Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study.

INTRODUCTION: Age-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function. METHODS: Data was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count). RESULTS: Participants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex. CONCLUSION: Our study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.

Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control: The Maastricht Study.

AIMS/HYPOTHESIS: The associations of sitting, standing, physical activity and sleep with cardiometabolic health and glycaemic control markers are interrelated. We aimed to identify 24 h time-use compositions associated with optimal metabolic and glycaemic control and determine whether these varied by diabetes status. METHODS: Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA1c, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure. RESULTS: Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA1c when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping. CONCLUSIONS/INTERPRETATION: Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.

Association of kidney function with physical performance: the Maastricht study.

BACKGROUND: Kidney failure has been associated with decreased physical capacity, although evidence regarding the physical performance of individuals with earlier stages of chronic kidney disease (CKD) remains limited. METHODS: Cross-sectional data were derived from the prospective, population-based Maastricht Study. Multivariate linear regression models were fitted to assess the association of estimated glomerular filtration rate (eGFR) and albuminuria categories with physical performance test outcomes. RESULTS: Overall, 7396 participants were included. Compared to eGFR 60-90 ml/min/1.73 m2, values < 60 ml/min/1.73 m2 were associated with significantly shorter 6-min walk distance (ß: - 13.04 m, 95% confidence intervals-CI - 19.95; - 6.13), worse timed chair rise stand test time (ß: 0.91 s, 95% CI 0.36; 1.47), lower maximal grip (ß: - 0.83 kg, 95% CI - 1.50; - 0.15) and elbow flexion (ß: - 3.64 Nm, 95% CI - 7.11; - 0.16) strength. Additionally, eGFR > 90 ml/min/1.73 m2 was linked to significantly shorter 6-min walk distance (ß: - 6.13 m, 95% CI - 9.44; - 2.82). Urinary albumin excretion > 30 mg/24 h was associated with shorter 6-min walk distance (ß: - 12.48 m, 95% CI - 18.28; - 6.68), worse timed chair rise stand test time (ß: 0.51 s, 95% CI 0.11; 1.06), lower maximal grip (ß: - 1.34 kg, 95% CI - 1.91; - 0.76) and elbow flexion strength (ß: - 3.31 Nm, 95% CI - 5.80; - 0.82). CONCLUSIONS: Reduced eGFR and higher albuminuria levels were associated with worse physical performance, especially shorter 6-min walk distance and lower muscle strength. The relationship between eGFR and physical function was non-linear, with also high eGFR values being associated with worse performance, especially in the six-minute walk test.

Test-retest reliability of the FitMáx©-questionnaire in a clinical and healthy population.

PURPOSE: The FitMáx© was developed as a questionnaire-based instrument to estimate Cardiorespiratory Fitness (CRF) expressed as oxygen uptake at peak exercise (VO2peak). Test-retest reliability is a clinometric measurement property, which defines stability over time if multiple measurements are performed (i.e. reliability). The present study aimed to assess the test-retest reliability of the FitMáx©-questionnaire in different patient groups. PATIENTS AND METHODS: A total of 127 cardiac, pulmonary and oncology patients and healthy subjects aged 19-84 years who completed the questionnaire twice within an average of 18 days were included for analysis. Participants were in a stable clinical situation (no acute disease or participating in a training program). To determine the test-retest reliability, the Intraclass Correlation Coefficient (ICC) and Standard Error of the Measurement (SEM) was calculated between the first (T0) and second (T1) administration of the questionnaires. RESULTS: An excellent agreement was found between the FitMáx©-questionnaire scores at T0 and T1, with an ICC of 0.97 (SEM 1.91) in the total study population and an ICC ranging from 0.93 to 0.98 (SEM 1.52-2.27) in the individual patient groups. CONCLUSION: The FitMáx©-questionnaire proves to be reliable and stable over time to estimate CRF of patients and healthy subjects. Trial registration NTR (Netherlands Trial Register), NL8846. Registered 25 August 2020, https://trialsearch.who.int/Trial2.aspx?TrialID=NL8846.

Association of physical activity with endothelial dysfunction among adults with and without chronic kidney disease: The Maastricht Study.

BACKGROUND AND AIMS: Physical activity (PA) constitutes an established protective factor while sedentary behavior (SB) an emerging independent risk factor for cardiovascular diseases. This study evaluated the association of PA and SB with endothelial dysfunction (ED) depending on kidney function status. METHODS: Cross-sectional data from the prospective, population-based Maastricht Study were used. PA and SB were measured using the ActivPAL3 accelerometer 24h/day for eight consecutive days. ED was evaluated by plasma levels of soluble vascular cell adhesion protein-1, intercellular adhesion molecule-1, E-selectin and von Willebrand factor, which were combined into an ED score with higher values depicting higher ED. RESULTS: Overall, 2,668 participants, 323 with chronic kidney disease, were included. In normal kidney function individuals, the ED score presented a significant negative association with total, lower-intensity and moderate-to-vigorous PA duration and a positive association with total sedentary time, sedentary breaks and sedentary bout duration. In participants with chronic kidney disease, a significant negative association of ED score with total [ß: -4.42, 95% confidence intervals (95% CI): -7.98; -0.87] and lower-intensity (ß: -7.08, 95% CI: -13.41; -0.74) PA duration, as well as a positive association of ED score with sedentary bout duration (ß: 43.72, 95% CI: 9.85; 77.59) were noted. The strength of associations did not significantly differ across kidney function subgroups (p > 0.05). CONCLUSIONS: This analysis showed that PA duration is inversely associated with ED both among patients with normal kidney function and chronic kidney disease. In chronic kidney disease, longer sedentary bouts were associated with greater endothelial dysfunction.

Both short and long sleep durations are associated with type 2 diabetes, independent from traditional lifestyle risk factors-The Maastricht Study.

OBJECTIVES: This study examined the cross-sectional association between sleep duration, prediabetes, and type 2 diabetes, and its independence from the traditional lifestyle risk factors diet, physical activity, smoking behavior, and alcohol consumption. METHODS: Cross-sectional data from 5561 people aged 40-75 years recruited into The Maastricht Study between 2010 and 2018 were used (1:1 female:male and mean age: 60.1 years [standard deviation: 8.6]). Sleep duration was operationalized as in-bed time, algorithmically derived from activPAL3 accelerometer data (median 7 nights, IQR 1). Glucose metabolism status was determined with an oral glucose tolerance test. Multinomial logistic regression was used to assess the association of sleep duration as restricted cubic spline with prediabetes and type 2 diabetes. We adjusted for sex, age, educational level, the use of sleep medication or antidepressants, and the following lifestyle risk factors: diet quality, physical activity, smoking behavior, and alcohol consumption. RESULTS: A U-shaped association between sleep duration and type 2 diabetes was found. Compared to those with a sleep duration of 8 hours, participants with a sleep duration of 5 and 12 hours had higher odds of type 2 diabetes (OR: 2.9 [95% CI 1.9 to 4.4] and OR 3.2 [2.0 to 5.2], respectively). This association remained after further adjustment for the lifestyle risk factors (OR: 2.6 [1.7 to 4.1] and OR 1.8 [1.1 to 3.1]). No such association was observed between sleep duration and prediabetes. CONCLUSIONS: Both short and long sleep durations are associated positively and independently of lifestyle and cardiovascular risk factors with type 2 diabetes, but not with prediabetes.

Monitoring aerobic capacity in cancer survivors using self-reported questionnaires: criterion validity and responsiveness.

BACKGROUND: Evaluating the criterion validity and responsiveness of the self-reported FitMáx©-questionnaire, Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ) to monitor aerobic capacity in cancer survivors. METHODS: Cancer survivors participating in a 10-week supervised exercise program were included. The FitMáx©-questionnaire, DASI, VSAQ and a cardiopulmonary exercise test (CPET) were completed before (T0) and after (T1) the program. Intraclass correlation coefficients (ICC) were calculated between VO2peak estimated by the questionnaires (questionnaire-VO2peak) and VO2peak measured during CPET (CPET-VO2peak), at T0 to examine criterion validity, and between changes in questionnaire-VO2peak and CPET-VO2peak (ΔT0-T1) to determine responsiveness. Receiver operating characteristic (ROC) analyses were performed to examine the ability of the questionnaires to detect true improvements (≥ 6%) in CPET-VO2peak. RESULTS: Seventy participants were included. Outcomes at T1 were available for 58 participants (83%). Mean CPET-VO2peak significantly improved at T1 (Δ1.6 mL·kg- 1·min- 1 or 8%). Agreement between questionnaire-VO2peak and CPET-VO2peak at T0 was moderate for the FitMáx©-questionnaire (ICC = 0.69) and VSAQ (ICC = 0.53), and poor for DASI (ICC = 0.36). Poor agreement was found between ΔCPET-VO2peak and Δquestionnaire-VO2peak for all questionnaires (ICC 0.43, 0.19 and 0.18 for the FitMáx©-questionnaire, VSAQ and DASI, respectively). ROC analysis showed that the FitMáx©-questionnaire was able to detect improvements in CPET-VO2peak (area under the curve, AUC = 0.77), when using a cut-off value of 1.0 mL·kg- 1·min- 1, while VSAQ (AUC = 0.66) and DASI (AUC = 0.64) could not. CONCLUSION: The self-reported FitMáx©-questionnaire has sufficient validity to estimate aerobic capacity in cancer survivors at group level. The responsiveness of the FitMáx©-questionnaire for absolute change is limited, but the questionnaire is able to detect whether aerobic capacity improved. The FitMáx©-questionnaire showed substantial better values of validity and responsiveness compared to DASI and VSAQ.

Retinal Functional and Structural Neural Indices: Potential Biomarkers for the Monitoring of Cerebral Neurodegeneration: The Maastricht Study.

BACKGROUND: If retinal indices of neurodegeneration are to be biomarkers for the monitoring of cerebral neurodegeneration, it is important to establish whether potentially modifiable risk factors for dementia are associated with retinal neurodegenerative changes. OBJECTIVE: To study associations of dementia risk factors with retinal sensitivity, an index of retinal neural function, and retinal nerve fiber layer (RNFL) thickness, an index of retinal neural structure. METHODS: We used cross-sectional data from The Maastricht Study (up to 5,666 participants, 50.5% men, mean age 59.7), and investigated associations with regression analyses (adjusted for potential confounders). RESULTS: Most risk factors under study (i.e., hyperglycemia, unhealthy diet, lower cardiorespiratory fitness, smoking, alcohol consumption, and hypertension) were significantly associated with lower retinal sensitivity and lower RNFL thickness. CONCLUSION: Findings of this population-based study support the concept that retinal neural indices may be biomarkers for the monitoring of therapeutic strategies that aim to prevent early-stage cerebral neurodegeneration and, ultimately, dementia.

Daily Physical Activity Patterns and Their Associations with Cardiometabolic Biomarkers: The Maastricht Study.

PURPOSE: This study aimed to identify physical activity patterns and examine their association with cardiometabolic biomarkers in a cross-sectional design. METHODS: Overall 6072 participants (mean age, 60.2 yr; SD 8.6 yr, 50% women) from The Maastricht Study provided daily physical activity data collected with thigh-worn activPAL3 accelerometers. The patterns of daily physical activity over weekdays and weekend days were identified by using Group Based Trajectory Modeling. Cardiometabolic biomarkers included body mass index, waist circumference, office blood pressure, glucose, HbA1c, and cholesterol levels. Associations between the physical activity patterns and cardiometabolic outcomes were examined using the analyses of covariance adjusted for sex, age, education, smoking, and diet. Because of statistically significant interaction, the analyses were stratified by type 2 diabetes status. RESULTS: Overall, seven physical activity patterns were identified: consistently inactive (21% of participants), consistently low active (41%), active on weekdays (15%), early birds (2%), consistently moderately active (7%), weekend warriors (8%), and consistently highly active (6%). The consistently inactive and low active patterns had higher body mass index, waist, and glucose levels compared with the consistently moderately and highly active patterns, and these associations were more pronounced for participants with type 2 diabetes. The more irregular patterns accumulated moderate daily total activity levels but had rather similar cardiometabolic profiles compared with the consistently active groups. CONCLUSIONS: The cardiometabolic profile was most favorable in the consistently highly active group. All patterns accumulating moderate to high levels of daily total physical activity had similar health profile suggesting that the amount of daily physical activity rather than the pattern is more important for cardiometabolic health.

The Association between Academic Schedule and Physical Activity Behaviors in University Students.

BACKGROUND: University students sit too much, which is detrimental to their physical and mental health. Academic schedules, including scheduled education time and self-study time, may influence their physical activity behaviors. OBJECTIVES: To investigate (1) the association between scheduled education time and students' physical activity levels during weekdays; (2) the association between self-study time and students' physical activity levels during the weekdays and weekends. METHODS: 126 (68 Maastricht University (UM); 58 KU Leuven (KUL)) first-year undergraduate students in biomedical sciences (mean ± SD age: 19.3 ± 1.0, BMI: 22.0 ± 3.0, 17% men, 83% women) completed a demographics questionnaire and reported their academic activities with a 7-day logbook. Furthermore, their physical activity behavior was measured with the activPAL monitor for 7 days. Linear mixed models were used to examine the associations between university (UM versus KUL), academic activities (scheduled education time and self-study time), and students' activity levels. RESULTS: During weekdays, each hour of scheduled education time per day was significantly associated with a 1.3 min decrease of moderate to vigorous physical activity (MVPA) per day. Scheduled education time was not significantly associated with the sedentary time, light-intensity physical activity (LPA), and active sedentary behavior ratio. Each hour of self-study per day was significantly associated with 8 min more of sedentary time per day, 6 min less LPA per day, and 1.3 min less MVPA per day. Self-study time was not significantly associated with active sedentary behavior ratio. During the weekend, each hour of self-study time per day was associated with an additional 17.8 min of sedentary time per day and a reduction of 15.2 min of LPA per day. Self-study time was not significantly associated with the time spent doing MVPA and active sedentary behavior ratio. CONCLUSIONS: It could be more effective to change students' physical activity behaviors during self-study than during scheduled education time. Therefore, offering a study environment that reduces sedentary behavior and promotes light-intensity physical activity, is crucial.

Effects of breaking up sitting with light-intensity physical activity on cognition and mood in university students.

BACKGROUND: University students often exhibit high levels of sedentary behavior that is negatively associated with cognition and mood. On the other hand, light-intensity physical activity (LIPA) may improve cognitive performance and mood. Therefore, this study investigated the acute effect of LIPA breaks during prolonged sitting on attention, executive functioning, and mood. METHODS: A randomized crossover design was used in this study. In total, 21 healthy adults (15 women, age = 24 ± 3 years, BMI = 23 ± 2 kg/m2 ) completed three prolonged sitting conditions: (1) without a demanding cognitive task (SIT), (2) with a demanding cognitive task (COGN), and (3) with every 25 min sitting interrupted by a 5-minute walk (INTERRUPT). Attention, executive function (response inhibition, task shifting, and working memory updating), and mood were assessed before and after each condition. RESULTS: Linear mixed models analyses showed that prolonged sitting frequently interrupted by LIPA (INTERRUPT) or with cognitively demanding activities (COGN) significantly improved task shifting compared to SIT. However, INTERRUPT did not significantly improve task shifting compared with COGN. No significant acute effects on attention, response inhibition, working memory updating, or mood were found. CONCLUSIONS: Frequent LIPA breaks or cognitively demanding activities have a selective, acute positive impact on one aspect of cognitive performance compared to idle sitting. No evidence was found that LIPA breaks have an acute improvement in attention, executive function, and mood compared to sitting with cognitive loading. To further investigate the effect of PA on cognitive performance, it is necessary to consider cognitive loading and control for the cognitive activity during sitting in the experimental design.

Replacing sitting with light-intensity physical activity throughout the day versus 1 bout of vigorous-intensity exercise: similar cardiometabolic health effects in multiple sclerosis. A randomised cross-over study.

PURPOSE: Persons with Multiple Sclerosis (PwMS) are physically inactive and spend more time in sedentary behaviours than healthy persons, which increases the risk of developing cardiometabolic diseases. In this randomised crossover study, the cardiometabolic health effects of replacing sitting with light-intensity physical activity (LIPA) and exercise (EX) were investigated. MATERIALS AND METHODS: Twenty-eight mildly disabled PwMS performed four 4-day activity regimens in free-living conditions; CONTROL (habitual activity), SIT, LIPA, and EX. Plasma glucose and insulin (oral glucose tolerance test), plasma lipids, inflammation, resting heart rate, blood pressure, body weight, and perceived exertion were measured (clinical-trials.gov: NCT03919058). RESULTS: CONTROL: 9.7 h sitting/day, SIT: 13.3 h sitting/day, LIPA: 8.3 h sitting, 4.7 h standing, and 2.7 h light-intensity walking/day, and EX: 11.6 h sitting/day with 1.3 h vigorous-intensity cycling. Compared to SIT, improvements (p < 0.001) after LIPA and EX were found for insulin total area under the curve (-17 019 ± 5708 and -23 303 ± 7953 pmol/L*min), insulin sensitivity (Matsuda index +1.8 ± 0.3 and +1.9 ± 0.4) and blood lipids (triglycerides: -0.4 ± 0.1 and -0.5 ± 0.1 mmol/L; non-high-density lipoprotein cholesterol: -0.3 ± 0.1 and -0.5 ± 0.1 mmol/L), with no difference between LIPA and EX. Perceived exertion was higher after EX compared to LIPA (Borg score [6-20]: +2.6 ± 3.3, p = 0.002). CONCLUSION: Replacing sitting with LIPA throughout the day exerts similar cardiometabolic health effects as a vigorous-intensity exercise in PwMS.IMPLICATIONS FOR REHABILITATIONIncreasing light-intensity physical activity (LIPA) throughout the day improves cardiometabolic health to the same extent as one vigorous-intensity exercise sessionIncreasing LIPA induces less exertion than performing a vigorous-intensity exercise.

Daily patterns of physical activity, sedentary behavior, and prevalent and incident depression-The Maastricht Study.

This study aims to compare the accelerometer-measured daily patterns of PA and sedentary behavior among participants with and without prevalent/incident depressive symptoms. We used data from 5582 individuals in The Maastricht Study (59.9 ± 8.6 years, 50.3% women). Daily patterns of sedentary time, light-intensity physical activity (LiPA), moderate-to-vigorous physical activity (MVPA), and sit-to-stand transitions were objectively measured at baseline with the activPAL3 activity monitor. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire, both at baseline and annually (median follow-up: 5.1 years). General linear models were used to compare patterns of physical activity and sedentary behavior between those with and without prevalent/incident depressive symptoms. Participants with prevalent depressive symptoms had significantly more sedentary time (18.6 min/day) and lower LiPA (26.8 min/day) and MVPA (4.8 min/day) than participants without depressive symptoms. Considering the daily patterns, participants with prevalent depressive symptoms had significantly more sedentary time early in the afternoon (12:00-18:00), early evening (18:00-21:00), and during the night (00:00-03:00), less time in LiPA in all periods between 09:00-21.00 and less MVPA in the morning (09:00:12:00), early afternoon (12:00-15:00), and evening (18:00-21:00), than those without. Similar differences in activity and sedentary behavior patterns between those and without incident depressive symptoms were observed albeit the differences were smaller. Overall, we did not find specific time slots particularly associated with both prevalent and incident depressive symptoms. These findings may indicate that less sedentary time and more intense PA can be important targets for the prevention of depression irrespective of the timing of the day.

Health burden in type 2 diabetes and prediabetes in The Maastricht Study.

Mortality in type 2 diabetes, is determined not only by classical complications, but also by comorbidities, and is linked to hyperglycaemia and apparent even in prediabetes. We aimed to comprehensively investigate, in a population-based cohort, health burden defined as the presence of comorbidities in addition to classical complications and cardiometabolic risk factors, in not only type 2 diabetes but also prediabetes. Such population-based study has not been performed previously. Extensive phenotyping was performed in 3,410 participants of the population-based Maastricht Study (15.0% prediabetes and 28.6% type 2 diabetes) to assess presence of 17 comorbidities, six classical complications, and ten cardiometabolic risk factors. These were added up into individual and combined sum scores and categorized. Group differences were studied with multinomial regression analyses adjusted for age and sex. Individuals with type 2 diabetes and prediabetes, as compared to normal glucose metabolism (NGM), had greater comorbidities, classical complications, cardiometabolic risk factors and combined sum scores (comorbidities sum score ≥ 3: frequencies (95% CI) 61.5% (57.6;65.4) and 41.2% (36.5;45.9) vs. 25.4% (23.5;27.4), p-trend < 0.001; classical complications ≥ 2 (26.6% (23.1;30.1; P < 0.001 vs. NGM) and 10.1% (7.8;12.7; P = 0.065 vs NGM) vs. 8.0% (6.9;9.3)); cardiometabolic risk factors ≥ 6 (39.7% (35.9;43.4) and 28.5% (24.5;32.6) vs. 14.0% (12.5;15.6); p-trend < 0.001); combined ≥ 8 (66.6% (62.7;70.5) and 48.4% (43.7;53.1) vs. 26.0%(24.1;28.0), p-trend < 0.001). Type 2 diabetes and prediabetes health burden was comparable to respectively 32 and 14 years of ageing. Our population-based study shows, independently of age and sex, a considerable health burden in both type 2 diabetes and prediabetes, which to a substantial extent can be attributed to comorbidities in addition to classical complications and cardiometabolic risk factors. Our findings emphasize the necessity of comorbidities' awareness in (pre)diabetes and for determining the exact role of hyperglycaemia in the occurrence of comorbidities.

The Acute Effects of Standing on Executive Functioning in Vocational Education and Training Students: The Phit2Learn Study.

Research suggests that sedentary behavior (SB) is negatively associated with cognitive outcomes. Interrupting prolonged sitting has been shown to improve cognitive functions, including executive functioning (EF), which is important for academic performance. No research has been conducted on the effect of standing on EF in VET students, who make up a large proportion of the adolescent population and who are known to sit more than other students of this age. In this study, we investigated the acute effects of reducing SB by short time standing on EF in vocational education and training (VET) students. In a randomized crossover study, 165 VET students were first taught for 15 min in seated position. After this, they performed while seated the Letter Memory Test for updating, and the Color Shape Test for shifting and inhibition. Students were randomly assigned to a sitting or standing condition. All students were taught again for 15 min and then took the same tests in the condition they were allocated to, respectively, standing or seated. After 1 week, the test procedure was repeated, in which students switched conditions. Mixed model analyses showed no significant effect of sitting or standing on updating, shifting, or inhibition. Also, no significant differences were found for the order of condition on updating, shifting, or inhibition. Our results suggest that 40 min of standing does not significantly influence EF among VET students.

Estimating VO2peak in 18-90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire.

Purpose: Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF. Materials and Methods: The FitMáx©-questionnaire, consisting of only three questions assessing walking, stair climbing, and cycling capacity, was compared with the commonly used Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ). These questionnaires were compared to peak oxygen uptake (VO2peak) as measured with cardiopulmonary exercise testing. This study included 759 cardiac, pulmonary and oncologic patients and healthy persons aged 18‒90. Results: FitMáx© strongly correlated (r = 0.94 (0.92‒0.95) SEE = 4.14 mL∙kg-1∙min-1) with measured VO2peak. Bias between predicted and measured VO2peak was -0.24 (-9.23‒8.75; 95% limits of agreement) mL·kg-1·min-1. The FitMáx© scored superiorly on correlation and SEE compared with the DASI and VSAQ, r = 0.75 (0.68‒0.80) SEE = 4.62 mL∙kg-1∙min-1 and r = 0.87 (0.83‒0.90) SEE = 6.75 mL∙kg-1∙min-1, respectively. Conclusion: FitMáx© is a valid and accessible questionnaire to estimate CRF expressed as VO2peak in clinical practice and shows substantial improvement compared to currently used questionnaires.

Sedentary behaviour and physical activity are associated with biomarkers of endothelial dysfunction and low-grade inflammation-relevance for (pre)diabetes: The Maastricht Study.

AIMS/HYPOTHESIS: Biomarkers of endothelial dysfunction and low-grade inflammation are important in the pathogenesis of CVD and can potentially be modified by physical activity and sedentary behaviour. Effects of physical activity on biomarkers of endothelial dysfunction may be especially prominent in type 2 diabetes. METHODS: In the population-based Maastricht Study (n = 2363, 51.5% male, 28.3% type 2 diabetes, 15.1% prediabetes [defined as impaired glucose tolerance and impaired fasting glucose]), we determined biomarkers of endothelial dysfunction and low-grade inflammation, and combined z scores were calculated. Physical activity and sedentary behaviour were measured by activPAL. Linear regression analyses were used with adjustment for demographic, lifestyle and cardiovascular risk factors. RESULTS: The association between total, light, moderate-to-vigorous and vigorous intensity physical activity and sedentary time on the one hand and biomarkers of endothelial dysfunction on the other were generally significant and were consistently stronger in prediabetes and type 2 diabetes as compared with normal glucose metabolism status (p for interaction <0.05). Associations between physical activity and sedentary behaviour on the one hand and low-grade inflammation on the other were also significant and were similar in individuals with and without (pre)diabetes (p for interaction >0.05). CONCLUSIONS/INTERPRETATION: Physical activity and sedentary behaviour are associated with biomarkers of endothelial dysfunction and low-grade inflammation. For biomarkers of endothelial dysfunction, associations between physical activity and sedentary behaviour were consistently stronger in (pre)diabetes than in normal glucose metabolism. Whether increasing physical activity or decreasing sedentary time can positively influence biomarkers of endothelial dysfunction in individuals with prediabetes and type 2 diabetes requires further study.

Test-retest reliability of skeletal muscle oxygenation measurement using near-infrared spectroscopy during exercise in patients with sport-related iliac artery flow limitation.

The ankle-brachial index is an accurate tool for detecting claudication in atherosclerotic patients. However, this technique fails to identify subtle flow limitations of the iliac arteries (FLIA) in endurance athletes. Near-infrared spectroscopy (NIRS) is a noninvasive technique that measures skeletal muscle tissue oxygenation status. The aim of the present study is to examine the absolute and relative test-retest reliability of NIRS and evaluate its potential as a diagnostic tool in FLIA. NIRS-derived exercise variables were analyzed during exercise and recovery in FLIA 17 patients and 19 healthy controls. The relative reliability of absolute variables (such as the maximal value) were slight to yet predominantly substantial (intraclass correlation coefficient [ICC], ICC range: 0.06-0.76) with good to excellent absolute reliability (absolute limits of agreement [ALoA], ALoA range: 0.8 ± 10.2 to 0.7 ± 13.1; coefficient of variation [CV], CV range: 5%-11%). Absolute values encompassing signal amplitudes showed moderate to almost perfect relative reliability (ICC range: 0.51-0.89) and poor to good absolute reliability (ALoA range: -1.3 ± 7.0 to -2.5 ± 15.7; CV range: 15%-32%). Kinetic variables showed moderate to almost perfect relative reliability for most recovery kinetics variables (ICC range: 0.54-0.86) with fair to good absolute reliability (ALoA range: 0.4 ± 12.2 to 3.9 ± 37.9; CV range: 18%-27%). Particularly, kinetic variables showed significant differences between patients and healthy subjects. NIRS is found to be a reliable method for examining muscle tissue oxygenation variables. Given the significant differences in especially recovery kinetics between normal subjects and patients, NIRS may contribute to diagnosing FLIA in endurance athletes.

The effects of standing in tutorial group meetings on learning: A randomized controlled trial.

BACKGROUND: Standing desks have been brought into the education environment to reduce sedentary behavior among students. The current study explored the effects of standing in tutorial group meetings on learning among undergraduate students. METHODS: Ninety-six participants were randomly allocated to a Sit or Stand group, with 2 h tutorial group meetings scheduled, once or twice per week, for nine weeks. Learning was analyzed using exam grades, concept maps, and tutorial interactions. RESULTS: Overall, the Sit and Stand groups did not differ from each other in terms of learning, measured through their exam, concept map, and the use of learning-oriented interactions. CONCLUSION: Standing in tutorial group meetings neither enhanced nor compromised learning. Considering the health risks associated with prolonged sedentary behavior, offering standing tutorial group meetings to undergraduate students is a recommended solution to break up prolonged sedentary behavior and encourage more physical activity, while maintaining the learning performance of students.