Physical activity in relation to metabolic health and obesity: The Feel4Diabetes study.

AIM: To examine physical activity levels in association with metabolic health and estimate the stability of metabolically healthy obese (MHO) phenotypes over a 2-year period. METHODS: In total, 2848 men and women from families at risk of the development of diabetes were recruited. Participants were classified as obese or non-obese and metabolic health was defined using five existing definitions. Physical activity was estimated with the International Physical Activity Questionnaire and pedometers. RESULTS: Prevalence of the MHO phenotype varied among definitions (0% to 20.2%). Overall, the MHO were more active than the metabolically unhealthy obese (MUO). Daily sitting hours (odds ratio [OR] = 1.055, 95% confidence interval [CI]: 1.009-1.104) and daily steps (per 500; OR = 0.934, 95% CI: 0.896-0.973) were remarkable predictors of metabolic health in individuals with obesity; and likewise, in individuals without obesity. After 2 years, 44.1% of baseline MHO adults transitioned to MUO, while 84.0% of the MUO at baseline remained at the same phenotype. Although physical activity was not a major determinant in phenotype transitioning, daily steps were associated with the maintenance of metabolic health over time in the non-obese group. CONCLUSION: A universally accepted definition for MHO is needed. Being physically active can contribute to a metabolically healthy profile even in the presence of obesity; still, MHO is a transient condition and physical activity alone may not be an adequate factor for its maintenance.

Effectiveness of interventions to increase device-measured physical activity in pregnant women: systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Interventions that provide pregnant women with opportunities to access and participate in physical activity have been shown to be beneficial to their health. Much of this evidence however has been based on self-reported physical activity data, which may be prone to inflated effects due to recall bias and social desirability bias. No previous synthesis of randomised controlled trials has assessed the effectiveness of these interventions using only device measured data, to assess their health benefits more accurately in pregnant women. This systematic review and meta-analysis aimed to address this evidence gap. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, SportDiscus, APA PsycINFO, Embase and Web of Science databases were queried from inception up to December 2, 2021. An updated search of PubMed was conducted on May 16, 2022. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials that recruited pregnant women, participating in any physical activity intervention (excluding interventions aimed entirely at body conditioning), compared with standard antenatal care (comparators), using device-measured total physical activity as an outcome were eligible for inclusion. METHODS: 3144 titles and abstracts were screened for eligibility, and 18 met the inclusion criteria. Data were analysed using random effect models, (standardised mean difference and mean difference), using data from baseline to last available follow-up (primary end point), and until between 24 to 30 weeks gestation. Gestational weight gain was also assessed at these timepoints in the included trials. RESULTS: No significant differences between the groups were found for total physical activity at last available follow-up or 24 to 30 weeks gestation (95% CI 0.03 to 0.27, p = 0.10: 95% CI -0.05 to 0.33, p = 0.15) respectively. On average, pregnant women randomised to a physical activity intervention completed 435 and 449 more steps per day than comparators at last available follow-up and at 24 to 30 weeks gestation (95% CI -0.5-870.6, p = 0.05: 95% CI 5.5-892.7, p = 0.05) respectively. Intervention participants also gained 0.69 kg less (95% CI -1.30 to -0.08, p = 0.03) weight than comparators. CONCLUSION: Based on device-measured data, interventions to promote physical activity during pregnancy have small but important effects on increasing physical activity and managing excessive gestational weight gain.

Agreement Between StepWatch3 and ActiGraph wGT3X+ for Measuring Step-Based Metrics in People With Peripheral Artery Disease.

The authors investigated the agreement between StepWatch3™ (SW3) and ActiGraph™ wGT3X+ monitors for measuring step-based metrics in patients with peripheral artery disease and older adults. In 23 patients with peripheral artery disease and 38 older participants, the authors compared the metrics obtained during an outdoor (400-m track) walking session (step count) and a 7-day free-living period (step count and 60/30/5/1-min maximal or peak step accumulation) using the SW3 (ankle) and the wGT3X+ (hip) with the low-frequency extension filter enabled (wGT3X+/LFE) or not (wGT3X+/N). During outdoor walking session, agreement was high, particularly for wGT3X+/LFE: correlations ≥.98, median absolute percentage errors <1%, and significant equivalence using a ± 15% equivalence zone or narrower. In free living, no wGT3X+ method was equivalent to SW3 for step count. The wGT3X+/LFE was equivalent to SW3 regarding all step accumulation metrics using a ± 20% equivalence zone or narrower, with median absolute percentage errors <11%. The wGT3X+/LFE method is the best option for comparisons with SW3 in peripheral artery disease and older adults.

Process evaluation of the Sophia Step Study- a primary care based three-armed randomized controlled trial using self-monitoring of steps with and without counseling in prediabetes and type 2 diabetes.

BACKGROUND: Describing implementation features of an intervention is required to compare interventions and to inform policy and best practice. The aim of this study was to conduct a process evaluation of the first 12 months of the Sophia Step Study: a primary care based RCT evaluating a multicomponent (self-monitoring of daily steps plus counseling) and a single component (self-monitoring of steps only) physical activity intervention to standard care on cardiometabolic health. METHODS: The evaluation was guided by the Medical Research Council Guidance for complex interventions. To describe the implementation communication with the health professionals implementing the interventions, attendance records and tracking of days with self-monitored pedometer-determined steps were used. Change in physical activity behaviour was measured at baseline, 6 and 12 months as daily steps by accelerometry. RESULTS: During April 2013 to January 2018 188 participants were randomized and intervened directly after inclusion. Response rate was 49% and drop out was 10%. A majority, 78%, had type 2 diabetes and 22% were diagnosed with prediabetes. Mean [Standard deviation (SD)] body mass index was 30.4 (4.4) kg/m2 and steps per day was 6566 (3086). The interventions were delivered as intended with minor deviation from the protocol and dose received was satisfying for both the multicomponent and single component group. The mean [95% Confidence Interval (CI)] change in daily steps from baseline to 6 months was 941(227, 1655) steps/day for the multicomponent intervention group, 990 (145, 1836) step/day for the single component group and - 506 (- 1118, 107) for the control group. The mean (95% CI) change in daily steps from baseline to 12 months was 31(- 507, 570) steps/day for the multicomponent intervention group, 144 (- 566, 853) step/day for the single component group and - 890 (- 1485, - 294) for the control group. There was a large individual variation in daily steps at baseline as well as in step change in all three groups. CONCLUSIONS: Applying self-monitoring of steps is a feasible method to implement as support for physical activity in the primary care setting both with and without counseling support. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02374788 . Registered 2 March 2015.

The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults.

BACKGROUND: Step-count monitors (pedometers, body-worn trackers and smartphone applications) can increase walking, helping to tackle physical inactivity. We aimed to assess the effect of step-count monitors on physical activity (PA) in randomised controlled trials (RCTs) amongst community-dwelling adults; including longer-term effects, differences between step-count monitors, and between intervention components. METHODS: Systematic literature searches in seven databases identified RCTs in healthy adults, or those at risk of disease, published between January 2000-April 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. Outcome was mean differences (MD) with 95% confidence intervals (CI) in steps at follow-up between treatment and control groups. Our preferred outcome measure was from studies with follow-up steps adjusted for baseline steps (change studies); but we also included studies reporting follow-up differences only (end-point studies). Multivariate-meta-analysis used random-effect estimates at different time-points for change studies only. Meta-regression compared effects of different step-count monitors and intervention components amongst all studies at ≤4 months. RESULTS: Of 12,491 records identified, 70 RCTs (at generally low risk of bias) were included, with 57 trials (16,355 participants) included in meta-analyses: 32 provided change from baseline data; 25 provided end-point only. Multivariate meta-analysis of the 32 change studies demonstrated step-counts favoured intervention groups: MD of 1126 steps/day 95%CI [787, 1466] at ≤4 months, 1050 steps/day [602, 1498] at 6 months, 464 steps/day [301, 626] at 1 year, 121 steps/day [- 64, 306] at 2 years and 434 steps/day [191, 676] at 3-4 years. Meta-regression of the 57 trials at ≤4 months demonstrated in mutually-adjusted analyses that: end-point were similar to change studies (+ 257 steps/day [- 417, 931]); body-worn trackers/smartphone applications were less effective than pedometers (- 834 steps/day [- 1542, - 126]); and interventions providing additional counselling/incentives were not better than those without (- 812 steps/day [- 1503, - 122]). CONCLUSIONS: Step-count monitoring leads to short and long-term step-count increases, with no evidence that either body-worn trackers/smartphone applications, or additional counselling/incentives offer further benefit over simpler pedometer-based interventions. Simple step-count monitoring interventions should be prioritised to address the public health physical inactivity challenge. SYSTEMATIC REVIEW REGISTRATION: PROSPERO number CRD42017075810 .

Relationships Among Children's Independent Mobility, Active Transportation, and Physical Activity: A Multisite Cross-Sectional Study.

PURPOSE: Children's independent mobility (IM) may facilitate both active transportation (AT) and physical activity (PA), but previous studies examining these associations were conducted in single regions that provided limited geographical variability. METHOD: We recruited 1699 children (55.0% girls) in 37 schools stratified by level of urbanization and socioeconomic status in 3 regions of Canada: Ottawa, Trois-Rivières, and Vancouver. Participants wore a SC-StepRx pedometer for 7 days and completed a validated questionnaire from which we derived a 6-point IM index, the number of AT trips over a week, and the volume of AT to/from school (in kilometer per week). We investigated relationships among measures of IM, AT, and PA employing linear mixed models or generalized linear mixed models adjusted for site, urbanization, and socioeconomic status. RESULTS: Each unit increase in IM was associated with 9% more AT trips, 19% higher AT volume, and 147 more steps per day, with consistent results across genders. Both measures of AT were associated with marginally higher PA when pooling boys' and girls' data. Children in Vancouver engaged in more AT. PA did not vary across site, urbanization, or socioeconomic status. CONCLUSION: IM was associated with more AT and PA regardless of where children lived, underscoring a need for IM interventions.

Efficacy of a compulsory homework programme for increasing physical activity and improving nutrition in children: a cluster randomised controlled trial.

BACKGROUND: Most physical activity interventions in children focus on the school setting; however, children typically engage in more sedentary activities and spend more time eating when at home. The primary aim of this cluster randomised controlled trial was to investigate the effects of a compulsory, health-related homework programme on physical activity, dietary patterns, and body size in primary school-aged children. METHODS: A total of 675 children aged 7-10 years from 16 New Zealand primary schools participated in the Healthy Homework study. Schools were randomised into intervention and control groups (1:1 allocation). Intervention schools implemented an 8-week applied homework and in-class teaching module designed to increase physical activity and improve dietary patterns. Physical activity was the primary outcome measure, and was assessed using two sealed pedometers that monitored school- and home-based activity separately. Secondary outcome measures included screen-based sedentary time and selected dietary patterns assessed via parental proxy questionnaire. In addition, height, weight, and waist circumference were measured to obtain body mass index (BMI) and waist-to-height ratio (WHtR). All measurements were taken at baseline (T0), immediately post-intervention (T1), and 6-months post-intervention (T2). Changes in outcome measures over time were estimated using generalised linear mixed models (GLMMs) that adjusted for fixed (group, age, sex, group x time) and random (subjects nested within schools) effects. Intervention effects were also quantified using GLMMs adjusted for baseline values. RESULTS: Significant intervention effects were observed for weekday physical activity at home (T1 [P < 0.001] and T2 [P = 0.019]), weekend physical activity (T1 [P < 0.001] and T2 [P < 0.001]), BMI (T2 only [P = 0.020]) and fruit consumption (T1 only [P = 0.036]). Additional analyses revealed that the greatest improvements in physical activity occurred in children from the most socioeconomically deprived schools. No consistent effects on sedentary time, WHtR, or other dietary patterns were observed. CONCLUSIONS: A compulsory health-related homework programme resulted in substantial and consistent increases in children's physical activity - particularly outside of school and on weekends - with limited effects on body size and fruit consumption. Overall, our findings support the integration of compulsory home-focused strategies for improving health behaviours into primary education curricula. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618000590268 . Registered 17 April 2018.

Physical activity in pre-school children: Trends over time and associations with body mass index and screen time.

Background: Pre-school years are important for adopting health behaviours; however, today's children seem to be overweight, present low physical activity (PA) levels and exceed screen time (ST) recommendations.Aim: To examine (a) time trends in PA in Greek pre-school children, (b) the associations among PA, body mass index (BMI) and ST and (c) potential PA differences between boys and girls.Subjects and methods: Data from five cross-sectional cohorts (2005 [n = 252]; 2008 [n = 212]; 2011 [n = 187]; 2014 [n = 194]; 2017 [n = 128]) were compared. PA was assessed using Omron HJ-720IT-E2 pedometers, whereas ST was reported by participants' parents. A 4-way ANOVA was applied on children's average week step counts.Results: A significant association (F = 828.90, p < 0.001, η2 = 0.638) between ST and PA was revealed, with children that had ST < 1 hour/day presenting the higher PA levels and being the only ones that met PA recommendations (11,500 steps/day). Statistically significant PA differences, though of no practical importance, were found among cohorts. There were no significant PA differences between boys and girls or among BMI categories. Nevertheless, obesity prevalence was found to exist at alarming levels (24.5% in 2008-41.4% in 2017), and a large percentage of children (23.6% in 2008-63.3% in 2017) presented excessive ST (> 2 hours/day).Conclusion: Effective interventions aiming at reducing ST and enhancing PA seem imperative if children's health is to be safeguarded.

A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study.

The links between increased participation in Physical Activity (PA) and improvements in health are well established. As this body of evidence has grown, so too has the search for measures of PA with high levels of methodological effectiveness (i.e. validity, reliability and responsiveness to change). The aim of this "review of reviews" was to provide a comprehensive overview of the methodological effectiveness of currently employed measures of PA, to aid researchers in their selection of an appropriate tool. A total of 63 review articles were included in this review, and the original articles cited by these reviews were included in order to extract detailed information on methodological effectiveness.Self-report measures of PA have been most frequently examined for methodological effectiveness, with highly variable findings identified across a broad range of behaviours. The evidence-base for the methodological effectiveness of objective monitors, particularly accelerometers/activity monitors, is increasing, with lower levels of variability observed for validity and reliability when compared to subjective measures. Unfortunately, responsiveness to change across all measures and behaviours remains under-researched, with limited information available.Other criteria beyond methodological effectiveness often influence tool selection, including cost and feasibility. However, researchers must be aware of the methodological effectiveness of any measure selected for use when examining PA. Although no "perfect" tool for the examination of PA in adults exists, it is suggested that researchers aim to incorporate appropriate objective measures, specific to the behaviours of interests, when examining PA in free-living environments.

Child and parental physical activity: Is there an association with young children activity?

OBJECTIVES: The aim of the study is to examine the physical activity (PA) of young children and their parents on weekdays and at the weekend, as well as possible associations between them. METHODS: Fifty-eight children (29 boys), aged 5-8 years (mean age = 6.53 years) and the parent who spent more time with them (25 fathers, 33 mothers, mean age 40.67 years) wore Omron HJ-720IT pedometers for seven consecutive days. Two ANOVAs for repeated measures were applied to examine PA differences between genders and week phases (weekdays vs. weekend days) in children and parents. Moreover, one sample t-tests were used to compare participants' PA to the recommended PA, while linear regression analyses were utilized to examine whether parental PA in each week phase was associated with children's PA. RESULTS: Children accumulated more steps on weekdays than at the weekend (F1,56 = 18.58, p < 0.001, η2 = 0.27), while boys presented higher PA than girls (F1,56 = 12.42, p = 0.001, η2 = 0.20), and accomplished the recommended daily PA, in contrast to girls. Mothers and fathers presented similar PA (p = 0.67, η2 = 0.004), with more steps on weekdays than at the weekend (F1,56 = 9.22, p = 0.004, η2 = 0.16). However, their PA was significantly lower than the recommended. Finally, there were no statistically significant associations between parents' and boys' ambulatory activity either on weekdays (p = 0.938) or at the weekend (p = 0.095). On the contrary, parents' PA explained 47% of girls' PA on weekdays (R = 0.68, F1,28 = 22.81, p < 0.001) and 23% at the weekend (R = 0.48, F1,28 = 6.40, p = 0.02) Conclusions: Boys appear to be more physically active than girls in Greece, whereas mothers and fathers present similar ambulatory activity. Moreover, parents' PA is related to that of their daughters and not to that of their sons. Taking into account that both girls and parents did not meet PA recommendations, family-based interventions are needed for both children and parents benefit.

A Randomized-Controlled Trial of Social Norm Interventions to Increase Physical Activity.

BACKGROUND: Physical activity confers numerous health benefits, yet few adults meet recommended physical activity guidelines. PURPOSE: The impact of brief messages providing descriptive and injunctive social norm feedback on physical activity was tested in this conceptual pilot study. METHODS: Young adults (N = 111) were randomly assigned to one of three conditions: descriptive norm feedback, descriptive-plus-injunctive norm feedback, or no social feedback (control condition). Participants used pedometers for eight weekdays and recorded their step counts each evening. The descriptive norm group received feedback about the average number of steps taken by group members the previous day. The descriptive-plus-injunctive norm group received feedback about the group average, as well as a sad face if the participant was below the average or a happy face if the participant was above the average. The control group received no feedback throughout the study. RESULTS: By days 7 and 8, the descriptive-plus-injunctive norm group reported significantly more steps relative to the control group, whereas the descriptive norm group showed a trend toward higher step counts relative to the control group. These effects did not differ for participants above versus below the group average at baseline. CONCLUSION: The combined use of descriptive and injunctive social norms increased physical activity over a short period. This simple feedback strategy has potential for achieving wide reach and dissemination on its own or combined with more comprehensive interventions. This initial evidence can guide larger trials of longer duration. TRIAL REGISTRATION NUMBER: The trial was registered with the ClinicalTrials.gov database (NCT02710201).

Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors.

PURPOSE: The aim of this study was to identify demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. METHODS: Baseline data were utilized from 574 female breast cancer survivors who participated in three different intervention studies: Resistance and Endurance exercise After ChemoTherapy (REACT), Exercise and Nutrition Routine Improving Cancer Health (ENRICH), and Move More for Life (MM4L). Participants were eligible if they were aged ≥18 years and had completed primary cancer treatment. Physical activity was objectively assessed by accelerometers or pedometers. Participants completed self-reported questionnaires on demographic, psychosocial, and environmental factors. Information regarding clinical factors was obtained from medical records or patient self-report. Multivariable linear regression analyses were applied on the pooled dataset to identify factors that were significantly correlated with physical activity. In addition, the explained variance of the model was calculated. RESULTS: The multivariable regression model revealed that older age, (ß = -0.01, 95 %CI = -0.02; -0.003), higher body mass index (ß = -0.05, 95 %CI = -0.06; -0.03), lower self-efficacy (ß = 0.2, 95 %CI = 0.08; 0.2), and less social support (ß = 0.1, 95 %CI = 0.05; 0.2) were significantly correlated with lower physical activity. This model explained 15 % of the variance in physical activity. CONCLUSION: Age, body mass index, self-efficacy, and social support were significantly correlated with objectively assessed physical activity in breast cancer survivors. It may therefore be recommended that physical activity intervention studies in these women target those who are older, and have a higher body mass index, and should operationalize behavior change strategies designed to enhance self-efficacy and social support. TRIAL REGISTRATION: The REACT study is registered at the Netherlands Trial Register [NTR2153]. The ENRICH study is registered at Australian New Zealand Clinical Trials Register [ANZCTRN12609001086257]. And the MM4L study is registered at Australian New Zealand Clinical Trials Register [ACTRN12611001061921].

A cross-sectional study of the relationship between parents' and children's physical activity.

BACKGROUND: Though parents' physical activity (PA) is thought to be a predictor of children's PA, findings have been mixed. The purpose of this study was to examine the relationship between pedometer-measured steps/day of parents' and their children and potential moderators of this relationship. We also assessed the parent-child PA relationship as measured by questionnaires. METHODS: Six-hundred and twelve 7-8 year olds and one of their parents wore Steps Count (SC)-T2 pedometers for four consecutive days. Parents reported their PA from the last seven days and their child's usual PA. Hierarchical linear regressions were used to assess the parent-child PA relationships, controlling for covariates. Gender (parent, child), gender homogeneity, weight status (parent, child), weight status homogeneity, and socioeconomic status (SES) variables (parent education, household income, area-level SES) were tested as potential moderators of this relationship. Partial r's were used as an estimate of effect size. RESULTS: Parents' steps was significantly related to children's steps (r partial = .24). For every 1,000 step increase in parents' steps, the children took 260 additional steps. None of the tested interactions were found to moderate this relationship. Using questionnaires, a relatively smaller parent-child PA relationship was found (r partial = .14). CONCLUSION: Physically active parents tend to have physically active children. Interventions designed to get children moving more throughout the day could benefit from including a parent component. Future research should explore the mechanisms by which parents influence their children, and other parent attributes and styles as potential moderators.

Process evaluation of the Walk Well study: a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities.

BACKGROUND: Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities. METHODS: Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity. RESULTS: Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of 'freedom of choice' in relation to lifestyle behaviours and study participation. CONCLUSIONS: Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants. TRIAL REGISTRATION: Current Controlled Trials ISRCTN50494254 (3(rd) April 2012).

Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus.

BACKGROUND: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM). OBJECTIVE: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM. METHODS: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement. RESULTS: All participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI -0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by -0.43% (95% CI -0.75 to -0.12, P=.01), but nonsignificantly in the control group by -0.21% (95% CI -0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes. CONCLUSION: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures.

Prospective effects of pedometer use and class competitions on physical activity in youth: A cluster-randomized controlled trial.

OBJECTIVE: To evaluate the immediate effects of a school-based multi-component program to foster a physically active lifestyle in adolescence. DESIGN/PARTICIPANTS: In a cluster-randomized controlled trial with pre- and post-assessment in 2014, 29 schools with 1162 8th grade students (48% girls) from Germany were included. Age ranged from 12 to 17 years (M=13.74; SD=0.67). INTERVENTION: While the control group attended education as usual, students in the intervention group received pedometers and took part in a class competition over a time period of 12 weeks. Classes with the most steps and best creative ideas to promote physical activity in everyday life were awarded. MAIN OUTCOME MEASURES: Primary outcomes included out-of-school sports activities (h/week), moderate to vigorous physical activity (days/week with a minimum of 60 min), active commuting (min/day), doing chores (min/day), and sedentary behavior (h/day) assessed through self-administered questionnaires as well as cardiorespiratory fitness measured using the 20-m shuttle-run test (completed laps). RESULTS: Significant interaction terms between group and wave of assessment were found on out-of-school sports activities (b=-1.09 [-1.89; -0.29], p=0.008), moderate to vigorous physical activity (b=-0.29 [-0.47; -0.10], p=0.002), and active commuting (b=-20.41 [-32.32; -8.49], p=0.001): students in the intervention group showed a higher increase of physical activity levels than students in the control group. The intervention effect on cardiorespiratory fitness missed significance marginally (b=-1.52 [-3.14; 0.98], p=0.065), There was no effect on students' sedentary behavior (b=0.06 [-0.72; 0.84], p=0.881). CONCLUSIONS: An easy to administer school-based physical activity program (12 weeks) may enhance students' leisure-time physical activity. TRIAL REGISTRATION NUMBER: ISRCTN49482118.

Validity of the Actical activity monitor for assessing steps and energy expenditure during walking.

This study examined the validity of the Actical accelerometer step count and energy expenditure (EE) functions in healthy young adults. Forty-three participants participated in study 1. Actical step counts were compared to actual steps taken during a 200 m walk around an indoor track at self-selected pace and during treadmill walking at different speeds (0.894, 1.56 and 2.01 m · s(-1)) for 5 min. The Actical was also compared to three pedometers. For study 2, 15 participants from study 1 walked on a treadmill at their predetermined self-selected pace for 15 min. Actical EE was compared to EE measured by indirect calorimetry. One-way analysis of variance and t-tests were used to examine differences. There were no statistical difference between Actical steps and actual steps in self-selected pace walking and during treadmill walking at moderate and fast speeds. During treadmill walking at slow speed, the Actical step counts significantly under predicted actual steps taken. For study 2, there was no statistical difference between measured EE and Actical-recorded EE. The Actical provides valid estimates of step counts at self-selected pace and walking at constant speeds of 1.56 and 2.01 m · s(-1). The Actical underestimates EE of walking at constants speeds ≥ 1.38 m · s(-1).

Distinct Trajectories of Physical Activity Among Patients with COPD During and After Pulmonary Rehabilitation.

Little is known about longitudinal trends in objectively measured physical activity (PA) during and after pulmonary rehabilitation (PR) for individuals with Chronic Obstructive Pulmonary Disease (COPD). The purpose of this study was to examine the PA trajectories of patients with COPD during and after PR and whether demographic, clinical, or program characteristics differed across these trajectories. The study was approved by Research Ethics Boards at all participating institutions, and written informed consent was obtained from each participant prior to study inclusion. COPD patients (N = 190) completed a questionnaire and wore a pedometer for 7 days at baseline, end of PR, and 3 and 9 months after completing PR. Latent class growth analyses showed that two distinct PA trajectories emerged. Active Maintainers averaged 9177 steps/day at baseline, and maintained this level throughout the assessment and post rehabilitation period. In contrast, Inactive Maintainers averaged 3133 steps/day at baseline, which also remained stable during and after PR. Follow-up analyses showed the Inactive Maintainers were more likely to be retired from work and have lower baseline scores for their stress tests and 6-minute walk tests compared to Active Maintainers (all p < 0.05). These results suggest that two distinct steps/day trajectories exist for COPD patients during and after completing PR that are partially explained by specific demographic and clinical characteristics.

Effects of intradialytic cycling compared with pedometry on physical function in chronic outpatient hemodialysis: a prospective randomized trial.

BACKGROUND: Individuals on hemodialysis have low physical function and activity levels. Clinical trials have shown improvements in these parameters with exercise programming. Pedometers have not been extensively evaluated in individuals on hemodialysis. This randomized clinical trial compared the effects of intradialytic cycling versus a pedometer program on physical function, physical activity and quality of life. METHODS: Sixty patients were randomly assigned to two study groups. The ergometer group cycled during each hemodialysis session for 24 weeks. Pedometer participants followed a home-based walking program for 24 weeks. The primary outcome was aerobic capacity [VO2peak and 6-minute walk (6MW) test]. Secondary outcomes included lower extremity strength [sit-to-stand (SS) test], flexibility [sit-and-reach (SR) test], physical activity (accelerometer) and health-related quality of life. Measurements were collected at baseline and at 12 and 24 weeks. RESULTS: At 12 and 24 weeks, there was no significant change in the VO2peak or 6MW test between or within study groups. SS testing in the ergometer group improved from 10.2 (SD 3.4) to 11.4 (SD 2.5) cycles from baseline to 24 weeks (P < 0.005). Similarly, in the pedometer group, SS cycles improved from 10.1 (SD 3.3) to 12.2 (SD 3.5) (P < 0.005). The SR test also significantly improved over time in both the study groups. No significant changes were noted for other secondary outcomes. CONCLUSIONS: Both intradialytic cycling and pedometer programming improved aspects of physical function. Neither intervention had a significant effect on aerobic capacity. No significant differences in any outcomes were identified between interventions groups.

Prediction of correlates of daily physical activity in Spanish children aged 8-9 years.

The aims of the study were (a) to examine the associations between the daily physical activity (PA) of 8- to 9-year-old children and their parents, and (b) to examine what effect the child's daily PA has on its cardiorespiratory fitness (CRF), body mass index (BMI), and health-related quality of life (HRQoL). The sample consisted of 1021 persons [351 children (8.73 ± 0.69 years in age) and 670 parents]. Pedometers were used to evaluate PA in parents and their children over the course of 4 days (Thursday-Sunday), with the instructions on how to wear the pedometers for 24 h a day. Also evaluated were height, weight, BMI, CRF (via the maximal multistage 20-m shuttle run test), and HRQoL (via the EQ-5D-Y questionnaire). Associations between these variables were studied using path model techniques. The father's PA predicts his child's daily PA. This in turn predicts the child's lower BMI, CRF, and perceived quality of life. The findings suggest that the role model of a physically active father positively influences the child's PA habits, and hence that the family environment can have an important part to play in promoting health.