Profile of adults users of smartphone applications for monitoring the level of physical activity and associated factors: A cross-sectional study.

Background: There are currently more than 200 million smartphones in Brazil. The potential of mobile technologies for favorable changes in health behavior such as physical activity has been previously described in the literature. Results of surveys in developed countries indicate that applications (APPs) are developed for people who are better educated, younger, and with higher incomes compared to non-users. However, the profile of users in developing countries like Brazil is not well-known. Understanding the profile of APP users might ease the development turned to physically inactive people and those at higher cardiovascular risk. Furthermore, the physiological and functional factors associated with the use of such APP are unknown. Objectives: To characterize the profile of APP users to monitor the physical activity level (PAL) and assess the demographic, socioeconomic, clinical, physiological, and functional characteristics associated with the use of smartphone APPs to monitor physical activity in Brazilian adults. Methods: We assessed 176 asymptomatic men and 178 women (43 ± 12 years; 27 ± 5 kg/m2). We initially asked participants about their current use of a smartphone APP containing PAL monitoring functionality, such as exercise session logs and/or step counts. In a cross-sectional design, we investigated schooling, socioeconomic status (Critério Brasil), and classic self-reported cardiovascular risk factors. We evaluated several physiological and functional variables such as maximum O2 consumption on a treadmill (VO2 max), blood pressure, body composition (bioelectrical impedance), handgrip strength, and isokinetic muscle strength of the dominant lower limb. Participants used a triaxial accelerometer for 7 days to quantify daily physical activity. We also assessed health-related quality of life (WHOQOL BREF), perceived stress (PSS14 Scale), and the built environment (NEWS Scale). We compared continuous variables using the Student's t-test and categorical variables using the χ2 test, between APP users and non-users. After univariate analysis, we included the main variables associated with the use of APP in a multiple logistic regression model. Results: One hundred and two participants (28.3%), unrelated to gender, reported using a smartphone APP for physical activity at the time of assessment. Except for perceived stress and the built environment that were not associated with the use of APP, users of APP were younger and had higher education, lower cardiovascular risk, better socioeconomic status, a better quality of life, better cardiorespiratory function, better body composition, greater physical fitness and more moderate to vigorous physical activity in daily life. The results of the multiple logistic regression showed that age, hypertension, VO2 max, socioeconomic status (Critério Brasil), and quality of life (WHOQOL BREF total score) were the variables most significantly associated with the use of the APP. Conclusions: Our results indicate that smartphone APPs to monitor physical activity are developed for younger adults with better socioeconomic status, lower cardiovascular risk, higher quality of life, and greater cardiorespiratory fitness. Greater efforts are needed to develop a science-based APP for people who most need this technology, enabling greater potential to prevent undesirable health outcomes in asymptomatic adults.

Mapping features and patterns of accelerometry data on human movement in different age groups and associated health problems: A cross-sectional study.

PURPOSE: Human movement is considered one of the important factors for maintaining an independent life. Individuals in different age groups have different characteristics of locomotion patterns and some health conditions can affect or be affected by mobility changes. Few studies clarify or present data about the influence of different ages and biopsychosocial factors on accelerometry features. The aim of this study was to identify characteristics and variables in the frequency signals for different age groups and their relationship with associated health conditions in raw accelerometry data obtained from the use of a triaxial accelerometer during 7 days of activities of daily living. METHOD: A cross-sectional study was conducted based on the database of the first evaluations of the Epidemiological Study of Movement (EPIMOV) cohort. Frequency, signal amplitude, and entropy accelerometry features of EPIMOV participants who used a triaxial accelerometer for 7 days were extracted. Sociodemographic, clinical, anthropometric and physical activity assessments were also performed. Two-way ANOVA was performed to compare accelerometry features within different age groups. A series of stepwise multiple regressions were performed on accelerometry variables to analyze their relationships with demographic, anthropometric and cardiovascular risk variables. RESULTS: The sample consisted mostly of female, white, and high school graduates. The most prevalent cardiovascular risk factors were sedentary behavior and obesity. When analyzing the accelerometry variables, it was possible to observe that the entropy feature, and the counts, decrease in the group of older adults, while the feature of harmonic components of gait (frequency × amplitude) increases in the group of older adults. Regarding the amplitude feature, there were no significant differences between the groups. Through stepwise multiple linear regression, it was possible to observe that demographic, anthropometric and cardiovascular risk factors are associated with most accelerometry variables. CONCLUSION: The results confirm that human movement can be influenced by different ages, sex, demographic, anthropometric and cardiovascular risk factors. Future studies and clinical analyzes can use the methods proposed in this research to adjust movement patterns for sex and different age groups, thus obtaining new interpretations about human movement.

Early flattening of the oxygen pulse during the cardiopulmonary exercise test in asymptomatic adults and its association with cardiovascular risk factors.

BACKGROUND: Individuals with cardiovascular exercise limitations present oxygen pulse morphology with early flattening (plateau) during the cardiopulmonary exercise test (CPET). Although this oxygen pulse response is well known in cardiac patients, these changes' prevalence and clinical relevance in asymptomatic individuals are not known. We aimed to quantify the proportion of asymptomatic adults with an early flattening of the oxygen pulse and investigate its association with classical cardiovascular risk factors. METHODS: We carried out a cross-sectional study with a sample of 824 adults aged between 18 and 80 years. We assessed anthropometry, body composition, and cardiovascular risk. In addition, we obtained cardiorespiratory and metabolic responses during a ramp protocol treadmill CPET. RESULTS: The prevalence of early flattening of the oxygen pulse was 36.8%. These participants were predominantly females, older, less educated, with a higher body mass and percentage of fat and a lower percentage of lean body mass. After a multinominal multiple logistic regression analysis, we identified female sex (odds ratio, 5.46: 95% confidence interval, 3.73-7.99), low education (2.24: 1.47-3.42), dyslipidemia (1.67: 1.14-2.45), smoking (1.64: 1.00-2.69), and physical inactivity (1.39: 1.02-1.96) as the leading independent predictors of the early flattening of oxygen pulse. CONCLUSION: The early flattening of oxygen pulse is common in asymptomatic adults and is highly determined by modifiable cardiovascular risk factors. These results suggest that identifying the early flattening of oxygen pulse may be helpful in the prevention of cardiovascular diseases.

Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study.

We investigated whether cardiorespiratory fitness (CRF) mediates the association between moderate-to-vigorous physical activity (MVPA) and lung function in asymptomatic adults. We examined the cross-sectional results of 1362 adults aged 18-80 years from the Epidemiology and Human Movement Study. Participants were submitted to spirometry to obtain forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Additionally, we used cardiopulmonary exercise testing to obtain peak oxygen uptake (V˙O2) as a measure of CRF. Participants used a triaxial accelerometer for 4-7 days to obtain MVPA. Mediation analyses were performed considering the CRF as a mediator, MVPA as an independent variable, and FVC and FEV1 as dependent variables with adjustment for age, sex, and cardiovascular risk score. We aimed to investigate the total (path c) and direct (paths a, b, c') effects through the regression coefficients. We also examined the indirect effect, which was obtained from the product of the coefficients (path ab). Our sample was composed mainly of overweight and middle-aged women. MVPA was positively related to CRF (path a), as well as CRF and lung function (path b). MVPA also presented a significant positive total effect (path c) in the lung function. However, this relationship became non-significant when CRF was included in the model for both FVC and FEV1 (path c'). We did not observe a direct effect of MVPA on the lung function. In contrast, the indirect effect was significant (path ab). Lastly, CRF mediated 60% of the total effect of MVPA on FVC and 61.9% on FEV1. CRF mediates the relationship between lung function and MVPA in asymptomatic adults. Therefore, our results reinforce the need to include CRF assessment in practice clinical routine and suggest that strategies focusing on CRF might be more promising to prevent respiratory diseases in adults.

Resilience Improves the Quality of Life and Subjective Happiness of Physiotherapists during the COVID-19 Pandemic.

Resilience is an individual characteristic that protects mental health. However, its impact on the lives of Brazilian physiotherapists during COVID-19 is not known. This study aimed to analyze whether resilience modulates the perceived quality of life (QoL) and subjective happiness (SH) of physiotherapists who work with COVID-19 patients, compared with those who do not. A cross-sectional study was conducted between 22 August and 22 October 2020. Physiotherapists working in critical and non-critical hospital sectors were invited to participate in the study. The participants completed sociodemographic questionnaires and were graded on the 14-item Resilience Scale, 36-item Short-Form Health Survey (SF-36), and the Subjective Happiness Scale. In total, 519 physiotherapists were enrolled in the study. Physiotherapists with low resilience who worked with COVID-19 patients reported lower scores on the SF-36 subscales (except for social functioning) and the Subjective Happiness Scale, compared with those with high resilience who did not work with COVID-19 patients. These responses were modulated by age, sex, absence from work, receipt of personal protective equipment, host leadership, and practice and maintenance of regular physical activity. In conclusion, physiotherapists with low resilience who worked with COVID-19 patients presented lower perceptions of QoL and SH, compared with the other study participants.

Self-Administered Six-Minute Walk Test Using a Free Smartphone App in Asymptomatic Adults: Reliability and Reproducibility.

BACKGROUND: The 6-min walk test (6MWT) is a simple, inexpensive, reliable, and reproducible test that provides a reasonable estimate of the cardiorespiratory fitness (CRF). We aimed to assess the reliability and reproducibility of a self-administered 6MWT in asymptomatic adults using a free smartphone app. METHODS: In the 1st phase, 93 participants underwent a supervised 6MWT (6MWTsup) in a 30 m indoor corridor, using a triaxial accelerometer and their smartphones to compare the total step counts and to develop a 6-min walk distance (6MWD) prediction equation. In the 2nd phase, 25 participants performed the 6MWTsup and two self-administered 6MWTs outdoors (6MWTsa1 and 6MWTsa2, at least 48 h apart) using a free smartphone app. RESULTS: The agreement between accelerometer- and app-based total step counts was limited (mean difference, -58.7 steps (-8.7%): 95% confidence interval, -326.5 (-46.8%) to 209.1 (29.3%)). The best algorithm for predicting the 6MWTsupm included: 795.456 + (0.815 heightm app-steps) - (1.620 ageyears) - (3.005 weightkg) - (1.155 app-steps), R2 = 0.609). The intraclass correlation coefficient between 6MWTsa2 and 6MWTsa1 was excellent (0.91: 0.81-0.96). The coefficient of variation was 6.4%. The agreement between the two self-administered tests was narrow (-1.9 (0.2%) meters: -57.4 (-9.5%) to 61.3 (9.9%)). CONCLUSIONS: The self-administered 6MWT has excellent reliability and reproducibility in asymptomatic adults, being a valuable tool for assessing CRF in community-based interventions.

Effect Modification of Cardiorespiratory Fitness, Obesity, and Physical Activity in Adults.

We investigated if cardiorespiratory fitness modifies the association between obesity and the level of physical activity. In this cross-sectional study, we analyzed data from 746 adults, free of diagnosed cardiorespiratory or locomotor diseases. We analyzed sociodemographic and clinical information, cardiovascular risk factors, cardiorespiratory fitness, anthropometry, and level of physical activity (time spent in moderate-to-vigorous physical activity). Those that spent more time in moderate-to-vigorous physical activity were younger, male, with lower body mass index, without self-reported arterial blood hypertension, diabetes and dyslipidemia, non-smokers, and presented with better cardiorespiratory fitness. The linear regression coefficients showed that cardiorespiratory fitness changes according to the level of physical activity and body mass index (obesity in low cardiorespiratory fitness: ß 6.0, p=0.213, 95%CI-3.5 to 15.6; in intermediate cardiorespiratory fitness: ß 6.3, p=0.114, 95%CI-1.5 to 14.2; in high cardiorespiratory fitness: ß-6.3, p=0.304, 95%CI-18.4 to 5.8). This effect modification trend was present after adjusting the model by covariates. Cardiorespiratory fitness potentially modifies the association between body mass index and the level of physical activity. It should be routinely assessed to identify persons with overweight/ obesity with low/ intermediate cardiorespiratory fitness to prescribe individualized training.

Effects of Substituting Sedentary Behavior with Light-Intensity or Moderate-to-Vigorous Physical Activity on Obesity Indices in Adults: A Prospective Short-Term Follow-Up Study.

BACKGROUND: Sedentary behavior (SB) is an independent risk factor for cardiovascular diseases. We hypothesized that there may be benefits of replacing SB with light-intensity (LIPA) and moderate-to-vigorous (MVPA) physical activity. Substituting SB with LIPA and MVPA might be associated with body composition changes. METHODS: We assessed body weight, body mass index (BMI), fat body mass (FBM), and physical activity level, as well as one-year changes, in 780 adults (EPIMOV Study). RESULTS: We analyzed into 10-min blocks SB, LIPA, MVPA, and total wear time. After 14 ± 3 months of follow-up, there were 242 completed procedures. We reallocated time spent in SB to LIPA or MVPA and assessed cross-sectional and prospective associations with the outcomes using isotemporal substitution models. In cross-sectional analysis, substituting 10-min blocks of SB with MVPA led to significant decreases of 1.23 kg in body weight, 0.30 kg/m² in BMI, and 0.38% in FBM. 10-min blocks substituting SB with LIPA produced significantly lower body weight (1 kg) and BMI (0.1 kg/m²) values. In longitudinal analysis, reallocating SB to MVPA was only associated with FBM decline (-0.31%). CONCLUSIONS: Substituting SB with MVPA is associated with significant improvement in obesity indices in both cross-sectional and follow-up. Replacing SB with LIPA produced a less consistent impact.

Factors related to the adoption and adherence of physical activity mobile applications by older people: a scoping review protocol.

INTRODUCTION: Ageing is a natural process marked by physiological changes and declines in functional capacity. One strategy to encourage healthy habits in older people is the use of applications on mobile devices to promote physical activity (PA). An immediate challenge is for these applications to be accessible to older people themselves, while a second challenge is to retain their interest and engagement in connection with PA itself. Therefore, the purpose of this review is to map the factors related to the adoption and adherence of PA mobile applications by older people. METHODS AND ANALYSIS: Five databases will be searched where articles and reviews, available between 2010 and present, in English, Portuguese or Spanish, at full text, will be included. In addition, two additional strategies will be performed, including grey literature. The search terms adoption, adherence, factors, mobile application, PA, older people and other terms related to them will be used in the search strategy. This review will include studies that identify factors related to the adoption and adherence to PA mobile applications by people over 60 years. The selection of studies will be carried out by two reviewers in five stages: identification of studies and duplicate removal; pilot test; selection by reading abstracts; inclusion by reading the full text and search in additional sources. Disagreements will be resolved by a third reviewer. Data will be extracted using a data extraction tool. Quantitative data will be described in a narrative manner and qualitative data will be categorised through inductive thematic analysis. ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review. Plans for the dissemination of the review include the presentation of the results at relevant scientific conferences and the submission and publication in significant journals.

Dynamic physiological responses in obese and non-obese adults submitted to cardiopulmonary exercise test.

PURPOSE: Obese individuals have reduced performance in cardiopulmonary exercise testing (CPET), mainly considering peak values of variables such as oxygen uptake ([Formula: see text]), carbon dioxide production ([Formula: see text]), tidal volume (Vt), minute ventilation ([Formula: see text]) and heart rate (HR). The CPET interpretation and prognostic value can be improved through submaximal ratios analysis of key variables like [Formula: see text], [Formula: see text], [Formula: see text] [Formula: see text] and oxygen uptake efficiency slope (OUES). The obesity influence on these responses has not yet been investigated. Our purpose was to evaluate the influence of adulthood obesity on maximal and submaximal physiological responses during CPET, emphasizing the analysis of submaximal dynamic variables. METHODS: We analyzed 1,594 CPETs of adults (755 obese participants, Body Mass Index ≥ 30 kg/m2) and compared the obtained variables among non-obese (normal weight and overweight) and obese groups (obesity classes I, II and III) through multivariate covariance analyses. RESULT: Obesity influenced the majority of evaluated maximal and submaximal responses with worsened CPET performance. Cardiovascular, metabolic and gas exchange variables were the most influenced by obesity. Other maximal and submaximal responses were altered only in morbidly obese. Only a few cardiovascular and ventilatory variables presented inconsistent results. Additionally, Vtmax, [Formula: see text], Vt/Inspiratory Capacity, Vt/Forced Vital Capacity, Lowest [Formula: see text], [Formula: see text], and the y-intercepts of [Formula: see text] did not significantly differ regardless of obesity. CONCLUSION: Obesity expressively influences the majority of CPET variables. However, the prognostic values of the main ventilatory efficiency responses remain unchanged. These dynamic responses are not dependent on maximum effort and may be useful in detecting incipient ventilatory disorder. Our results present great practical applicability in identifying exercise limitation, regardless of overweight and obesity.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network.

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Association between the handgrip strength and the isokinetic muscle function of the elbow and the knee in asymptomatic adults.

BACKGROUND: The handgrip strength is a practical, valid, reliable, low-cost tool that presents strong correlations with several health conditions. However, handgrip strength may be inaccurate to prospectively predict the variability of muscular function since the decrease in muscular strength over the years varies according to a muscular group or between upper and lower limbs. Our hypothesis is that the handgrip strength cannot explain the variance of muscle function prospectively. PURPOSE: The aim of this study was to evaluate the cross-sectional and prospective association between handgrip strength and isokinetic muscle function of the knee and elbow in 780 asymptomatic adults. METHODS: In a sample of 780 adults, we obtained handgrip strength and elbow and knee muscle function (for both flexion and extension at 60°/s and 300°/s) using, respectively, a hydraulic dynamometer and an isokinetic dynamometer. In a cross-sectional analysis, we analyzed the data obtained from baseline assessment. Then, we calculated the absolute change as a result of the variation data between the baseline and the 1-year follow-up assessment of each participant. The correlations were analyzed using Pearson or Spearman coefficients. We used multivariate models to investigate the association between handgrip strength and isokinetic muscle function. RESULTS AND DISCUSSION: The cross-sectional correlations were significantly moderate-to-strong (r = 0.41-0.71, p < 0.01), but became weak-to-moderate (r = 0.26-0.34, p < 0.01) prospectively. In the cross-sectional analysis, the handgrip strength was selected as a strong predictor for isokinetic variables (∆R 2 = 0.171-0.583, p < 0.05) as expected. Although handgrip strength was also selected as a significant predictor in prospective analysis, it explained only a little variance in isokinetic muscle function of the knee (∆R 2 = 0.7-0.117, p < 0.05). Regarding the predictive models for the elbow, handgrip strength was not selected prospectively. CONCLUSION: The 1-year absolute change of the handgrip strength cannot explain the variance of the isokinetic muscle function. Thus, specific measures are required for assessing muscle function in epidemiological studies.

Tailoring digital apps to support active ageing in a low income community.

Despite physical activity being one of the determinants of healthy aging, older people tend to become less active over the years. Maintaining physical activity levels during the life course is a motivational challenge. Digital tools have been used to change this pattern, such as smartphone applications to support physical activity; but there is a lack of in-depth research on the diversity of user's experiences, especially considering older users or non-users of information and communication technologies. OBJECTIVE: Our goal was to identify requirements for designing a mobile app to encourage physical activity in a low-income community population of older people in Brazil (i.e. over 40 years old). METHOD: We conducted a qualitative focus group study, involving by co-design of a physical activity application (Pacer)®. Seventeen volunteers were divided into 2 focus groups of physical active and insufficiently active, and 2 further 4 subgroups in each characterised by digital engagement. The following procedures were performed: (i) baseline assessments; (ii) a focus group with physically active older people and a focus group with insufficiently active older people (iii) design activities with both groups to re-design Pacer. RESULTS: Developing physical activity apps for older people should consider the following features: free application, simple interface, motivational messages using audio and visual information, sharing information among users, multimedia input and sharing and user customisation. In particular, we recommend that exercise apps in low-income communities be tailored to our four categories of users differing in baseline physical activity and digital engagement, to match the social and behavioural preferences we discovered.

Use of a Smartphone App to Increase Physical Activity Levels in Insufficiently Active Adults: Feasibility Sequential Multiple Assignment Randomized Trial (SMART).

BACKGROUND: The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity. OBJECTIVE: We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants' perception regarding the protocol and the use of the app for physical activity qualitatively. METHODS: We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention. RESULTS: Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median -198 steps/day [IQR -279 to -103] to 20 steps/day [IQR -204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants' reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals. CONCLUSIONS: The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/.

Pattern of respiratory muscle activity during exercise tests in children born prematurely.

INTRODUCTION: Preterm children display only slightly lower exercise capacity than term children do during their development, despite their previous cardiopulmonary impairments. This raises doubts about the role of the respiratory muscles' influence on exercise capacity. This study aimed to compare respiratory muscle activity in preterm and term children using an exercise test. METHODS: This cross-sectional study involved comparison of 35 term children and 39 matched preterm children aged 6-9 years, who were born prematurely with a birth weight <1500 g. An adapted treadmill incremental test was utilized and surface electromyography of the sternocleidomastoid (SCM), upper trapezius (UT), and rectus abdominis (RA) muscles was performed. The root mean square was calculated every minute and compared between and within groups. A Monte Carlo simulation was also applied, and the area under the curve was calculated to evaluate the differences between groups. RESULTS: During the entire exercise, the SCM muscle activity was higher in preterm children with a larger area under the curve than in the term children. There was no difference in the RA and UT muscle activity between groups throughout the test. CONCLUSION: The results suggest a greater contribution of the SCM muscle sin preterm children's performance than in term children's performance during high-intensity exercises. TRIAL REGISTRATION: Brazilian Clinical Trial Registry (ReBec) - RBR-89hr2h.

Effects of the juçara fruit supplementation on metabolic parameters in individuals with obesity: a double-blind randomized controlled trial.

Adipose tissue inflammation has been proposed as a central mechanism connecting obesity with its metabolic and vascular complications due to the imbalance in the expression of several hormones and adipokines. Berries rich in polyphenols and unsaturated fatty acids have been able to prevent both obesity and adipose tissue inflammation, improving metabolic functions in human subjects and animal models of obesity. Juçara has been considered a super fruit owing to its nutritional composition and relevant biological activities with an interesting response in animals. Thus, we aimed to verify the potential antiobesogenic effect of juçara supplementation in humans. We conducted a double-blind, placebo-controlled, randomized trial with 35 adults with obesity of both sexes. They were assessed for resting metabolic rate, anthropometry and body composition, blood pressure, metabolic parameters and adipokines. Subsequently, they were randomized into two groups to use or not (placebo) 5 g lyophilized juçara for 6 weeks. Supplementation with juçara was significantly effective in reducing body fat, increasing high-density lipoprotein cholesterol and doubling serum adiponectin. Besides, juçara supplementation, high-density lipoprotein cholesterol and neck circumference were predictors to explain the enhancement in adiponectin. Juçara supplementation was determinant to improve adiponectin levels, and it may be considered a novel strategy for the treatment of obesity-related metabolic diseases.

Evaluation of Inflammatory Markers in Patients Undergoing a Short-Term Aerobic Exercise Program while Hospitalized due to Acute Exacerbation of COPD.

INTRODUCTION: Acute exacerbation is an important factor for a worse prognosis in patients with chronic obstructive pulmonary disease (COPD). It promotes the increase of the inflammatory process and worsens quality of life, lung function, and muscle weakness. It is believed that physical exercise performed during the exacerbation breaks the vicious cycle of systemic manifestations without an increase in the inflammatory process. OBJECTIVE: To evaluate the influence of short-term aerobic physical exercise during hospitalization on inflammatory markers. Patients and Methods. 26 patients were evaluated (69.2% female, FEV 137.5 ± 12.9%, and age 68.4 ± 11.6 years) 24 hours after hospitalization for smoking history, Charlson index, quality of life, systemic inflammatory markers, and body composition. After 48 hours of hospitalization, all patients underwent a 6-minute walk test (6MWT) and a new spirometry test, and BODE index was calculated. After 72 hours of hospitalization, patients in the intervention group underwent aerobic exercise on a treadmill for 15 minutes twice daily; before and after the aerobic exercise, blood samples were collected for evaluation of inflammatory markers. Finally, a month after hospital discharge, all patients were reevaluated according to systemic inflammatory markers, quality of life, body composition, spirometry, 6MWT, and BODE index. RESULTS: Patients of both groups did not differ in severity of disease and general characteristics. The intervention group did not show worsening in the inflammatory process after aerobic activity: TNF-α from 1.19 (0 99-1.71) to 1.21 (0.77-1.53) (p = 0.58), IL-6 from 2.41 (2.02-0.58) to 2.66 (1.69-0.48) (p = 0.21), and CRP from 3.88 (2.26-8.04) to 4.07 (2.65-13.3) (p = 0.56). There was a negative correlation between the IL-6 marker and the 6MWT; that is, with the reduction in inflammatory levels, there was an improvement in exercise capacity one month after hospital discharge. CONCLUSION: The present study showed that the aerobic physical activity initiated during hospitalization in patients with exacerbated COPD did not worsen the inflammatory process.

The Design and Development of a Personalized Leisure Time Physical Activity Application Based on Behavior Change Theories, End-User Perceptions, and Principles From Empirical Data Mining.

Introduction: Many adults do not reach the recommended physical activity (PA) guidelines, which can lead to serious health problems. A promising method to increase PA is the use of smartphone PA applications. However, despite the development and evaluation of multiple PA apps, it remains unclear how to develop and design engaging and effective PA apps. Furthermore, little is known on ways to harness the potential of artificial intelligence for developing personalized apps. In this paper, we describe the design and development of the Playful data-driven Active Urban Living (PAUL): a personalized PA application. Methods: The two-phased development process of the PAUL apps rests on principles from the behavior change model; the Integrate, Design, Assess, and Share (IDEAS) framework; and the behavioral intervention technology (BIT) model. During the first phase, we explored whether location-specific information on performing PA in the built environment is an enhancement to a PA app. During the second phase, the other modules of the app were developed. To this end, we first build the theoretical foundation for the PAUL intervention by performing a literature study. Next, a focus group study was performed to translate the theoretical foundations and the needs and wishes in a set of user requirements. Since the participants indicated the need for reminders at a for-them-relevant moment, we developed a self-learning module for the timing of the reminders. To initialize this module, a data-mining study was performed with historical running data to determine good situations for running. Results: The results of these studies informed the design of a personalized mobile health (mHealth) application for running, walking, and performing strength exercises. The app is implemented as a set of modules based on the persuasive strategies "monitoring of behavior," "feedback," "goal setting," "reminders," "rewards," and "providing instruction." An architecture was set up consisting of a smartphone app for the user, a back-end server for storage and adaptivity, and a research portal to provide access to the research team. Conclusions: The interdisciplinary research encompassing psychology, human movement sciences, computer science, and artificial intelligence has led to a theoretically and empirically driven leisure time PA application. In the current phase, the feasibility of the PAUL app is being assessed.

Aerobic Capacity of Preterm Children with Very Low Birth Weight at School Age and its Associated Factors.

INTRODUCTION: Respiratory morbidities of preterm infants can cause significant ventilatory impairment thus compromising the aerobic capacity in childhood and adolescence. Therefore, the present study was conducted to evaluate the aerobic capacity in school age preterm children with VLBW and its associated factors. METHODS: A cross-sectional study was conducted among preterm born with VLBW and term children, both aged 6-9 years. An individualized symptom-limited treadmill testing protocol performed aerobic capacity. Measured variables: oxygen pulse (PuO2), percentage of maximum heart rate for age (%HR max), tidal volume/inspiratory capacity ratio (TV/IC), oxygen consumption (VO2) peak, and the ratio of the anaerobic threshold of gas exchange to the predicted percentage of maximum VO2 (VO2@LA/%VO2 max.pred.) were compared between groups. Univariate and multiple linear regression analyses were used to determine the factors associated with aerobic capacity. RESULTS: Thirty-four preterm and 32 term children were included. Similar VO2 peak and the other variables were observed. The development of bronchopulmonary dysplasia (BPD) and being obese/overweight was positively associated with %HR max. The Z-score for height/age and birth weight <1000g was positively associated with PuO2 and peak VO2, and negatively associated with overweight/obesity and female sex. CONCLUSIONS: Aerobic capacity was similar in both groups. Sex, development of BPD, birth weight <1000g and factors related to body growth, such as Z-score for height/age and overweight/obesity, were associated with aerobic capacity in preterm children with VLBW.