Accelerometer-derived sleep metrics in mild and difficult-to-treat asthma.

INTRODUCTION: Poor sleep health is associated with increased asthma morbidity and mortality. Accelerometers have been validated to assess sleep parameters though studies using this method in patients with asthma are sparse and none have compared mild to difficult-to-treat asthma populations. METHODS: We performed a retrospective analysis from two recent in-house trials comparing sleep metrics between patients with mild and difficult-to-treat asthma. Participants wore accelerometers for 24-hours/day for seven days. RESULTS: Of 124 participants (44 mild, 80 difficult-to-treat), no between-group differences were observed in sleep-window, sleep-time, sleep efficiency or wake time. Sleep-onset time was ~ 40 min later in the difficult-to-treat group (p = 0.019). DISCUSSION: Broadly, we observed no difference in accelerometer-derived sleep-metrics between mild and difficult-to-treat asthma. This is the largest analysis of accelerometer-derived sleep parameters in asthma and the first comparing groups by asthma severity. Sleep-onset initiation may be delayed in difficult-to-treat asthma but a dedicated study is needed to confirm.

Comparison of physical activity metrics from two research-grade accelerometers worn on the non-dominant wrist and thigh in children.

This study compared physical activity metrics from the activPAL (AP) worn on the thigh with the ActiGraph worn on the non-dominant wrist using open-source methods. Measures included average acceleration, intensity gradient (IG) and the minimum acceleration value of the most active X mins (MX). Fifty-two children (26 boys; age: 10.4 ± 0.6 years) provided≥1 day (24 h) of concurrent wear time from the activPAL and ActiGraph. Measures tended to be lower from the activPAL versus the ActiGraph. Poor agreement was evident for average acceleration but good for the IG. For the IG, the absolute and relative zones needed to reach equivalence was 4% and 0.4 SDs, respectively and for average acceleration were 10% and 1.2 SDs, respectively. Good agreement was evident for M60, M30, M20, M15 and M10 between devices. Regardless of the reference device used, equivalent estimates for the intensity gradient, M60, M30, M20, M15 and M10 were observed with relative and absolute equivalence zones being≤4% and≤0.5 SDs, respectively. The IG, M60, M30, M20, M15 and M10 appear good candidates for comparing activity data collected from the activPAL and ActiGraph. Future research can use the AP to report on sedentary behaviours as well as PA outcomes.

Development and Evaluation of Sedentary Time Cut-Points for the activPAL in Adults Using the GGIR R-Package.

The purpose of this study was to develop sedentary cut-points for the activPAL and evaluate their performance against a criterion measure (i.e., activPAL processed by PALbatch). Part 1: Thirty-five adults (23.4 ± 3.6 years) completed 12 laboratory activities (6 sedentary and 6 non-sedentary activities). Receiver operator characteristic (ROC) curves proposed optimal Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD) cut-points of 26.4 mg (ENMO) and 30.1 mg (MAD). Part 2: Thirty-eight adults (22.6 ± 4.1 years) wore an activPAL during free-living. Estimates from PALbatch and MAD revealed a mean percent error (MPE) of 2.2%, mean absolute percent error (MAPE) of 6.5%, limits of agreement (LoA) of 19% with absolute and relative equivalence zones of 5% and 0.3 SD. Estimates from PALbatch and ENMO revealed an MPE of -10.6%, MAPE of 14.4%, LoA of 31% and 16% and 1 SD equivalence zones. After standing was isolated from sedentary behaviours, ROC analysis proposed an optimal cut-off of 21.9 mg (herein ENMOs). Estimates from PALbatch and ENMOs revealed an MPE of 3.1%, MAPE of 7.5%, LoA of 25% and 9% and 0.5 SD equivalence zones. The MAD and ENMOs cut-points performed best in discriminating between sedentary and non-sedentary activity during free-living.

A Total Diet Replacement Weight Management Program for Difficult-to-Treat Asthma Associated With Obesity: A Randomized Controlled Feasibility Trial.

BACKGROUND: Obesity is often associated with uncontrolled, difficult-to-treat asthma and increased morbidity and mortality. Previous studies suggest that weight loss may improve asthma outcomes, but with heterogenous asthma populations studied and unclear consensus on the optimal method of weight management. The Counterweight-Plus Programme (CWP) for weight management is an evidence-based, dietitian-led total diet replacement (TDR) program. RESEARCH QUESTION: Can use of the CWP compared with usual care (UC) improve asthma control and quality of life in patients with difficult-to-treat asthma and obesity? STUDY DESIGN AND METHODS: We conducted a 1:1 (CWP to UC) randomized, controlled single-center trial in adults with difficult-to-treat asthma and BMI of ≥ 30 kg/m2. The CWP was a 12-week TDR phase (800 kcal/d low-energy formula) followed by stepwise food reintroduction and weight loss maintenance for up to 1 year. The primary outcome was the change in Asthma Control Questionnaire 6 (ACQ6) score over 16 weeks. The secondary outcome was change in Asthma Quality of Life Questionnaire (AQLQ) score. RESULTS: Thirty-five participants were randomized (36 screened) and 33 attended the 16-week follow-up (n = 17 in the CWP group, n = 16 in the UC group). Overall, mean ACQ6 score at baseline was 2.8 (95% CI, 2.4-3.1). Weight loss was greater in the CWP than UC group (mean difference, -12.1 kg; 95% CI, -16.9 to -7.4; P < .001). ACQ6 score improved more in the CWP than UC group (mean difference, -0.69; 95% CI, -1.37 to -0.01; P = .048). A larger proportion of participants achieved the minimal clinically important difference in ACQ6 score with CWP than with UC (53% vs 19%; P = .041; Number needed to treat, 3 [95% CI, 1.5-26.9]). AQLQ score improvement was greater in the CWP than UC group (mean difference, 0.76; 95% CI, 0.18-1.34; P = .013). INTERPRETATION: Using a structured weight management program results in clinically important improvements in asthma control and quality of life over 16 weeks compared with UC in adults with difficult-to-treat asthma and obesity. This generalizable program is easy to deliver for this challenging phenotype. Longer-term outcomes continue to be studied. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03858608; URL: www. CLINICALTRIALS: gov.

Physical activity levels in asthma: relationship with disease severity, body mass index and novel accelerometer-derived metrics.

OBJECTIVES: Patients with asthma may feel limited in physical activity (PA). Reduced PA has been demonstrated in asthmatics versus healthy controls, and increasing PA associated with improved asthma outcomes. Obesity is commonly found with difficult-to-control asthma and worsens outcomes. We compared PA levels in participants with difficult-to-control asthma and elevated body mass index (BMI) (DOW group) and two mild-moderate asthma groups: one with BMI <25 kg/m2 (MHW) and one with BMI ≥25 (MOW). METHODS: This cross-sectional study used 7-day recordings from wrist-worn accelerometers to compare PA between groups. Inactive time, light (LPA), moderate-vigorous PA (MVPA) were measured, along with two novel metrics: intensity gradient (IG) reflecting PA intensity, and average acceleration (AA) reflecting PA volume. PA parameters were compared using ANOVA or Kruskall-Wallis testing. Correlation and linear regression analyses explored associations between PA parameters and asthma outcomes. As AA was the PA parameter correlated most closely with asthma-related outcomes, an exploratory analysis compared outcomes in highest and lowest AA quartiles. RESULTS: 75 participants were recruited; 57 accelerometer readings were valid and included in analysis. Inactive time was significantly higher (p < 0.001), and LPA (p < 0.007), MVPA (p < 0.001), IG (p < 0.001) and AA (p < 0.001) all significantly lower in DOW versus MHW and MOW groups, even after adjusting for age and BMI. Quartiles based on AA had significantly different asthma profiles. CONCLUSIONS: Overweight/obese participants with difficult-to-control asthma performed less PA, and activity of reduced intensity and volume. Increased AA is associated with improvement in several asthma-related outcomes. Increased PA should be recommended to relevant patients.

Exploring the feasibility of a cluster pilot randomised control trial to improve children's 24-hour movement behaviours and dietary intake: Happy homework.

We aimed to explore the feasibility, acceptability, and potential efficacy of Happy Homework (HH); an 8-week home-focussed intervention, with the purpose of encouraging children's positive dietary behaviours and engagement in positive physical activity (PA) and sleep behaviours. We randomised four Scottish schools (n = 71 participants; 5 classrooms) to either the HH intervention (n = 2) or usual curriculum control group (n = 2). HH consisted of movement and dietary-focused parent and child tasks. Primary outcome measures were intervention feasibility, acceptability, and potential efficacy. Secondary outcomes were objectively measured PA via ActiGraph GT3X+, sedentary behaviours (SBs) and sleep duration via activPAL4™ accelerometers and dietary behaviours, fruit and vegetable consumption and screen-time via questionnaires. After controlling for pre-test levels, post intervention stepping time and sleep duration were significantly greater for the HH group in comparison to the control group. The HH group reported eating more fruit and vegetables at post-test than the control group. Participants also reported the intervention to be enjoyable and motivating. These findings provide promising evidence that given a greater sample size, better retention and the prioritisation of health and wellbeing homework, HH could enhance children's health and wellbeing.

Comparing the activPAL CREA and GHLA Algorithms for the Classification of Postures and Activity in Free-Living Children.

The activPAL accelerometer has been used extensively in research to assess sedentary behaviour (SB) and physical activity (PA) outcomes. The aim of this study was to assess the comparability of PA and SB outcomes from two automated algorithms (CREA and GHLA) applied to the activPAL accelerometer. One hundred and twenty participants aged 8−12 years wore an activPAL accelerometer on their right thigh continuously for seven days on two occasions, providing valid data from 1058 days. The PALbatch software downloaded the data after applying the CREA and GHLA (latest) algorithms. The comparability of the algorithms were assessed using the mean absolute percent error (MAPE), intra-class correlation coefficients (ICC), and equivalence testing. Comparisons for daily wear time, primary lying, sitting and standing time, sedentary and stepping time, upright time, total number of steps, sit−stand transitions and stepping time ≤ 1 min revealed mainly small MAPE (≤2%), excellent ICCs (lower bound 95% CI ≥ 0.97), and equivalent outcomes. Time spent in sitting bouts > 60 min and stepping bouts > 5 min were not equivalent with the absolute zone needed to reach equivalence (≥7%). Comparable outcomes were provided for wear time and postural outcomes using the CREA or GHLA algorithms, but not for time spent in sitting bouts > 60 min and stepping bouts > 5 min.

A pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult-to-control asthma and elevated body mass index.

BACKGROUND: Difficult-to-control asthma associated with elevated body mass index (BMI) is challenging with limited treatment options. The effects of pulmonary rehabilitation (PR) in this population are uncertain. METHODS: This is a randomised controlled trial of an eight-week asthma-tailored PR programme versus usual care (UC) in participants with difficult-to-control asthma and BMI ≥ 25 kg/m2. PR comprised two hours of education and supervised exercise per week, with encouragement for two individual exercise sessions. Primary outcome was difference in change in Asthma Quality of Life Questionnaire (AQLQ) in PR versus UC groups between visits. Secondary outcomes included difference in change in Asthma Control Questionnaire-6 (ACQ6), and a responder analysis comparing proportion reaching minimum clinically important difference for AQLQ and ACQ6. RESULTS: 95 participants were randomised 1:1 to PR or UC. Median age was 54 years, 60% were female and median BMI was 33.8 kg/m2. Mean  (SD) AQLQ was 3.9 (+/-1.2) and median (IQR) ACQ6 2.8(1.8-3.6). 77 participants attended a second visit and had results analysed. Median (IQR) change in AQLQ was not significantly different: 0.3 (- 0.2 to 0.6) in PR and - 0.1 (- 0.5 to 0.4) in UC, p = 0.139. Mean change in ACQ6 was significantly different: - 0.4 (95% CI - 0.6 to - 0.2) in PR and 0 (- 0.3 to + 0.3) in UC, p = 0.015, but below minimum clinically important difference. In ACQ6 responder analysis, minimum clinically important difference was reached by 18 PR participants (54.5%) versus 10 UC (22.7%), p = 0.009. Dropout rate was 31% between visits in PR group, and time to completion was significantly prolonged in PR group at 94 (70-107) days versus 63 (56-73) in UC, p < 0.001. CONCLUSIONS: PR improved asthma control and reduced perceived breathlessness in participants with difficult-to-control asthma and elevated BMI. However, this format appears to be suboptimal for this population with high drop-out rates and prolonged time to completion. Trial registration Clinicaltrials.gov. ID NCT03630432. Retrospectively registered, submitted May 26th 2017, posted August 14th 2018.

A Personalized Smartphone-Delivered Just-in-time Adaptive Intervention (JitaBug) to Increase Physical Activity in Older Adults: Mixed Methods Feasibility Study.

BACKGROUND: Just-in-time adaptive interventions (JITAIs) provide real time in-the-moment behavior change support to people when they need it most. JITAIs could be a viable way to provide personalized physical activity (PA) support to older adults in the community. However, it is unclear how feasible it is to remotely deliver a PA intervention through a smartphone to older adults or how acceptable they would find a JITAI targeting PA in everyday life. OBJECTIVE: The aims of this study are to describe the development of JitaBug, a personalized smartphone-delivered JITAI designed to support older adults to increase or maintain their PA level, assess the feasibility of conducting an effectiveness trial of the JitaBug intervention, and explore the acceptability of JitaBug among older adults in a free-living setting. METHODS: The intervention was developed using the Behavior Change Wheel and consisted of a wearable activity tracker (Fitbit) and a companion smartphone app (JitaBug) that delivered goal-setting, planning, reminders, and JITAI messages to encourage achievement of personalized PA goals. Message delivery was tailored based on time of day, real time PA tracker data, and weather conditions. We tested the feasibility of remotely delivering the intervention with older adults in a 6-week trial. Data collection involved assessment of PA through accelerometery and activity tracker, self-reported mood and mental well-being through ecological momentary assessment, and contextual information on PA through voice memos. Feasibility outcomes included recruitment capability and adherence to the intervention, intervention delivery in the wild, appropriateness of data collection methodology, adverse events, and participant satisfaction. RESULTS: Of the 46 recruited older adults (aged 56-72 years), 31 (67%) completed the intervention. The intervention was successfully delivered as intended; 87% (27/31) of the participants completed the intervention independently; 94% (2247/2390) of the PA messages were successfully delivered; 99% (2239/2261) of the Fitbit and 100% (2261/2261) of the weather data calls were successful. Valid and usable wrist-worn accelerometer data were obtained from 90% (28/31) of the participants at baseline and follow-up. On average, the participants recorded 50% (7.9/16, SD 7.3) of the voice memos, 38% (3.3/8, SD 4.2) of the mood assessments, and 50% (2.1/4, SD 1.6) of the well-being assessments through the app. Overall acceptability of the intervention was very good (23/30, 77% expressed satisfaction). Participant feedback suggested that more diverse and tailored PA messages, app use reminders, technical refinements, and an improved user interface could improve the intervention and make it more appealing. CONCLUSIONS: This study suggests that a smartphone-delivered JITAI is an acceptable way to support PA in older adults in the community. Overall, the intervention is feasible; however, based on user feedback, the JitaBug app requires further technical refinements that may enhance use, engagement, and user satisfaction before moving to effectiveness trials.

Equivalence of activity outcomes derived from three research grade accelerometers worn simultaneously on each wrist.

This study evaluated the equivalence of activity outcomes from three accelerometer brands worn on both wrists during free living. Forty-four adults wore a GENEActiv, ActiGraph and Axivity accelerometer for 7 days. Outcomes were assessed between and within accelerometer brand and wrist location with average acceleration and the intensity gradient (IG) being of particular interest. Pairwise 95% equivalence tests and intra-class correlation coefficients (ICC) evaluated agreement. Average acceleration and the IG were largely equivalent between combinations of accelerometer device and wrists when applying a 10% equivalence zone. There was largely a lack of equivalence between pairings for time spent in acceleration values ≥100 mg. However, equivalence was largely achieved when applying an equivalence zone that encompassed values ranging from 0.3 to 0.45 SDs for IG and time spent above 100 mg and 150 mg. Agreement between pairings tended to be stronger between different brands on the non-dominant (ICCs ≥ 0.73-0.97) versus the dominant wrist (ICCs ≥ 0.57-0.97) and between wrists for the same accelerometer (ICCs ≥ 0.59-0.97) for average acceleration and the IG. These are important findings since device placement is not consistent in studies. Further work that applies an equivalence zone reflecting the variability of the outcome measure is encouraged.

Relationship Between Parent and Child Physical Activity Using Novel Acceleration Metrics.

Background: Raw acceleration data lend themselves to innovative metrics in which comparisons can be made across populations. This study examined whether the intensity gradient (IG) or average acceleration (AvAcc) was associated with body mass index (BMI) in children and adults and explored parent-child associations between time spent in physical activity intensities and BMI. Methods: Parent-child dyads (n = 90) wore a wrist-mounted ActiGraph GT3X+ monitor for ≥ 3 valid days (i.e., ≥ 16 hrs each day). Participants' BMI was calculated. Results: Girls' BMI-z scores were positively associated with parent BMI and inactive time. Parent BMI was negatively associated with boys' inactive time. Parental inactive time predicted girls' BMI-z scores. The metrics were not associated with parent BMI, and no independent effects were observed between the metrics. Associations between boys' IG and BMI z-score were observed. No independent effects were observed between the metrics and no significant associations were observed between boys' BMI z-score and AvAcc. Girls' AvAcc and IG were not associated with BMI z-score and no independent effects were observed between the metrics. Conclusion: Findings support previous research which suggests that parent's activity does not influence their child's activity.

Feasibility and Acceptability of a Classroom-Based Active Breaks Intervention for 8-12-Year-Old Children.

Purpose: This study explored the feasibility of conducting a classroom-based active breaks intervention on sedentary behavior (SB), physical activity (PA) and attention in 8-12-year-old children. Methods: Eight schools were randomized on a 1:1 basis to the control or intervention. Teachers selected 10 cards detailing an activity break at random. Children then undertook each of the ten activity breaks for 30 s, three times per day for 6 weeks. School and participant recruitment, attrition rates, percentage of outcome measures collected, and acceptability were used to explore the feasibility of the study. Mixed effects models were undertaken to examine intervention effects upon measures of PA, SB and attention. Results: Two hundred and thirty-nine consent forms were issued and 153 were returned (64%). Of the 153 consents, 146 children (95%) were measured at baseline, and 117 participated in the follow-up measures (80%) 6 weeks later suggesting the intervention was acceptable for the participants. From teacher interviews, it was noted that the intervention was feasible to implement, and teachers observed positive classroom behavior changes in children. Inclusion rates for outcome measures ranged from 49% to 66%. Significant, intervention effects were observed for sitting time (B = -27.19; 95%CI: -36.84, -17.17), standing time (B = 23.51; 95%CI 14.1, 32.45) and the number of sit to stand transitions (B = 16.1; 95%CI 4.7, 26.79). Conclusion: Findings suggest that it was feasible and acceptable to implement an active breaks intervention within the classroom setting. Future work should consider the effectiveness of implementing this intervention across a full academic year.

The Effects of Socioeconomic Status on Parent and Child Moderate-to-Vigorous Physical Activity and Body Mass Index.

Purpose: Physical inactivity and overweight status has been linked to low socioeconomic status (SES) in youth. Parents are known to influence both their child's weight and physical activity (PA). The relationship between parent and child PA is of interest to many researchers; however, previous research typically relies on self-reported measures. The purpose of this study was to examine the relationship between parent and child moderate-to-vigorous PA (MVPA) and body mass index (BMI) in a sample of children (4-11 years old) using wrist-worn accelerometers and to explore mediating processes by which SES influences child MVPA and BMI through their parents MVPA and BMI. Methods: Parent and child dyads (n = 174) wore an ActiGraph GT3X+ accelerometer on their non-dominant wrist for 7 days. Mediation analyses were conducted to understand the indirect relationships between SES and child MVPA and BMI. Results: Weekend parent and child MVPA was significantly related (p < .01). Parent and child BMIs were also significantly related (p < .001). There was a significant negative direct effect of SES on child BMI (p < .05). Additionally, we observed a significant negative indirect effect of SES on child BMI via their parents BMI (B = -.04, SE .02, 95% CI = -.07 to -.01). Conclusions: Whilst parent and child MVPA were significantly related during the weekend, there were no associations between SES and MVPA. Future interventions aiming to improve health outcomes in children should consider the influence SES can have as well as parental activity on children's weekend MVPA.

Generation and validation of ActiGraph GT3X+ accelerometer cut-points for assessing physical activity intensity in older adults. The OUTDOOR ACTIVE validation study.

The study of physical activity in older adults is becoming more and more relevant. For evaluation of physical activity recommendations, intensity-specific accelerometer cut-points are utilized. However, research on accelerometer cut-points for older adults is still scarce. The aim of the study was to generate placement-specific cut-points of ActiGraph GT3X+ activity counts and raw measures of acceleration to determine physical activity intensity in older adults. A further aim was to compare the validity of the generated cut-points for a range of different physical activities. The study was a single experimental trial using a convenience sample. Study participants were 20 adults aged 59 to 73 years. Accelerometers were worn at six different placements (one on each wrist, one on each ankle, and two at the hip) and breath-by-breath indirect calorimetry was used as the reference for energy. The experiment comprised of two parts; a) The first required participants to walk on a treadmill at incremental speeds (3.0-5.0 km·h-1), and b) Five different everyday activities (reading, cleaning, shopping, cycling, aerobics) were staged in the laboratory setting. Accelerometer cut-points (activity counts, raw data) were derived for each of the investigated placements by linear regression using the treadmill part. Performance of the cut-points was assessed by applying the cut-points to the everyday activities. We provide cut-points for six placements and two accelerometer metrics in the specific age group. However, the derived cut-points did not outperform published ones. More research and innovative approaches are needed for improving internal and external validity of research results across populations and age groups.

Cardio-Metabolic Risk Factors in Scottish South Asian and Caucasian Youth.

(1) Background: Scotland has one of the highest rates of obesity in the Western World, it is well established that poor weight profiles, and particularly abdominal obesity, is strongly associated with Type II diabetes and cardiovascular diseases. Whether these associations are apparent in ethnic population groups in Scotland is unclear. The purpose of this study was to examine the associations between different measures of fatness with clustered cardio metabolic risk factors between Scottish South Asian adolescents and Scottish Caucasian adolescents; (2) Methods: A sample of 208 Caucasian adolescents and 52 South Asian adolescents participated in this study. Stature, waist circumference, body mass index, blood pressure, physical activity, and cardiovascular disease (CVD) risk were measured; (3) Results: Significant, partial correlations in the South Asian cohort between body mass index (BMI) and individual risk factors were generally moderate. However, correlations between Waist circumference (WC) and individual risk factors were significant and strong. In the Caucasian cohort, a significant yet weak correlation between WC and total cholesterol (TG) was noted although no other associations were evident for either WC or BMI. Multiple regression analysis revealed that both BMI and WC were positively associated with CCR (p < 0.01) in the South Asian group and with the additional adjustment of either WC or BMI, the independent associations with clustered cardio-metabolic risk (CCR) remained significant (p < 0.005); (4) Conclusions: No positive relationships were found between BMI, WC, and CCR in the Caucasian group. Strong and significant associations between measures of fatness and metabolic risk were evident in Scottish South Asian adolescents.

High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies.

Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11-18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518-1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.

Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults.

INTRODUCTION: Early detection screening tools are needed to aid in preventing vascular complications associated with type 2 diabetes. As low muscular strength is linked to increased diabetes risk, the purpose of this study is to establish muscular strength cut points for determining diabetes risk using a large, nationally representative U.S. METHODS: Using the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey data, 5,108 participants aged 20-80 years (68.6% aged 20-50 years; young male participants, n=1,813, mean age=33.43 years; young female participants, n=1,692, mean age=33.39 years; older male participants, n=813, mean age=59.92 years; older female participants, n=790, mean age=60.45 years) and free of common diabetes comorbidities were included. Muscular strength was assessed using a handgrip dynamometer and normalized by adjusting for body weight. A logistic regression for survey data controlling for covariates was used to determine normalized grip strength cut points. Diabetes risk was determined using American Diabetes Association diagnostic criteria. Analyses were conducted in the summer of 2019. RESULTS: Normalized grip strength significantly predicted diabetes (p=0.0332), and the cut points for detecting diabetes risk included 0.78 (young male participants), 0.57 (young female participants), 0.68 (older male participants), and 0.49 (older female participants). The risk percentages for diabetes and estimated rates reported for all subgroups were comparable, and the risk percentages included 6.84 (95% CI=5.32, 8.36; younger male participants), 7.49 (95% CI=5.87, 9.10; younger female participants), 5.76 (95% CI=2.34, 9.19, older male participants), and 4.27 (95% CI=2.44, 6.10; older female participants). CONCLUSIONS: Normalized grip strength using the cut points proposed in this paper may be a useful screening tool for diabetes risk in apparently healthy, normotensive adults.

Segmented sedentary time and physical activity patterns throughout the week from wrist-worn ActiGraph GT3X+ accelerometers among children 7-12 years old.

Background: This study examined the volume and patterns of physical activity (PA) and sedentary time (ST) across different segments of the week among boys and girls. Methods: A total of 188 children aged 7-12 years wore a wrist-mounted ActiGraph GT3X+ accelerometer for 7 days. Time spent in PA and ST was calculated using ActiLife software. The mean number of minutes of light PA, moderate PA, vigorous PA, moderate-to-vigorous PA (MVPA), and ST were calculated per weekday (before school, during school, and after school) and per weekend day (morning and afternoon-evening). Results: After school represented the greatest accumulation of ST compared with before school and during school segments. Boys engaged in 225.4 min/day of ST (95% confidence interval (CI): 216-235), and girls engaged in 222.2 min/day of ST (95%CI: 213-231). During school, boys engaged in significantly more MVPA than girls (46.1 min/day (95%CI: 44-48) vs. 40.7 min/day (95%CI: 39-43)). Across the whole weekday, boys participated in significantly more MVPA than girls (103.9 min/day (95%CI: 99-109) vs. 95.7 min/day (95%CI: 90-101)). The weekend afternoon-evening segment represented the larger accumulation of ST, where boys were significantly more sedentary than girls (367.5 min/day (95%CI: 353-382) vs. 339.8 min/day (95%CI: 325-355), respectively). Conclusion: Our findings suggest that children are highly sedentary and spend little of their time in school in MVPA, especially girls. Routine breaks in school elicit increases in light PA and MVPA. Future work should consider the use of more active breaks within school time to encourage PA and reduce ST.

An Insight Into the Involvement of Mothers of Low Socioeconomic Status in Scottish Primary School Health Education Activities.

School-based health activities that involve parents are more likely to be effective for child health and well-being than activities without a parent component. However, such school-based interventions tend to recruit the most motivated parents, and limited evidence exists surrounding the involvement of hard-to-reach parents with low socioeconomic status (SES). Mothers remain responsible for the majority of family care; therefore, this study investigated mothers with low SES to establish the reasons and barriers to their involvement in school-based health activities and to propose strategies to increase their involvement in those activities. Interviews were conducted with mothers with low SES, who were typically not involved in school-based health activities (n = 16). An inductive-deductive approach to hierarchical analysis revealed that there are several barriers resulting in mothers being less involved, particularly due to issues surrounding the schools' Parent Councils and the exclusivity of school-based events. Efforts made by the school to promote health activities and involve parents in such activities were revealed, alongside recommendations to improve on these practices. The findings offer multiple ways in which future school-based health interventions can recruit and involve mothers with low SES.

The use of the intensity gradient and average acceleration metrics to explore associations with BMI z-score in children.

This study used the intensity gradient (IG) and average acceleration metrics to describe children's activity profiles and explore associations with body mass index (BMI) z-score. Two hundred and forty-six children (n = 138 girls) aged 9.6 ± 1.4 years wore a wrist-mounted ActiGraph wGT3X-BT accelerometer for 7 days on their non-dominant wrist. Physical activity (PA) metrics captured included: the IG which describes the intensity distribution of accelerations across the 24 h monitoring period; average acceleration which provides a measure of the volume of activity; total moderate-to-vigorous PA (MVPA) and inactive time. Acceleration was averaged over 5s epochs. Finally, BMI z-score was calculated for each participant. Average acceleration was negatively associated with BMI z-score (p < 0.05) independent of age and gender but not IG. The IG was negatively associated with BMI z-score independent of potential correlates and average acceleration. Total MVPA was not associated with BMI-z score. The IG and average acceleration metrics may be used to explore the independent or cumulative effects of the volume and intensity distribution of activity upon measures of health and well-being in children to inform specific activity recommendations.