Reliability and validity of objective measures of physical activity in youth with cerebral palsy who are ambulatory

BACKGROUND Physical therapy for youth with cerebral palsy (CP) who are ambulatory includes interventions to increase functional mobility and participation in physical activity (PA). Thus, reliable and valid measures are needed to document PA in youth with CP. OBJECTIVE The purpose of this study was to evaluate the inter-instrument reliability and concurrent validity of 3 accelerometer-based motion sensors with indirect calorimetry as the criterion for measuring PA intensity in youth with CP. METHODS Fifty-seven youth with CP (mean age=12.5 years, SD=3.3; 51% female; 49.1% with spastic hemiplegia) participated. Inclusion criteria were: aged 6 to 20 years, ambulatory, Gross Motor Function Classification System (GMFCS) levels I through III, able to follow directions, and able to complete the full PA protocol. Protocol activities included standardized activity trials with increasing PA intensity (resting, writing, household chores, active video games, and walking at 3 self-selected speeds), as measured by weight-relative oxygen uptake (in mL/kg/min). During each trial, participants wore bilateral accelerometers on the upper arms, waist/hip, and ankle and a portable indirect calorimeter. Intraclass coefficient correlations (ICCs) were calculated to evaluate inter-instrument reliability (left-to-right accelerometer placement). Spearman correlations were used to examine concurrent validity between accelerometer output (activity and step counts) and indirect calorimetry. Friedman analyses of variance with post hoc pair-wise analyses were conducted to examine the validity of accelerometers to discriminate PA intensity across activity trials. RESULTS All accelerometers exhibited excellent inter-instrument reliability (ICC=.94-.99) and good concurrent validity (rho=.70-.85). All accelerometers discriminated PA intensity across most activity trials. LIMITATIONS This PA protocol consisted of controlled activity trials. CONCLUSIONS Accelerometers provide valid and reliable measures of PA intensity among youth with CP.

Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis

Objective To assess the impact of exercise referral schemes on physical activity and health outcomes. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references. Study selection - Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. - Population: sedentary individuals with or without medical diagnosis. - Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. - Comparators: usual care, no intervention, or alternative exercise referral schemes. Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings. Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.

Children's physical activity and psychological health: the relevance of intensity

Aim To examine the relevance of physical activity intensity when assessing the relationship between activity and psychological health in 9–10-year-old children. Methods Activity was assessed by accelerometry in 57 boys (n = 23) and girls (n = 34). Total activity and time spent in very light (≤1.9 METs) through to vigorous activity (≥6 METs) were recorded. Psychological health inventories to assess anxiety, depression and aspects of self-worth were completed. Results Time accumulated in very light activity had positive correlations with anxiety and depression (r > 0.30, p < 0.05) and negative correlations with aspects of physical self-worth (r > −0.29, p < 0.05). Time accumulated in vigorous activity had negative correlations with anxiety and behavioural conduct (r > −0.30, p < 0.05) and positive correlation with aspects of physical self-worth (r > 0.28, p < 0.05). Children spending over 4 h in very light intensity activity had more negative psychological profiles than children spending under 4 h at this intensity. Conclusion Aspects of psychological health were negatively correlated with very light intensity activity and positively correlated with vigorous intensity activity. Further research should investigate whether reducing time spent in very light intensity activity and increasing time spent in vigorous intensity activity improves psychological health in children.

Physical activity and health related quality of life

Background Research on the relationship between Health Related Quality of Life (HRQoL) and physical activity (PA), to date, have rarely investigated how this relationship differ across objective and subjective measures of PA. The aim of this paper is to explore the relationship between HRQoL and PA, and examine how this relationship differs across objective and subjective measures of PA, within the context of a large representative national survey from England. Methods Using a sample of 5,537 adults (40–60 years) from a representative national survey in England (Health Survey for England 2008), Tobit regressions with upper censoring was employed to model the association between HRQoL and objective, and subjective measures of PA controlling for potential confounders. We tested the robustness of this relationship across specific types of PA. HRQoL was assessed using the summary measure of health state utility value derived from the EuroQol-5 Dimensions (EQ-5D) whilst PA was assessed via subjective measure (questionnaire) and objective measure (accelerometer- actigraph model GT1M). The actigraph was worn (at the waist) for 7 days (during waking hours) by a randomly selected sub-sample of the HSE 2008 respondents (4,507 adults – 16 plus years), with a valid day constituting 10 hours. Analysis was conducted in 2010. Results Findings suggest that higher levels of PA are associated with better HRQoL (regression coefficient: 0.026 to 0.072). This relationship is consistent across different measures and types of PA although differences in the magnitude of HRQoL benefit associated with objective and subjective (regression coefficient: 0.047) measures of PA are noticeable, with the former measure being associated with a relatively better HRQoL (regression coefficient: 0.072). Conclusion Higher levels of PA are associated with better HRQoL. Using an objective measure of PA compared with subjective shows a relatively better HRQoL.

Chronic disease risks and use of a smartphone application during a physical activity and dietary intervention in Australian truck drivers

- Objective This study examined chronic disease risks and the use of a smartphone activity tracking application during an intervention in Australian truck drivers (April-October 2014). - Methods Forty-four men (mean age=47.5 [SD 9.8] years) completed baseline health measures, and were subsequently offered access to a free wrist-worn activity tracker and smartphone application (Jawbone UP) to monitor step counts and dietary choices during a 20-week intervention. Chronic disease risks were evaluated against guidelines; weekly step count and dietary logs registered by drivers in the application were analysed to evaluate use of the Jawbone UP. - Results Chronic disease risks were high (e.g. 97% high waist circumference [≥94 cm]). Eighteen drivers (41%) did not start the intervention; smartphone technical barriers were the main reason for drop out. Across 20-weeks, drivers who used the Jawbone UP logged step counts for an average of 6 [SD 1] days/week; mean step counts remained consistent across the intervention (weeks 1–4=8,743[SD 2,867] steps/day; weeks 17–20=8,994[SD 3,478] steps/day). The median number of dietary logs significantly decreased from start (17 [IQR 38] logs/weeks) to end of the intervention (0 [IQR 23] logs/week; p<0.01); the median proportion of healthy diet choices relative to total diet choices logged increased across the intervention (weeks 1–4=38[IQR 21]%; weeks 17–20=58[IQR 18]%). - Conclusions Step counts were more successfully monitored than dietary choices in those drivers who used the Jawbone UP. - Implications Smartphone technology facilitated active living and healthy dietary choices, but also prohibited intervention engagement in a number of these high-risk Australian truck drivers.

Does vigorous physical activity provide additional benefits beyond those of moderate?

Background Although guidelines suggest that vigorous physical activity (PA) confers “extra” benefits compared with those from moderate-intensity activity alone, the magnitude of this additional benefit is unclear. The aim was to compare the reduction in risk of hypertension (HT) and depressive symptoms (DS) for 12 yr in middle-age women who reported (a) only moderate-intensity PA (MOPA) and (b) a combination of moderate and vigorous PA (MVPA), after controlling for overall volume of activity. Methods The study involved 11,285 participants in the Australian Longitudinal Study on Women’s Health, who completed surveys in 1998 (age = 46–52 yr), 2001, 2004, 2007, and 2010. Generalized estimating equation models (with 3-yr time lag) were used to examine the relationship between PA in seven categories from 0 to >2000 MET·min·wk−1 and occurrence of HT and DS for women who reported MOPA or MVPA. Results For HT, risk was slightly lower for MVPA than for MOPA across the entire range of PA levels, but this difference was only significant at the highest PA level (>2000; odds ratio [OR] = 0.80 MOPA and 0.56 MVPA). For DS, OR values were similar in both groups up to 500 MET·min·wk−1, then slightly lower for MVPA than for MOPA at higher PA levels. Again, this difference was only significant at the highest PA level (>2000; OR = 0.57 MOPA and 0.42 MVPA). OR values were slightly attenuated in adjusted models. Conclusions Doing both vigorous and moderate activity does not have significant additional benefits in terms of HT and DS, above those from moderate-intensity activity alone, except at very high levels of PA.

Republished research: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis

Study question Can exercise referral schemes improve health outcomes in individuals with or without pre-existing conditions? Summary answer We found weak evidence of a short term increase in physical activity and reduction in levels of depression in sedentary individuals after participation in exercise referral schemes, compared with after usual care. What is known and what this paper adds Exercise referral schemes are commonly used in primary care to promote physical activity. Evidence indicating a health benefit of these schemes is limited, so their value in primary care remains to be ascertained.

Promoting diet and physical activity in nurses: A systematic review

Objective: To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses. Data Source: English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed. Study Inclusion and Exclusion Criteria: Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non–peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses. Data Extraction: Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer. Data Synthesis: Extracted data were synthesized in a tabular format and narrative summary. Results: Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA. Conclusions: Outcomes of interventions to change nurses' PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.

Physical activity in mid-age and older women: Lessons from the Australian longitudinal study on women’s health

The Australian Longitudinal Study on Women’s Health (ALSWH) commenced in Australia in 1996 when researchers recruited approximately 40,000 women in three birth cohorts: 1973–1978, 1946–1951, and 1921–1926. Since then participants have completed surveys on a wide range of health issues, at approximately three-year intervals. This overview describes changes in physical activity (PA) over time in the mid-age and older ALSWH cohorts, and summarizes the findings of studies published to date on the determinants of PA, and its associated health outcomes in Australian women. The ALSWH data show a significant increase in PA during mid-age, and a rapid decline in activity levels when women are in their 80s. The study has demonstrated the importance of life stages and key life events as determinants of activity, the additional benefits of vigorous activity for mid-age women, and the health benefits of ‘only walking’ for older women. ALSWH researchers have also drawn attention to the benefits of activity in terms of a wide range of physical and mental health outcomes, as well as overall vitality and well-being. The data indicate that maintaining a high level of PA throughout mid and older age will not only reduce the risk of premature death, but also significantly extend the number of years of healthy life.

Prospective relationships between physical activity and optimism in young and mid-aged women

BACKGROUND: There is growing evidence that regular physical activity (PA) reduces the risk of poor mental health. Less research has focused on the relationship between PA and positive wellbeing. The study aims were to assess the prospective associations between PA and optimism, in both young and mid-aged women. METHODS: 9688 young women (born 1973-1978) completed self-report surveys in 2000 (age 22 to 27), 2003, 2006, and 2009; and 11,226 mid-aged women (born 1946-1951) completed surveys in 2001 (age 50-55) 2004, 2007, and 2010, as part of the Australian Longitudinal Study on Women's Health. Generalized estimating equation models (with 3-year time lag) were used to examine the relationship between PA and optimism in both cohorts. RESULTS: In both cohorts, women reporting higher levels of PA had greater odds of reporting higher optimism over the 9-year period, (young, OR = 5.04, 95% CI: 3.85-6.59; mid-age, OR = 5.77, 95% CI: 4.76-7.00) than women who reported no PA. Odds were attenuated in adjusted models, with depression accounting for a large amount of this attenuation (young, OR = 2.00, 95% CI: 1.57-2.55; mid-age, OR = 1.64 95% CI: 1.38-1.94). CONCLUSIONS: Physical activity can promote optimism in young and mid-aged women over time, even after accounting for the negative effects of other psychosocial indicators such as depression.

Evaluation of restoration of vegetation infested with cat's claw creeper vine (Dolichandra unguis-cati): soil seed bank response to herbicide and physical removal

Cat’s claw creeper vine, Dolichandra unguis-cati (L.) L.G.Lohmann (formerly known as Macfadyena unguis-cati (L.) A.H.Gentry), a Weed of National Significance (WoNS), is a structural woody parasite that is highly invasive along sensitive riparian corridors and native forests of coastal and inland eastern Australia. As part of evaluation of the impact of herbicide and mechanical/physical control techniques on the long-term reduction of biomass of the weed and expected return of native flora, we have set-up permanent vegetation plots in: (a) infested and now chemically/physically treated, (b) infested but untreated and (c) un-infested patches. The treatments were set up in both riparian and non-riparian habitats to document changes that occur in seed bank flora over a two-year post-treatment period. Response to treatment varied spatially and temporally. However, following chemical and physical removal treatments, treated patches exhibited lower seed bank abundance and diversity than infested and patches lacking the weed, but differences were not statistically significant. Thus it will be safe to say that spraying herbicides using the recommended rate does not undermine restoration efforts.

Patient preferences for receiving remote communication support for lifestyle physical activity behaviour change: The perspective of patients with musculoskeletal disorders from three hospital services

This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods People with musculoskeletal disorders ( n=221 of 296 eligible) accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”). Results Most (n=155, 70%) desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10), followed by email and telephone (both 5/10), text messaging (1/10), and private Internet-based social network messages (0/10). Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p<0.001), telephone calls (coefficient = 3.000, p<0.001), and email (coefficient = 2.059, p=0.02). Older age was associated with lower preference for email (coefficient = −0.100, p<0.001), texting (coefficient = −0.096, p<0.001), and social network messages (coefficient = −0.065, p<0.001). Conclusion Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

Promoting and maintaining physical activity in the transition to retirement: A systematic review of interventions for adults around retirement age

It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age.

Spatial and temporal variability in midge (Nematocera) assemblages in shallow Finnish lakes (60−70 °N) : community-based modelling of past environmental change

Multi- and intralake datasets of fossil midge assemblages in surface sediments of small shallow lakes in Finland were studied to determine the most important environmental factors explaining trends in midge distribution and abundance. The aim was to develop palaeoenvironmental calibration models for the most important environmental variables for the purpose of reconstructing past environmental conditions. The developed models were applied to three high-resolution fossil midge stratigraphies from southern and eastern Finland to interpret environmental variability over the past 2000 years, with special focus on the Medieval Climate Anomaly (MCA), the Little Ice Age (LIA) and recent anthropogenic changes. The midge-based results were compared with physical properties of the sediment, historical evidence and environmental reconstructions based on diatoms (Bacillariophyta), cladocerans (Crustacea: Cladocera) and tree rings. The results showed that the most important environmental factor controlling midge distribution and abundance along a latitudinal gradient in Finland was the mean July air temperature (TJul). However, when the dataset was environmentally screened to include only pristine lakes, water depth at the sampling site became more important. Furthermore, when the dataset was geographically scaled to southern Finland, hypolimnetic oxygen conditions became the dominant environmental factor. The results from an intralake dataset from eastern Finland showed that the most important environmental factors controlling midge distribution within a lake basin were river contribution, water depth and submerged vegetation patterns. In addition, the results of the intralake dataset showed that the fossil midge assemblages represent fauna that lived in close proximity to the sampling sites, thus enabling the exploration of within-lake gradients in midge assemblages. Importantly, this within-lake heterogeneity in midge assemblages may have effects on midge-based temperature estimations, because samples taken from the deepest point of a lake basin may infer considerably colder temperatures than expected, as shown by the present test results. Therefore, it is suggested here that the samples in fossil midge studies involving shallow boreal lakes should be taken from the sublittoral, where the assemblages are most representative of the whole lake fauna. Transfer functions between midge assemblages and the environmental forcing factors that were significantly related with the assemblages, including mean air TJul, water depth, hypolimnetic oxygen, stream flow and distance to littoral vegetation, were developed using weighted averaging (WA) and weighted averaging-partial least squares (WA-PLS) techniques, which outperformed all the other tested numerical approaches. Application of the models in downcore studies showed mostly consistent trends. Based on the present results, which agreed with previous studies and historical evidence, the Medieval Climate Anomaly between ca. 800 and 1300 AD in eastern Finland was characterized by warm temperature conditions and dry summers, but probably humid winters. The Little Ice Age (LIA) prevailed in southern Finland from ca. 1550 to 1850 AD, with the coldest conditions occurring at ca. 1700 AD, whereas in eastern Finland the cold conditions prevailed over a longer time period, from ca. 1300 until 1900 AD. The recent climatic warming was clearly represented in all of the temperature reconstructions. In the terms of long-term climatology, the present results provide support for the concept that the North Atlantic Oscillation (NAO) index has a positive correlation with winter precipitation and annual temperature and a negative correlation with summer precipitation in eastern Finland. In general, the results indicate a relatively warm climate with dry summers but snowy winters during the MCA and a cool climate with rainy summers and dry winters during the LIA. The results of the present reconstructions and the forthcoming applications of the models can be used in assessments of long-term environmental dynamics to refine the understanding of past environmental reference conditions and natural variability required by environmental scientists, ecologists and policy makers to make decisions concerning the presently occurring global, regional and local changes. The developed midge-based models for temperature, hypolimnetic oxygen, water depth, littoral vegetation shift and stream flow, presented in this thesis, are open for scientific use on request.

Spatial variation of climate and the impact of disturbances on local climate and forest recovery in northern Finland

The structure and function of northern ecosystems are strongly influenced by climate change and variability and by human-induced disturbances. The projected global change is likely to have a pronounced effect on the distribution and productivity of different species, generating large changes in the equilibrium at the tree-line. In turn, movement of the tree-line and the redistribution of species produce feedback to both the local and the regional climate. This research was initiated with the objective of examining the influence of natural conditions on the small-scale spatial variation of climate in Finnish Lapland, and to study the interaction and feedback mechanisms in the climate-disturbances-vegetation system near the climatological border of boreal forest. The high (1 km) resolution spatial variation of climate parameters over northern Finland was determined by applying the Kriging interpolation method that takes into account the effect of external forcing variables, i.e., geographical coordinates, elevation, sea and lake coverage. Of all the natural factors shaping the climate, the geographical position, local topography and altitude proved to be the determining ones. Spatial analyses of temperature- and precipitation-derived parameters based on a 30-year dataset (1971-2000) provide a detailed description of the local climate. Maps of the mean, maximum and minimum temperatures, the frost-free period and the growing season indicate that the most favourable thermal conditions exist in the south-western part of Lapland, around large water bodies and in the Kemijoki basin, while the coldest regions are in highland and fell Lapland. The distribution of precipitation is predominantly longitudinally dependent but with the definite influence of local features. The impact of human-induced disturbances, i.e., forest fires, on local climate and its implication for forest recovery near the northern timberline was evaluated in the Tuntsa area of eastern Lapland, damaged by a widespread forest fire in 1960 and suffering repeatedly-failed vegetation recovery since that. Direct measurements of the local climate and simulated heat and water fluxes indicated the development of a more severe climate and physical conditions on the fire-disturbed site. Removal of the original, predominantly Norway spruce and downy birch vegetation and its substitution by tundra vegetation has generated increased wind velocity and reduced snow accumulation, associated with a large variation in soil temperature and moisture and deep soil frost. The changed structural parameters of the canopy have determined changes in energy fluxes by reducing the latter over the tundra vegetation. The altered surface and soil conditions, as well as the evolved severe local climate, have negatively affected seedling growth and survival, leading to more unfavourable conditions for the reproduction of boreal vegetation and thereby causing deviations in the regional position of the timberline. However it should be noted that other factors, such as an inadequate seed source or seedbed, the poor quality of the soil and the intensive logging of damaged trees could also exacerbate the poor tree regeneration. In spite of the failed forest recovery at Tunsta, the position and composition of the timberline and tree-line in Finnish Lapland may also benefit from present and future changes in climate. The already-observed and the projected increase in temperature, the prolonged growing season, as well as changes in the precipitation regime foster tree growth and new regeneration, resulting in an advance of the timberline and tree-line northward and upward. This shift in the distribution of vegetation might be decelerated or even halted by local topoclimatic conditions and by the expected increase in the frequency of disturbances.