated with overall cancer risk among college students in the United States: Results from the National College Health Assessment.

To our knowledge, this is the first epidemiologic study to examine the association between physical activity (PA) and cancer using data from the American College Health Association-National College Health Assessment (ACHA-NCHA). The goal of the study was to understand the dose-response relation between PA and cancer, as well as the associations between meeting US PA guidelines and overall cancer risk in US college students. The ACHA-NCHA provided self-reported information on demographic characteristics, PA, body mass index, smoking status, and overall cancer during 2019-2022 (n = 293,682; 0.08% cancer cases). To illustrate the dose-response relationship, a restricted cubic spline logistic regression analysis was used to evaluate the association of overall cancer with moderate-to-vigorous PA (MVPA) on a continuous basis. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals for the associations between meeting the three U.S. PA guidelines and overall cancer risk. The cubic spline observed that MVPA was inversely associated with the odds of overall cancer risk after adjusting for covariates; a one hour/week increase in moderate and vigorous PA was associated with a 1% and 5% reduced overall cancer risk, respectively. Multivariable-adjusted logistic regression analyses showed that meeting the US guidelines for aerobic PA for adults (≥150 minutes/week of moderate aerobic PA or ≥75 minutes of vigorous PA) (OR: 0.85), for PA for adults (≥2 days of muscle strengthening activity in addition to aerobic MVPA) (OR: 0.90), and for highly active adults (≥2 days of muscle strengthening activity and ≥300 minutes/week of aerobic moderate PA or 150 minutes/week of vigorous PA) (OR: 0.89) were statistically significant and inversely associated with cancer risk. MVPA, especially meeting US guidelines, may be inversely associated with overall cancer among college students in the US. To reduce cancer risks, multilevel interventions to promote US physical activity guidelines among college students are warranted.

Step-Based Metrics and Translations of Physical Activity Guidelines among Adults in the HCHS/SOL.

In a cross-sectional sample of US Hispanic/Latino adults, we aimed to describe step-based metric distributions, estimate their associations with activity counts and self-report, and calibrate step-based translations of current (2018) US physical activity (PA) guidelines, that is, ≥150 min·wk -1 moderate-to-vigorous PA (MVPA) from accelerometer counts and self-report. The Hispanic Community Health Study/Study of Latinos enrolled 16,415 Hispanic/Latino adults 18-74 yr from four US cities (2008-2011). Participants completed the Global PA Questionnaire and 1 wk of Actical accelerometer wear ( n = 12,528). Weighted medians were used to describe step-based metrics, and Spearman correlations estimated their relationships with count-based and self-reported PA indicators. Receiver operator characteristic curve analyses were used to examine the ability of each step-based metric to classify participants meeting PA guidelines. Overall, US Hispanic/Latino adults accumulated medians of 6770 steps per day and 6, 18, 236, and 630 min·d -1 at ≥100, ≥70, 1-69, and 0 steps per minute, respectively. Count-based time in MVPA, light PA, and sedentary behavior were most strongly correlated ( rs = 0.79-0.85) with times ≥70, 1-69, and 0 steps per minute, respectively, whereas self-reported MVPA had similar correlations with steps per day and times ≥40 and ≥70 steps per minute ( rs = 0.28-0.29). Time ≥70 steps per minute had the greatest capacity to classify participants meeting PA guidelines with both measures of MVPA. This study provides the first normative values (based on percentiles) of step-based metrics for US Hispanic/Latino adults, which can facilitate surveillance, program planning, research, and data interpretation. Our finding that PA guidelines corresponded to 6000-7000 steps per day or ~20 min·d -1 at ≥70 steps per minute with an Actical accelerometer can be considered alongside dose-response relationships with health outcomes to develop step-based recommendations that are consistent with and better communicate PA guidelines.

Prevalence, Trends, and Correlates of Joint Patterns of Aerobic and Muscle-Strengthening Activity and Sleep Duration: A Pooled Analysis of 359,019 Adults in the National Health Interview Survey 2004–2018

Physical activity (PA) and sleep duration have established associations with health outcomes individually but tend to co-occur and may be better targeted jointly. This study aimed to describe the cross-sectional prevalence, trends, and population characteristic correlates of activity-sleep patterns in a population-representative sample of US adults from the National Health Interview Survey (2004-2018). Participants (N = 359,019) self-reported aerobic and muscle-strengthening activity and sleep duration. They were categorized as "meeting both"/"meeting PA only"/"meeting sleep only"/"meeting neither" of the 2018 US PA guidelines and age-based sleep duration recommendations. Trends in activity-sleep patterns were analyzed using weighted multinomial logistic regression, and correlates were identified using weighted binary Poisson regressions, with P ≤ .001 considered significant. "Meet sleep only" was most prevalent (46.4%) by 2018, followed by "meet neither" (30.3%), "meet both" (15.6%), and "meet PA only" (7.7%). Many significant sociodemographic, biological, and health-behavior correlates of the activity-sleep groups were identified, and the direction and magnitude of these associations differed between groups. Public health campaigns should emphasize the importance of both sufficient PA and sleep; target women and older adults, current smokers, and those with lower education and poorer physical and mental health; and consider specific barriers experienced by minority ethnic groups.

Abstract P069: Temporal Patterns Of Adherence To The Physical Activity Goal In A Mobile Health Weight-loss Trial

Background: Wearable trackers such as Fitbit may promote physical activity (PA) levels recommended by the US Physical Activity Guidelines. However, there is a lack of evidence on the associations between long-term wearable tracker use and temporal patterns of PA levels. Therefore, we aimed to identify distinct trajectories of the adherence to PA goals using group-based trajectory modeling in a year-long mobile health weight-loss trial. Method: PA data were collected within the SMARTER weight-loss trial that recruited adults (i.e., age ≥18 years) from 2018 to 2020 from southwest PA, USA. Healthy adults with body mass index between 27-43 kg/m 2 were randomized to either self-monitoring with daily personalized feedback messages (SM+FB, n=251) or self-monitoring only (SM, n=251) and followed for 52 weeks. Adherence to weekly PA goals, the primary outcome of this analysis, was computed as the percentage of fairly active and very active total minutes per week measured by Fitbit Charge 2™ relative to the minimum PA goal of 150 minutes/week recommended for all study participants. We used group-based trajectory modeling to identify distinct temporal patterns of adherence to weekly PA goals. Results: The sample (N = 502) was mostly female (n=399, 79%), white (n=423, 82%) with a mean age of 45.0 ± 14.4 years. Among the models considered, the five-group trajectory model for adherence to weekly PA goals was selected based on the best data fit: low adherence with a linear decline (n=80, 16.0%; b[intercept] ± SE: 73.18 ± 5.03, p<.0001; b[linear] ± SE: -6.37±.28, p<.0001); low initial adherence with nonlinear increase (n=194, 38.7%; b[intercept] ± SE: 93.48 ± 3.63, p<.0001; b[linear] ± SE: .49 ± .31, p=.108;b[quadratic] ± SE: -.03±.01, p<.0001); moderate initial adherence with linear decline (n=145, 28.8%, b[intercept] ± SE: 230.53 ±2.83, p<.0001; b[linear] ± SE: -.40±.09, p<.0001), moderate initial adherence with nonlinear decline (n=39, 7.8%, b[intercept] ± SE: 216.99 ± 18.72, p<.0001; b[linear] ± SE: 0.25 ± 7.46, p=.974; b[quadratic] ± SE: -1.57 ± .93, p=.090; b[cubic] ± SE: .12 ± .05, p=.010; b[quartic] ± SE: -.004 ± .001, p=.010; b[quantic] ± SE: .00003±.00001, p<.0001), and high initial adherence with nonlinear decline (n=44, 8.8%; b[intercept] ± SE: 379.46 ± 9.84, p<.0001; b[linear] ± SE: 2.37 ± 1.59, p=.138; b[quadratic] ± SE: .10 ± .07, p=.171; b[cubic] ± SE: -.003±.001, p=.003). Conclusions: We identified five distinct trajectories for long-term adherence to the PA goal over 52 weeks. More research is needed to determine additional means of supporting PA in individuals with low and declining adherence trajectories.

Best Practices for Meta-Reviews in Physical Activity and Health Research: Insights From the Physical Activity Guidelines for Americans Advisory Committee Scientific Report.

Systematic reviews (SRs) and meta-analyses (MAs) have proliferated with a concomitant increase in reviews of SRs/MAs or "meta-reviews" (MRs). As uncovered by the 2018 US Physical Activity Guidelines Advisory Committee (PAGAC), there is a paucity of best practice guidance on MRs on physical activity health-related research. This manuscript aims to fill this gap. In total, the PAGAC conducted 38 literature searches across 3 electronic databases and triaged 20,838 titles, 4913 abstracts, and 2139 full texts from which 1130 articles qualified for the PAGAC Scientific Report. During the MR process, the following challenges were encountered: (1)if the SR/MA authors had limited experience in synthesis methodology, they likely did not account for risk of bias in the conclusions they reached; (2)many SRs/MAs reviewed the same primary-level studies; (3)many SRs/MAs failed to disclose effect modifier analyses; (4)source populations varied; (5)physical activity exposures were nonstandardized; and (6)dose-response effects or effect modification of the physical activity exposure could not be identified. Using examples from the PAGAC Scientific Report, we provide (1)a high-level introduction to MRs; (2)recommended steps in conducting a MR; (3)challenges that can be encountered; and (4)guidance in addressing these challenges.

Pre-pregnancy Health Behaviors and Gestational Weight Gain Among Hispanic/Latino Women: Hispanic Community Health Study/Study of Latinos.

To examine the association between preconception diet quality, sedentary behavior, and physical activity with gestational weight gain (GWG) among Hispanic/Latina women. This was a retrospective cohort study of participants from visits 1 and 2 of the Hispanic Community Health Study/Study of Latinos and singleton pregnancies between the 2 visits. Diet quality (alternative healthy eating index/AHEI-2010), sedentary behaviors, and physical activity (global physical activity questionnaire) were measured at visit 1 and accounted for preconception health behaviors. GWG was evaluated as a continuous and categorical variable according to the 2009 Institute of Medicine guidelines (inadequate, adequate, excessive). Linear and generalized logit survey regressions were used to study the association between health behaviors and GWG, using adequate GWG as the reference. Of the 457 women included, deliveries occurred at 3.2years (mean) from visit 1; 48.7% of women had excessive GWG. Mean AHEI-2010 scores were < 45% for women of all Hispanic/Latina backgrounds. There was no association between each 10-unit increase in AHEI-2010 or a 500kcal/day increase in energy intake for mean and categorical GWG. There was no association between 30min/day higher sedentary behavior, 30min/day higher physical activity, or meeting the 2008 US physical activity guidelines for mean and categorical GWG. We did not find any association between diet quality, sedentary behavior, and physical activity at visit 1 with GWG in pregnancies occurring between visits 1 and 2. We noted widespread poor diet quality as measured by the AHEI-2010 and low levels of physical activity among Hispanic/Latina women.

Associations Between Physical Activity And Mental Health In Pregnant And Non-pregnant Women During Covid-19

The COVID-19 pandemic posed a threat to the mental health of many, especially pregnant women, a population already at-risk for mental health concerns. Regular physical activity (PA) is associated with better mental health in pregnant women, although the presence of the pandemic may have modified the strength of associations between PA and mental health during pregnancy. PURPOSE: To examine associations between PA status, pregnancy, and mental health (positive mental health [PMH], depression, anxiety and stress) in women during the COVID-19 pandemic. METHODS: Data from US women 18-34 years old (pregnant, n = 69, non-pregnant, n = 1115) was used from a larger study that examined COVID-19-related behavioral changes, social changes, physical, and mental wellbeing during April 3-June 3, 2020. Participants self-reported demographics, health history, regular current moderate and vigorous PA, depression (Beck Depression Inventory-II), anxiety (Beck Anxiety Inventory), PMH (Short Warwick-Edinburgh Mental Wellbeing Scale-7), and stress (Perceived Stress Scale-4). A series of 2 x 2 ANCOVAs evaluated the effects of activity (active/insufficiently active; based on meeting US PA guidelines of 150 min/wk of moderate-to-vigorous physical activity) and pregnancy status (yes/no), and their interaction, on PMH, depression, anxiety, and stress, covarying for education, income, chronic conditions, and past mental health conditions. RESULTS: Being active was significantly associated with better depressive symptoms, stress and PMH (all p < 0.05), while pregnancy and the interaction between activity and pregnancy were not associated with mental health (all p > 0.05). In pregnant women, being active was associated with a moderate depression difference (estimated means: 12.0 vs. 17.5; Cohen’s d = -0.56) compared to being insufficiently active. In non-pregnant women, the depression difference by activity status was minimal (14.7 vs 15.6; d = -0.09). CONCLUSIONS: Meeting PA guidelines was associated with better mental health regardless of pregnancy status, underlining the importance of PA for mental health. The association of regular PA with lower depression in at-risk populations (eg, pregnant women) may be magnified during periods of increased vulnerability (eg, during a pandemic) and further research is warranted.

The effect of physical activity on the association between perceived racial discrimination and depression in African Americans

Background: The purpose of this cross-sectional study was to examine the effect of physical activity (PA) on the relationship between perceived racial discrimination and major depressive disorder (MDD) in African Americans. Methods: 645 African Americans (mean age 45 years) were interviewed on their perceived racial discrimination, PA, and past 12-month MDD. Participants were categorized into tertiles (lower, middle, upper) of racial discrimination as well as “active” or “inactive” groups based on the US PA guidelines. Odds ratios and 95% confidence intervals (CIs) were calculated for MDD prevalence across discrimination tertiles stratified by PA group after adjusting for potential confounders. Results: The upper (higher) discrimination group had 2.99 (95% CIs 1.03-8.67) increased odds of MDD compared with the lower group after adjusting for potential confounders. The stratified analysis indicated that the increased odds of MDD in the upper discrimination group were observed only among the inactive group (5.19 [1.08-24.87]) after adjusting for age and sex. The association between discrimination and MDD was not significant among active participants. Limitations: Limitations include generalizability since participants were predominantly women and recruited solely from Iowa or Georgia; the low number of MDD cases in some groups; and that causation cannot be inferred from this cross-sectional study. Conclusion: Not meeting the PA guidelines may be associated with higher depression among African Americans experiencing higher levels of perceived racial discrimination.

Changes in Compliance With Physical Activity Guidelines and Cardiovascular Disease Mortality.

The effects of compliance with the US Physical Activity (PA) Guidelines and changes in compliance over time on cardiovascular disease (CVD) mortality are unknown. Male participants in the Aerobics Center Longitudinal Study (n = 15,411; 18-100y) reported leisure-time PA between 1970 and 2002. The frequency of and time spent in PA were converted into metabolic equivalent minutes per week. The participants were classified into remained inactive, became active, became inactive, or remained active groups according to their achievement of the PA guidelines along the follow-up, equivalent here to at least 500 metabolic equivalent minutes of PA per week. Cox regression adjusted for different models was used for the analyses, using age, body mass index, smoking and drinking status, hypertension, diabetes, hypercholesterolemia, and parental history of CVD. Over a mean follow-up of 6.2 years, 439 CVD deaths occurred. Consistently meeting the PA guidelines, compared with not meeting, was associated with a 54% (95% confidence interval, 0.32-0.67) decreased risk of CVD mortality. After controlling for all potential confounders, the risk reduction was 47% (95% confidence interval, 0.36-0.77). Maintaining adherence to the PA guidelines produces substantial reductions in the risk of CVD deaths in men. Furthermore, discontinuing compliance with the guidelines may offset the beneficial effects on longevity.

Joint prevalence of physical activity and sitting time during COVID-19 among US adults in April 2020.

The COVID-19 pandemic significantly altered much of US life with shifts to working-from-home and social distancing changing day-to-day behavior. We aimed to determine the self-reported prevalence of meeting US physical activity guidelines, stratified by sitting time during the early lockdown phase of COVID-19 in US adults. We conducted two cross-sectional internet-based studies April 3rd-May 4th, 2020 in convenience samples of US adults. Participants self-reported daily sitting time and weekly moderate-to-vigorous physical activity (MVPA) via questions from the International Physical Activity Questionnaire. A total of 5036 US adults (65.3% women, 30.2% with chronic conditions) provided complete physical activity and sitting time data (80.3% of total). Overall, 42.6% of participants reported sitting for > 8 h/day (95% CI: 41.2%–44.0%) and 72.5% (71.2%–73.7%) reported being either sufficiently (150–300 MVPA minutes) or highly active (>300 min). The greatest proportion of people self-reported being highly active and sitting for > 8 h/day (24.0%; 22.8%-25.2%), followed by being highly active and sitting for 6–8 h/day (20.9%; 19.8%–22.1%). Sitting and activity appeared similar between sexes, while there was evidence of some age differences. For example, more young adults (ages 18–34) appeared to self-report being inactive and more appeared to sit for > 8 h/day compared to older adults. High sitting time was reported by US adults (>40% sitting > 8 h/day) during April 2020. However, high levels of physical activity (>70% meeting guidelines) were also reported. Since physical activity cannot eliminate the negative health effects of sitting, maintaining activity and limiting sitting during periods of large workplace and societal shifts is encouraged.

Association of Sedentary Time and Incident Heart Failure Hospitalization in Postmenopausal Women.

The 2018 US Physical Activity Guidelines recommend reducing sedentary behavior (SB) for cardiovascular health. SB's role in heart failure (HF) is unclear. We studied 80 982 women in the Women's Health Initiative Observational Study, aged 50 to 79 years, who were without known HF and reported ability to walk ≥1 block unassisted at baseline. Mean follow-up was 9 years for physician-adjudicated incident HF hospitalization (1402 cases). SB was assessed repeatedly by questionnaire. Time-varying total SB was categorized according to awake time spent sitting or lying down (≤6.5, 6.6-9.5, >9.5 h/d); sitting time (≤4.5, 4.6-8.5, >8.5 h/d) was also evaluated. Hazard ratios and 95% CI were estimated using Cox regression. Controlling for age, race/ethnicity, education, income, smoking, alcohol, menopausal hormone therapy, and hysterectomy status, higher HF risk was observed across incremental tertiles of time-varying total SB (hazard ratios [95% CI], 1.00 [referent], 1.15 [1.01-1.31], 1.42 [1.25-1.61], trend P<0.001) and sitting time (1.00 [referent], 1.14 [1.01-1.28], 1.54 [1.34-1.78], trend P<0.001). The inverse trends remained significant after further controlling for comorbidities including time-varying myocardial infarction and coronary revascularization (hazard ratios: SB, 1.00, 1.11, 1.27; sitting, 1.00, 1.09, 1.37, trend P<0.001 each) and for baseline physical activity (hazard ratios: SB 1.00, 1.10, 1.24; sitting 1.00, 1.08, 1.33, trend P<0.001 each). Associations with SB exposures were not different according to categories of baseline age, race/ethnicity, body mass index, physical activity, physical functioning, diabetes, hypertension, or coronary heart disease. SB was associated with increased risk of incident HF hospitalization in postmenopausal women. Targeted efforts to reduce SB could enhance HF prevention in later life.

S1213 Resident Perception on Nutrition Counseling

INTRODUCTION: Poor nutrition is a major contributor to obesity and is a major public health problem. However, nutrition education on patient counseling in all phases of medical training is limited and those nutritional interventions are not translated into action in medical training or practice. METHODS: A 10-question survey was conducted to understand resident perception and knowledge-base of nutrition counseling. It was given to 32 internal medicine residents. We assessed their confidence level on counseling patients on nutrition, weight loss, and quality of their counsel through multiple choice questions. The questionnaire was developed through US physician expert opinion consensus, US Department of Agriculture dietary guidelines, and Harvard School of Nutrition guidelines. RESULTS: We sent the pre-survey prior to a noon conference didactic about introduction to nutrition counseling. On a 5-point confidence scale (1 = not confident, 3 = somewhat confident, 5 = very confident) residents reported an average of 3.16 to 3.44 on their ability to counsel on nutrition. Additionally, less than 35% of residents surveyed were able to correctly answer knowledge-based questions of US dietary guidelines. CONCLUSION: We surveyed resident-physicians on their comfortability of nutrition education for patients. Afterwards, these residents went through an introductory noon conference describing diet patterns, weight loss and exercise strategies, and practical ways to deliver nutrition counseling to patients. Our pre-survey data revealed that residents are not very confident on counseling patients about counseling and that less than half the residents had correct knowledge on dietary guidelines. As physicians are the primary access to give patients dietary advice on health behaviors, it is important that residents are given the education and tools to confidently counsel patients on evidence-based nutrition and weight-loss goals. Future focus on education in resident curriculum will include in-depth analysis and study on dietary guidelines in patients like NASH, IBD, CKD. Additionally, we will create didactics based on ACG guidelines on nutrition in the hospitalized patient. Residents need further nutrition education as it is not only good medicine and patient-centered care, but sound economics to alleviate the global disease burden with preventative medicine.Table 1.: How confident do you feel in your ability to accomplish the following tasks? (n = 32)Figure 1.: According to US dietary guidelines, how many servings of vegetables should an average American consume in 1 day? (n = 32).Figure 2.: According to US physical activity guidelines, how much should an average American exercise per week? (n = 32).

Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study.

BackgroundAccess to physical activity among youth with spina bifida (SB) is much lower than it is for children without disability. Enjoyable home-based exercise programs are greatly needed.ObjectiveOur objective is to examine the feasibility of a virtual reality (VR) active video gaming system (ie, bundle of consumer-available equipment) to meet US physical activity guidelines in two youth with SB.MethodsTwo youth with SB—a 12-year-old female and a 13-year-old male; both full-time wheelchair users—participated in a brief, 4-week exercise program using a popular VR head-mounted display: Oculus Quest (Facebook Technologies). The system included a Polar H10 (Polar Canada) Bluetooth heart rate monitor, a no-cost mobile phone app (VR Health Exercise Tracker [Virtual Reality Institute of Health and Exercise]), and 13 games. The intervention protocol was conducted entirely in the homes of the participants due to the coronavirus disease 2019 (COVID-19) pandemic. The VR system was shipped to participants and they were instructed to do their best to complete 60 minutes of moderate-intensity VR exercise per day. Exercise duration, intensity, and calories expended were objectively monitored and recorded during exercise using the heart rate monitor and a mobile app. Fatigue and depression were measured via self-report questionnaires at pre- and postintervention. Participants underwent a semistructured interview with research staff at postintervention.ResultsAcross the intervention period, the total average minutes of all exercise performed each week for participants 1 and 2 were 281 (SD 93) and 262 (SD 55) minutes, respectively. The total average minutes of moderate-intensity exercise performed per week for participants 1 and 2 were 184 (SD 103) (184/281, 65.4%) and 215 (SD 90) (215/262, 82.1%) minutes, respectively. One participant had a reduction in their depression score, using the Quality of Life in Neurological Disorders (Neuro-QoL) test, from baseline to postintervention, but no other changes were observed for fatigue and depression scores. Participants reported that the amount of exercise they completed was far higher than what was objectively recorded, due to usability issues with the chest-worn heart rate monitor. Participants noted that they were motivated to exercise due to the enjoyment of the games and VR headset as well as support from a caregiver.ConclusionsThis study demonstrated that two youth with SB who used wheelchairs could use a VR system to independently and safely achieve exercise guidelines at home. Study findings identified a promising protocol for promoting exercise in this population and this warrants further examination in future studies with larger samples.

Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults.

The COVID-19 pandemic altered many facets of life. We aimed to evaluate the impact of COVID-19-related public health guidelines on physical activity (PA), sedentary behavior, mental health, and their interrelations. Cross-sectional data were collected from 3052 US adults 3–8 April 2020 (from all 50 states). Participants self-reported pre- and post-COVID-19 levels of moderate and vigorous PA, sitting, and screen time. Currently-followed public health guidelines, stress, loneliness, positive mental health (PMH), social connectedness, and depressive and anxiety symptoms were self-reported. Participants were grouped by meeting US PA guidelines, reporting ≥8 h/day of sitting, or ≥8 h/day of screen time, pre- and post-COVID-19. Overall, 62% of participants were female, with age ranging from 18–24 (16.6% of sample) to 75+ (9.3%). Self-reported PA was lower post-COVID among participants reporting being previously active (mean change: −32.3% [95% CI: −36.3%, −28.1%]) but largely unchanged among previously inactive participants (+2.3% [−3.5%, +8.1%]). No longer meeting PA guidelines and increased screen time were associated with worse depression, loneliness, stress, and PMH (p < 0.001). Self-isolation/quarantine was associated with higher depressive and anxiety symptoms compared to social distancing (p < 0.001). Maintaining and enhancing physical activity participation and limiting screen time increases during abrupt societal changes may mitigate the mental health consequences.

Objectively measured sedentary time, physical activity and liver enzyme elevations in US Hispanics/Latinos.

Sedentariness and physical inactiveness are associated with deleterious health outcomes, but their associations with liver enzyme elevations remain uncertain. In 10385 US Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos, we examined associations of sedentary time and moderate-to-vigorous physical activity (MVPA) measured by accelerometers with liver enzyme elevations. Elevated alanine aminotransferase (ALT), aspartate aminotransferase and γ-glutamyltransferase (GGT) were defined as the highest gender-specific deciles. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using weighted Poisson regressions. After adjusting for demographical/socioeconomic factors and MVPA, increasing quartiles of sedentary time were associated with a higher prevalence of elevated ALT (PRs [95% CI]=1.0, 1.17 [0.92-1.47], 1.21 [0.96, 1.53] and 1.51 [1.13-2.02]; P-trend=.007) and elevated GGT (PRs [95% CI]=1.0, 1.06 [0.82-1.36], 1.35 [1.06-1.73] and 1.66 [1.27-2.16]; P-trend=.0001). These associations were attenuated but remained significant after further adjustment for cardiometabolic traits including body-mass index, waist-hip-ratio, lipids and homeostatic model assessment of insulin resistance. In contrast, increasing quartiles of MVPA were associated with a lower prevalence of elevated ALT (PRs [95% CI]=1.0, 0.97 [0.77-1.23], 0.84 [0.66-1.06] and 0.72 [0.54-0.96]; P-trend=.01) after adjusting for demographical/socioeconomic factors and sedentary time, but this association became non-significant after further adjustment for cardiometabolic traits. Notably, the association of sedentary time with GGT elevation was significant both in individuals meeting the US Physical Activity Guidelines for Americans (MVPA ≥150minutes/week) and in those who did not (both P-trend≤.003). Our findings suggest that objectively measured sedentary time is independently associated with elevated ALT and GGT in US Hispanics/Latinos.

Physical Activity and Insulin Resistance in 6,500 NHANES Adults: The Role of Abdominal Obesity.

This cross-sectional investigation studied differences in insulin resistance across levels of physical activity in 6,500 US adults who were randomly selected as part of the National Health and Nutrition Examination Survey (NHANES). Another important objective was to determine the influence of abdominal obesity on the physical activity and insulin resistance relationship. MET-minutes were utilized to quantify total activity based on participation in 48 different physical activities. Two strategies were employed to categorize levels of physical activity: one was based on relative MET-minutes (quartiles), and the other approach was based on the US physical activity guidelines. Insulin resistance was indexed using the homeostatic model assessment (HOMA). Abdominal obesity was indexed using waist circumference. Effect modification was tested by dividing waist circumferences into sex-specific quartiles and then evaluating the relationship between physical activity and HOMA-IR within each quartile separately. Results showed that relative physical activity level was associated with HOMA-IR after controlling for demographic and demographic and lifestyle covariates (F = 11.5, P < 0.0001 and F = 6.0, P=0.0012, respectively). Adjusting for demographic and demographic and lifestyle covariates also resulted in significant relationships between guideline-based activity and HOMA-IR (F = 8.0, P < 0.0001 and F = 4.9, P=0.0017, respectively). However, statistically controlling for differences in waist circumference with the other covariates nullified the relationship between total physical activity and HOMA-IR. Effect modification testing showed that when the sample was delimited to adults with abdominal obesity (Quartile 4), relative (F = 5.6, P=0.0019) and guideline-based physical activity (F = 3.7, P=0.0098) and HOMA-IR were significantly associated. Physical activity and HOMA-IR were not related within the other three quartiles. In conclusion, it appears that differences in physical activity may play a meaningful role in insulin resistance in those with abdominal obesity, but total activity does not seem to account for differences in insulin resistance among US adults with smaller waists.