Exploring the Association of a Total Physical Activity Energy Expenditure and Diabetes Mellitus in Adults: A Cross-Sectional Analysis of the Canadian Health Measures Survey.

Background: Physical activity (PA) guidelines for adults recommend participation in aerobic activities of moderate-to-vigorous intensity and a minimum of two sessions of resistance training (RT) weekly. These guidelines account for a small amount of the total PA energy expenditure and include no recommendation for low intensity activities (sleeping, sedentary behavior, and light intensity PA). Consequently, there is a need to investigate the benefits of total PA energy expenditure and diabetes mellitus (DM); to investigate the association between total PA energy expenditure and DM in adults aged 45 years or above. Methods: Data from the Canadian Health Measures Survey (CHMS; n = 5591) were used for the cross-sectional analysis. DM was measured using hemoglobin glycated (A1c) and questionnaires in adults aged 45 and above. PA and sedentary behavior were estimated using accelerometry. Sleep and RT were self-reported. Total PA energy expenditure was computed using the sum of metabolic equivalent of task-min/week. Results: The mean age of the sample was 58.0 ± 0.2 years old. No associations were observed between total PA energy expenditure and self-reported T2DM in all models (P > 0.05). For objectively measured DM, this association was significant when adjusted for age, sex, ethnicity, and smoking [OR: 0.45; 95% CI (0.25-0.80)]; however, the association was no longer significant once adjusted for waist circumference and further adjusted for meeting the International PA Guidelines [OR: 0.64; 95% CI (0.33-1.27)] (P > 0.05). Conclusion: Total PA energy expenditure performed weekly is not associated with DM when considering other known risk factors, including waist circumference and meeting the PA guidelines.

Associations between physical activity motives and trends in moderate-to-Vigorous physical activity among adolescents over five years.

This study examined the longitudinal associations between five physical activity (PA) motives and moderate-to-vigorous PA (MVPA) across a 5-year period spanning late childhood to middle adolescence.METHODS: Data (n = 937; 55% girls; mean age = 10.33 years) were drawn from the Monitoring Activities for Teenagers to Comprehend their Habits study. PA motives and MVPA were assessed 15 times over the course of 5 years. Measurement invariance for the Motives for Physical Activity Measure-Revised (MPAM-R) questionnaire was established, and sex-stratified mixed-effects regression models were analysed.MVPA increased until a mean age of 12.18 years for girls and 12.89 years for boys before decreasing through the final assessment. From late childhood to middle adolescence, for boys, enjoyment motives were positively (ß(95% CI) = 6.14(3.86-8.43)), while fitness motives were negatively (ß(95% CI) = -4.80(-8.0, -1.59)) associated with MVPA. Whereas, for girls, competence motives were positively ß(95% CI) = 3.44(1.59-5.28)) associated with MVPABoys may benefit from PA interventions, if these were primarily aimed at increasing ones' enjoyment, whereas developing a girl's competence may provide greater contributions to a girl's future PA behaviours. PA interventions should avoid promoting the desire to be active to improve fitness, particularly among boys.

Potential functional benefits of a comprehensive evaluation of physical activity for aging adults: a CLSA cross-sectional analysis.

BACKGROUND: Physical activity recommendations for aging adults do not account for possible benefits of light-intensity physical activity on physical function. The purpose of this study was to assess if a sum of all physical activities (regardless of intensity) related to physical function for aging adults, independent of physical activity guidelines. METHODS: This cross-sectional study was conducted with baseline data of the Canadian Longitudinal Study on Aging (CLSA n = 25,072) including ages from 45 to 85. Physical activity was collected via the Physical Activity Scale for Elderly questionnaire. The sum of all activities, based on the Metabolic Equivalent of a Task (MET), was called Total Index. Physical function was derived from objective measures. Logistic regression was used for statistical analysis based on the specific age and sex median values of physical function. RESULTS: The Total Index was associated with being in the lowest median of physical function when adjusted for the physical activity guidelines and other potential confounders (OR = 1.02, 95% CI = 1.01-1.03, p < 0.05). CONCLUSION: This study suggests that components of physical activity not currently included in current guidelines may be associated with better physical function outcomes for aging adults.

Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study.

BACKGROUND: American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS: We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS: Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION: Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.

CONTEXTE: Des études américaines ont montré que le volume d'activité des chirurgiens et des hôpitaux est inversement proportionnel au risque de mortalité après la chirurgie colorectale. Les données pour le Canada sont limitées, et à notre connaissance, une seule étude a porté sur d'autres paramètres que le décès. Nous avons décrit les liens entre volume d'activité des chirurgiens et mortalité de toute cause/complications postopératoires après la chirurgie colorectale au Nouveau-Brunswick. MÉTHODES: Nous avons utilisé les registres de congés des hôpitaux reliés aux données de la Statistique de l'état civil, du registre provincial du cancer et du registre des patients. Nous avons recensé toutes les admissions pour chirurgie colorectale de 2007 à 2013. Nous avons utilisé la régression logistique pour établir le risque de décès et le risque de complications (fuite anastomotique, colostomie non planifiée, infection intra-abdominale ou pneumonie) dans les 30 jours suivant le congé de l'hôpital par rapport au volume d'activité des chirurgiens (c.-à-d., interventions totales des 2 années précédentes) ajusté en fonction des caractéristiques individuelles et contextuelles, propres aux chirurgiens et aux hôpitaux. RÉSULTATS: En tout, 125 chirurgiens ont effectué 9170 interventions dans 18 hôpitaux. Nous avons observé un risque moindre de complications après la chirurgie colorectale pour chaque palier de 10 interventions effectuées annuellement (risque relatif 0,94, intervalle de confiance de 95 %, 0,91­0,96). Nous n'avons observé aucun lien avec la mortalité. Les liens sont demeurés constants, peu importe que les modèles soient restreints aux patients cancéreux ou aux interventions effectuées par des chirurgiens généraux et entre les modèles qui tenaient également compte du volume global d'activité des hôpitaux. CONCLUSION: Selon nos résultats, l'augmentation du volume d'activité est associée à un risque moindre de complications, mais n'a pas de lien avec la mortalité de toute cause après la chirurgie colorectale au Nouveau-Brunswick. Nous n'avons pas non plus constaté de lien entre le volume d'activité et l'issue différentielle de la chirurgie du côlon et du rectum.

Provider volume and maternal complications after Caesarean section: results from a population-based study.

BACKGROUND: A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. METHODS: Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. RESULTS: Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. CONCLUSIONS: Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

Association Between a Comprehensive Movement Assessment and Metabolically Healthy Overweight Obese Adults.

Physical activity (PA) and sedentary behavior are associated with metabolic health in overweight and obese individuals. However, the role of comprehensive health-related movement guidelines on PA, recreational screen time, and sleep among Metabolically Healthy Overweight-Obese (MHO) individuals is unknown. We investigated differences in comprehensive movement assessment scores between adults classified as MHO or Non-MHO. The sample included 513 adults (46.2% male), aged 19 to 85 years, body mass index (BMI) ≥ 25, from cycle 2005-2006 of the National Health and Nutrition Examination Survey. Comprehensive movement assessment outcomes were defined as meeting modified 24-Hour Movement Guidelines criteria, with thresholds adapted for adults. 13.8% of participants were MHO (normal serum glucose, triglycerides, HDL-cholesterol, and systolic and diastolic blood pressure). Only 1.4% of MHO participants met all guidelines. MHO and Non-MHO participants had similar comprehensive movement assessment scores (MHO: 18.3% vs. Non-MHO: 10.9%; p = 0.072). MHO individuals had less continuous recreational screen time than Non-MHO individuals (1.8 ± 1.4 hrs/day vs. 2.5 ± 1.6 hrs/day; p < 0.001). Meeting the recreational screen time recommendation was the only variable associated with the MHO phenotype (OR:4.84 95%CI: 2.33-10.07). This association remained after adjusting for age, sex, ethnicity, education, and BMI (OR: 3.53 95%CI: 1.72-7.24). Our results suggest the importance of limiting recreational screen time in adults to optimize cardiometabolic risk profile in individuals living with overweight or obesity. Using movement guidelines with a screen time component to assess the risk associated with health outcomes in adults appears to provide a better assessment.

Does lean body mass equal health despite body mass index?

OBJECTIVE: To determine the association between having simultaneously high body mass index (BMI) and high relative lean body mass (LBM) and cardio-metabolic risk factors, metabolic syndrome (MetS), and diabetes in adults. MATERIALS AND METHODS: A cross-sectional analysis was performed on 4982 adults aged 19-85 years that participated in the National Health and Nutrition Examination Survey (cycles 1999-2000-2005-2006). The primary exposure variable was categorization into four groups: (a) Low-BMI/Low-LBM, (b) Low-BMI/High-LBM, (c) High-BMI/Low-LBM, and (d) High-BMI/High-LBM. LBM was assessed using dual-energy X-ray absorptiometry. The primary outcome measures were cardio-metabolic risk factors, MetS based on the ATP III definition; participants were required to have at least three of the following five criteria: high waist circumference, low HDL cholesterol, elevated triglyceride levels, high resting blood pressure, and self-reported diabetes. RESULTS: Compared to the High-BMI/High-LBM, most cardio-metabolic risk factors were significantly different among groups (P < .05) while no such differences were observed for the High-BMI/Low-LBM (P > .05). Exception of waist circumference (OR [95%]: 21.8 [8.84-53.82]), there was no increased odds of having cardio-metabolic risk factors in the High-BMI/Low-LBM compared with the High-BMI/High-LBM (P > .05). The odds of having MetS and diabetes for the High-BMI/Low-LBM compared with the High-BMI/High-LBM were OR (95% CI): 1.68 (0.84-3.36) and 0.59 (0.26-1.34), respectively. CONCLUSIONS: Our results suggest that having a high-BMI as well as high relative LBM levels is not associated with cardio-metabolic risk factors, MetS, and diabetes. Therefore, maintaining a BMI below 30 kg/m2 appears to be clinically relevant, regardless of LBM levels.

Physical Activity and Sedentary Patterns among Metabolically Healthy Individuals Living with Obesity.

BACKGROUND: Some individuals living with obesity are free from typical cardiometabolic risk factors and are termed metabolically healthy obese (MHO). The patterns of physical activity and sedentary behaviors among MHO are currently unknown. METHODS: This study includes 414 youth (12-18 years old), 802 adults (19-44 years old), and 1230 older adults (45-85 years old) living with obesity from the 2003-2004 or 2005-2006 NHANES cycles. Time spent in bouts of 1, 5, 10, 30, and 60 minutes for moderate-to-vigorous physical activity (MVPA) and sedentary time was measured objectively using accelerometers. Participants were categorized as MHO if they had no cardiometabolic risk factors above the identified thresholds (triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, and glucose). RESULTS: The proportion of MHO was 19%, 14%, and 12% in youth, adults, and older adults, respectively. MHO adults displayed a higher 1-minute bout of MVPA per day compared to non-MHO (p = 0.02), but no difference was observed for MVPA and sedentary behavior patterns for youth and older adults. When adjusted for confounders, all bouts of sedentary behavior patterns in youth were significantly associated with being classified as MHO. CONCLUSION: This study suggests that greater sedentary time is associated with cardiometabolic risk factors in youth even if they are physically active.

Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study.

BACKGROUND: Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick. METHODS: Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics. RESULTS: About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association. CONCLUSION: Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.

CONTEXTE: Plusieurs études internationales rapportent un lien négatif entre le volume d'activité de l'hôpital ou du fournisseur de soins de santé et le risque de décès postopératoire lié à une arthroplastie totale de la hanche. Les seules études canadiennes qui se sont intéressées à cette question ont été réalisées en Ontario et n'ont pas rapporté ce lien. Dans notre étude, nous tentons de décrire des liens entre le décès postopératoire lié à une arthroplastie totale de la hanche et le volume de la charge de travail du fournisseur de soins de santé, également ajustés pour tenir compte du volume d'activité de l'hôpital, au sein d'une cohorte basée sur la population au Nouveau-Brunswick. MÉTHODES: Nos analyses reposent sur les données portant sur les congés des hôpitaux, associées aux statistiques de l'état civil et aux données des registres des patients. Nous avons examiné toutes les premières hospitalisations connues en vue d'une arthroplastie totale de la hanche au Nouveau-Brunswick entre le 1er janvier 2007 et le 31 décembre 2013. Le volume d'activité du fournisseur de soins de santé a été défini comme étant la totalité des arthroplasties totales de la hanche pratiquées au cours des 2 années précédentes. Nous avons ajusté les modèles de régression logistique de manière à identifier le risque de décès dans les 30 et 90 jours en fonction du volume de la charge de travail du fournisseur de soins de santé, pour tenir compte de caractéristiques personnelles et contextuelles choisies. RÉSULTATS: Environ 7095 patients ont été admis pour une arthroplastie totale de la hanche au Nouveau-Brunswick au cours de la période de 7 ans à l'étude, et 170 patients sont décédés dans les 30 jours. Nous n'avons pas observé de liens entre le volume d'activité du fournisseur de soins de santé et la mortalité postopératoire dans nos modèles. L'ajustement pour tenir compte des caractéristiques contextuelles ou du volume d'activité de l'hôpital n'a eu aucune incidence sur ce lien. CONCLUSION: Nos résultats suggèrent que les patients hospitalisés afin de subir une arthroplastie de la hanche au Nouveau-Brunswick peuvent s'attendre à un risque similaire de décès, peu importe que leur fournisseur de soins de santé pratique un volume faible ou élevé d'arthroplasties totales de la hanche ou que le patient soit admis dans un petit ou un grand hôpital de la province.

"Monkey see, monkey do": Peers' behaviors predict preschoolers' physical activity and dietary intake in childcare centers.

Preschoolers observe and imitate the behaviors of those who are similar to them. Therefore, peers may be role models for preschoolers' dietary intake and physical activity in childcare centers. This study examined whether peers' behaviors predict change in preschoolers' dietary intake and physical activity in childcare centers over 9months. A total of 238 preschoolers (3 to 5years old) from 23 childcare centers in two Canadian provinces provided data at the beginning (October 2013 and 2014) and the end (June 2014 and 2015) of a 9-month period for this longitudinal study. Dietary intake was collected at lunch using weighed plate waste and digital photography on two consecutive weekdays. Physical activity was assessed using accelerometers over five days. Multilevel linear regressions were used to estimate the influence of peers' behaviors on preschoolers' change in dietary intake and physical activity over 9months. Results showed that preschoolers whose dietary intake or physical activity level deviated the most from those of their peers at the beginning of the year demonstrated greater change in their intakes and activity levels over 9months, which enabled them to become more similar to their peers (all ß 95% CI ranged from -0.835 to -0.074). This study suggests that preschoolers' dietary intake and physical activity may be influenced by the behaviors of their peers in childcare centers. Since peers could play an important role in promoting healthy eating behaviors and physical activity in childcare centers, future studies should test interventions based on positive role modeling by children.

Does proximity to physical activity infrastructures predict maintenance of organized and unorganized physical activities in youth?

Physical activity (PA) infrastructures can provide youth chances to engage in PA. As determinants of organized and unorganized PA (OPA and UPA) may differ, we investigated if proximity to PA infrastructures (proximity) was associated with maintenance of OPA and UPA over 3 years. Youth from New Brunswick, Canada (n = 187; 10-12 years at baseline) reported participation in OPA and UPA every 4 months from 2011 to 2014 as part of the MATCH study. Proximity data were drawn from parent's questionnaires. Proximity scores were divided into tertiles. Kaplan-Meier and Cox proportional hazard models were used to assess associations between proximity and maintenance of OPA and UPA. There were no crude or adjusted differences in average maintenance of participation in OPA [mean number of survey cycle participation (95%CI) was 6.6 (5.7-7.5), 6.3 (5.5-7.1), and 5.8 (5.1-6.6)] or UPA [6.8 (6.2-7.4), 5.9 (5.3-6.5), and 6.6 (5.9-7.3)] across low, moderate, and high tertiles of proximity, respectively. Findings suggest that proximity does not affect maintenance of participation in OPA or UPA during adolescence. Other environmental aspects may have a greater effect. Further research is needed before conclusions can be made.