Geriatric depression and anxiety screening via deep learning using activity tracking and sleep data.

BACKGROUND: Geriatric depression and anxiety have been identified as mood disorders commonly associated with the onset of dementia. Currently, the diagnosis of geriatric depression and anxiety relies on self-reported assessments for primary screening purposes, which is uncomfortable for older adults and can be prone to misreporting. When a more precise diagnosis is needed, additional methods such as in-depth interviews or functional magnetic resonance imaging are used. However, these methods can not only be time-consuming and costly but also require systematic and cost-effective approaches. OBJECTIVE: The main objective of this study was to investigate the feasibility of training an end-to-end deep learning (DL) model by directly inputting time-series activity tracking and sleep data obtained from consumer-grade wrist-worn activity trackers to identify comorbid depression and anxiety. METHODS: To enhance accuracy, the input of the DL model consisted of step counts and sleep stages as time series data, along with minimal depression and anxiety assessment scores as non-time-series data. The basic structure of the DL model was designed to process mixed-input data and perform multi-label-based classification for depression and anxiety. Various DL models, including the convolutional neural network (CNN) and long short-term memory (LSTM), were applied to process the time-series data, and model selection was conducted by comparing the performances of the hyperparameters. RESULTS: This study achieved significant results in the multi-label classification of depression and anxiety, with a Hamming loss score of 0.0946 in the Residual Network (ResNet), by applying a mixed-input DL model based on activity tracking data. The comparison of hyper-parameter performance and the development of various DL models, such as CNN, LSTM, and ResNet contributed to the optimization of time series data processing and achievement of meaningful results. CONCLUSIONS: This study can be considered as the first to develop a mixed-input DL model based on activity tracking data for the multi-label identification of late-life depression and anxiety. The findings of the study demonstrate the feasibility and potential of using consumer-grade wrist-worn activity trackers in conjunction with DL models to improve the identification of comorbid mental health conditions in older adults. The study also established a multi-label classification framework for identifying the complex symptoms of depression and anxiety.

Association of Remote Patient-Reported Outcomes and Step Counts With Hospitalization or Death Among Patients With Advanced Cancer Undergoing Chemotherapy: Secondary Analysis of the PROStep Randomized Trial.

BACKGROUND: Patients with advanced cancer undergoing chemotherapy experience significant symptoms and declines in functional status, which are associated with poor outcomes. Remote monitoring of patient-reported outcomes (PROs; symptoms) and step counts (functional status) may proactively identify patients at risk of hospitalization or death. OBJECTIVE: The aim of this study is to evaluate the association of (1) longitudinal PROs with step counts and (2) PROs and step counts with hospitalization or death. METHODS: The PROStep randomized trial enrolled 108 patients with advanced gastrointestinal or lung cancers undergoing cytotoxic chemotherapy at a large academic cancer center. Patients were randomized to weekly text-based monitoring of 8 PROs plus continuous step count monitoring via Fitbit (Google) versus usual care. This preplanned secondary analysis included 57 of 75 patients randomized to the intervention who had PRO and step count data. We analyzed the associations between PROs and mean daily step counts and the associations of PROs and step counts with the composite outcome of hospitalization or death using bootstrapped generalized linear models to account for longitudinal data. RESULTS: Among 57 patients, the mean age was 57 (SD 10.9) years, 24 (42%) were female, 43 (75%) had advanced gastrointestinal cancer, 14 (25%) had advanced lung cancer, and 25 (44%) were hospitalized or died during follow-up. A 1-point weekly increase (on a 32-point scale) in aggregate PRO score was associated with 247 fewer mean daily steps (95% CI -277 to -213; P<.001). PROs most strongly associated with step count decline were patient-reported activity (daily step change -892), nausea score (-677), and constipation score (524). A 1-point weekly increase in aggregate PRO score was associated with 20% greater odds of hospitalization or death (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4; P=.01). PROs most strongly associated with hospitalization or death were pain (aOR 3.2, 95% CI 1.6-6.5; P<.001), decreased activity (aOR 3.2, 95% CI 1.4-7.1; P=.01), dyspnea (aOR 2.6, 95% CI 1.2-5.5; P=.02), and sadness (aOR 2.1, 95% CI 1.1-4.3; P=.03). A decrease in 1000 steps was associated with 16% greater odds of hospitalization or death (aOR 1.2, 95% CI 1.0-1.3; P=.03). Compared with baseline, mean daily step count decreased 7% (n=274 steps), 9% (n=351 steps), and 16% (n=667 steps) in the 3, 2, and 1 weeks before hospitalization or death, respectively. CONCLUSIONS: In this secondary analysis of a randomized trial among patients with advanced cancer, higher symptom burden and decreased step count were independently associated with and predictably worsened close to hospitalization or death. Future interventions should leverage longitudinal PRO and step count data to target interventions toward patients at risk for poor outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04616768; https://clinicaltrials.gov/study/NCT04616768. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-054675.

Comparison of Early Postoperative Step and Stair Counts With the Direct Anterior Approach Versus the Posterior Approach for Total Hip Arthroplasty.

BACKGROUND: The purpose of this study was to evaluate the impact of direct anterior approach (DAA) or posterior approach (PA) on step and stair counts after total hip arthroplasty using a remotely monitored mobile application with a smartwatch while controlling for baseline characteristics. METHODS: This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year. Step and stair counts were available for 1,501 and 847 patients, respectively. Longitudinal regression models were created to control for baseline characteristics. RESULTS: Patients in the DAA group had significantly lower body mass index (P = .049) and comorbidities (P = .028), but there were no significant differences in age (P = .225) or sex (P = .315). The DAA patients had a higher average and improvement from baseline in step count at 2 and 3 weeks postoperatively after controlling for patient characteristics (P = .028 and P = .044, respectively). The average stair counts were higher for DAA patients at one month postoperatively (P = .035), but this difference was not significant after controlling for patient demographics. Average stair ascending speeds and changes from baseline were not different between DAA and PA patients. Descending stair speed was higher at 2 weeks postoperatively for DAA patients, but was no longer higher after controlling for baseline demographics. CONCLUSIONS: After controlling for baseline characteristics, DAA patients demonstrate earlier improvement in step count than PA patients after total hip arthroplasty. However, patient selection and surgeon training may continue to influence outcomes through a surgical approach.

Apple Watch 6 vs. Galaxy Watch 4: A Validity Study of Step-Count Estimation in Daily Activities.

The purpose of this study was to examine the validity of two wearable smartwatches (the Apple Watch 6 (AW) and the Galaxy Watch 4 (GW)) and smartphone applications (Apple Health for iPhone mobiles and Samsung Health for Android mobiles) for estimating step counts in daily life. A total of 104 healthy adults (36 AW, 25 GW, and 43 smartphone application users) were engaged in daily activities for 24 h while wearing an ActivPAL accelerometer on the thigh and a smartwatch on the wrist. The validities of the smartwatch and smartphone estimates of step counts were evaluated relative to criterion values obtained from an ActivPAL accelerometer. The strongest relationship between the ActivPAL accelerometer and the devices was found for the AW (r = 0.99, p < 0.001), followed by the GW (r = 0.82, p < 0.001), and the smartphone applications (r = 0.93, p < 0.001). For overall group comparisons, the MAPE (Mean Absolute Percentage Error) values (computed as the average absolute value of the group-level errors) were 6.4%, 10.5%, and 29.6% for the AW, GW, and smartphone applications, respectively. The results of the present study indicate that the AW and GW showed strong validity in measuring steps, while the smartphone applications did not provide reliable step counts in free-living conditions.

Criterion-Related Validity of Consumer-Wearable Activity Trackers for Estimating Steps in Primary Schoolchildren under Controlled Conditions: Fit-Person Study.

The purposes were to examine the criterion-related validity of the steps estimated by consumer-wearable activity trackers (wrist-worn activity trackers: Fitbit Ace 2, Garmin Vivofit Jr, and Xiomi Mi Band 5; smartphone applications: Pedometer, Pedometer Pacer Health, and Google Fit/Apple Health) and their comparability in primary schoolchildren under controlled conditions. An initial sample of 66 primary schoolchildren (final sample = 56; 46.4% females), aged 9-12 years old (mean = 10.4 ± 1.0 years), wore three wrist-worn activity trackers (Fitbit Ace 2, Garmin Vivofit Jr 2, and Xiaomi Mi Band 5) on their non-dominant wrist and had three applications in two smartphones (Pedometer, Pedometer Pacer Health, and Google Fit/Apple Health for Android/iOS installed in Samsung Galaxy S20+/iPhone 11 Pro Max) in simulated front trouser pockets. Primary schoolchildren's steps estimated by the consumer-wearable activity trackers and the video-based counting independently by two researchers (gold standard) were recorded while they performed a 200-meter course in slow, normal and brisk pace walking, and running conditions. Results showed that the criterion-related validity of the step scores estimated by the three Samsung applications and the Garmin Vivofit Jr 2 were good-excellent in the four walking/running conditions (e.g., MAPE = 0.6-2.3%; lower 95% CI of the ICC = 0.81-0.99), as well as being comparable. However, the Apple applications, Fitbit Ace 2, and Xiaomi Mi Band 5 showed poor criterion-related validity and comparability on some walking/running conditions (e.g., lower 95% CI of the ICC < 0.70). Although, as in real life primary schoolchildren also place their smartphones in other parts (e.g., schoolbags, hands or even somewhere away from the body), the criterion-related validity of the Garmin Vivofit Jr 2 potentially would be considerably higher than that of the Samsung applications. The findings of the present study highlight the potential of the Garmin Vivofit Jr 2 for monitoring primary schoolchildren's steps under controlled conditions.

Associations of pedometer-measured ambulatory activity with incidence of atherosclerotic cardiovascular diseases: Strong heart family study.

OBJECTIVE: Coronary heart disease has several risk factors that require a multifactorial community intervention approach in prevention efforts. Prevalence of coronary heart disease and its risk factors have been disproportionately high among American Indians. The objective of this study is to evaluate the impact of ambulatory activity levels on the development of coronary heart disease in this population. METHODS: Using pedometer data and other lifestyle and clinical factors from 2492 participants in the Strong Heart Family Study, we examined the associations of average daily step counts with incident coronary heart disease during an 18 to 20 year follow-up. RESULTS: After adjusting for potential confounders, participants with daily step counts in the 4th quartile (>7282 steps per day) had significantly lower odds of developing coronary heart disease compared to those in the 1st quartile (<3010 steps per day) (p = 0.035). CONCLUSIONS: Higher daily step count (over 7282 steps per day) is significantly associated with lower incidence of coronary heart disease among American Indian participants of the Strong Heart Family Study in a 20-year follow-up period.

Interrupting bedtime to reverse frailty levels in acute care: a study protocol for the Breaking Bad Rest randomized controlled trial.

BACKGROUND: Hospitalized older patients spend most of the waking hours in bed, even if they can walk independently. Excessive bedrest contributes to the development of frailty and worse hospital outcomes. We describe the study protocol for the Breaking Bad Rest Study, a randomized clinical trial aimed to promoting more movement in acute care using a novel device-based approach that could mitigate the impact of too much bedrest on frailty. METHODS: Fifty patients in a geriatric unit will be randomized into an intervention or usual care control group. Both groups will be equipped with an activPAL (a measure of posture) and StepWatch (a measure of step counts) to wear throughout their entire hospital stay to capture their physical activity levels and posture. Frailty will be assessed via a multi-item questionnaire assessing health deficits at admission, weekly for the first month, then monthly thereafter, and at 1-month post-discharge. Secondary measures including geriatric assessments, cognitive function, falls, and hospital re-admissions will be assessed. Mixed models for repeated measures will determine whether daily activity differed between groups, changed over the course of their hospital stay, and impacted frailty levels. DISCUSSION: This randomized clinical trial will add to the evidence base on addressing frailty in older adults in acute care settings through a devices-based movement intervention. The findings of this trial may inform guidelines for limiting time spent sedentary or in bed during a patient's stay in geriatric units, with the intention of scaling up this study model to other acute care sites if successful. TRIAL REGISTRATION: The protocol has been registered at clinicaltrials.gov (identifier: NCT03682523).

Daily step counts before, during, and after COVID-19 pandemic: a smartphone-tracking study of university students in Egypt and Saudi Arabia.

BACKGROUND: COVID-19 pandemic has drastically changed people's lifestyles and daily routines around the world. This study aimed to investigate changes in daily step counts - as an indicator of physical activity - before, during, and after the pandemic among university students in Egypt and Saudi Arabia and to identify regional and gender factors that may have influenced physical activity during these periods. METHODS: A total of 1273 university students from Egypt (Assiut University and Zagazig University) and Saudi Arabia (Taif University, King Faisal University, and Imam AbdulRahman Bin Faisal University) provided valid data on their daily step counts recorded by a smartphone application (iPhone Health App) from January 2019 to December 2021. The data was divided and averaged based on three periods: the pre-pandemic year (January to December 2019), the first pandemic year (January to December 2020), and the second pandemic year (January to December 2021). RESULTS: The results showed a significant decrease in daily steps from pre-pandemic to the first pandemic year, followed by an increase in the second pandemic year. However, daily step counts did not fully recover to pre-pandemic levels in male Egyptian and marginally in male Saudi participants. In both nationalities, female participants did not show a significant difference in daily steps between the pre-pandemic and second-pandemic years. Female Egyptian participants had significantly lower daily step counts than male Egyptian participants, and a gender difference in daily steps was also observed in Saudi female participants in the pre-pandemic and the second pandemic year but not during the first pandemic year. CONCLUSION: These findings outline the need for strategies in Egypt and Saudi Arabia to promote physical activity and reduce sedentary behavior, especially among young women, to mitigate the negative consequences of COVID-19 and meet physical activity guidelines.

Effect of a Wearable Device-Based Physical Activity Intervention in North Korean Refugees: Pilot Randomized Controlled Trial.

BACKGROUND: Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. OBJECTIVE: This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). METHODS: We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. RESULTS: The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and -521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. CONCLUSIONS: The wearable device-based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted. TRIAL REGISTRATION: Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622.

[Prediction equation of physical activity level based on step counts for Chinese adults: development and validation].

OBJECTIVE: To develop a prediction equation for estimation physical activity level(PAL) based on the average daily steps in Chinese adults and to verify its prediction power. METHODS: A total of 800 adults with no restriction on physical activity were recruited. Excluding those who wore Actigragh WGT3X-BT accelerometer continuously for less than 3 days, 743 subjects(324 males, 419 females, mean age 31.4 years) were finally included. Daily steps, time of low intensity physical activity(LPA), moderate physical activity(MPA) and vigorous physical activity(VPA) and physical activity energy expenditure(PAEE) were measured by the accelerometer. The method of external validation was adopted. The measured PAL calculated by basal metabolic rate(BMR) measured by indirect thermography(IC) and total energy expenditure(TEE) measured by doubly labeled water method was used as the gold standard. The consistency of the prediction formula was verified by Bland-Altman analysis and the accuracy was verified by the accurate. RESULTS: The prediction equation was developed: PAL=1.17 + 0.000028 Steps. In the external verification, the mean difference was 0.05, the 95% consistency limit was(-0.26, 0.36), and the accuracy was 73%, indicating a good consistency. CONCLUSION: The prediction formula of PAL for Chinese adults based on the steps has good performance and can be applied to the management of physical activity and the prevention of obesity in Chinese adults.

A comparison of the utility of different step-indices to translate the physical activity recommendation in adolescents.

Previous studies translating the daily moderate-to-vigorous physical activity (MVPA) recommendation of total steps/day among adolescents are inconsistent, and those with cadence-based steps are scarce. The main purpose was to compare the accuracy of different daily steps index-based cut-points related to the daily 60 minutes of MVPA recommendation measured by a waist-worn accelerometer for adolescents. Following a cross-sectional design, 428 Spanish adolescents (final sample 351, 50.4% males), aged 13-16 years old, wore an ActiGraph GT3X/+ accelerometer (reference standard = MVPA; index tests = total steps/day, average steps/min and peak 1-min cadence) on the right hip for eight consecutive days. 32.5% of the adolescents met the daily MVPA recommendation. The multiple ROC curve comparisons showed that the accuracy of the daily total step-based recommendation (AUC = 0.97) was statistically higher than for those with the steps/min (AUC = 0.90) and peak 1-min cadence (AUC = 0.58) (p < 0.001). The 10,000-step-per-day cut-point (k= 0.59-0.83) showed highest accuracy values than the 12,000 steps/day (k= 0.20-0.32). Daily total step-based recommendations are more accurate than those with steps/min and peak 1-min cadence for classifying adolescents as being physically active or inactive. A 10,000-step-per-day target is simple and accurate for both male and female adolescents.

A Method for Behavior Change Support by Controlling Psychological Effects on Walking Motivation Caused by Step Count Log Competition System.

Systems presenting information that encourages competition by using rankings and scores (hereafter referred to as competition information) have become widespread to support behavioral change. However, users without high levels of motivation, such as behavior change support targets, do not necessarily benefit from competition information. In this study, we propose a method to control the psychological effects caused by competition information to support behavior change. We implemented a competition information presentation system using step counts logs to support increasing one's daily steps. We designed two patterns of competition information considering psychological effects. One is likely to have good effects, using three mechanisms to easily obtain results corresponding to the effort, make closely matched rivals with similar abilities, and pay attention to a small number of rivals. The other is unlikely to have positive effects and may potentially even have negative ones, using a mechanism that brings about the opposite results of the former pattern. We evaluated 42 participants with low levels of motivation over six weeks. The results showed that the former information pattern increased participants' step counts by about 1000 steps per day, and the latter information pattern did not lead to an increase. We confirmed the feasibility of the proposed method and discussed the possibility of the appropriate use and potential abuse of such techniques for manipulating motivation. Our study can be helpful in designing a competition information presentation system considering psychological effects.

A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A Pilot Randomized Controlled Trial.

RATIONALE & OBJECTIVE: Patients receiving dialysis report very low physical activity. We implemented a pilot trial to assess the feasibility of a pedometer-based intervention to gather preliminary evidence about its impact on physical activity, symptoms, and surrogates of cardiovascular risk. STUDY DESIGN: Pilot randomized controlled trial. SETTING & PARTICIPANTS: 60 dialysis patients from San Francisco dialysis clinics. INTERVENTION: Participants were randomly assigned 1:1 to receiving pedometers with weekly step goals or usual care for 3 months. OUTCOMES: The primary outcome was step counts, measured using pedometers. Secondary outcomes included physical performance using the Short Physical Performance Battery, the Physical Function and Vitality scales of the 36-Item Short Form Health Survey, the Dialysis Symptoms Index, and the Center for Epidemiologic Studies-Depression Scale, with endothelial function as a secondary and heart rate variability as an exploratory surrogate measure of cardiovascular risk. Targeted enrollment was 50% and targeted completion was 85%. RESULTS: 49% of approached patients were enrolled, and 92% completed the study. After 3 months, patients randomly assigned to the intervention (n=30) increased their average daily steps by 2,256 (95% CI, 978-3,537) more than the 30 controls (P<0.001). Heart rate variability (standard deviation of N-N intervals) increased by 14.94 (95% CI, 0.31-33.56) millisecondsin the intervention group as compared with controls (P = 0.05). There were no statistically significant differences across intervention groups in symptoms, physical performance, or endothelial function. Participants in the intervention group reverted to baseline steps during the postintervention follow-up. LIMITATIONS: The Northern California study setting may limit generalizability. Walking does not capture the full spectrum of physical activity. CONCLUSIONS: A short-term pedometer-based intervention led to increased step counts in dialysis patients, but the increase was not sustained. Pedometer-based interventions are feasible for dialysis patients, but future studies are needed to address whether more prolonged interventions can improve physical function or symptoms. FUNDING: Supported by grants from the American Kidney Fund, National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases, and International Society of Nephrology. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study identifier NCT02623348.

Psychological factors are associated with return to pre-injury levels of sport and physical activity after ACL reconstruction.

PURPOSE: The impetus of anterior cruciate ligament reconstruction (ACLR) is to allow patients to return to sport and to remain engaged in physical activity. Many patients exhibit deficits in psychological domains of health-related quality of life which may impede return to sport and physical activity participation. Therefore, the purpose of this study was to examine the association of patient-based, specifically psychological, and functional outcomes with return to sport and physical activity. METHODS: Forty participants, a minimum of 1-year post-ACLR, reported to the laboratory for one-testing session. Participants completed a series of patient-based and functional outcome assessments. Participants were also instructed to wear a pedometer for 1 week to monitor their daily steps. RESULTS: Twenty-five participants (62%) did not return to sport and 29 participants (72%) did not average 10,000 steps per day. Individuals with elevated levels of self-reported kinesiophobia were 17% less likely to return to sport. Self-reported knee self-efficacy and knee-related quality of life accounted for 27.1% of the variance of average daily step counts. CONCLUSIONS: Psychological factors, specifically injury-related fear and self-efficacy, were associated more significantly than functional outcomes with return to sport and physical activity levels. Clinicians should examine psychological factors throughout rehabilitation in patients after ACLR. Future research should explore the effectiveness of psychoeducation techniques to decrease injury-related fear and enhance self-efficacy in this population. LEVEL OF EVIDENCE: III.

Sensor-Based Daily Physical Activity: Towards Prediction of the Level of Concern about Falling in Peripheral Neuropathy.

Concern about falling is prevalent and increases the risk of falling in people with peripheral neuropathy (PN). However, the assessment of concern about falling relies on self-report surveys, and thus continuous monitoring has not been possible. We investigated the influence of concern about falling on sensor-based daily physical activity among people with PN. Forty-nine people with PN and various levels of concern about falling participated in this study. Physical activity outcomes were measured over a period of 48 hours using a validated chest-worn sensor. The level of concern about falling was assessed using the falls efficacy scale-international (FES-I). The low concern group spent approximately 80 min more in walking and approximately 100 min less in sitting/lying compared to the high concern group. In addition, the low concern group had approximately 50% more walking bouts and step counts compared to the high concern group. Across all participants, the duration of walking bouts and total step counts was significantly correlated with FES-I scores. The duration of walking bouts and total step counts may serve as eHealth targets and strategies for fall risk assessment among people with PN.

Meeting physical activity recommendations is associated with health-related quality of life in women before and after Roux-en-Y gastric bypass surgery.

PURPOSE: Meeting physical activity (PA) recommendations is positively associated with health-related quality of life (HRQoL), but it is still unclear whether PA (specifically objectively measured) is associated with HRQoL in bariatric surgery candidates, both before and after surgery. Thus, the aim of this study was to examine the cross-sectional association between meeting objectively measured PA recommendations and HRQoL before and after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: Sixty-six women undergoing RYGB with pre-surgery and 62 women with post-surgery valid PA and HRQoL data were included from the control group of a RCT study aiming at improving HRQoL and PA post-RYGB surgery. Measures before and 12 months after RYGB included the Short Form Health Survey (SF-36) and objectively measured PA, sedentary time (ST), and step counts with GT3X+ accelerometers. Multiple linear regression models were used to analyze the associations between PA and HRQoL. RESULTS: Participants who engaged in more than 150 min of moderate to vigorous PA (MVPA)/week (PA recommendations) had considerably higher SF-36 scores (HRQoL) than those who did not, both pre and 12-month post-surgery, with greatest difference in the subscale bodily pain, 15.5 (p = 0.021) higher score (higher scores means less pain) pre-surgery and a 19.7 (p = 0.004) higher score post-surgery. Higher LPA and step counts and lower ST also showed positive associations in some of the subscales of SF-36. CONCLUSIONS: Meeting the PA recommendations and overall engaging in more PA was associated with higher HRQoL, pre-, and post-RYGB surgery, highlighting the importance of PA both pre- and post-surgery.

A monitoring system to provide feedback on student physical activity during physical education lessons.

School-based physical education (PE) provides opportunities to accumulate moderate-to-vigorous physical activity (MVPA), but many students are insufficiently active during PE lessons. Providing teachers with feedback regarding their students' physical activity may increase the effectiveness of PE for achieving MVPA goals, but existing physical activity monitoring technologies have limitations in class environments. Therefore, the purpose of this study was to develop and validate a system capable of providing feedback on PE lesson MVPA. Equations for translating step counts to %MVPA were derived from measures in 492 students who concurrently wore an ActiGraph GT3X+ (ActiGraph) and Yamax pedometer (Yamax) during a PE lesson. To enhance feedback availability during PE lessons, we then developed a bespoke monitoring system using wireless tri-axial pedometers (HMM) and a smart device app. After developing and testing the monitoring system, we assessed its validity and reliability in 100 students during a PE lesson. There was a strong correlation of 0.896 between step counts and accelerometer-determined %MVPA and quantile regression equations showed good validity for translating step counts to %MVPA with a mean absolute difference of 5.3 (95% CI, 4.4-6.2). The physical activity monitoring system was effective at providing %MVPA during PE lessons with a mean difference of 1.6 ± 7.1 compared with accelerometer-determined %MVPA (7% difference between the two measurement methods). Teachers and students can use a smart device app and wireless pedometers to conveniently obtain feedback during PE lessons. Future studies should determine whether such technologies help teachers to increase physical activity during PE lessons.

Status of physical activity in Japanese adults and children.

Objective: To summarise the status of physical activity in Japanese adults and children. Methods: Results obtained by several nationwide surveys such as the National Health and Nutrition Survey of Japan carried out annually were reviewed. Moreover, relevant guidelines or summaries and results of papers were introduced. Results: Average step counts have decreased by about 1000 steps from peak values observed before the year 2000, but the decrease after 2010 was less than 200 steps in both sexes. Based on the results of a meta-analysis and national survey, a new physical activity guideline for Japanese, 'ActiveGuide', was published. The most important message is the '+10', which indicates an 'additional 10 minutes of moderate-to-vigorous PA per day to the status quo'. According to the Japan Report Card on Physical Activity for Children and Youth, there was no nationwide survey on the overall Physical Activity Levels for children. However, grades for Organised Sports Participation and Active Transportation were very good. The mean values of cardiorespiratory endurance for Japanese children were around the 90th centiles of the international criterion-referenced data. Conclusions: More accurate measures of daily physical activity, sedentary behaviour and sleep should be developed for a nationwide survey.

Physical Activity and Sex Hormone-Binding Globulin in Older Adults.

Besides its known function as a transport protein for testosterone and other steroid hormones, sex hormone-binding globulin (SHBG) is a biomarker associated with many adverse health effects. The aim of this study was to investigate the association of physical activity with SHBG serum levels in older adults. The physical activity and SHBG values for 1,259 older adults (43.4% female; 56.6% male) with a mean age of 75.6 ± 6.5 years were included in the analysis. The average daily walking duration was 104.2 ± 40.4 (mean ± SD) min. A positive dose-response relationship of daily walking duration with quartiles of SHBG was seen after adjustment for age, sex, history of cardiovascular diseases, diabetes, smoking, γ-glutamyl transferase, and C-reactive protein (p for trend = .010). However, this relationship disappeared after adjustment for body mass index (p for trend = .977). Body mass index seems to be an important determinant of SHBG and a possible confounding factor in the relationship of physical activity and SHBG.

Daily Step-Based Recommendations Related to Moderate-to-Vigorous Physical Activity and Sedentary Behavior in Adolescents.

Among adolescents empirical studies examining the total daily steps translation of the moderate-to-vigorous physical activity recommendation are scarce and inconsistent, and there are no previous studies with cadence-based steps and related to sedentary behavior. The main objective of the present study was to establish and compare the accuracy of daily step-based recommendations related to the moderate-to-vigorous physical activity and sedentary behavior thresholds in adolescents. The present study followed a cross-sectional design. A total of 126 adolescents (56 girls) aged 12-15 years old were assessed by ActiGraph GT3X accelerometers for eight consecutive days (moderate-to-vigorous physical activity, sedentary behavior, and steps) and the multistage 20-meter shuttle run test (cardiorespiratory fitness). ROC curve analyses showed that total daily steps (AUC = 0.94, 0.89-0.99; Threshold ≥ 11,111 steps/ day; P = 0.93; k = 0.67; p < 0.001) was a more appropriate indicator than cadence-based daily steps for distinguishing between physically active and inactive adolescents. Daily step-based thresholds represent a promising way to translate a total daily sedentary behavior threshold (e.g., total daily steps, AUC = 0.87, 0.81-0.93; Sensitivity = 0.87; Specificity = 0.70). Adolescents who met a favorable combination of step-based recommendations related to both physical activity and sedentary behavior thresholds had a higher probability of having a healthy cardiorespiratory fitness profile than those who did not meet either of them (e.g., risk ratio = 5.05, 1.69-15.08) or only the one related to physical activity (e.g., risk ratio = 4.09, 1.36-12.29). These findings may help policy-makers to provide accurate daily step-based recommendations that would simplify the physical activity and sedentary behavior thresholds for adolescents.