Does the severity of asthma affect exercise capacity and daily physical activity?

OBJECTIVE: Exercise capacity, daily physical activity, and psychological profile are crucial aspects in the management of asthmatic patients. Whether these features are expressed in a different way in mild-moderate (MMA) and severe asthma (SA) is unknown. METHODS: In this observational cross-sectional study, patients matching the American Thoracic Society/European Respiratory Society (ATS/ERS) definition for SA underwent incremental cardiopulmonary exercise testing (CPET), full lung function testing, and an evaluation of daily step count and physical activity. Questionnaires on quality of life, general fatigue, and presence of anxiety and depression traits (Hospital Anxiety and Depression Scale - HADS) were administered. Patients were compared with a cohort of age- and gender-matched MMA patients. RESULTS: We enrolled 16 SA, 17 MMA patients, and 16 healthy subjects. Compared to MMA, SA subjects showed a median (interquartile range) reduced peak oxygen consumption during CPET (20.4 (17.2-23.3) vs. 25.6 (18.5-30.3) ml/min/kg; p = 0.019), a reduced resting lung function (FEV1% of predicted 77 (67-84) vs. 96 (84-100); p < 0.001) and a pronounced anxiety trait at HADS (9.5 (3-11.7) vs. 4.0 (2.0-7.5); p = 0.023). In addition, SA patients showed a significantly higher reduction in inspiratory capacity from rest to peak (310 (160-520) vs. 110 (-65-325) ml; p = 0.031). We found no significant differences in mean daily step count or quality of life. CONCLUSIONS: Compared to MMA, SA patients present a reduced exercise capacity and a more pronounced anxiety trait, but not worse daily physical activity or quality of life. These aspects should be considered in the clinical management and research development of SA.

A mixed method investigation of teacher-identified barriers, facilitators and recommendations to implementing daily physical activity in Ontario elementary schools.

BACKGROUND: Fewer than 17% of children worldwide are meeting the international recommendations for daily physical activity. Since most children are in school for the bulk of their day, the classroom has been identified as an ideal space to incorporate physical activity opportunities. In Ontario (Canada), the Daily Physical Activity (DPA) policy aims to ensure all elementary school children receive a minimum of 20 min of moderate to vigorous physical activity each school day during instructional time. However, a 2015 evaluation found that only half of Ontario teachers were meeting this expectation; this work advocated for additional research to monitor implementation and its predictors and to further identify fidelity recommendations. Thus, the current study investigated contemporary factors influencing DPA fidelity in Ontario elementary schools and provides teacher-identified recommendations to support DPA implementation. METHODS: The first part of the study was a quantitative approach surveying 186 elementary school teachers across Ontario. Descriptive statistics including frequencies and means were used to characterize barriers, facilitators, and recommendations to DPA implementation. Spearman's correlations were used to assess the relation between the likelihood of DPA implementation and intrapersonal factors of gender, teaching experience, prior DPA training and personal physical activity participation. The second part of the study consisted of a qualitative approach using teacher interviews to explore in-depth teachers' recommendations to support DPA implementation. A thematic analysis was used to analyze the transcripts and identify recommendations for DPA. RESULTS: Survey results showed that only 23% of teachers met the mandated 20 min of DPA per day. Barriers to implementation included space and time constraints, inadequate training, student behavioural issues and low self-efficacy. Gender, teaching experience and prior DPA training were not related to the likelihood of DPA implementation. Teachers who rated themselves as more physically fit were more likely to implement DPA. Teacher interviews elucidated key areas for improving DPA implementation including greater DPA training opportunities, resources, community partnerships, accountability and strategies that support school-wide implementation. CONCLUSION: The current study demonstrated that fidelity to the DPA policy in Ontario elementary schools is on the decline. This work highlights unique factors implicated in DPA fidelity and brings to the forefront teacher recommendations to improve DPA implementation.

An evaluation of the 'bottom-up' implementation of the Active at school! programme in Quebec, Canada.

The lack of physical activity (PA) amongst children is a public health concern in many industrialized countries. School-based daily physical activity (DPA) policies are a promising intervention for increasing PA levels amongst children. Informed by a logic model framework, this study examines the factors associated with meeting a 'top-down' DPA objective in the context of a 'bottom-up' implementation of a school-based DPA initiative in Quebec, Canada. An online survey assessing school-level inputs, outputs and outcomes was sent to all participating schools (415). Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression to evaluate potential associations between factors (inputs and outputs) and the school's adherence to providing at least 60 minutes of DPA (outcome). Adjusted ORs (AORs) and 95% CIs were calculated using a multivariate logistic regression to identify the best set of factors to predict adherence to the DPA objective. A total of 404 schools completed the questionnaire, amongst which 71% reported meeting the DPA target by implementing school-tailored activities. Three factors were identified as the best set of school inputs and outputs to predict meeting the objective: financial resources (per student) (AOR = 1.02; 95% CI 1.01-1.03), a shared vision amongst the school-team members that PA benefits learning outcomes (AOR = 1.94; 95% CI 1.04-3.19) and having conducted a detailed situational analysis (AOR = 1.89; 95% CI 1.00-3.58). Given that 'bottom-up' implementation might favour the development of policies that are more acceptable to stakeholders, our results should be considered by decision-makers and school administrators when implementing DPA initiatives.

The lack of physical activity (PA) amongst children is a public health concern in many industrialized countries. School-based daily physical activity (DPA) policies are a promising intervention for increasing PA levels amongst children. The primary purpose of this study was to examine the school-level factors of Quebec's Active at school! initiative, whose goal was to encourage elementary school teams to develop and implement tailored mobilizing strategies and activities for providing 60 minutes of DPA to their students. Our results suggest that the school team's perception of PA benefits on learning outcomes, the financial resources (per student) provided to the school, and a locally conducted situational analysis at the beginning of the implementation process are significant predictors of meeting the DPA objective. The secondary aim of our study was to explore whether the factors were different according to the geographical setting of the schools. Conducting a situational analysis was shown to be of particular importance for urban schools but did not seem to play a pivotal role for rural schools, suggesting that different organizational culture and population characteristics may be at work when implementing a bottom-up initiative in these two contexts.

Does physical activity lower the risk for metabolic syndrome: a longitudinal study of physically active older women.

BACKGROUND: The associations between physical activity and metabolic syndrome (MetS) have been mainly found in cross-sectional studies. The aim of this longitudinal study was to examine the relationship between meeting step-based guidelines and changes in the risk of metabolic syndrome. METHODS: This study included data from older women (baseline age 62.9 ± 4.3 years) from a 7-year longitudinal study in Central Europe. At baseline and follow-up, physical activity was measured by an accelerometer, and the risk for MetS was assessed according to the NCEP-ATP III criteria. In 59 women, multivariate repeated measures ANOVA was used to compare differences in changes in the risk of MetS in groups based on meeting step-based guidelines (10,000 steps/day and 9000 steps/day for women aged <65 and ≥ 65 years, respectively). RESULTS: Over 7 years, steps/day increased from 10,944 ± 3560 to 11,652 ± 4865, and the risk of MetS decreased from 41 to 12% in our sample. Women who longitudinally met step-based guidelines had a significantly higher mean concentration of high-density cholesterol (HDL-C) (64.5 and 80.3 mg/dL at baseline and follow-up, respectively) and a lower concentration of triglycerides (TGs) (158.3 and 123.8 mg/dL at baseline and follow-up, respectively) at follow-up compared to baseline. Moreover, women who increased their daily steps over 7 years to the recommended steps/day value significantly decreased the concentration of TGs (158.3 mg/dL and 123.8 mg/dL at baseline and follow-up, respectively). CONCLUSIONS: Our study might suggest that the long-term meeting of step-based guidelines or an increase in daily steps/day to achieve the recommended value could be related to a lower risk of MetS, specifically in concentrations of HDL-C and TG. These findings may help in designing interventions aiming to decrease the risk of MetS in older women.

Between-day repeatability of sensor-based in-home gait assessment among older adults: assessing the effect of frailty.

BACKGROUND: While sensor-based daily physical activity (DPA) gait assessment has been demonstrated to be an effective measure of physical frailty and fall-risk, the repeatability of DPA gait parameters between different days of measurement is not clear. AIMS: To evaluate test-retest reliability (repeatability) of DPA gait performance parameters, representing the quality of walking, and quantitative gait measures (e.g. number of steps) between two separate days of assessment among older adults. METHODS: DPA was acquired for 48-h from older adults (age ≥ 65 years) using a tri-axial accelerometer. Continuous walking bouts (≥ 60 s) were identified from acceleration data and used to extract gait performance parameters, including time- and frequency-domain gait parameters, representing walking speed, variability, and irregularity. To assess repeatability, intraclass correlation coefficient (ICC) was calculated using two-way mixed effects F-test models for day-1 vs. day-2 as the independent random effect. Repeatability tests were performed for all participants and also within frailty groups (non-frail and pre-frail/frail identified using Fried phenotype). RESULTS: Data was analyzed from 63 older adults (29 non-frail and 34 pre-frail/frail). Most of the time- and frequency-domain gait performance parameters showed good to excellent repeatability (ICC ≥ 0.70), while quantitative parameters, including number of steps and walking duration showed poor repeatability (ICC < 0.30). Among majority of the gait performance parameters, we observed higher repeatability among the pre-frail/frail group (ICC > 0.78) compared to non-frail individuals (0.39 < ICC < 0.55). CONCLUSION: Gait performance parameters, showed higher repeatability compared to quantitative measures. Higher repeatability among pre-frail/frail individuals may be attributed to a reduced functional capacity for performing more intense and variable physical tasks. TRIAL REGISTRATION: The clinical trial was retrospectively registered on June 18th, 2013 with ClinicalTrials.gov, identifier NCT01880229.

Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP).

BACKGROUND: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. OBJECTIVE: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. METHODS: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro-B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). RESULTS: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4 km, IQR -0.2 to 1.9; daily step count: median 591, IQR -509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). CONCLUSIONS: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. TRIAL REGISTRATION: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12144.

Association between the type of physical activity and metabolic syndrome in middle-aged and older adult residents of a semi-mountainous area in Japan.

BACKGROUND: Physical activity is reported to prevent metabolic syndrome. However, it is unclear whether exercise or daily physical activity is more beneficial for residents of semi-mountainous areas. This study aimed to identify whether daily physical activity is more beneficial than exercise for the prevention of metabolic syndrome among middle-aged and older residents in semi-mountainous areas. METHODS: We analyzed secondary data of 636 people who underwent a specific health checkup in a semi-mountainous area of Japan. Physical activity was classified into four types: inactivity (I-type; without exercise and without daily physical activity), only exercise (E-type; with exercise and without daily physical activity), only daily physical activity (D-type; without exercise and with daily physical activity), and full physical activity type (F-type; with exercise and with daily physical activity). We compared the means of risk factors for metabolic syndrome by these four types, followed by logistic regression analysis, to identify whether and to what extent the D-type was less likely to have metabolic syndrome than the E-type. RESULTS: The prevalence of metabolic syndrome was 28.5% (men 45.7%, women 15.8%). The proportions of men with exercise and daily physical activity were 38.7% and 52.8%, respectively. For women, the proportions were 33.0% and 47.1%, respectively. In women, the D-type had the significantly lowest BMI, smallest waist circumference, highest HDL-C, and lowest prevalence of metabolic syndrome of the four types; the same was not observed in men. Additionally, D-type activity was more strongly associated with a reduced risk of metabolic syndrome than E-type activity in women (adjusted odds ratio 0.24; 95% confidence interval 0.06-0.85, P = 0.028). CONCLUSIONS: Compared to middle-aged and older women residents with exercise in a semi-mountainous area of Japan, those with daily physical activity may effectively prevent metabolic syndrome.

Sensor-based characterization of daily walking: a new paradigm in pre-frailty/frailty assessment.

BACKGROUND: Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA). METHODS: DPA was acquired for 48 h from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables. RESULTS: One hundred twenty-six older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step- and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p < 0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity. DISCUSSION: Everyday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty. TRIAL REGISTRATION: The clinical trial was retrospectively registered on June 18th, 2013 with ClinicalTrials.gov, identifier NCT01880229.

New strategies of physical activity assessment in cystic fibrosis: a pilot study.

BACKGROUND: Regular physical activity (PA) is a valued part of cystic fibrosis (CF) care. Although the accelerometer, SenseWear Armband (SWA), accurately measures habitual PA in CF, it is mostly used for research purposes. For the first time, we analyzed different methods of measuring PA in daily life by the use of smartphones and other electronic devices such as smartwatch and Fitbit. METHODS: Twenty-four stable adults with CF (mean age 37.5 ± 11.5SD yrs.; FEV1 58 ± 19% predicted, BMI 22.9 ± 3.2) were studied. Daily PA was monitored for seven consecutive days. All patients wore the accelerometer SWA and at the same time they monitored PA with the electronic device they used routinely. They were allocated into one of four arms according to their device: Smartwatch, Fitbit, Android smartphones and iOS smartphones. PA related measurements included: duration of PA, energy expenditure, number of steps. RESULTS: There was a good agreement between SWA and Fitbit for number of steps (p = 0.605) and energy expenditure (p = 0.143). iOS smartphones were similar to SWA in monitoring the number of steps (p = 0.911). Significant differences were found between SWA and both Smartwatch and Android smartphones. CONCLUSIONS: Fitbit and iOS smartphones seem to be a valuable approach to monitor daily PA. They provide a good performance to measure step number compared to SWA.

Association of daily physical activity with cognition and mood disorders in treatment-naive patients with early-stage Parkinson's disease.

To determine the association of daily physical activity with cognition, mood disorders, and olfactory function in treatment-naive patients with early-stage Parkinson's disease (PD). The study subjects were 52 treatment-naive patients with early-stage PD (< 80 years). Daily physical activity was measured using a wearable sensor with a built-in triaxial accelerometer, and its association with cognition [mini-mental state examination (MMSE), clock-drawing test (CDT), frontal assessment battery (FAB), and behavioral assessment of the dysexecutive syndrome (BADS)], depressive symptoms [Beck Depression Inventory-Second Edition (BDI-II)], apathy [Starkstein Apathy Scale (AS)], and olfactory function [Odor Stick Identification Test for the Japanese (OSIT-J)] was analyzed using multiple linear regression after adjustment for age, sex, and education status. The daily physical activity (0.42 ± 0.11 m/s2) of the PD group was significantly lower than that of healthy controls (p < 0.001). Moreover, the daily physical activity of the PD group was significantly associated with FAB (ß = 0.337, p = 0.027) and BADS (ß = 0.374, p = 0.017) scores, but not with MMSE, CDT, BDI-II, AS, and OSIT-J scores. The daily physical activity is significantly reduced in treatment-naive patients with early-stage PD, and the low activity correlates with frontal/executive function.

School and classroom effects on Daily Physical Activity (DPA) policy implementation fidelity in Ontario classrooms: a multi-level analysis.

BACKGROUND: This paper examines school and classroom effects on Daily Physical Activity (DPA) policy implementation in classrooms in Ontario, Canada. In 2005 the Ontario Ministry of Education mandated a policy requiring school boards to "ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time". Based on an adaptation of Chaudoir's conceptual framework, this paper contributes to understanding the extent to which school factors (as reported by administrators) and classroom factors (as reported by teachers) are associated with policy implementation fidelity at the classroom level. METHODS: Cross-sectional online surveys were conducted in 2014 with elementary school administrators and teachers, based on representative random samples of schools and classrooms. A measure assessing implementation fidelity was developed from the six required components of the policy and for this paper fidelity at the classroom level is treated as the outcome variable. Several school- and classroom-level measures were also included in the surveys and a number of these were selected for inclusion here. Data from the two surveys were merged and selected variables were included in the multi-level analysis. Two-level logistic regression models were conducted to account for nesting of classrooms within schools and a series of models were conducted to identify factors associated with implementation fidelity. RESULTS: The analytic sample for this study included 170 school administrators and 307 classroom teachers from corresponding schools. Findings from the multi-level logistic regression analyses indicated that only classroom/teacher-level factors were significantly associated with implementation fidelity at the classroom level. None of the school/administrator predictors were significantly related to fidelity. The most parsimonious model included five significant classroom/teacher predictors: teachers' perception of DPA as realistic and achievable; confidence (self-efficacy); scheduling DPA in timetables; lack of space; and lack of time. CONCLUSIONS: Findings from the study indicate the theoretical and practical importance of addressing classroom and teacher factors since they are most proximal to implementation fidelity to the policy. Several of these factors also reflect complex structural and organizational contexts, indicating that a systems approach to understanding and supporting DPA implementation fidelity is warranted.

Is daily physical activity affected by dynamic hyperinflation in adults with cystic fibrosis?

BACKGROUND: The aim of this study was to investigate the relationship between dynamic hyperinflation and daily physical activity (DPA) in adults with cystic fibrosis (CF). METHODS: Thirty-four clinically stable CF were studied. All patients undertook incremental cardiopulmonary exercise testing (CPET). CPET-related measurements included: oxygen uptake (V'O2), carbon dioxide production (V'CO2), ventilatory profile, work rate (W), inspiratory capacity (IC), end-expiratory lung volume (EELV). PA was assessed using the accelerometer SenseWear Pro3 Armband. RESULTS: Exercise tolerance was reduced in most of patients and the mean V'O2,peak value was 75.2% of predicted (28.5 ± 4.8 ml/min/kg). Seventy % of patients responded to CPET with dynamic hyperinflation. Higher incidence of dynamic hyperinflation was found in CF males compared to CF females (p = 0.026). Patients who developed dynamic hyperinflation during CPET had higher vigorous PA (p = 0.01) and more total energy expenditure (p = 0.006) than patients who did not. EELVΔ was related to activities requiring vigorous intensity and total energy expenditure (R = 0.46, p = 0.001; R = 0.57, p <  0.001). CONCLUSIONS: In adults with CF and mild to moderate lung impairment, DPA might not be limited by dynamic hyperinflation.

Effects of promoting daily physical activity on physical and mental health in older individuals.

[Purpose] A trial was conducted to examine the effects of promoting daily physical activity, tailored to specific living situations, on physical and mental health indicators in older adults. [Participants and Methods] Participants in the 'Intervention' group (N=21) wore accelerometers during the 12-week trial period, and for one week during preliminary and follow-up surveys. Based on their physical activity levels as measured by accelerometers, participants were given instructions to increase their daily physical activity. Participants in the 'Control' group (N=18) wore the accelerometer only during the preliminary and follow-up survey. [Results] Number of steps increased significantly in the intervention group and a significant decrease in light physical activity time was observed in the control group. No such decrease was observed in the intervention group. With regard to health-related quality of life, significant interactions were observed between groups based on the 36-Item Short-Form Health Survey Mental Component Summary score, and some sub-items. A combined analysis of both groups found a significant positive correlation between the change in light physical activity time and the Mental Component Summary score. [Conclusion] An increase in daily physical activity was considered to have a sustained bolstering effect on mental health.

Habitual exercise decreases systolic blood pressure during low-intensity resistance exercise in healthy middle-aged and older individuals.

Since aerobic exercise (e.g., walking) and resistance exercise (e.g., lifting objects and mopping) are both parts of the activities of daily living, an exaggerated elevation in systolic blood pressure (SBP) during aerobic and resistance exercise is an early marker of cardiovascular disease. This study investigated the effects of habitual exercise on SBP during low-intensity resistance exercise using both cross-sectional and interventional approaches. First, in 57 normotensive women (61.9 ± 1.0 yr of age), daily physical activity level, as assessed by triaxial accelerometry, was correlated with SBP during resistance exercise at 20 and 40% of the 1 repetition maximum (r = -0.408 and r = -0.348, respectively). Maximal oxygen uptake was correlated with SBP during exercise at 20% (r = -0.385) and 40% (r = -0.457). Physical activity level or maximal oxygen uptake was identified as a predictor of SBP during the exercise in stepwise regression analysis, independent of SBP at rest and other factors (R2 = 0.729-0.781). Second, 66 men and women (64.6 ± 0.9 yr of age) participated in a 6-wk intervention as a part of the training (walking, 4.3 ± 0.3 days/wk, 55.6 ± 4.1 min/day, 70.7 ± 1.2% of maximal heart rate) or control group. SBP during resistance exercise in the training group decreased after the intervention (before vs. after: 20%, 143 ± 4 vs. 128 ± 4 mmHg; and 40%, 148 ± 5 vs. 134 ± 4 mmHg). In the control group, there were no significant differences in SBP before and after the intervention. SBP during resistance exercise after the intervention was lower in the training group relative to the control group. These results suggest that habitual exercise decreases SBP during low-intensity resistance exercise.

Evaluation of Daily Physical Activity (DPA) policy implementation in Ontario: surveys of elementary school administrators and teachers.

BACKGROUND: School-based structured opportunities for physical activity can provide health-related benefits to children and youth, and contribute to international guidelines recommending 60 min of moderate-to-vigorous physical activity (MVPA) per day. In 2005, the Ministry of Education in Ontario, Canada, released the Daily Physical Activity (DPA) policy requiring school boards to "ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time". This paper reports on the first provincial study evaluating implementation fidelity to the DPA policy in Ontario elementary schools and classrooms. Using an adapted conceptual framework, the study also examined associations between implementation of DPA and a number of predictors in each of these respective settings. METHODS: Separate cross-sectional online surveys were conducted in 2014 with Ontario elementary school administrators and classroom teachers, based on a representative random sample of schools and classrooms. An implementation fidelity score was developed based on six required components of the DPA policy. Other survey items measured potential predictors of implementation at the school and classroom levels. Descriptive analyses included frequency distributions of implementation fidelity and predictor variables. Bivariate analyses examining associations between implementation and predictors included binary logistic regression for school level data and generalized linear mixed models for classroom level data, in order to adjust for school-level clustering effects. RESULTS: Among administrators, 61.4 % reported implementation fidelity to the policy at the school level, while 50.0 % of teachers reported fidelity at the classroom level. Several factors were found to be significantly associated with implementation fidelity in both school and classroom settings including: awareness of policy requirements; scheduling; monitoring; use of resources and supports; perception that the policy is realistic and achievable; and specific barriers to implementation. CONCLUSIONS: Findings from the surveys indicate incomplete policy implementation and a number of factors significantly associated with implementation fidelity. The results indicate a number of important implications for policy, practice and further research, including the need for additional research to monitor implementation and its predictors, and assess the impacts of study recommendations and subsequent outcomes of a reinvigorated DPA moving forward.

Evaluating the technical use of a Fitbit during an intervention for patients with pulmonary arterial hypertension with quality of life as primary endpoint: Lessons learned from the UPHILL study.

This article examines technical use of Fitbit during an intervention for pulmonary hypertension (PAH)-patients. Technical issues with the device led to data being unavailable(37.5%). During intervention objective daily physical activity (DPA) decreased and subjective DPA increased. This emphasizes that an assessment of DPA in PAH requires incorporating both objective and subjective measurements.

Daily physical activity and prognostic implications in patients with heart failure: an accelerometer study.

BACKGROUND: Physical activity (PA) measured by accelerometry is proposed as a novel trial endpoint for heart failure (HF). However, standardised methods and associations with established markers are lacking. This study aimed to examine PA measurements and accelerometer repeatability in patients with HF and age- and sex-matched controls, and study correlations with established prognostic HF markers, body composition, and quality of life (QoL). METHODS: Accelerometry was performed in 105 patients with HF with left ventricular ejection fraction (LVEF) ≤ 40% and in 46 controls. Participants also underwent dual X-ray absorptiometry, cardiopulmonary exercise testing, a six-minute walking test (6MWT), echocardiography, and NT-proBNP measurement, and completed a QoL questionnaire. RESULTS: Average acceleration was markedly reduced in patients with HF compared with healthy controls (16.1 ± 4.8 mg vs 27.2 ± 8.5 mg, p < 0.001). Healthy controls spent a median daily 56 min (IQR 41-96 min) in moderate-to-vigorous PA (MVPA), whereas HF patients spent only 12 min (IQR 6-24) in MVPA. In HF patients, average acceleration correlated moderately with 6MWT (R = 0.41, p < 0.001) and maximal oxygen uptake (peak VO2) (R = 0.36, p < 0.001) but not with NT-proBNP, LVEF, or QoL. Patients in NYHA class II showed a higher average acceleration than patients in NYHA III (16.6 ± 4.9 mg vs 14.0 ± 3.6 mg, p = 0.01). CONCLUSIONS: Daily PA was severely reduced in patients with HF compared with healthy controls. In HF patients, we found moderate correlations of accelerometer measurements with markers of physical capacity but not with LVEF or NT-proBNP. TRIAL REGISTRATION: NCT05063955. Registered 01 June 2021-retrospectively registered.

Functional Connectivity Between Default Mode and Ventral Attention Networks Mediates the Effects of Chronotype on Daily Physical Activity.

Daily physical activity (dPA) is closely related to circadian rhythm and chronotype. The functional connectivity (FC) within or between the default mode (DMN) and ventral attention network (vAN) were associated with dPA and chronotype. DMN-vAN FC was investigated for its role in chronotype and dPA. 153 participants completed the reduced version of the Morningness-Eveningness Questionnaire (rMEQ), dPA was measured via actigraphy (5-day), and then resting-state fMRI scans were performed. rMEQ scores and steps recorded by the actigraphic devices (with each hour as the time window to calculate steps for five consecutive days per hour, subsequently yielding the maximum number of steps and its corresponding time, ie, SM and SMT) represent chronotype and dPA respectively. The results found that the rMEQ scores were significantly negatively correlated with SMT. The positive correlation between the rMEQ scores and the DMN-vAN FC was significant. There were also significant positive correlations between SMT and DMN-vAN FC. Further analysis revealed that DMN-vAN mediates the relationship between chronotype and SMT. The FC of DMN-vAN may be the underlying neural mechanism through which chronotype influences dPA. These findings could support the development of reasonable activity schedules or specific intervention programs to improve physical health.

Pre-Service Teachers' Perceptions of and Experiences with Classroom Physical Activity.

Physical inactivity is one of the most modifiable factors linked to childhood obesity. Several Canadian provinces adopted daily physical activity (DPA) policies to promote physical activity during the school day. In Ontario, only 23% of in-service teachers meet DPA mandates. Promoting DPA implementation must occur at the pre-service level to foster self-efficacy and create long-term teaching habits. This study surveyed 155 pre-service teachers from an Ontario university to determine key perceptions and practices that should be targeted during their educational training to improve DPA fidelity. Findings revealed that over 96% of pre-service teachers viewed physical activity as beneficial for their own and their students mental and physical health, and as much as 33% received no education or training related to DPA. Pre-service teachers valued DPA more if they had opportunities to learn about and observe DPA during school placements. Pre-service teachers were more confident implementing DPA if they were more physically active, viewed themselves as more athletic, and had more positive physical education experiences. This work brings to the forefront important factors that could contribute to DPA implementation among in-service teachers and highlights target areas at the pre-service level for improved fidelity.

Prevalence of Contributing Factors Leading to the Development of Insulin Resistance Among Male Medical Students at a Private College in Saudi Arabia.

Background Insulin resistance can result from various genetic and lifestyle factors. Initially, symptoms of insulin resistance may not be readily noticeable, but as the condition progresses, individuals may start experiencing symptoms. This study aimed to investigate the factors contributing to the development of insulin resistance among medical students at a private college in Saudi Arabia. Methodology We conducted a cross-sectional study using a convenient non-probability sampling technique, with a sample size of 241 participants. We employed validated questionnaires to gather information on physical activity, sleep, dietary habits, and stress. Specifically, we used the International Physical Activity Questionnaire (IPAQ)-Short Form for assessing physical activity, the Single-Item Sleep Quality Scale (SQS) for evaluating sleep quality, the Healthy Eating Quiz (HEQ) to gauge dietary patterns, and the stress questionnaire designed by the International Stress Management Association (ISMA) to measure stress levels. Additionally, we collected anthropometric measurements, as well as systolic and diastolic blood pressure readings. We calculated prevalence using percentages and employed the chi-square test to analyze variables, with a significance level set at p-values <0.05. Results This study investigated risk factors associated with lifestyle, focusing on waist circumference as an indicator of insulin resistance. Our findings revealed that a majority of individuals with high waist circumference were physically inactive and more susceptible to stress, and this difference was statistically significant when compared to those with normal waist circumference. Additionally, we observed that sleep deprivation and poor nutrition were more prevalent among individuals with high waist circumference, although these differences were not statistically significant. Conclusions This study highlights a high prevalence of elevated waist circumference, indicating insulin resistance, among medical students. Furthermore, it underscores the significant presence of well-known risk factors associated with insulin resistance within this population of medical students.