Polarized running training adapted to versus contrary to the menstrual cycle phases has similar effects on endurance performance and cardiovascular parameters.

PURPOSE: This study compared the effects of polarized running training adapted to the menstrual cycle (MC) phases versus polarized training adapted contrary to the MC on endurance performance and cardiovascular parameters. METHODS: Thirty-three naturally menstruating, moderately trained females (age: 26 ± 4 years; BMI: 22.3 ± 3.2 kg/m2; V ˙ O2max/rel: 40.35 ± 4.61 ml/min/kg) were randomly assigned to a control (CON) and intervention (INT) group. Both groups participated in a load-matched eight-week running training intervention. In the INT, high-intensity sessions were aligned with the mid and late follicular phase, low-intensity sessions with the early and mid-luteal phase, and recovery with the late luteal and early follicular phase. In the CON, high-intensity sessions were matched to the late luteal and early follicular phase, and recovery to the mid and late follicular phase. Endurance performance and cardiovascular parameters were assessed at baseline and after the intervention. RESULTS: Twenty-six females completed the intervention. A repeated measures ANOVA determined no time × group interaction effect for any parameter. A significant time effect was found for maximal oxygen uptake (F(1,12) = 18.753, p = 0.005, ηp2 = 0.630), the velocity at the ventilatory threshold one (F(1,12) = 10.704, p = 0.007, ηp2 = 0.493) and two (F(1,12) = 7.746, p = .018, ηp2 = .413). CONCLUSION: The training intervention improved endurance performance in both groups, with no further benefit observed from the MC-adapted polarized training in a group-based analysis. Replications with an extended intervention period, a larger sample size, and a more reliable MC determination are warranted.

Acute self-myofascial release modulates cardiac autonomic function and hemodynamic parameters at rest and reduces cardiovascular stress reaction.

PURPOSE: Self-myofascial release (SMR) is a form of self-massage aiming to release tension, improve blood flow, and alleviate muscle soreness. This study aimed to determine whether a single session of SMR could impact cardiovascular parameters at rest and during a cold pressor test (CPT). METHODS: Twenty male participants (aged 26 ± 2 years) underwent a 20-min SMR and a 20-min seated control condition (CON) on two separate test days in a randomized order. Peripheral and central blood pressure (BP), total peripheral resistance (TPR), pulse wave velocity (PWV), heart rate (HR), root mean square of successive RR interval differences (RMSSD), and the quotient of low-frequency power and high-frequency power (LF/HF) were measured both at rest and during a CPT before (t0), 2 min (t1), and 20 min (t2) after the SMR and CON. RESULTS: Time × condition interactions could be detected for peripheral and central diastolic BP, TPR, HR, and RMSSD. Following the SMR, peripheral diastolic BP, central diastolic BP, TPR, and RMSSD were reduced, while HR was increased compared to the CON. Regarding the CPT time × condition interactions could be detected for peripheral, and central diastolic BP, with lower values after SMR. CONCLUSION: The results of the present study suggest that a single bout of SMR confers favorable cardiovascular benefits in healthy normotensive individuals. Furthermore, SMR can attenuate the hemodynamic reactivity to a stress test. Future research should address whether regular SMR leads to chronic adaptations similar to regular, moderate aerobic exercise, massage therapy, and static stretching.

Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions.

BACKGROUND: Wearable technology is used by consumers and researchers worldwide for continuous activity monitoring in daily life. Results of high-quality laboratory-based validation studies enable us to make a guided decision on which study to rely on and which device to use. However, reviews in adults that focus on the quality of existing laboratory studies are missing. METHODS: We conducted a systematic review of wearable validation studies with adults. Eligibility criteria were: (i) study under laboratory conditions with humans (age ≥ 18 years); (ii) validated device outcome must belong to one dimension of the 24-hour physical behavior construct (i.e., intensity, posture/activity type, and biological state); (iii) study protocol must include a criterion measure; (iv) study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in five electronic databases as well as back- and forward citation searches. The risk of bias was assessed based on the QUADAS-2 tool with eight signaling questions. RESULTS: Out of 13,285 unique search results, 545 published articles between 1994 and 2022 were included. Most studies (73.8% (N = 420)) validated an intensity measure outcome such as energy expenditure; only 14% (N = 80) and 12.2% (N = 70) of studies validated biological state or posture/activity type outcomes, respectively. Most protocols validated wearables in healthy adults between 18 and 65 years. Most wearables were only validated once. Further, we identified six wearables (i.e., ActiGraph GT3X+, ActiGraph GT9X, Apple Watch 2, Axivity AX3, Fitbit Charge 2, Fitbit, and GENEActiv) that had been used to validate outcomes from all three dimensions, but none of them were consistently ranked with moderate to high validity. Risk of bias assessment resulted in 4.4% (N = 24) of all studies being classified as "low risk", while 16.5% (N = 90) were classified as "some concerns" and 79.1% (N = 431) as "high risk". CONCLUSION: Laboratory validation studies of wearables assessing physical behaviour in adults are characterized by low methodological quality, large variability in design, and a focus on intensity. Future research should more strongly aim at all components of the 24-hour physical behaviour construct, and strive for standardized protocols embedded in a validation framework.

Challenging the Portrait of the Unhealthy Gamer-The Fitness and Health Status of Esports Players and Their Peers: Comparative Cross-Sectional Study.

BACKGROUND: Esports players are often referred to as sedentary athletes, as gaming requires prolonged sedentary screen exposure. As sedentary behavior and physical inactivity are major causes of noncommunicable diseases and premature death, esports players may be at an increased risk for health implications. Prior research has established esports players as having higher levels of body fat and lower levels of lean body mass versus age-matched controls, suggesting the need to assess further health and fitness outcomes of this demographic. However, while research interest is undoubtedly increasing, the majority of studies has focused on subjective self-report data and has lacked relevant objective health and fitness measurements. OBJECTIVE: This study aimed to assess the health and fitness status of a group of competitive esports players in relation to an age- and sex-matched comparison group. METHODS: In total, 51 competitive esports players (mean 23, SD 3 years, 2 female) and 51 nonesports players (mean 24, SD 3 years, 2 female) were enrolled in this cross-sectional laboratory study. The esports players and the nonesports players completed a questionnaire assessing demographic data and self-reported physical activity levels. Furthermore, physical parameters including BMI, waist-to-height ratio, body fat percentage, systolic blood pressure, diastolic blood pressure, pulse wave velocity, maximal grip strength, and maximal oxygen consumption were assessed. RESULTS: There were no significant differences in BMI (t100=1.54; P=.13; d=0.30), waist-to-height ratio (t100=1.44; P=.16; d=0.28), body fat percentage (t100=-0.48; P=.63; d=-0.09), systolic blood pressure (t100=-0.06; P=.93; d=-0.01), diastolic blood pressure (t100=0.37; P=.71; d=0.07), pulse wave velocity (t93=-2.08; P=.15; d=-0.43), maximal grip strength (t100=-.08; P=.94; d=-0.02), maximal oxygen consumption (t100=-0.11; P=.92; d=-0.02), and physical activity (PA) levels (t86=2.17; P=.08; d=0.46) between the groups. CONCLUSIONS: While the health narrative directed toward esports players has been mainly negative, this laboratory-based study indicated that esports players are not less healthy or fit compared to their peers. However, it seems that esports players are very heterogeneous and seem to span across the whole range of the fitness and health spectrum. Thus, the generalized statements of the esports athlete as an obese and unhealthy individual may need to be reconsidered.

Physiological Demands of Exergames in Older Adults-A Systematic Literature Review.

New approaches are needed to address low physical activity levels among older adults and to promote daily physical activity tailored to their interests and abilities. This study aimed to review the current literature analyzing the physiological demands of exergames in older adults. A systematic database search was conducted in October 2020 and March 2022. A total of 3,540 studies were screened, and 16 were incorporated into the data analysis. The studies included 527 participants, 61% female, with a mean age of 72.3 ± 4.7 years. Analyzed physiological parameters included mean heart rate, rate of perceived exertion, and metabolic equivalents or oxygen uptake. Exergames are capable of offering light- to moderate-intensity activity for older adults (mean heart rate: 108 ± 9.1 bpm; mean rate of perceived exertion: 11.5 ± 1.8; metabolic equivalents: 2.7 ± 0.7). Although implications are positive, high diversity was found in the study design according to intervention duration and assessment of physiological parameters.

Development and validation of assessments of adolescent health literacy: a Rasch measurement model approach.

BACKGROUND: Health literacy (HL) is implicated in improved health decision-making and health promotion, and reduced racial, ethnic, and socioeconomic health disparities. Three major areas of HL include functional, interactive, and critical HL. HL skills develop throughout the lifespan as individuals' psychosocial and cognitive capacities develop and as they accumulate experiences with navigating health systems. Though adolescence is marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. Both the adult and adolescent HL literature are also limited by the paucity of validated test-based measures for assessing HL. The existing test-based validated HL measures for adolescents were originally designed for adults. However, adolescents are at an earlier phase of developing their HL skills (e.g., fewer experiences navigating the health system) compared to adults and measures originally designed for adults may assume prior knowledge that adolescents may lack therein underestimating adolescents' HL. This study developed and validated test-based assessments of adolescents' functional, interactive, and critical HL. METHODS: Items were generated in an iterative process: focus groups with adolescents informed item content, cognitive interviews with adolescents and expert consultation established content and face validity of the initial items, and items were revised or removed where indicated. High school students (n = 355) completed a measurement battery including the revised HL items. The items were evaluated and validated using Rasch measurement models. RESULTS: The final 6-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (23 items) fit their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12-15-year-olds vs. 16-18-year-olds), and ethnicity in all assessments. The assessments had good convergent validity with an established measure of functional HL and scores on the assessments were positively related to reading instructions before taking medicine and questioning the truthfulness of health information found online. CONCLUSIONS: These assessments are the first test-based measures of adolescents' interactive and critical HL, the first test-based measure of functional HL designed for adolescents, and the first composite test-based assessment of all three major areas of HL. These assessments should be used to inform strategies for improving adolescents' HL, decision-making, and behaviors.

Predictors of physical activity behavior change based on the current stage of change-an analysis of young people from Hawai'i.

This study investigated the corresponding change between psycho-social predictors and physical activity (PA) behavior and if these relationships were dependent on the stages of change from the Transtheoretical Model in Minority American adolescents. We conducted a longitudinal field study with N = 357 students aged 13-18 years (M = 14.24 years, SD = 0.88); predominantly Filipino (61.2%) using a test-retest design assessing psycho-social PA predictors (enjoyment, self-efficacy, family support, friends' support, knowledge, stage of change) and moderate-to-vigorous physical activity (MVPA) at two time points over six months. Hierarchical regression results indicated that a positive change of enjoyment, knowledge about PA and family support predicted a change of MVPA, independently of stage. The time-varying covariation showed the importance of the current stage of change for enjoyment, self-efficacy and support of friends for a change of MVPA. Overall, our findings suggest that an individual's current stage of change should be considered to determine individually appropriate starting points and goals for designing interventions to promote PA among Minority American adolescents.

Are Physical Activity, Screen Time, and Mental Health Related During Childhood, Preadolescence, and Adolescence? 11-Year Results From the German Motorik-Modul Longitudinal Study.

Mental health (MH) and behavioral health are fundamental to a good quality of life. Only a few studies have investigated the association between behavioral health (e.g., physical activity (PA), screen time (ST)) and MH from childhood to adolescence. Therefore, we investigated the relationships of PA and ST with MH by sex in an 11-year longitudinal cohort study of German schoolchildren during 2003-2017. A subsample (n = 686; 55.2% female) of participants from the German Motorik-Modul (MoMo) Longitudinal Study who participated in all 3 measurement phases (mean ages: time 1 (baseline; 2003-2006), 5.57 (standard deviation (SD), 1.00) years; time 2 (wave 1; 2009-2012), 11.85 (SD, 1.03) years; time 3 (wave 2; 2014-2017), 16.86 (SD, 1.04) years) were analyzed with regard to PA, ST, and MH (emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, prosocial behavior, and overall strengths and difficulties). Path panel prediction models were fitted with time 1, time 2, and time 3 PA, ST, and MH indicators. PA predicted less television (TV)/video watching in females, and TV/video watching predicted personal computer (PC)/Internet use in both sexes. Behavior and MH results suggested that, for females, higher TV/video watching and PC/Internet use was related to higher MH challenges over the course of maturation. Some preadolescent males' MH challenges increased ST (TV/video watching and PC/Internet use) in adolescence. Researchers should explore innovative and effective methods for reducing childhood ST, especially among females with early signs of MH issues, and addressing preadolescent males' MH challenges.

High-intensity interval training and energy management education, compared with moderate continuous training and progressive muscle relaxation, for improving health-related quality of life in persons with multiple sclerosis: study protocol of a randomized controlled superiority trial with six months' follow-up.

BACKGROUND: Persons with multiple sclerosis (PwMS) often have reduced aerobic capacity and report fatigue as the most disabling symptom impacting their health-related quality of life (HRQoL). A multidisciplinary rehabilitation approach is recommended for successful management of symptoms, although there is little supporting evidence. The aim of this study is to evaluate the effect of a multimodal therapy approach, including endurance training and patient education, during a three-week inpatient rehabilitation stay, on HRQoL in PwMS at six months follow-up. Inpatient energy management education (IEME) + high-intensity interval training (HIIT) will be compared with progressive muscle relaxation (PMR) + moderate continuous training (MCT). METHODS: This study has a two-armed single-blind randomized controlled superiority trial design. One hundred six PwMS-related fatigue (relapsing-remitting or chronic progressive phenotypes; Expanded Disability Status Scale (EDSS) ≤ 6.5) will be recruited at the Valens clinic, Switzerland, and randomized into either an experimental (EG) or a control group (CG). EG: participants will perform IEME twice and HIIT three times per week during the three-week rehabilitation stay. IEME is a group-based intervention, lasting for 6.5 h over three weeks. HIIT contains of five 1.5-min high-intensive exercise bouts on a cycle ergometer at 95-100% of peak heart rate (HRpeak), followed by active breaks of unloaded pedalling for 2 min to achieve 60% of HRpeak. CG: participants will perform PMR twice and MCT three times per week during the three-week rehabilitation stay, representing local usual care. PMR consists of six 1-h relaxation group sessions. MCT consists of 24-min continuous cycling at 65% of HRpeak. The primary outcome is HRQoL (Physical and Mental Component Summaries of the Medical Outcome Study 36-item Short Form Health Survey; SF-36), measured at entry to the clinic (baseline, T0), three weeks after T0 (T1) and at four (T2) and six (T3) months after T0. Secondary outcomes comprise cardiorespiratory fitness, inflammatory markers (measured at T0 and T1), fatigue, mood, self-efficacy, occupational performance, physical activity (measured at T0, T1, T2 and T3) and behaviour changes in energy management (measured at T2 and T3). DISCUSSION: This study will provide detailed information on a multimodal therapy approach to further improve rehabilitation for PwMS. TRIAL REGISTRATION: This trial was prospectively registered at ClinicalTrials.gov ( NCT04356248 ; 22 April 2020).

The relationship of self-reported and device-based measures of physical activity and health-related quality of life in adolescents.

BACKGROUND: Physical activity (PA) has beneficial effects on health and health-related quality of life (HRQoL), which is a protective factor of illness and mortality. The purpose of this examination was to investigate if self-reported and device-based measures of PA were related to HRQoL in adolescents. METHODS: Participants (N = 1565; 54.3% female; Mage = 14.37 years, SDage = 1.99) were recruited from 167 sample points across Germany. Adolescents self-reported their PA, supplemented by a 1-week examination of device-based PA using accelerometry. Additionally, they completed the multidimensional KIDSCREEN-27 to assess HRQoL. RESULTS: Results showed that self-reported PA was correlated with overall HRQoL, Physical Well-Being, Psychological Well-Being, Social Support & Peers, and School Environment, whereas device-based PA was only correlated with Physical as well as Psychological Well-Being. Further, self-reported PA significantly predicted all facets of HRQoL except for Autonomy and Parent Relations, whereas device-based PA solely heightened the amount of explained variance in the Physical Well-Being subscale. CONCLUSIONS: Findings demonstrate the importance of self-reported PA as it is related to almost all facets of HRQoL. Both measures of PA are not congruent in their relationship with HRQoL and thus implications have to be carefully considered. Future studies should investigate the direct effect of PA on HRQoL and health in a longitudinal approach to account for the causality of effects.

Relating outdoor play to sedentary behavior and physical activity in youth - results from a cohort study.

BACKGROUND: Outdoor play, sedentary behavior (SB), and moderate-to-vigorous physical activity (MVPA) are related to youth's health, however, there are research gaps regarding 1) associations between outdoor play, SB, and MVPA across a broad pediatric age range (6-17 years), and 2) longitudinal associations between outdoor play, SB, and MVPA across childhood and adolescence. Two studies were conducted to address those research gaps: Study 1 aimed to investigate relationships between outdoor play and accelerometer-assessed SB and MVPA in a cross-sectional nationwide sample of children and adolescents in Germany. Study 2 aimed to investigate prospective associations between outdoor play and self-reported screen-time SB and MVPA and in a sample of children with three measurement timepoints across 11 years. METHODS: Data were obtained of the German national representative Motorik-Modul (MoMo) Study and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In Study 1, N = 2278 participants (6-17 years) were included with self-reported outdoor play and accelerometer-assessed SB and MVPA. Associations were examined via multiple linear regressions. In Study 2, N = 570 participants (baseline: 4-7 years) were included in the longitudinal analysis with follow-ups six and 11 years later. Screen-time SB (TV watching and PC/Gaming), MVPA, and outdoor play were self-reported. Associations were investigated through a path prediction model. RESULTS: Study 1 showed that compared to <1 h outdoor play, higher engagement in daily outdoor play was related to lower SB (1-2 h: - 9.75 min/day, P = 0.017; ≥2 h: - 17.78 min/day, P < 0.001) and higher MVPA (≥2 h: + 3.87 min/day, P = 0.001). The cross-sectional relationship between MVPA and outdoor play was moderated by sex (in favor of males) and age (in favor of younger children). Study 2 showed that outdoor play in early childhood negatively predicted PC use/Gaming in later childhood, but was unrelated to MVPA. CONCLUSION: In Study 1, outdoor play was negatively related to SB cross-sectionally. In Study 2, outdoor play in early childhood was negatively related to PC and Gaming time in later childhood. Thus, providing outdoor play opportunities, especially during early childhood, has potential to prevent SB. Future research should investigate longitudinal relationships using device-based assessments for SB and MVPA.

Momentary mood predicts upcoming real-life sedentary behavior.

Humans in the industrialized world spend a large amount of daily time in sedentary behavior. Since sedentariness negatively impacts a variety of psychophysiological outcomes, the identification of antecedents that lead to sedentary behavior is an important public health issue. In this context, mood, a central indicator for both psychological well-being and mental health, is severely understudied. To investigate whether mood dimensions influence subsequent sedentary behavior, we assessed both constructs at baseline via questionnaires and via ambulatory assessment (AA) over 5 days in 92 university employees. We continuously measured sedentary behavior using accelerometers and assessed mood repeatedly 10 times each day on smartphone diaries. We employed multiple regression analyses to analyze between-subject effects and multilevel modeling to analyze within-subject effects. Higher momentary ratings of valence (P < .05) and energetic arousal (P < .01) predicted lower amounts of subsequent sedentary behavior, whereas higher ratings of calmness (P < .01) predicted higher amounts of subsequent sedentary behavior. The context moderated the effect of energetic arousal and calmness on sedentary behavior with increased effects in the home compared to the work context. Mood significantly predicted sedentary behavior on a within-subject level but not on a between-subject level. Preliminary evidence suggests that mood regulates sedentary behavior in everyday life. Time-sensitive analyses, such as from moment to moment revealed an association between mood and sedentary behavior (within-subject), whereas analyses between different individuals revealed no associations (between-subject). These preliminary findings may inform multicomponent intervention strategies that target mood, to reduce sedentary behavior in daily life.

The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012.

BACKGROUND: A growing body of studies that investigated the longitudinal association between physical activity (PA) and the outcome of incident obesity, coronary heart disease (CHD), diabetes and hypertension has become available in recent years. Thus, the purpose of this systematic review was to provide an update on the association between PA and onset of obesity, CHD, diabetes and hypertension in individuals aged ≥18 years who were free of the respective conditions at baseline. METHODS: We systematically searched OVID, Pubmed, and Web of Science databases for pertinent literature published between January of 2012 and February of 2019. To ensure that conclusions are based on high quality evidence, we only included longitudinal studies conducted in samples of ≥500 participants and with ≥5 years of follow-up. RESULT: The search yielded 8929 records of which 26 were included in this review. Three studies were conducted on the outcome of incident obesity, eight on incident CHD, nine on incident diabetes, four on incident hypertension, one on the outcome of both diabetes and hypertension, and one on the outcome of CHD, diabetes and hypertension. Overall, there was an association between PA and lower risk of incident obesity, CHD and diabetes, but not hypertension. Higher levels or amount of PA were associated with a reduced risk of new onset of the respective diseases in 20 studies (77%). Whereas four studies reported an elevated risk of incidence of diseases with lower PA levels (15%). PA was not associated with incidence of diseases in two studies (8%). CONCLUSION: Higher levels of PA are likely associated with a lower risk of becoming obese, develop CHD or diabetes. These findings replicate and strengthen conclusions from earlier reviews underlining the importance of promoting PA in adults. The associations between PA and incident hypertension were less consistent. More research, particularly using prospective cohort designs in large population-based samples, is needed to further untangle the association between PA and incident hypertension. TRAIL REGISTRATION: CRD42019124474 (PROSPERO Protocol registration). Date of registration in PROSPERO 27 February 2019.

Ambulatory Assessment for Physical Activity Research: State of the Science, Best Practices and Future Directions.

Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 "Physical Activity Assessment - State of the Science, Best Practices, Future Directions" where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessment that near realtime, which minimizes retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within- subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21st century such as insufficient PA and high levels of sedentary behavior.

Trends in Health Behavior Patterns Among U.S. Adults, 2003-2015.

Background: Over the last two decades, considerable resources from U.S. federal and philanthropic entities were dedicated to improving preventive and reducing chronic disease risk behaviors. Purpose: Given the population health efforts to improve health behaviors in adults, this study explored how health behavior patterns shifted over the years by exploring multiple health behavior patterns. Methods: Data were obtained from the odd years between 2002 and 2016 Behavioral Risk Factor Surveillance System. Latent class analyses including fruit and vegetables, physical activity, cigarette smoking, and heavy and binge drinking were conducted for each year. Results: Three-class models best fit the data and were most interpretable. Each year included Healthy or Physically Active (preventive behaviors, no risk behaviors), Apathetic (no preventive/risk behaviors), and Binge-drinking groups. Gender and age consistently distinguished the Healthy/Physically Active groups from the Apathetic and Binge-drinking groups across the years. Conclusions: This study confirms health behavior clusters exist and have been stable across time. This is encouraging as trends have not gotten worse, but there is room for improvement. Repetition of the groups across years suggests that despite population-level interventions, a large segment of the U.S. population at risk for chronic diseases are not engaging in preventive health.

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model.

OBJECTIVE: Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity. METHODS: A random sample provided baseline data (n=689; 63% female; M age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals. RESULTS: Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035). CONCLUSIONS: Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

Physical activity stages of change surveillance data shows that the majority of Hawai'i's Keiki (Children) meet the guidelines.

Targeting Native Hawaiian and other Pacific Islander (NHOPI) children based on their physical activity (PA) stages of change (SOC) may improve intervention effectiveness. No known SOC surveillance system exists for NHOPI jurisdictions. The purpose was to determine the PA SOC prevalence over 5 years in children living in Hawai'i. Self-reported PA SOC from 5 cohorts (3-6 grade students) in Hawai'i were compared between cohorts and sex. The combined PA SOC distribution (n = 1726, 50.7% female) was: Precontemplation, 7.5%; Contemplation, 7.6%; Preparation, 9.9%; Action, 33.4%; Maintenance, 41.5%. There were no significant difference between cohorts 1 and 2 (n = 258), χ2 (16) = 21.75, p = 0.15; 2 and 3 (n = 129), χ2 (16) = 17.51, p = 0.35; 3 and 4 (n = 171), χ2 (16) = 17.28, p = 0.77; 4 and 5 (n = 129), χ2 (16) = 17.51, p = 0.35; and for all cohorts between males and females (p > 0.05). Most participants were in Action and Maintenance. Prevention efforts should emphasize maintaining PA levels. Extending PA behavior surveillance systems to include intention in NHOPI jurisdictions is warranted.

Future directions of multiple behavior change research.

Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals' habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination.

Despite the increased health risks of a sedentary lifestyle, only 49 % of American adults participate in physical activity (PA) at the recommended levels. In an effort to move the PA field forward, we briefly review three emerging areas of PA intervention research. First, new intervention research has focused on not only increasing PA but also on decreasing sedentary behavior. Researchers should utilize randomized controlled trials, common terminology, investigate which behaviors should replace sedentary behaviors, evaluate long-term outcomes, and focus across the lifespan. Second, technology has contributed to an increase in sedentary behavior but has also led to innovative PA interventions. PA technology research should focus on large randomized trials with evidence-based components, explore social networking and innovative apps, improve PA monitoring, consider the lifespan, and be grounded in theory. Finally, in an effort to maximize public health impact, dissemination efforts should address the RE-AIM model, health disparities, and intervention costs.

Perceived influence and college students' diet and physical activity behaviors: an examination of ego-centric social networks.

BACKGROUND: Obesity is partially a social phenomenon, with college students particularly vulnerable to changes in social networks and obesity-related behaviors. Currently, little is known about the structure of social networks among college students and their potential influence on diet and physical activity behaviors. The purpose of the study was to examine social influences impacting college students' diet and physical activity behaviors, including sources of influence, comparisons between sources' and students' behaviors, and associations with meeting diet and physical activity recommendations. METHODS: Data was collected from 40 students attending college in Hawaii. Participants completed diet and physical activity questionnaires and a name generator. Participants rated nominees' influence on their diet and physical activity behaviors as well as compared nominees' behaviors to their own. Descriptive statistics were used to look at perceptions of influence across network groups. Logistic regression models were used to examine associations between network variables and odds of meeting recommendations. RESULTS: A total of 325 nominations were made and included: family (n = 116), college friends (n = 104), high school friends (n = 87), and significant others (n = 18). Nearly half of participants were not from Hawaii. Significant others of non-Hawaii students were perceived to be the most influential (M(SD) = 9(1.07)) and high school friends the least influential (M(SD) = 1.31(.42)) network. Overall, perceived influence was highest for diet compared to physical activity, but varied based on comparisons with nominees' behaviors. Significant others were most often perceived has having similar (44 %) or worse (39 %) eating behaviors than participants, and those with similar eating behaviors were perceived as most influential (M(SD) = 9.25(1.04)). Few associations were seen between network variables and odds of meeting recommendations. CONCLUSIONS: Among the groups nominated, high school friends were perceived as least influential, especially among students who moved a long distance for college. Intervention strategies addressing perceived norms and using peer leaders may help promote physical activity among college students, while diet interventions may need to involve significant others in order to be successful. Testing of these types of intervention strategies and continued examination of social networks and their influences on diet and physical activity behaviors are needed.