A Review of Current Literature on Vital Sign Assessment of Physical Activity in Primary Care.

PURPOSE: To conduct an integrated review of the performance and implementation of two physical activity (PA) assessment tools, the exercise vital sign (EVS) and the physical activity vital sign (PAVS), in U.S. primary care practice. DESIGN: An integrative review following Whittemore and Knafl's methodology. METHODS: Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched. Search terms were "exercise vital sign" OR "physical activity vital sign" AND "primary care". Additional inclusion criteria were studies conducted in the United States, published in English, in primary care, between 2010 and 2016. RESULTS: Nine studies met inclusion criteria. Five studies reported validity data of the EVS tool, while four studies reported data from the PAVS tool. Compared with the accelerometer, the EVS tool overestimated moderate-vigorous PA, while the PAVS tool demonstrated moderate agreement in identifying those not meeting national PA guidelines. The EVS tool was successfully implemented in large, integrated practices utilizing electronic health record systems. PA documentation increased compared to non-EVS practices. The predictive ability of the PAVS tool for clinical outcomes was shown. Studies of PA assessment tool use in children were not found. CONCLUSIONS: Preliminary evidence on the validity of both the EVS and PAVS tools support cautious use of each as a screening tool in primary care. There were no data on reliability, with limited data on tool use in diverse populations or settings. Data in children, older adults, and diverse population subgroups were lacking. CLINICAL RELEVANCE: Two brief exercise vital signs tools have each shown some initial validity for use by primary care clinicians as measures to identify patients not meeting PA guidelines.

Physical activity for an ethnically diverse sample of endometrial cancer survivors: a needs assessment and pilot intervention.

OBJECTIVE: To determine the physical activity (PA) behavior, needs and preferences for underserved, ethnically diverse women with a history of endometrial cancer (EC). METHODS: Women with a history of EC (41 non-Hispanic black, 40 non-Hispanic white, and 18 Hispanic) completed a needs assessment during their regular follow-up appointments at Montefiore Medical Center in Bronx, NY, USA. An 8-week pilot PA intervention based on the results of the needs assessment was conducted with 5 EC survivors. RESULTS: Mean body mass index (BMI) among the 99 respondents was 34.1±7.6 kg/m², and 66% did not exercise regularly. Self-described weight status was significantly lower than actual BMI category (p<0.001). Of the 86% who were interested in joining an exercise program, 95% were willing to attend at least once weekly. The primary motivations were improving health, losing weight, and feeling better physically. Despite the high interest in participation, volunteer rate was very low (8%). However, adherence to the 8-week pilot PA intervention was high (83%), and there were no adverse events. Body weight decreased in all pilot participants. CONCLUSION: These data show that ethnically diverse EC survivors have a great need for, and are highly interested in, PA interventions. However, greater care needs to be taken to assess and identify barriers to increase participation in such programs.

Walking economy during cued versus non-cued self-selected treadmill walking in persons with Parkinson's disease.

BACKGROUND: Gait impairments related to Parkinson's disease (PD) include variable step length and decreased walking velocity, which may result in poorer walking economy. Auditory cueing is a common method used to improve gait mechanics in PD that has been shown to worsen walking economy at set treadmill walking speeds. It is unknown if auditory cueing has the same effects on walking economy at self-selected treadmill walking speeds. OBJECTIVES: To determine if auditory cueing will affect walking economy at self-selected treadmill walking speeds and at speeds slightly faster and slower than self-selected. METHODS: Twenty-two participants with moderate PD performed three, 6-minute bouts of treadmill walking at three speeds (self-selected and ± 0.22 m·sec-1). One session used cueing and the other without cueing. Energy expenditure was measured and walking economy was calculated (energy expenditure/power). RESULTS: Poorer walking economy and higher energy expenditure occurred during cued walking at a self-selected and a slightly faster walking speed, but there was no apparent difference at the slightly slower speed. CONCLUSION: These results suggest that potential gait benefits of auditory cueing may come at an energy cost and poorer walking economy for persons with PD at least at some treadmill walking speeds.

Associations between healthy lifestyle behaviors and academic performance in U.S. undergraduates: a secondary analysis of the American College Health Association's National College Health Assessment II.

PURPOSE: To examine associations between academic performance and moderate-vigorous physical activity, strength training, fruit and vegetable intake, and sleep. DESIGN: Cross-sectional observational study. SETTING: Forty U.S. colleges and universities participating in the Fall 2008 National College Health Assessment-II (NCHA-II) (median response, 27%). SUBJECTS: A total of 16,095 undergraduate students (18-24 years; 70.3% female). MEASURES: Self-reported lifestyle variables from the NCHA-II questions were dichotomized as meeting or not meeting public health recommendations. Grade average ranged from 1.00 to 4.00 points. ANALYSIS: Linear regression, adjusting for sociodemographic and health-related variables. RESULTS: The prevalence of meeting public health recommendations was as follows: moderate-vigorous physical activity, 41.9%; strength training, 32.4%; fruit and vegetable intake, 4.6%; and sleep, 23.6 %. Grade average was higher in students meeting moderate-vigorous physical activity, fruit and vegetable intake, and sleep recommendations (p ≤ .019). If moderate-vigorous physical activity was met, grade average was higher by .03 points, .15 points higher when meeting fruit and vegetable intake recommendations, and .06 points higher for sleep. There was no significant change in grade average in those meeting strength-training recommendations. CONCLUSION: College students who adhere to public health recommendations for lifestyle behaviors have modestly higher grade averages after adjusting for sociodemographic and negative health behaviors.

Walking economy during cued versus non-cued treadmill walking in persons with Parkinson's disease.

BACKGROUND: Gait impairment is common in Parkinson's disease (PD) and may result in greater energy expenditure, poorer walking economy, and fatigue during activities of daily living. Auditory cueing is an effective technique to improve gait; but the effects on energy expenditure are unknown. OBJECTIVE: To determine whether energy expenditure differs in individuals with PD compared with healthy controls and if auditory cueing improves walking economy in PD. METHODS: Twenty participants (10 PD and 10 controls) came to the laboratory for three sessions. Participants performed two, 6-minute bouts of treadmill walking at two speeds (1.12 m·sec-1 and 0.67 m·sec-1). One session used cueing and the other without cueing. A metabolic cart measured energy expenditure and walking economy was calculated (energy expenditure/power). RESULTS: PD had worse walking economy and higher energy expenditure than control participants during cued and non-cued walking at the 0.67 m·sec-1 speed and during non-cued walking at the 1.12 m·sec-1. With auditory cueing, energy expenditure and walking economy worsened in both participant groups. CONCLUSIONS: People with PD use more energy and have worse walking economy than adults without PD. Walking economy declines further with auditory cuing in persons with PD.

Relationship between physical activity and general mental health.

PURPOSE: We investigated the relationship between physical activity and mental health and determined the optimal amount of physical activity associated with better mental health. METHOD: Self-reported data from a national random sample of 7674 adult respondents collected during the 2008 U.S. Health Information National Trends 2007 Survey (HINTS) were analyzed in 2012. Mental health was plotted against the number of hours of physical activity per week using a fractional 2-degree polynomial function. Demographic and physical health factors related to poorer mental health were examined. The optimal range of physical activity associated with poorer mental health was examined by age, gender, and physical health. RESULTS: A curvilinear association was observed between physical activity and general mental health. The optimal threshold volume for mental health benefits was of 2.5 to 7.5h of weekly physical activity. The associations varied by gender, age, and physical health status. Individuals who engaged in the optimal amount of physical activity were more likely to have reported better mental health (odds ratio=1.39, p=0.006). CONCLUSIONS: This study established a hyperbolic dose-response relationship between physical activity and general mental health, with an optimal range of 2.5 to 7.5h of physical activity per week.

Assessment of measures for abdominal adiposity in persons with spinal cord injury.

Ultrasound may be a useful tool to assess abdominal adiposity, but it has not been validated in the spinal cord injury (SCI) population. This study evaluated associations between abdominal ultrasound and other methods to assess adiposity in 24 men with SCI and 20 able-bodied (AB) men. Waist (WC) and hip circumference (HC) and waist-to-hip ratio (WHR) were measured. Trunk (TRK%), android (A%) and waist fat (W%) were determined by dual energy x-ray absorptiometry (DXA); ultrasonography determined abdominal subcutaneous (SF) and visceral fat (VF). The SCI group had greater TRK% (40.0 ± 9.6 vs. 32.0 ± 10.3), W% (47.0 ± 9.7 vs. 40.6 ± 9.4), A% (43.0 ± 9.8 vs. 35.8 ± 10.6) and WHR (0.99 ± 0.1 vs. 0.92 ± 0.06) than the AB group. WC and WHR correlated with VF in the SCI group. These associations suggest that ultrasound may be a useful tool in clinical practice for the measurement of VF in weight loss programs and for the assessment of cardiometabolic disorders.

Physical and mental health-related correlates of physical function in community dwelling older adults: a cross sectional study.

BACKGROUND: Physical function is the ability to perform both basic and instrumental activities of daily living, and the ability of older adults to reside in the community depends to a large extent on their level of physical function. Multiple physical and health-related variables may differentially affect physical function, but they have not been well characterized. The purpose of this investigation was to identify and examine physical and mental health-related correlates of physical function in a sample of community-dwelling older adults. METHODS: Nine hundred and four community dwelling older men (n = 263) and women (n = 641) with a mean (95% Confidence Interval) age of 76.6 (76.1, 77.1) years underwent tests of physical function (Timed Up and Go; TUG), Body Mass Index (BMI) was calculated from measured height and weight, and data were collected on self-reported health quality of life (SF-36), falls during the past 6 months, number of medications per day, depression (Geriatric Depression Scale; GDS), social support, and sociodemographic variables. RESULTS: Subjects completed the TUG in 8.7 (8.2, 9.2) seconds and expended 6,976 (6,669, 7,284) Kcal.wk-1 in physical activity. The older persons had a mean BMI of 27. 6 (27.2, 28.0), 62% took 3 or more medications per day, and 14.4% had fallen one or more times over the last 6 months. Mean scores on the Mental Component Summary (MCS) was 50.6 (50.2, 51,0) and the Physical Component Summary (PCS) was 41.3 (40.8, 41.8).Multiple sequential regression analysis showed that, after adjustment for TUG floor surface correlates of physical function included age, sex, education, physical activity (weekly energy expenditure), general health, bodily pain, number of medications taken per day, depression and Body Mass Index. Further, there is a dose response relationship such that greater degree of physical function impairment is associated with poorer scores on physical health-related variables. CONCLUSIONS: Physical function in community-dwelling older adults is associated with several physical and mental health-related factors. Further study examining the nature of the relationships between these variables is needed.