A Comparison of Objectively Measured Free-Living Physical Behaviour in Adults with and without Lower Limb Amputation.

Objectively monitored free-living physical behaviours of adults with and without lower limb amputation (LLA) were compared. METHODS: 57 adults with LLA wore an activPAL3™ for 8 days. A comparison data set (n = 57) matched on gender, age and employment status was used. Variables included: time sitting; standing; stepping; sit-to-stand transitions; step count and cadence. Comparisons were made between adults with and without LLA and between gender, level and cause of amputation. RESULTS: Participants with LLA due to trauma versus circulatory causes were less sedentary and more active; however, no difference in physical behaviour was recorded across gender or level of amputation. Participants with LLA spent more time sitting (p < 0.001), less time standing and stepping (p < 0.001) and had a lower step count (p < 0.001). Participants with LLA took more steps in cadence bands less than 100 steps·min-1 and fewer steps in cadence bands greater than 100 steps·min-1 compared to participants without LLA. CONCLUSIONS: People with LLA were less active and more sedentary than people without LLA and participated in less activity at a moderate or higher intensity when matched on age, gender and employment. Interventions are needed to promote active lifestyles in this population.

Exercise and Protein Effects on Strength and Function with Weight Loss in Older Women.

Obesity negatively affects lower extremity physical function (LEPF) in older adults. Exercise and a higher protein diet are both known to positively and independently affect body composition, muscle strength, and LEPF during weight loss; however, their potential interactive effects have not been well characterized in older women. PURPOSE: The aim of this study was to determine the relative efficacy of a higher protein diet with or without exercise to improve body composition, muscle strength, and LEPF in older inactive overweight/obese women after weight loss. METHODS: Postmenopausal women (body mass index = 31.1 ± 5.1 kg·m, 69.2 ± 3.6 yr) completed a 6-month weight loss program after randomization to three groups (n = 72 randomized; 15% dropout): 1) higher protein diet (PRO, ~30% energy from protein; n = 20), 2) PRO plus exercise (PRO + EX; n = 19), or 3) a conventional protein control diet plus EX (CON + EX, ~18% energy from protein; n = 22). EX was supervised, multicomponent (aerobic, muscle strengthening, balance, and flexibility), and three sessions per week. Body composition was measured via dual-energy x-ray absorptiometry, leg strength by isokinetic dynamometry, and LEPF via 6-min walk, 8-ft up and go, and 30-s chair stand tests. RESULTS: Changes in weight (-7.5 ± 4.1 kg; -9.2% ± 4.8%), fat mass, and leg lean mass did not differ among groups (all P > 0.50). Despite weight loss, muscle strength improved in the exercise groups (PRO + EX and CON + EX) but it declined in the PRO group (P = 0.008). For all LEPF measures, the PRO group had attenuated improvements compared with both PRO + EX and CON + EX (all P < 0.01). CONCLUSION: Exercise during weight loss is critical to preserve strength and enhance LEPF; however, a higher protein diet does not appear to influence body composition, muscle strength, or LEPF changes when combined with multicomponent exercise.

How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review.

BACKGROUND: Cadence (steps/min) may be a reasonable proxy-indicator of ambulatory intensity. A summary of current evidence is needed for cadence-based metrics supporting benchmark (standard or point of reference) and threshold (minimums associated with desired outcomes) values that are informed by a systematic process. OBJECTIVE: To review how fast, in terms of cadence, is enough, with reference to crafting public health recommendations in adults. METHODS: A comprehensive search strategy was conducted to identify relevant studies focused on walking cadence and intensity for adults. Identified studies (n=38) included controlled (n=11), free-living observational (n=18) and intervention (n=9) designs. RESULTS: There was a strong relationship between cadence (as measured by direct observation and objective assessments) and intensity (indirect calorimetry). Despite acknowledged interindividual variability, ≥100 steps/min is a consistent heuristic (e.g, evidence-based, rounded) value associated with absolutely defined moderate intensity (3 metabolic equivalents (METs)). Epidemiological studies report notably low mean daily cadences (ie, 7.7 steps/min), shaped primarily by the very large proportion of time (13.5 hours/day) spent between zero and purposeful cadences (<60 steps/min) at the population level. Published values for peak 1-min and 30-min cadences in healthy free-living adults are >100 and >70 steps/min, respectively. Peak cadence indicators are negatively associated with increased age and body mass index. Identified intervention studies used cadence to either prescribe and/or quantify ambulatory intensity but the evidence is best described as preliminary. CONCLUSIONS: A cadence value of ≥100 steps/min in adults appears to be a consistent and reasonable heuristic answer to 'How fast is fast enough?' during sustained and rhythmic ambulatory behaviour. TRIAL REGISTRATION NUMBER: NCT02650258.

The Brighton musculoskeletal Patient-Reported Outcome Measure (BmPROM): An assessment of validity, reliability, and responsiveness.

BACKGROUND: In response for the need of a freely available, stand-alone, validated outcome measure for use within musculoskeletal (MSK) physiotherapy practice, sensitive enough to measure clinical effectiveness, we developed an MSK patient reported outcome measure. OBJECTIVES: This study examined the validity and reliability of the newly developed Brighton musculoskeletal Patient-Reported Outcome Measure (BmPROM) within physiotherapy outpatient settings. METHODS: Two hundred twenty-four patients attending physiotherapy outpatient departments in South East England with an MSK condition participated in this study. The BmPROM was assessed for user friendliness (rated feedback, N = 224), reliability (internal consistency and test-retest reliability, n = 42), validity (internal and external construct validity, N = 224), and responsiveness (internal, n = 25). RESULTS: Exploratory factor analysis indicated that a two-factor model provides a good fit to the data. Factors were representative of "Functionality" and "Wellbeing". Correlations observed between the BmPROM and SF-36 domains provided evidence of convergent validity. Reliability results indicated that both subscales were internally consistent with alphas above the acceptable limits for both "Functionality" (α = .85, 95% CI [.81, .88]) and 'Wellbeing' (α = .80, 95% CI [.75, .84]). Test-retest analyses (n = 42) demonstrated a high degree of reliability between "Functionality" (ICC = .84; 95% CI [.72, .91]) and "Wellbeing" scores (ICC = .84; 95% CI [.72, .91]). Further examination of test-retest reliability through the Bland-Altman analysis demonstrated that the difference between "Functionality" and "Wellbeing" test scores did not vary as a function of absolute test score. Large treatment effect sizes were found for both subscales (Functionality d = 1.10; Wellbeing 1.03). CONCLUSION: The BmPROM is a reliable and valid outcome measure for use in evaluating physiotherapy treatment of MSK conditions.

Classroom-Based Physical Activity and Sedentary Behavior Interventions in Adolescents: A Systematic Review and Meta-Analysis.

BACKGROUND: It is reported that 81% of adolescents are insufficiently active. Schools play a pivotal role in promoting physical activity (PA) and reducing sedentary behavior (SB). The aim of this systematic review and meta-analysis was to evaluate classroom-based PA and SB interventions in adolescents. METHODS: A search strategy was developed using the Population Intervention Comparison Outcome Study (PICOS) design framework. Articles were screened using strict inclusion criteria. Study quality was assessed using the Effective Public Health Practice Project quality assessment tool ( http://www.ephpp.ca/tools.html ). Outcome data for preintervention and postintervention were extracted, and effect sizes were calculated using Cohen's d. RESULTS: The strategy yielded 7574 potentially relevant articles. Nine studies were included for review. Study quality was rated as strong for 1 study, moderate for 5 studies, and weak for 3 studies. Five studies were included for meta-analyses, which suggested that the classroom-based interventions had a nonsignificant effect on PA (P = .55, d = 0.05) and a small, nonsignificant effect on SB (P = .16, d = -0.11). CONCLUSION: Only 9 relevant studies were found, and the effectiveness of the classroom-based PA and SB interventions varied. Based on limited empirical studies, there is not enough evidence to determine the most effective classroom-based methodology to increase PA and SB.

Effectiveness of active school transport interventions: a systematic review and update.

BACKGROUND: Active school transport (AST) is a promising strategy to increase children's physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. METHODS: Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen's d as a measure of effect size. RESULTS: Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen's d ranged from -0.61 to 0.75, with most studies reporting "trivial-to-small" positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. CONCLUSIONS: Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. TRIAL REGISTRATION: Registered in PROSPERO: CRD42016033252.

Associations between metabolic syndrome components and markers of inflammation in Welsh school children.

We investigated the multivariate dimensionality and strength of the relationship between metabolic syndrome (MetS) and inflammation in children. Caucasian school children (N = 229; 12-14 years) from Wales were tested on several health indicators including measures of body composition, inflammation, fasting glucose regulation, blood pressure, and lipids. The multivariate association between MetS and inflammation was investigated via canonical correlation analysis. Data were corrected for non-normality by log transformation, and sex-specific z-scores computed for variables where there was a significant sex difference. Structure r's were interpreted to determine the dimensions of MetS and inflammation responsible for significant canonical variates. The overall multivariate association between MetS and inflammation was significant (Wilks' Lambda = 0.54, p < 0.001). The relationship was explained primarily by the waist circumference dimension of MetS (CC = 0.87) and inflammatory markers of fibrinogen (CC = 0.52) and C-reactive protein (CC = 0.50). The pattern of results was similar regardless of whether variables were adjusted for sex differences. CONCLUSION: Central adiposity is the strongest predictor of the inflammatory aspect of cardiovascular disease risk in Caucasian adolescents. Future research into MetS and cardiometabolic risk should consider multivariate statistical approaches, in order to identify the separate contributions of each dimension in interrelationships and to identify which dimensions are influenced by preventive interventions. What is Known: • Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease (CVD) and type 2 diabetes. Markers of inflammation are also potential predictors of later development of CVD and type 2 diabetes. • The contribution of individual markers in interrelationships between MetS and inflammation is unknown. What is New: • We uniquely demonstrate that within a multivariate model, waist circumference is the primary link between MetS variables and markers of inflammation in children. • Waist circumference may therefore be a useful population-level screening tool to identify future risk of CVD.

Impact of physical activity domains on subsequent physical activity in youth: a 5-year longitudinal study.

This study evaluates how domains of physical activity (PA) in youth predict later PA and assesses factors influencing changes in sports participation. Young people from the Children's Sport Participation and Physical Activity study (n = 873; baseline age 10-18 years; 30.4% male) completed self-report surveys in 2009 and 2014. In a multiple linear regression analysis, participation frequency in club sport (ß = 0.18) and extracurricular sport (ß = 0.13) significantly predicted PA 5 years later, adjusted for age, sex and urban/rural classification (P < 0.01). Overall, rates of regular (at least once per week) youth sports participation were high (males 79.3-85.5%; females 74.8-83.2%). Uptake and dropout of specific sports varied widely. Despite high levels of migration into and out of Gaelic games, they remained popular at follow-up. Weight training was the only sport that increased in both sexes (P < 0.05). Fitness, friends and enjoyment were top motivations for taking up a new sport. Other commitments, a lack of interest and time were important factors leading to sports dropout. PA promotion strategies should include youth sport, take into consideration what sports are attractive to young people and address reasons for uptake and dropout.

Measuring free-living physical activity in COPD patients: Deriving methodology standards for clinical trials through a review of research studies.

This article presents a review of the research literature to identify the methodology used and outcome measures derived in the use of accelerometers to measure free-living activity in patients with COPD. Using this and existing empirical validity evidence we further identify standards for use, and recommended clinical outcome measures from continuous accelerometer data to describe pertinent measures of sedentary behaviour and physical activity in this and similar patient populations. We provide measures of the strength of evidence to support our recommendations and identify areas requiring continued research. Our findings support the use of accelerometry in clinical trials to understand and measure treatment-related changes in free-living physical activity and sedentary behaviour in patient populations with limited activity.

Measurement Considerations of Peak Stepping Cadence Measures Using National Health and Nutrition Examination Survey 2005-2006.

BACKGROUND: This study examined the optimal measurement conditions to obtain reliable peak cadence measures using the accelerometer-determined step data from the National Health and Nutrition Examination Survey 2005-2006. METHODS: A total of 1282 adults (> 17 years) who provided valid accelerometer data for 7 consecutive days were included. The peak 1- and 30-minute cadences were extracted. The sources of variance in peak stepping cadences were estimated using Generalizability theory analysis. A simulation analysis was conducted to examine the effect of the inclusion of weekend days. The optimal number of monitoring days to achieve 80% reliability for peak stepping cadences were estimated. RESULTS: Intraindividual variability was the largest variance component of peak cadences for young and middle-aged adults aged < 60 years (50.55%-59.24%) compared with older adults aged ≥ 60 years (31.62%-41.72%). In general, the minimum of 7 and 5 days of monitoring were required for peak 1- and 30-minute cadences among young and middle-aged adults, respectively, whereas 3 days of monitoring was sufficient for older adults to achieve the desired reliability (0.80). The inclusion of weekend days in the monitoring frame may not be practically important. CONCLUSIONS: The findings could be applied in future research as the reference measurement conditions for peak cadences.

Validity of a two-item physical activity questionnaire for assessing attainment of physical activity guidelines in youth.

BACKGROUND: As physical activity is important for health and well-being, it is essential to monitor population prevalence of physical activity. Surveillance is dependent on the use of valid and reliable measurement tools. The PACE+ questionnaire is used globally in youth and has acceptable reliability; however it has not been validated in a European sample. The purpose of this study is to validate this instrument in a sample of 10-18 year old Irish youth. METHODS: Participants (n = 419, 45.7 % male) completed the PACE+ two-item questionnaire and were asked to wear an Actigraph accelerometer for eight consecutive days. Freedson cut-points were used to estimate moderate to vigorous physical activity from accelerometer counts. Analyses compared self-report and accelerometry data in participants with (1) ≥5 and (2) seven valid accelerometer days. Calculations were performed for the whole sample, and were stratified by sex and school level (primary; post-primary). RESULTS: Spearman correlations between self-reported physical activity levels and accelerometry derived minutes of moderate-to-vigorous physical activity per day were small (r = 0.27; seven valid days) to moderate (r = 0.34; ≥5 valid days). Higher correlations were found in older participants (post-primary r = 0.39; primary r = 0.24) and females (r = 0.39; males r = 0.27) using ≥5 valid days. The agreement level was high (68-96 %). The accuracy of classifying those not meeting the guidelines (specificity) was moderate to high (59-100 %). CONCLUSIONS: The PACE+ self-report instrument has acceptable validity for assessing non-achievement of the adolescent physical activity recommendations. The validity is higher in females and increases with age. The continued use of the tool is recommended and will allow for comparability between studies, tracking of physical activity over time including trends in youth population prevalence.

Muscle volume is related to trabecular and cortical bone architecture in typically developing children.

INTRODUCTION: Muscle is strongly related to cortical bone architecture in children; however, the relationship between muscle volume and trabecular bone architecture is poorly studied. The aim of this study was to determine if muscle volume is related to trabecular bone architecture in children and if the relationship is different than the relationship between muscle volume and cortical bone architecture. MATERIALS AND METHODS: Forty typically developing children (20 boys and 20 girls; 6 to 12y) were included in the study. Measures of trabecular bone architecture [i.e., apparent trabecular bone volume to total volume (appBV/TV), trabecular number (appTb.N), trabecular thickness (appTb.Th) and trabecular separation (appTb.Sp)] in the distal femur, cortical bone architecture [cortical volume, total volume, section modulus (Z) and polar moment of inertia (J)] in the midfemur, muscle volume in the midthigh and femur length were assessed using magnetic resonance imaging. Total physical activity and moderate-to-vigorous physical activity were assessed using an accelerometer-based activity monitor worn around the waist for four days. Calcium intake was assessed using diet records. Relationships among the measures were tested using multiple linear regression analysis. RESULTS: Muscle volume was moderately-to-strongly related to measures of trabecular bone architecture [appBV/TV (r=0.81), appTb.N (r=0.53), appTb.Th (r=0.67), appTb.Sp (r=-0.71); all p<0.001] but more strongly related to measures of cortical bone architecture [cortical volume (r=0.96), total volume (r=0.94), Z (r=0.94) and J (r=0.92; all p<0.001)]. Similar relationships were observed between femur length and measures of trabecular (p<0.01) and cortical (p<0.001) bone architecture. Sex, physical activity and calcium intake were not related to any measure of bone architecture (p>0.05). Because muscle volume and femur length were strongly related (r=0.91, p<0.001), muscle volume was scaled for femur length (muscle volume/femur length(2.77)). When muscle volume/femur length(2.77) was included in a regression model with femur length, sex, physical activity and calcium intake, muscle volume/femur length(2.77) was a significant predictor of appBV/TV, appTb.Th and appTb.Sp (partial r=0.44 to 0.49, p<0.05) and all measures of cortical bone architecture (partial r=0.47 to 0.54; p<0.01). CONCLUSIONS: The findings suggest that muscle volume in the midthigh is related to trabecular bone architecture in the distal femur of typically developing children. The relationship is weaker than the relationship between muscle volume in the midthigh and cortical bone architecture in the midfemur, but the discrepancy is driven, in large part, by the greater dependence of cortical bone architecture measures on femur length.

The physical environment and health-enhancing activity during the school commute: global positioning system, geographical information systems and accelerometry.

Active school travel is in decline. An understanding of the potential determinants of health-enhancing physical activity during the school commute may help to inform interventions aimed at reversing these trends. The purpose of this study was to identify the physical environmental factors associated with health-enhancing physical activity during the school commute. Data were collected in 2009 on 166 children commuting home from school in Scotland. Data on location and physical activity were measured using global positioning systems (GPS) and accelerometers, and mapped using geographical information systems (GIS). Multi-level logistic regression models accounting for repeated observations within participants were used to test for associations between each land-use category (road/track/path, other man-made, greenspace, other natural) and moderate-to-vigorous physical activity (MVPA). Thirty-nine children provided 2,782 matched data points. Over one third (37.1%) of children's school commute time was spent in MVPA. Children commuted approximately equal amounts of time via natural and man-made land-uses (50.2% and 49.8% respectively). Commuting via road/track/path was associated with increased likelihood of MVPA (Exp(B)=1.23, P <0.05), but this association was not seen for commuting via other manmade land-uses. No association was noted between greenspace use and MVPA, but travelling via other natural land-uses was associated with lower odds of MVPA (Exp(B)=0.32, P <0.05). Children spend equal amounts of time commuting to school via man-made and natural land-uses, yet man-made transportation route infrastructure appears to provide greater opportunities for achieving health-enhancing physical activity levels.

Cadence, energy expenditure, and gait symmetry during music-prompted and self-regulated walking in adults with unilateral transtibial amputation.

BACKGROUND: Walking cadence has shown promise for estimating walking intensity in healthy adults. Auditory cues have been shown to improve gait symmetry in populations with movement disorders. We investigated the walking cadence-energy expenditure relationship in unilateral transtibial amputees (TTAs), and the potential of music cues for regulating walking cadence and improving gait symmetry. METHODS: Seventeen unilateral TTAs performed 2 5-min treadmill walking trials, followed by 2 5-min overground walking trials (self-regulated "brisk" intensity, and while attempting to match a moderate-tempo digital music cue). RESULTS: Walking cadence significantly (P < .001) and accurately (R(2) = .55, SEE = 0.50 METs) predicted energy expenditure, and a cadence of 86 steps·min(-1) was equivalent to a 3-MET intensity. Although most participants were able to match cadence to prescribed music tempo, gait symmetry was not improved during the music-guided condition, compared with the self-regulated condition. CONCLUSIONS: This is the first study to investigate the utility of walking cadence for monitoring and regulating walking intensity in adults with lower limb prosthesis. Cadence has similar or superior accuracy as an indicator of walking intensity in this population, compared with the general population, and adults with a unilateral TTA are capable of walking at moderate intensity and above for meaningful bouts of time.

Stride rate and walking intensity in healthy older adults.

PURPOSE: The study investigated (a) walking intensity (stride rate and energy expenditure) under three speed instructions; (b) associations between stride rate, age, height, and walking intensity; and (c) synchronization between stride rate and music tempo during overground walking in a population of healthy older adults. METHODS: Twenty-nine participants completed 3 treadmill-walking trials and 3 overground-walking trials at 3 self-selected speeds. Treadmill VO2 was measured using indirect calorimetry. Stride rate and music tempo were recorded during overground-walking trials. RESULTS: Mean stride rate exceeded minimum thresholds for moderate to vigorous physical activity (MVPA) under slow (111.41 ± 11.93), medium (118.17 ± 11.43), and fast (123.79 ± 11.61) instructions. A multilevel model showed that stride rate, age, and height have a significant effect (p < .01) on walking intensity. CONCLUSIONS: Healthy older adults achieve MVPA with stride rates that fall below published minima for MVPA. Stride rate, age, and height are significant predictors of energy expenditure in this population. Music can be a useful way to guide walking cadence.

Safety in numbers 5: Evaluation of computer-based authentic assessment and high fidelity simulated OSCE environments as a framework for articulating a point of registration medication dosage calculation benchmark.

This paper reports a key educational initiative undertaken by NHS Education for Scotland (NES), based upon recommendations from a 'Numeracy in Healthcare' consultation. We report here the design of a web-based technical measurement authentic assessment environment evolved from the safeMedicate suite of programs that provided a model for an environment within which a medication dosage calculation problem-solving (MDC-PS) benchmark could be articulated. A sample of 63 third-year pre-registration nursing students was recruited from four participating universities in the UK. A counterbalanced design was employed where the virtual authentic assessment environment was evaluated for internal consistency reliability and criterion-related validity against an objective structured clinical assessment (OSCE) undertaken in high-fidelity simulated clinical environments. Outcome measures indicated an extremely high internal consistency of the web-based environment. It was concluded that the combination of a web-based authentic assessment environment and further assessment of safe technical measurement interpretation and dexterity in a practice/practice simulation setting, populated with a benchmark and a criterion referenced rubric validated by the profession, is an innovative, viable, valid and reliable assessment method for the safe administration of medicines. As a result, the rubric for assessment of the appropriate range of calculation type and complexity informed the NMC's revised Essential Skills Clusters for Medicines Management (NMC, 2010a; NMC, 2010b). This inclusion provides a particularly strong example of both research directly influencing policy and of evidence-based regulation.

Evaluation of inactive adults' ability to maintain a moderate-intensity walking pace.

OBJECTIVES: To determine self-selected brisk walking pace in currently inactive adults and investigate the efficacy of rhythmic auditory stimuli to regulate moderate intensity walking. DESIGN: A single-sample controlled laboratory design. METHODS: Currently inactive adults (N=25; 76% female; age=34±13yr) completed a moderate intensity treadmill walking trial, during which cadence and steady-state O2 were measured. Participants then completed a 10-min self-paced "brisk" walk followed by a 10-min moderate-paced walk, prompted by a clip-on metronome matched to the treadmill cadence. Data were analyzed using RM t-test, Cohen's d, Bland-Altman plot, and one-way RM ANOVA. RESULTS: Mean energy expenditure and cadence during the treadmill trial were 3.88±0.53METs and 114±8stepsmin(-1). During self-paced brisk walking cadence was 124±8stepsmin(-1). Cadence during metronome-paced walking was slower for all participants (114±8stepsmin(-1); p<0.05, d=1.23). From the Bland-Altman plots, 23 participants walked within ±3stepsmin(-1) of the metronome cadence, and the other 2 participants were within ±10stepsmin(-1). There were no significant differences (p>0.05) among the minute-by-minute cadences across the 10min of either condition. CONCLUSIONS: Energy expenditure during 2.7mph treadmill walking was higher than 3 METs. Inactive adults walk at a higher cadence during "brisk" walking, compared to walking at a metronome-guided moderate pace. While the natural walking pace of inactive adults was at an intensity known to produce health benefits, and was maintained for 10min, the use of rhythmic auditory feedback is an effective method for regulating walking at a prescribed intensity in inactive adults.

Increasing older adults' walking through primary care: results of a pilot randomized controlled trial.

BACKGROUND: Physical activity can positively influence health for older adults. Primary care is a good setting for physical activity promotion. OBJECTIVE: To assess the feasibility of a pedometer-based walking programme in combination with physical activity consultations. DESIGN: Two-arm (intervention/control) 12-week randomized controlled trial with a 12-week follow-up for the intervention group. SETTING: One general practice in Glasgow, UK. PARTICIPANTS: PARTICIPANTS were aged ≥65 years. The intervention group received two 30-minute physical activity consultations from a trained practice nurse, a pedometer and a walking programme. The control group continued as normal for 12 weeks and then received the intervention. Both groups were followed up at 12 and 24 weeks. OUTCOME MEASURES: Step counts were measured by sealed pedometers and an activPALTM monitor. Psychosocial variables were assessed and focus groups conducted. RESULTS: The response rate was 66% (187/284), and 90% of those randomized (37/41) completed the study. Qualitative data suggested that the pedometer and nurse were helpful to the intervention. Step counts (activPAL) showed a significant increase from baseline to week 12 for the intervention group, while the control group showed no change. Between weeks 12 and 24, step counts were maintained in the intervention group, and increased for the control group after receiving the intervention. The intervention was associated with improved quality of life and reduced sedentary time. CONCLUSIONS: It is feasible to recruit and retain older adults from primary care and help them increase walking. A larger trial is necessary to confirm findings and consider cost-effectiveness.

Predicting active school travel: the role of planned behavior and habit strength.

BACKGROUND: Despite strong support for predictive validity of the theory of planned behavior (TPB) substantial variance in both intention and behavior is unaccounted for by the model's predictors. The present study tested the extent to which habit strength augments the predictive validity of the TPB in relation to a currently under-researched behavior that has important health implications, namely children's active school travel. METHOD: Participants (N = 126 children aged 8-9 years; 59 % males) were sampled from five elementary schools in the west of Scotland and completed questionnaire measures of all TPB constructs in relation to walking to school and both walking and car/bus use habit. Over the subsequent week, commuting steps on school journeys were measured objectively using an accelerometer. Hierarchical multiple regressions were used to test the predictive utility of the TPB and habit strength in relation to both intention and subsequent behavior. RESULTS: The TPB accounted for 41 % and 10 % of the variance in intention and objectively measured behavior, respectively. Together, walking habit and car/bus habit significantly increased the proportion of explained variance in both intention and behavior by 6 %. Perceived behavioral control and both walking and car/bus habit independently predicted intention. Intention and car/bus habit independently predicted behavior. CONCLUSIONS: The TPB significantly predicts children's active school travel. However, habit strength augments the predictive validity of the model. The results indicate that school travel is controlled by both intentional and habitual processes. In practice, interventions could usefully decrease the habitual use of motorized transport for travel to school and increase children's intention to walk (via increases in perceived behavioral control and walking habit, and decreases in car/bus habit). Further research is needed to identify effective strategies for changing these antecedents of children's active school travel.

Using cadence to study free-living ambulatory behaviour.

The health benefits of a physically active lifestyle across a person's lifespan have been established. If there is any single physical activity behaviour that we should measure well and promote effectively, it is ambulatory activity and, more specifically, walking. Since public health physical activity guidelines include statements related to intensity of activity, it follows that we need to measure and promote free-living patterns of ambulatory activity that are congruent with this intent. The purpose of this review article is to present and summarize the potential for using cadence (steps/minute) to represent such behavioural patterns of ambulatory activity in free-living. Cadence is one of the spatio-temporal parameters of gait or walking speed. It is typically assessed using short-distance walks in clinical research and practice, but free-living cadence can be captured with a number of commercially available accelerometers that possess time-stamping technology. This presents a unique opportunity to use the same metric to communicate both ambulatory performance (assessed under testing conditions) and behaviour (assessed in the real world). Ranges for normal walking cadence assessed under laboratory conditions are 96-138 steps/minute for women and 81-135 steps/minute for men across their lifespan. The correlation between mean cadence and intensity (assessed with indirect calorimetry and expressed as metabolic equivalents [METs]) based on five treadmill/overground walking studies, is r = 0.93 and 100 steps/minute is considered to be a reasonable heuristic value indicative of walking at least at absolutely-defined moderate intensity (i.e. minimally, 3 METs) in adults. The weighted mean cadence derived from eight studies that have observed pedestrian cadence under natural conditions was 115.2 steps/minute, demonstrating that achieving 100 steps/minute is realistic in specific settings that occur in real life. However, accelerometer data collected in a large, representative sample suggest that self-selected walking at a cadence equivalent to ≥100 steps/minute is a rare occurrence in free-living adults. Specifically, the National Health and Nutrition Examination Survey (NHANES) data show that US adults spent ≅4.8 hours/day in non-movement (i.e. zero cadence) during wearing time, ≅8.7 hours at 1-59 steps/minute, ≅16 minutes/day at cadences of 60-79 steps/minute, ≅8 minutes at 80-99 steps/minute, ≅5 minutes at 100-119 steps/minute, and ≅2 minutes at 120+ steps/minute. Cadence appears to be sensitive to change with intervention, and capitalizing on the natural tempo of music is an obvious means of targeting cadence. Cadence could potentially be used effectively in epidemiological study, intervention and behavioural research, dose-response studies, determinants studies and in prescription and practice. It is easily interpretable by researchers, clinicians, programme staff and the lay public, and therefore offers the potential to bridge science, practice and real life.