Compliance with physical activity recommendations in US adults with diabetes

Aims To investigate whether US adults with diabetes meet both the national and American Diabetes Association (ADA) recommendations for physical activity compared with people without diabetes, and to examine the trends of this behaviour over time. Methods We analysed data from large nationally representative cohorts from the 1996–2005 Behavioral Risk Factor Surveillance System. The number of participants ranged from 98 127 in 1996 to 204 977 in 2005, and the number of people with diabetes ranged from 4379 in 1996 to 13 608 in 2005. Participants were classified by their exercise status and physical activity levels. The age‐standardized prevalence of physical activity participation or meeting physical activity recommendations was calculated in people with and without diabetes. Results People with diabetes participated less in physical activity (63.1–68.9 vs. 71.7–78.3%) and met physical activity recommendations less than people without diabetes (40.2–42.9 vs. 48.0–51.5% for meeting national recommendations and 38.5–41.7 vs. 46.6–49.8% for meeting ADA recommendations). The percentage of people with diabetes who participated in physical activity in the past 10 years or met physical activity recommendations in the past 5 years did not vary, whereas significantly increasing trends were observed in people without diabetes. The odds for adults with diabetes meeting physical activity recommendations were significantly lower than in adults without diabetes even after multivariate adjustment. Conclusion People with diabetes were less likely to meet either national or ADA recommendations for physical activity than people without diabetes. Our results demonstrate the need for more efforts from health‐care professionals to promote physical activity in people with diabetes.     

Leisure-time physical activity patterns among US adults with asthma

BACKGROUND: Little is known about the physical activity patterns among US adults who have asthma. METHODS: Using data for 165,123 respondents of the 2000 Behavioral Risk Factor Surveillance System, we examined leisure-time physical activity. RESULTS: After adjusting for age, about 30% of participants with current asthma (12,489 participants), 24% with former asthma (4,892 participants), and 27% who never had asthma (147,742 participants) were considered to be inactive (p < 0.001). After adjusting for age, the estimated energy expenditure from leisure-time physical activity was 206 kilocalories (kcal) per week lower among respondents with current asthma than among respondents with former asthma (p < 0.001) and 91 kcal/week lower than respondents who had never had asthma (p < 0.001). About 27% of participants with current asthma, 28% of participants with former asthma, and 28% of participants who had never had asthma were participating in recommended levels of physical activity. Walking was the most frequently reported activity for all three groups (respondents with current asthma, 39%; respondents with former asthma, 39%; and respondents who had never had asthma, 38%. Participants with asthma were less likely to engage in running (p < 0.001), basketball (p = 0.001), golf (p < 0.001), and weightlifting (p = 0.001) but were more likely to use an exercise bicycle (p = 0.035) than were participants without asthma. CONCLUSIONS: Like most US adults, the majority of those with asthma were not meeting the current recommendations for physical activity.     

Long-term follow-up and objective physical activity measurements of community-based physical interventions in adults: a systematic review and meta-analysis

BackgroundPhysical inactivity is a global public health concern. Systematic reviews indicate that interventions can increase short-term physical activity levels. However, long-term health benefits require sustained physical activity increases and systematic review evidence from interventions with objective measures of physical activity beyond 12 months is lacking. This review aimed to identify and describe randomised trials in adults with objective physical activity measures and follow-up beyond 12 months and evaluate the extent to which intervention effects are sustained beyond 12 monthsMethodsWe searched MEDLINE, EMBASE, PsycINFO, Web of Science, Cochrane Library, CINAHL, and ASSIA between Jan 1, 2000, and April 16, 2018, restricting our search to publications in English, with a combination of the key search terms “physical activity”, “objective physical activity measures”, and “randomised controlled trial”. We included trials reporting long-term effects (≥12 months) on objective physical activity (step count and moderate-to-vigorous physical activity) with community-based participants, aged 18 years and older, without specific medical conditions. Studies in which control participants received physical activity interventions were excluded. Two independent reviewers completed data extraction. We did meta-analyses using random effects models and at different follow-up points. Outcomes were daily step counts and weekly minutes of moderate-to-vigorous activity. This study was registered with PROSPERO, CRD42017075753.FindingsOf the 17 233 unique records identified by our search, we included nine studies in the review and five in the meta-analyses. Interventions included individual walking programmes, group-based sessions, and a school volunteering programme. Follow-up ranged from 12 months to 4 years. The age range of participants was 18–89 years. We observed physical activity increases at 12 months for intervention group participants versus control participants in steps per day (mean difference 554 steps, 95% CI 384–724, p<0·0001; 2446 participants in four studies) and weekly minutes of moderate-to-vigorous physical activity (35 min, 27–43; p<0·0001; 2647 participants in four studies). This increase was sustained up to 4 years for both steps per day (494 steps, 251–738; p<0·0001; 1944 participants in four studies) and weekly minutes of moderate-to-vigorous physical activity (25 min, 13–37; p<0·0001; 1458 participants in three studies).InterpretationWe found evidence of physical activity intervention effects beyond 12 months, sustained up to 4 years for both steps per day and minutes of moderate-to-vigorous physical activity, with important implications for potential long-term health benefits. However, few physical activity interventions with objective measures had follow-up beyond 12 months.FundingNone     

Composite measures of physical activity and pain associate better with functional assessments than pain alone in knee osteoarthritis

Clinical Rheumatology - Recent research showed that physical activity (PA)–adjusted pain measures were more strongly associated with radiographic osteoarthritis (OA) severity than an...     

Sedentary behavior, physical activity, and concentrations of insulin among US adults

Time spent watching television has been linked to obesity, metabolic syndrome, and diabetes, all conditions characterized to some degree by hyperinsulinemia and insulin resistance. However, limited evidence relates screen time (watching television or using a computer) directly to concentrations of insulin. We examined the cross-sectional associations between time spent watching television or using a computer, physical activity, and serum concentrations of insulin using data from 2800 participants aged at least 20 years of the 2003-2006 National Health and Nutrition Examination Survey. The amount of time spent watching television and using a computer as well as physical activity was self-reported. The unadjusted geometric mean concentration of insulin increased from 6.2 μU/mL among participants who did not watch television to 10.0 μU/mL among those who watched television for 5 or more hours per day (P = .001). After adjustment for age, sex, race or ethnicity, educational status, concentration of cotinine, alcohol intake, physical activity, waist circumference, and body mass index using multiple linear regression analysis, the log-transformed concentrations of insulin were significantly and positively associated with time spent watching television (P = < .001). Reported time spent using a computer was significantly associated with log-transformed concentrations of insulin before but not after accounting for waist circumference and body mass index. Leisure-time physical activity but not transportation or household physical activity was significantly and inversely associated with log-transformed concentrations of insulin. Sedentary behavior, particularly the amount of time spent watching television, may be an important modifiable determinant of concentrations of insulin.     

Relationship between accelerometer-based measures of physical activity and the Yale Physical Activity Survey in adults with arthritis

Objective

To evaluate the correlation between the Yale Physical Activity Survey (YPAS) scores and objective accelerometer measures of time spent in light intensity physical activities, moderate to vigorous intensity physical activities, and moderate to vigorous activities in bouts lasting at least 10 minutes.

Methods

This study analyzed baseline data from 171 persons with rheumatoid arthritis (RA) and 139 persons with osteoarthritis (OA) in a randomized clinical trial (Increasing Motivation for Physical Activity in Arthritis Clinical Trial). Persons fulfilling the 1987 American College of Rheumatology criteria for RA and persons with symptomatic radiologic knee OA (Kellgren/Lawrence class ≥2) wore an accelerometer for 7 days, then responded to the YPAS questionnaire and questions regarding demographics (age, sex, and race) and health factors (body mass index, disease status [Health Assessment Questionnaire/Western Ontario and McMaster Universities Osteoarthritis Index], comorbidities, pain, and function). Spearman's correlation coefficients were estimated between each YPAS summary measure and accelerometer measures.

Results

In the RA participants, the strongest correlation was between the YPAS activity dimensions summary index (Y‐ADSI) and average daily minutes of bouted moderate/vigorous activity (r = 0.51). Additionally, the Y‐ADSI correlated significantly with both objectively measured average daily accelerometer counts (r = 0.45) and average daily minutes of moderate/vigorous activity (r = 0.43). For OA participants, a similar pattern emerged: the Y‐ADSI had significant correlations with average daily minutes of bouted moderate/vigorous activity (r = 0.36), average daily minutes of moderate/vigorous activity (r = 0.31), and average daily counts (r = 0.24).

Conclusion

For both the RA and OA groups, the Y‐ADSI had the strongest significant correlations with objectively measured physical activity, which supports Y‐ADSI use as a tool for clinical applications and in rheumatology research.     

Inflammatory markers and physical function among older adults with knee osteoarthritis

OBJECTIVE: To investigate whether serum concentrations of various inflammatory markers are associated with physical function and disease severity among older obese adults with knee osteoarthritis (OA). METHODS: Data are from baseline assessments in 274 patients with knee OA participating in an exercise and nutrition intervention study. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess self-reported physical function, pain, and stiffness. The presence of disability was assessed, walking speed was calculated on the basis of the 6-minute walk test, and knee radiographs determined the radiographic severity of OA. Serum concentration of interleukin 6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and the soluble receptors IL-6sR, IL-2sR, TNF-sR1 and TNF-sR2 were measured by ELISA. RESULTS: In multivariate regression analyses adjusted for age, sex, race, body mass index, comorbid conditions, and use of nonsteroid antiinflammatory drugs, higher serum levels of TNF-sR1 and TNF-sR2 were significantly associated with lower scores on the WOMAC physical function, with more symptoms of pain and stiffness, and with more reported physical disability. In addition, higher serum levels of TNF-sR1 and TNF-sR2 were significantly associated with slower walking speed, and tended to be associated with worse radiographic scores. Higher serum levels of IL-6 tended to be associated with slower walking speed, but no significant associations were observed for CRP, IL-6sR, or IL-2sR. CONCLUSION: Especially high levels of the soluble receptors of TNF-alpha were found to be associated with lower physical function, increased OA symptoms, and worse knee radiographic scores in older obese adults with knee OA.     

Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults

BACKGROUND: Physical activity has been associated with a reduced risk of coronary heart disease, but the mechanism underlying this association is unclear. Because coronary heart disease is increasingly seen as an inflammatory process, it might be reasonable to hypothesize that physical activity reduces risk of coronary heart disease by reducing or preventing inflammation. METHODS: The study examined the relationship between physical activity and elevated inflammation as indicated by a high C-reactive protein level, white blood cell count, or fibrinogen level. Study subjects were 3638 apparently healthy US men and women 40 years and older who participated in the Third National Health and Nutrition Examination Survey. RESULTS: More frequent physical activity was independently associated with a lower odds of having an elevated C-reactive protein level. Compared with those engaging in physical activity 0 to 3 times per month, the odds of having an elevated C-reactive protein level was reduced among those engaging in physical activity 4 to 21 times per month (odds ratio, 0.77; 95% confidence interval, 0.58-1.02) and 22 or more times per month (odds ratio, 0.63; 95% confidence interval, 0.43-0.93) (P for trend,.02). Similar associations were seen for white blood cell count and fibrinogen levels. CONCLUSIONS: More frequent physical activity is independently associated with a lower odds of having elevated inflammation levels among apparently healthy US adults 40 years and older, independent of several confounding factors. The results suggest that the association between physical activity and reduced coronary heart disease risk may be mediated by anti-inflammatory effects of regular physical activity.     

Comparison of subjective and objective measures in recurrently wheezy infants

OBJECTIVES: The aim of this study was to compare subjective measures (overall health assessment both by the study physician and the child's mother) with objective measurements of forced expiratory volumes (FEV(t)) and maximal flow at functional residual capacity V(max)FRC) in recurrently wheezy infants. METHODS: Sixteen wheezy infants (12 boys) aged 8-26 months were studied. A clinical assessment at visit 1 was followed by the run-in period during which day- and nighttime asthma symptom scores were obtained. The actual study period consisted of 2 visits when patient's lung function was assessed. The first of which was during an acute exacerbation (visit 2), while the second was when the infant was asymptomatic (visit 3). FEV(t) were obtained by the raised volume rapid thoracic compression technique (RVRTC) and V(max)FRC by the tidal volume rapid thoracic compression technique (TVRTC). RESULTS: Mean FEV(t) but not mean V(max)FRC were significantly lower at visit 2 compared to visit 3 (FEV(0.5): p = 0.005, and FEV(0.75): p = 0.002; V(max)FRC: p = 0.15) and correlated well with overall health assessment by the study physician (FEV(0.5): r = 0.82, and FEV(0.75): r = 0.84), but not with the overall health assessment by the mother. CONCLUSIONS: We have shown in the present study that objective measurements of FEV(t) from a raised lung volume correlate well with the overall health assessment by the study physician; this was in contrast to measurements of V(max)FRC in the tidal volume range. We therefore conclude that the RVRTC technique is a feasible method to assess and monitor obstructive lung disease in infancy.     

Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study

OBJECTIVE: To examine effects of activity strategy training (AST), a structured rehabilitation program taught by occupational therapists and designed to teach adaptive strategies for symptom control and engagement in physical activity (PA). METHODS: A randomized controlled pilot trial was conducted at 4 sites (3 senior housing facilities and 1 senior center) in southeastern, lower Michigan. Fifty-four older adults with hip or knee osteoarthritis (mean +/- SD age 75.3+/-7.1 years) participated. At each site, older adults were randomly assigned to 1 of 2 programs: exercise plus AST (Ex + AST) or exercise plus health education (Ex + Ed). The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period, and were conducted concurrently within each site. Pain, total PA and PA intensity (measured objectively by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors questionnaire), arthritis self-efficacy, and physical function were assessed at baseline and posttest. RESULTS: At posttest, participants who received Ex + AST had significantly higher levels of objective peak PA (P=0.02) compared with participants who received Ex + Ed. Although not statistically significant, participants in Ex + AST tended to have larger pain decreases, increased total objective and subjective PA, and increased physical function. No effects were found for arthritis self-efficacy. CONCLUSION: Although participants were involved in identical exercise programs, participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education. Future studies will be needed to examine larger samples and long-term effects of AST.     

Correlates of knee pain among US adults with and without radiographic knee osteoarthritis.

We examined the associations of sociodemographic variables, health behaviors, health status and psychological well being with radiographic knee osteoarthritis (OA) and self-reported knee pain for 4056 US adults aged 45-74 years. Among persons with or without knee OA known correlates of radiographic knee OA (age, sex, race, obesity) were generally not associated with knee pain. Radiographic severity, psychological well being and health status were associated with knee pain, both among persons with and without radiographic knee OA, suggesting that nonradiographic correlates of self-reported knee pain are independent of whether a person has radiographic knee OA.     

Participation restrictions among older adults with osteoarthritis: a mediated model of physical symptoms, activity limitations, and depression

OBJECTIVE: Research emphasizes the negative impact of osteoarthritis (OA) on social participation, yet few studies have examined the roles of symptoms, activity limitations, and depression in this relationship. The present longitudinal study tested a model that hypothesizes that the relationship between physical symptoms and later participation restrictions among older adults with OA is mediated by activity limitations and depressive symptoms. METHODS: Participants were 184 community-dwelling senior adults (age>or=55 years) with a physician diagnosis of OA who were interviewed at 2 time points 18 months apart. Measures included demographic variables; a derived physical symptoms measure based on severity of pain, stiffness, and fatigue in the previous week; and depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale. Measures of activity limitations and participation restrictions were derived by factor analysis of questions about difficulty in everyday life. Sequential multiple linear regression analyses controlling for demographic and illness-related variables were used to test for mediation. RESULTS: Severity of time 1 physical symptoms was associated with difficulties in participation 18 months later. Sequential introduction of variables showed that this relationship was partially mediated by time 1 activity limitations and time 1 depressive symptoms. When both of these variables were included in the model, the effect of symptoms severity was completely mediated. CONCLUSION: This study demonstrates the importance of taking into account both the physical (activity limitations) and psychological (depressive symptoms) consequences of OA symptoms and suggests that these factors act as a pathway to subsequent participation restrictions.     

Assessing physical activity in persons with knee osteoarthritis using accelerometers: Data from the osteoarthritis initiative

Objective

Physical activity measured by accelerometers requires basic assumptions to translate the output into meaningful measures. We used accelerometer data from the Osteoarthritis Initiative to investigate in the context of knee osteoarthritis (OA) the following data processing assumptions derived from the general US adult population: nonwear (a period the monitor was removed), based on zero activity exceeding 60 minutes; and a valid day of monitoring, based on wear time evidence exceeding 10 hours.

Methods

We examined the influence of nonwear thresholds ranging from 20 to 300 minutes of zero activity on mean daily activity minutes (counts >0), mean daily activity counts, and mean daily moderate to vigorous physical activity minutes. The effect of selecting minimums of 8, 10, or 12 wear hours to signify a valid day of monitoring on data retention was examined.

Results

Our sample of 3,536 days of accelerometer data from 519 persons with knee OA showed that mean daily activity minutes increased with the nonwear threshold until stabilizing at 463 minutes per day, corresponding to the 90‐minute nonwear threshold. Similar patterns were observed for mean daily activity counts. Varying the nonwear threshold had no effect on mean daily moderate to vigorous physical activity minutes. Choosing the 90‐minute nonwear threshold and a minimum of 10 wear hours to constitute a valid day provided 94% data retention.

Conclusion

Data supported applying the 90‐minute nonwear threshold to the knee OA population instead of the 60‐minute threshold for the general population, while retaining the 10‐hour valid day threshold.     

The biphasic effects of alcohol: comparisons of subjective and objective measures of stimulation, sedation, and physical activity

BACKGROUND: Alcohol produces biphasic effects of both stimulation and sedation. Sensitivity to these effects may increase the risk for the development of alcoholism. Alcohol-induced changes in stimulation and sedation are commonly assessed with self-report questionnaires in human research and with physical activity monitoring in animal research. However, little is known about the effects of alcohol on physical activity or the relationship between physical activity and subjective self-report measures of stimulation and sedation following alcohol consumption in humans. METHODS: Thirty healthy men and women (n = 15 each) from 21 to 38 years old completed daily measurements of physical activity and self-reports of stimulation and sedation following alcohol or placebo consumption. Across each of the four experimental days, all participants consumed a placebo, 0.4, 0.6, or 0.8 g/kg dose of 95% alcohol in a counterbalanced order. Breath alcohol concentrations, physical activity levels, and self-reported stimulation and sedation were measured at baseline and on the ascending and descending limbs of the breath alcohol concentration (BrAC) curve. RESULTS: All alcohol doses increased physical activity, but these increases were time- and dose-dependent. Increases in physical activity lasted across both ascending and descending limbs of the BrAC curve. Following the 0.6 g/kg dose, both physical activity and self-reported stimulation increased during the ascending BrAC. Separate analyses of self-reported sedation scores indicated that alcohol consumption also increased sedation for the 0.6 and 0.8 g/kg doses. Physical activity was not significantly correlated with either self-reported stimulation or sedation at any time point. CONCLUSIONS: These findings suggest that assessments of subjectively measured stimulation and sedation and objectively measured physical activity each assess unique aspects of the effects of alcohol. Used simultaneously, these measures may be useful for examining underlying mechanisms of the effects of alcohol on behavior.