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Developing a Framework to Evaluate the Validity of Longitudinal Accelerometer-Based Indicators of Physical Activity Maintenance
Genevieve F. Dunton, Wei-Lin Wang, Jixin Li, Donald Hedeker, Stephen S. Intille, and Alexander J. Rothman
Does Attraction Toward Physical Activity Predict Physical Activity Behavior in Older Adults?
Brynn L. Hudgins, Yeongjun Seo, Kelsey M. Bittel, Kemiah Williams, Derek J. Hevel, Jeffrey D. Labban, and Jackie P. Maher
Background/Objectives: Few studies have investigated associations between the motivational outcome based on physical activity (PA) affective experiences (i.e., attraction vs. antipathy toward PA) and behavior. This study investigated cross-sectional and longitudinal associations between attraction (vs. antipathy) toward PA and device-based PA in older adults. Methods: Older adults (n = 139; 71% female, M age = 70.5) completed assessments of attraction (vs. antipathy) toward PA and 14 days of device-based accelerometry at Times 1 and 2. Results: Greater attraction toward PA at Time 1 was associated with greater steps (β = 5.31, p < .01) and moderate to vigorous intensity PA (β = 3.08, p < .05) at Time 1. Greater attraction toward PA at Time 1 was not significantly associated with steps or moderate to vigorous intensity PA at Time 2. Conclusion: Greater emphasis on resultant motivation from PA affective experiences may be useful in promoting PA in older adults. Significance/Implications: In spite of mixed findings in the present study, there is strong evidence that positive affective responses during a single bout of PA play an important role in predicting future engagement. Yet, affective experiences during PA can be individualistic and often influenced by contextual factors. Interventions designed to increase PA should focus on factors that may create positive affective experiences for participants.
Generative Artificial Intelligence Users Beware: Ethical Concerns of ChatGPT Use in Publishing Research
Samuel W. Logan
Barriers and Facilitators for Physical Activity Among Children and Youth With Autism—A Scoping Review
Ingrid Okkenhaug, Magnus Rom Jensen, and Solvor Solhaug
Background: The purpose of this scoping review was to systematically synthesize barriers and facilitators for physical activity (PA) among children and youth with autism spectrum disorders (ASD) across the socioecological model. Methods: Five electronic databases were searched in March 2022 for studies examining barriers and facilitators for PA among children and youth with ASD. An updated search was performed in April 2024. The framework synthesis method was utilized, and the socioecological model was the chosen framework. Results: Fifty-four studies published from 2008 to 2024 were included. Among the included studies, 57% included the perspectives of children and youth with ASD alone or together with proxies (eg, parents, teachers, and coaches), while 43% included only the perspectives of proxies. Barriers and facilitators on the intrapersonal and interpersonal levels were most substantial. The analysis led to 2 main categories of barriers and facilitators, those unique to children and youth with ASD, and those similar to what had been identified through research on children and youth, both typically developing and with other disabilities. Conclusions: This comprehensive scoping review shows the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and highlights both the factors unique to this population and more general factors affecting PA participation. The findings from this synthesis might be used to guide the development of inclusive PA in physical education, organized sports, and other community PA arenas.
Embedding Multimodal Rehabilitation Within Routine Cancer Care in Sheffield—The Active Together Service Evaluation Protocol
Anna Myers, Liam Humphreys, Michael Thelwell, Katie Pickering, Gabbi Frith, Gail Phillips, Carol Keen, Robert Copeland, and on behalf of the Active Together Clinical Advisory Group
Background: Approximately 3 million people in the United Kingdom are currently living with or beyond cancer. People undergoing treatment for cancer are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) in enhancing psychological and physical well-being in patients with cancer and improving outcomes. Active Together is an evidence-based, multimodal rehabilitation service for patients with cancer, providing support to help patients prepare for and recover from treatment. This paper presents the evaluation protocol for the Active Together service, aiming to determine its impact on patient-reported outcomes and clinical endpoints, as well as understand processes and mechanisms that influence its delivery and outcomes. Methods: This evaluation comprises an outcome and process evaluation, with service implementation data integrated into the analysis of outcome measures. The outcome evaluation will assess changes in outcomes of patients that attend the service and compare health care resource use against historical data. The process evaluation will use performance indicators, semistructured interviews, and focus groups to explore mechanisms of action and contextual factors influencing delivery and outcomes. Integrating psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service. Conclusions: Evidence to support the role of multimodal rehabilitation before, during, and after cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world impact of cancer rehabilitation and strengthen the case for widespread adoption of rehabilitation into routine care for people with cancer.
Independent, Stratified, and Joint Associations of Sedentary Time and Physical Activity With Cardiovascular Disease: A Systematic Review
Charles Phillipe de Lucena Alves, Otávio Amaral de Andrade Leão, Felipe Mendes Delpino, Gregore Iven Mielke, Ulf Ekelund, Eduardo Caldas Costa, and Inácio Crochemore-Silva
Background: Recent statistics highlight cardiovascular diseases (CVD) as a major global cause of death. This review examines the methodological approaches and the main results of independent, stratified, and joint association of sedentary time (ST) and physical activity (PA) on CVD outcomes. Methods: We searched PubMed, Embase, Web of Science, and Scopus for prospective cohorts that examined the independent, stratified, or joint associations of ST and PA with CVD outcomes. Independent associations were defined as analyses mutually adjusted for PA and ST. Stratified associations were considered when there was a reference group in each stratum of PA or ST, and joint associations were defined by a single reference group for all other combined categories of ST and PA levels. Results: Of 45 articles, 69% explored independent association of ST or PA on CVD outcomes, while 31% using a stratified/joint approach. Most studies used self-reports for ST and PA and focused on CVD mortality. Mutually adjusted analyses identified ST positively and PA inversely associated to CVD outcomes. Stratified studies showed higher ST’s pronounced impact on CVD for lower PA levels. High PA mitigated but did not eliminate ST’s negative impact. Joint analyses revealed highest CVD risk in those with both high ST and low PA, and elevated risk in various intermediate combinations. Conclusions: Employing independent, stratified, and joint association approaches can yield distinct and complementary public health messages aimed at promoting cardiovascular health. Recommendations should aim to not only to encourage boosting PA levels, but also, concurrently decrease ST.
Poor Activities of Daily Living Predict Future Weight Loss in Older Adults After Hospital Discharge—Secondary Analysis of a Randomized Trial
Hrafnhildur Eymundsdottir, Berglind S. Blondal, Ólöf G. Geirsdottir, and Alfons Ramel
This study examined whether participants with poor activities of daily living (ADLs) at hospital discharge had increased weight loss after 6 months of follow-up and whether nutrition therapy can prevent this weight loss. This dietary randomized controlled trial (N = 104) examined community-dwelling older adults (66–95 years) discharged from hospital and at risk for malnutrition, receiving either 6 months of nutrition therapy (intervention) or only standard care (control). ADL was assessed using seven questions on self-care based on the Katz et al.’s method. At discharge, 45 (43%), 36 (35%), and 23 (22%) had high, medium, and poor ADL, respectively, with no differences between the control and intervention groups according to chi-square test. Participants in the control group with poor ADL had significantly higher weight loss than participants with high ADL (age- and sex-adjusted analysis of covariance: 3.6 kg; 95% confidence interval [1.0, 6.1] kg, p = .007). No such difference was observed in the intervention group. Participants with poor ADL at hospital discharge develop lower body weight by around 3.5 kg 6 months later when compared with participants with high ADL. Receiving nutrition therapy could help older adults with poor ADL to maintain body weight after hospital discharge.
A Pre–Post Study Design Exploring the Potential Benefits of a Hiking Intervention for Active and Inactive Older Adults
Iris A. Lesser and Cynthia J. Thomson
Introduction: Physical activity (PA) is essential for healthy aging, yet PA levels are low in older adults. Group-based nature programming may be an ideal opportunity for engaging older adults in PA and improving health-related quality of life. Methods: Twenty-seven older adults, 55–75 years of age (n = 14 active and n = 13 previously inactive), enrolled in a biweekly 8-week hiking program. At baseline, participants completed online questionnaires on health-related quality of life, behavioral and psychological outcomes, and a one-mile walk test to assess cardiorespiratory fitness. Results: Average attendance was 81% in the previously inactive groups and 74% in the active group. There was a significant increase in the physical component of quality of life over time in the previously inactive group (p = .03, d = 0.71). Participants significantly improved their cardiorespiratory fitness (p = .003, d = 0.77) and competency (p = .005, d = 0.41) as assessed by the Basic Psychological Needs for Exercise Scale. The previously inactive group additionally increased their self-efficacy for exercise (p = .001, d = 1.43). Both active and previously inactive groups exercised at a similar relative intensity during the hikes based on heart rate; however, perceived exertion at the end of the hike on average was lower among active participants (p = .014). Conclusion: Group-based hiking for previously inactive older adults significantly improved physical health-related quality of life over an 8-week biweekly intervention. Hiking at an individualized pace may allow for hiking to be an appropriate PA program in previously inactive older adults.
Factors Associated With Leisure-Time Bicycling Among Adults in the United States: An Urban–Rural Comparison
Eugene C. Fitzhugh, Carissa Smock, Laura E. Balis, Jeanette Gustat, Debra Kellstedt, James N. Roemmich, Zachary Townsend, and Christiaan Abildso
Background: Bicycling is a healthy form of physical activity that can be performed by most adults as part of leisure-time (LT) activity. However, little is known about LT bicycling behaviors, especially in the rural areas of the United States. This study sought to contrast the prevalence and factors associated with LT bicycling in populations living in urban settings with those living in rural settings. Methods: The 2019 Behavior Risk Factor Survey, which contains information regarding LT physical activity behaviors among adults (N = 396,261) in the United States, was used to determine the prevalence, demographic profile, and likelihood of meeting the physical activity guidelines of LT bicyclists. The 2013 National Center for Health Statistics Urban/Rural Classification Scheme was used to classify respondents living in rural and urban settings. Results: Among US adults, 3.8% (95% CI, 3.7–3.9) reported LT bicycling activity, the sixth most common physical activity. Adults living in urban counties compared with rural counties had a greater prevalence of LT bicycling (3.9% vs 2.3%, respectively), with adults living in rural counties having a 34% lower probability of LT bicycling. Rural bicycling prevalence rates were lower across all demographics. Urban bicyclists, compared with rural bicyclists, cycled more months of the year. Overall, 85.5% of all bicyclists met the aerobic physical guidelines, with no differences between urban and rural bicyclists. Conclusions: Bicycling remains an important LT physical activity among adults in the United States. However, a rural–urban difference in the prevalence does exist for LT bicycling. The reasons for this disparity warrant further investigation.
Inequality in Physical Activity in Organized Group Settings for Children: A Cross-Sectional Study
Ann E. Rogers, Christopher S. Wichman, Michaela A. Schenkelberg, and David A. Dzewaltowski
Background: Adult-led organized settings for children (eg, classrooms) provide opportunities for physical activity (PA). The structure of setting time may influence inequalities (ie, unequalness) in the distribution of PA. This study examined differences in PA inequality by setting and time-segment purpose in time-segmented organized group settings for children. Methods: PA and setting meetings were assessed using accelerometer and video observation data from school, before-/after-school, and youth club groups (n = 30) for third- through sixth-grade children (n = 699) in 2 rural US communities. Meetings (n = 130) were time-segmented into smaller units (sessions; n = 835). Each session was assigned a purpose code (eg, PA). Accelerometer data were paired with the meetings and sessions, and the Gini coefficient quantified inequality in activity counts and moderate to vigorous PA minutes for each segment. Beta generalized estimating equations examined differences in PA inequality by setting and session purpose. Results: Activity count inequality was lowest (P < .05) during youth club meetings (Gini = 0.17, 95% CI, 0.14–0.20), and inequality in moderate to vigorous PA minutes was greatest (P < .01) during school (Gini = 0.34, 95% CI, 0.30–0.38). Organized PA sessions (Gini = 0.20, 95% CI, 0.17–0.23) had lower activity count inequality (P < .0001) than academic (Gini = 0.30, 95% CI, 0.27–0.34), enrichment (Gini = 0.31, 95% CI, 0.27–0.36), and nonactive recreation (Gini = 0.30, 95% CI, 0.25–0.34) sessions. Inequality in moderate to vigorous PA minutes was lower (P < .05) in organized PA (Gini = 0.26, 95% CI, 0.20–0.32) and free play (Gini = 0.28, 95% CI, 0.19–0.39) than other sessions. Conclusions: PA inequality differed by setting time structure, with lower inequality during organized PA sessions. The Gini coefficient can illuminate PA inequalities in organized settings and may inform population PA improvement efforts in rural communities.