Sociospatial distribution of access to facilities for moderate and vigorous intensity physical activity in Scotland by different modes of transport

Background People living in neighbourhoods of lower socioeconomic status have been shown to have higher rates of obesity and a lower likelihood of meeting physical activity recommendations than their more affluent counterparts. This study examines the sociospatial distribution of access to facilities for moderate or vigorous intensity physical activity in Scotland and whether such access differs by the mode of transport available and by Urban Rural Classification. Methods A database of all fixed physical activity facilities was obtained from the national agency for sport in Scotland. Facilities were categorised into light, moderate and vigorous intensity activity groupings before being mapped. Transport networks were created to assess the number of each type of facility accessible from the population weighted centroid of each small area in Scotland on foot, by bicycle, by car and by bus. Multilevel modelling was used to investigate the distribution of the number of accessible facilities by small area deprivation within urban, small town and rural areas separately, adjusting for population size and local authority. Results Prior to adjustment for Urban Rural Classification and local authority, the median number of accessible facilities for moderate or vigorous intensity activity increased with increasing deprivation from the most affluent or second most affluent quintile to the most deprived for all modes of transport. However, after adjustment, the modelling results suggest that those in more affluent areas have significantly higher access to moderate and vigorous intensity facilities by car than those living in more deprived areas. Conclusions The sociospatial distributions of access to facilities for both moderate intensity and vigorous intensity physical activity were similar. However, the results suggest that those living in the most affluent neighbourhoods have poorer access to facilities of either type that can be reached on foot, by bicycle or by bus than those living in less affluent areas. This poorer access from the most affluent areas appears to be reversed for those with access to a car.

Development and validation of the influenza intensity and impact questionnaire (FluiiQ™)

Objective
Clinical trials of new agents to reduce the severity and impact of influenza require accurate assessment of the effect of influenza infection. Because there are limited high-quality adult influenza Patient Reported Outcomes (PRO) measures, the aim was to develop and validate a simple but comprehensive questionnaire for epidemiological research and clinical trials.

Methods
Construct and item generation was guided by the literature, concept mapping, focus groups, and interviews with individuals with laboratory-confirmed influenza and expert physicians. Items were administered to 311 people with influenza-like illness (ILI) across 25 US sites. Analyses included classic psychometrics, structural equation modeling (SEM), and Rasch analyses.

Results
Concept mapping generated 149 concepts covering the influenza experience and clustered into symptoms and impact on daily activities, emotions, and others. Items were drafted using simplicity and brevity criteria. Eleven symptoms from the literature underwent review by physicians and patients, and two were removed and one added. The symptoms domain factored into systemic and respiratory symptoms, whereas the impact domains were unidimensional. All domains displayed good internal consistency (Cronbach α ≥ 0.8) except the three-item respiratory domain (α = 0.48). A five-factor SEM indicated excellent fit where systemic, respiratory, and daily activities domains differentiated patients with ILI or confirmed influenza. All scales were responsive over time.

Conclusions
Patient and clinician consultations resulted in an influenza PRO measure with high validity and good overall evidence of reliability and responsiveness. The Influenza Intensity and Impact Questionnaire (FluiiQ™) will improve the evaluation of existing and future agents designed to prevent or control influenza infection by increasing the breadth and depth of measurement in this field.

Evaluation of Actical equations and thresholds to predict physical activity intensity in young children

This study examined the validity of current Actical activity energy expenditure (AEE) equations and intensity cut-points in preschoolers using AEE and direct observation as criterion measures. Forty 4–6-year-olds (5.3 ± 1.0 years) completed a ~150-min room calorimeter protocol involving age-appropriate sedentary behaviours (SBs), light intensity physical activities (LPAs) and moderate-to-vigorous intensity physical activities (MVPAs). AEE and/or physical activity intensity were calculated using Actical equations and cut-points by Adolph, Evenson, Pfeiffer and Puyau. Predictive validity was examined using paired sample t-tests. Classification accuracy was evaluated using weighted kappas, sensitivity, specificity and area under the receiver operating characteristic curve. The Pfeiffer equation significantly overestimated AEE during SB and underestimated AEE during LPA (P < 0.0125 for both). There was no significant difference between measured and predicted AEEs during MVPA. The Adolph cut-point showed significantly higher accuracy for classifying SB, LPA and MVPA than all others. The available Actical equation does not provide accurate estimates of AEE across all intensities in preschoolers. However, the Pfeiffer equation performed reasonably well for MVPA. Using cut-points of ≤6 counts · 15 s−1, 7–286 counts · 15 s−1 and ≥ 287 counts · 15 s−1 when classifying SB, LPA and MVPA, respectively, is recommended.

Associations of low- and high-intensity light activity with cardiometabolic biomarkers

Light-intensity physical activity (LIPA) accounts for much of adults' waking hours (≈40%) and substantially contributes to overall daily energy expenditure. Encompassing activity behaviours of low intensity (standing with little movement) through to those with a higher intensity (slow walking), LIPA is ubiquitous, yet little is known about how associations with health may vary depending on its intensity. We examined the associations of objectively assessed LIPA, categorized as either low- or high- LIPA, and MVPA, with cardiometabolic risk biomarkers.

Toxicity and dose intensity of FOLFOX in patients with increased body mass index

This study was conducted at St James‘s Hospital, Dublin, Ireland, in 2010. It evaluated the dose intensity and toxicities experienced by patients of normal and increased body mass index treated with FOLFOX chemotherapy, and demonstrated that overweight patients may tolerate doses based on actual body weight.

Changes in mitochondrial function and mitochondria associated protein expression in response to 2-weeks of high intensity interval training

PURPOSE: High-intensity short-duration interval training (HIT) stimulates functional and metabolic adaptation in skeletal muscle, but the influence of HIT on mitochondrial function remains poorly studied in humans. Mitochondrial metabolism as well as mitochondrial-associated protein expression were tested in untrained participants performing HIT over a 2-week period. METHODS: Eight males performed a single-leg cycling protocol (12 × 1 min intervals at 120% peak power output, 90 s recovery, 4 days/week). Muscle biopsies (vastus lateralis) were taken pre- and post-HIT. Mitochondrial respiration in permeabilized fibers, citrate synthase (CS) activity and protein expression of peroxisome proliferator-activated receptor gamma coactivator (PGC-1α) and respiratory complex components were measured. RESULTS: HIT training improved peak power and time to fatigue. Increases in absolute oxidative phosphorylation (OXPHOS) capacities and CS activity were observed, but not in the ratio of CCO to the electron transport system (CCO/ETS), the respiratory control ratios (RCR-1 and RCR-2) or mitochondrial-associated protein expression. Specific increases in OXPHOS flux were not apparent after normalization to CS, indicating that gross changes mainly resulted from increased mitochondrial mass. CONCLUSION: Over only 2 weeks HIT significantly increased mitochondrial function in skeletal muscle independently of detectable changes in mitochondrial-associated and mitogenic protein expression.

What is the role of tobacco control advertising intensity and duration in reducing adolescent smoking prevalence? Findings from 16 years of tobacco control mass media advertising in Australia

ABSTRACT
Objective: To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence.
Methods: Australian students (aged 12–17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314–16 611). The outcome measure was students’ smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (≥100 TRPs/month; ≥400 TRPs/month; ≥800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables.
Results: Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to ≥400 TRPs/month and ≥800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was ≥400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was ≥800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence.
Conclusions: Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence.

Sprint interval and moderate-intensity continuous training have equal benefits on aerobic capacity, insulin sensitivity, muscle capillarisation and endothelial eNOS/NAD(P)Hoxidase protein ratio in obese men

Key points: Skeletal muscle capillary density and vasoreactivity are reduced in obesity, due to reduced nitric oxide bioavailability. Sprint interval training (SIT) has been proposed as a time efficient alternative to moderate-intensity continuous training (MICT), but its effect on the skeletal muscle microvasculature has not been studied in obese individuals. We observed that SIT and MICT led to equal increases in capillarisation and endothelial eNOS content, while reducing endothelial NOX2 content in microvessels of young obese men. We conclude that SIT is equally effective at improving skeletal muscle capillarisation and endothelial enzyme balance, while being a time efficient alternative to traditional MICT. Sprint interval training (SIT) has been proposed as a time efficient alternative to moderate-intensity continuous training (MICT), leading to similar improvements in skeletal muscle capillary density and microvascular function in young healthy humans. In this study we made the first comparisons of the muscle microvascular response to SIT and MICT in an obese population. Sixteen young obese men (age 25 ± 1 years, BMI 34.8 ± 0.9 kg m-2) were randomly assigned to 4 weeks of MICT (40-60 min cycling at ∼65% V˙O2 peak , 5 times per week) or constant load SIT (4-7 constant workload intervals of 200% Wmax 3 times per week). Muscle biopsies were taken before and after training from the m. vastus lateralis to measure muscle microvascular endothelial eNOS content, eNOS serine1177 phosphorylation, NOX2 content and capillarisation using quantitative immunofluorescence microscopy. Maximal aerobic capacity (V˙O2 peak ), whole body insulin sensitivity and arterial stiffness were also assessed. SIT and MICT increased skeletal muscle microvascular eNOS content and eNOS ser1177 phosphorylation in terminal arterioles and capillaries (P < 0.05), but the latter effect was eliminated when normalised to eNOS content (P = 0.217). SIT and MICT also reduced microvascular endothelial NOX2 content (P < 0.05) and both increased capillary density and capillary-fibre perimeter exchange index (P < 0.05). In parallel, SIT and MICT increased V˙O2 peak (P < 0.05) and whole body insulin sensitivity (P < 0.05), and reduced central artery stiffness (P < 0.05). As no significant differences were observed between SIT and MICT it is concluded that SIT is a time efficient alternative to MICT to improve aerobic capacity, insulin sensitivity and muscle capillarisation and endothelial eNOS/NAD(P)Hoxidase protein ratio in young obese men.

What doesn’t kill you makes you fitter: A systematic review of high-intensity interval exercise for patients with cardiovascular and metabolic diseases

High-intensity interval exercise (HIIE) has gained popularity in recent years for patients with cardiovascular and metabolic diseases. Despite potential benefits, concerns remain about the safety of the acute response (during and/or within 24 hours postexercise) to a single session of HIIE for these cohorts. Therefore, the aim of this study was to perform a systematic review to evaluate the safety of acute HIIE for people with cardiometabolic diseases. Electronic databases were searched for studies published prior to January 2015, which reported the acute responses of patients with cardiometabolic diseases to HIIE (≥80% peak power output or ≥85% peak aerobic power, VO2peak). Eleven studies met the inclusion criteria (n = 156; clinically stable, aged 27-66 years), with 13 adverse responses reported (∼8% of individuals). The rate of adverse responses is somewhat higher compared to the previously reported risk during moderate-intensity exercise. Caution must be taken when prescribing HIIE to patients with cardiometabolic disease. Patients who wish to perform HIIE should be clinically stable, have had recent exposure to at least regular moderate-intensity exercise, and have appropriate supervision and monitoring during and after the exercise session.

The use of kernel density estimation to examine associations between neighborhood destination intensity and walking and physical activity

BACKGROUND: Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how the distribution of destinations is related to activity. Kernel density estimation is a spatial analysis technique that accounts for the location of features relative to each other. Using kernel density estimation, this study sought to investigate whether individuals who live near destinations (shops and service facilities) that are more intensely distributed rather than dispersed: 1) have higher odds of being sufficiently active; 2) engage in more frequent walking for transport and recreation. METHODS: The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Destinations within these areas were geocoded and kernel density estimates of destination intensity were created using kernels of 400m (meters), 800m and 1200m. Using multilevel logistic regression, the association between destination intensity (classified in quintiles Q1(least)-Q5(most)) and likelihood of: 1) being sufficiently active (compared to insufficiently active); 2) walking≥4/week (at least 4 times per week, compared to walking less), was estimated in models that were adjusted for potential confounders. RESULTS: For all kernel distances, there was a significantly greater likelihood of walking≥4/week, among respondents living in areas of greatest destinations intensity compared to areas with least destination intensity: 400m (Q4 OR 1.41 95%CI 1.02-1.96; Q5 OR 1.49 95%CI 1.06-2.09), 800m (Q4 OR 1.55, 95%CI 1.09-2.21; Q5, OR 1.71, 95%CI 1.18-2.48) and 1200m (Q4, OR 1.7, 95%CI 1.18-2.45; Q5, OR 1.86 95%CI 1.28-2.71). There was also evidence of associations between destination intensity and sufficient physical activity, however these associations were markedly attenuated when walking was included in the models. CONCLUSIONS: This study, conducted within urban Melbourne, found that those who lived in areas of greater destination intensity walked more frequently, and showed higher odds of being sufficiently physically active-an effect that was largely explained by levels of walking. The results suggest that increasing the intensity of destinations in areas where they are more dispersed; and or planning neighborhoods with greater destination intensity, may increase residents' likelihood of being sufficiently active for health.