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Associated Factors of Time Spent Walking for Community-Dwelling Stroke Survivors

Young-Ah Choi, Jung Soo Lee, and Yeo Hyung Kim

Background: This study aimed to investigate the factors associated with the time that community-dwelling stroke survivors spent walking. Methods: We analyzed the cross-sectional data of 1534 community-dwelling stroke survivors from the Korean National Health and Nutrition Examination Survey. Complex-sample logistic regression analyses were performed to determine the factors associated with insufficient walking time (<90 min/wk). The mean time spent walking was examined according to age, sex, resistance exercise level, and self-reported disability using complex-sample general linear models. Results: Women (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.0–2.3), current smokers (OR 1.7; 95% CI, 1.1–2.8), insufficient resistance exercise (OR 2.3; 95% CI, 1.5–3.5), and those with rural residences (OR 1.4; 95% CI, 1.0–1.9) were independently associated with insufficient walking time. The mean time spent walking was significantly lower in older adults aged ≥65 years than in young adults aged <65 years (200.0 ± 42.0 min/wk vs 287.2 ± 36.6 min/wk, P = .002), in women than in men (200.9 ± 44.9 vs 286.2 ± 37.7 min/wk, P = .027), and in individuals engaging in insufficient resistance exercise compared with those engaging in sufficient resistance exercise (203.2 ± 36.2 vs 283.9 ± 43.0 min/wk, P = .008). The mean walking time did not vary according to the presence of self-reported disabilities. Conclusions: Environmental and personal factors are associated with insufficient walking time in community-dwelling stroke survivors.

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Moving to an Activity-Friendly Community Can Increase Physical Activity

Chanam Lee, Minjie Xu, Xuemei Zhu, Samuel D. Towne Jr, Huiyan Sang, Hanwool Lee, and Marcia G. Ory

Background: Creating activity-friendly communities (AFCs) is an important strategy to increase physical activity (PA). While cross-sectional links between community environments and PA are well documented, their causal relationships remain insufficiently explored. Methods: Using the accelerometer and survey data collected from adults who moved to an AFC (cases) and similar non-AFC-residing adults who did not move (comparisons), this pre–post, case-comparison study examines if moving to an AFC increases PA. Data came from 115 participants (cases = 37, comparisons = 78) from Austin, Texas, who completed 2 waves of 1-weeklong data collection. Difference-in-difference analyses and fixed-effect models were used to test the significance of the pre–post differences in moderate-to-vigorous PA (MVPA) between cases and comparisons, for the full sample and the subsample of 37 pairs matched in key covariates using the Propensity Score Matching method. Results: Average treatment effect generated based on Propensity Score Matching and difference-in-difference showed that moving to this AFC led to an average of 10.88 additional minutes of daily MVPA (76.16 weekly minutes, P = .015). Fixed-effect models echoed the result with an increase of 10.39 minutes of daily MVPA after moving to the AFC. We also found that case participants who were less active at baseline and had higher income increased their MVPA more than their counterparts. Conclusions: This study showed that, among our study sample, moving to an AFC increased residents’ PA significantly when compared to their premove level and the comparison group. This causal evidence suggests the potential of AFCs as sustainable interventions for PA promotion.

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Erratum. Physical Activity and Its Association With Body Mass Index: A Cross-Sectional Analysis in Middle-Aged Adults From 4 Sub-Saharan African Countries

Journal of Physical Activity and Health

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Public Open Spaces and Leisure-Time Walking: A Longitudinal Study With Brazilian People in the COVID-19 Pandemic

Alex Antonio Florindo, Bianca Mitie Onita, Margarethe Thaisi Garro Knebel, Rildo de Souza Wanderley Júnior, Inaian Pignatti Teixeira, and Gavin Turrell

Aim: To examine whether changes in public open spaces (POS) were associated with leisure-time walking (LTW) between 2014 and 2021. Methods: The sample comprised a prospective cohort of individuals living in São Paulo City, Brazil. The baseline sample was collected in 2014/2015 (4042 people aged 12 y or older) and the second wave in 2020/2021 (1431 people aged 18 y or older, 35.4% of total). Changes in POS scores in 500-m network buffers were based on household address, including positive or negative maintenance and increases or decreases in parks, public squares, and bike paths between 2015 and 2020. The International Physical Activity Questionnaire was used to evaluate LTW in the baseline and second wave. To examine the association of LTW with changes in POS, we used multilevel models in 4 levels: health administration areas, census tracts, individuals, and observations of individuals. The exposure was the POS tertiles, and the outcome was LTW. Results: Changes in LTW prevalence were observed in both periods and according to POS tertiles distributions. When adjusted for time (baseline/second wave), gender, education, and age, the highest POS tertile was significantly associated with a high likelihood for LTW (odds ratio = 1.44; 95% confidence interval, 1.03–2.02). Conclusion: The results showed that people in São Paulo who lived within 500-m buffers with the highest access to POS were more likely to practice LTW between 2014/2015 and 2020/2021. These results have important implications for policies that were implemented in 2014, including the New Master Plan to contribute to São Paulo’s good ranking among healthy cities.

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Activity Behaviors Before and During Pregnancy Are Associated With Women’s Device-Measured Physical Activity and Sedentary Time in Later Parenthood: A Longitudinal Cohort Analysis

Kathryn R. Hesketh, Janis Baird, Sarah R. Crozier, Keith M. Godfrey, Nicholas C. Harvey, Cyrus Cooper, and Esther M.F. van Sluijs

Purpose: To explore how activity behaviors before/during pregnancy relate to those in later parenthood, we assessed associations between sitting and moderate-/strenuous exercise before/during pregnancy, and sedentary time (SED) and moderate to vigorous physical activity (MVPA) 4–7 years postpartum (“later parenthood”). Methods: Longitudinal data were from the Southampton Women’s Survey, United Kingdom. Women reported time spent sitting (in hours per day), in moderate-strenuous exercise (hours per week), and in strenuous exercise (hours per week) at 3 time points before/during pregnancy (ie, preconception, at ∼12-wk and ∼34-wk gestation). From this, we derived 3 behavior trajectories for each woman. In later parenthood, women wore an accelerometer for ≤7 days (mean: 5.4 [SD: 1.8] d), which we used to derive 2 outcomes: minutes per day SED and in MVPA. Multilevel linear regression was used to explore associations between trajectories before/during pregnancy and device-measured SED/MVPA in later parenthood. Results: A total of 780 women provided valid data before/during pregnancy and in later parenthood. Consistent high sitters (vs low) were more sedentary 4–7 years postpartum (β = 39.5 min/d [95% confidence interval, 23.26 to 55.82]), as were women in groups who sat more in later pregnancy. Consistently high moderate/-strenuous exercisers (vs low) were 22% (95% confidence interval, 2%–47%) more active in later parenthood; those engaging in strenuous activity preconception tended to have higher MVPA as parents. Conclusions: Trajectories of sitting and exercise before/during pregnancy are associated with SED and MVPA, respectively, in later parenthood. Interventions to reduce sitting in pregnancy and to encourage higher intensity activity preconception may benefit maternal and child health.

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Physical Activity Accumulated Across Adulthood and Resting Heart Rate at Age 41–46 Years in Women: Findings From the Menarche to Premenopause Study

Gregore I. Mielke, Jenny Doust, Hsiu-Wen Chan, and Gita D. Mishra

Objective: To investigate the association between physical activity accumulated from early (age 22–27 y) to mid (age 40–45 y) adulthood and resting heart rate at age 41–46 years in women. Methods: Data were from 479 participants in the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health. Participants reported physical activity every 3 years from age 22–27 years to 40–45 years. Linear regression models were used to investigate the associations of a cumulative physical activity score (average physical activity across 18 y; up to 7 surveys) and changes in physical activity from age 22–33 years to 34–45 years with resting heart rate at age 41–46 years. Results: Average resting heart rate at age 41–46 years was 75 (SD: 11) beats per minute. An inverse nonlinear dose–response association between cumulative physical activity and resting heart rate was observed. Overall, accumulation of physical activity was associated with lower resting heart rate regardless of the age when physical activity was accumulated. Women in the highest tertile of physical activity at both age 22–33 years and 34–45 years had a resting heart rate, on average, 8 beats per minute lower (95% confidence interval, −11.42 to −4.69) than those consistently in the lowest tertile of physical activity. Conclusion: Accumulating physical activity, irrespective of timing, appears to provide cardiovascular health benefits for women before the transition to menopause.

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Physical Activity and Chronic Stress in Early Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort

Otávio Amaral de Andrade Leão, Thaynã Ramos Flores, Gregore Iven Mielke, Inácio Crochemore-Silva, Andréa Dâmaso Bertoldi, Marlos Rodrigues Domingues, Joseph Murray, Rafaela Costa Martins, Luciana Tovo-Rodrigues, Isabel O. de Oliveira, and Pedro Curi Hallal

Background: The association of physical activity through early childhood on children’s chronic stress still is unclear. Therefore, the aim of the present study is to test the association of physical activity through early childhood (1–4 y) with chronic stress, measured by hair cortisol at age 4. Methods: Longitudinal study including children from the 2015 Pelotas (Brazil) Birth Cohort. Cortisol at age 4 was measured using a hair sample, which provided cortisol concentration from the past months. Physical activity was measured using accelerometers at 1, 2, and 4 years. Linear regression models were used to assess the association between physical activity and chronic stress. Trajectory models were also applied to examine chronic stress in relation to physical activity patterns throughout early childhood. Results: Children with valid physical activity and hair cortisol data were included in the analyses (N = 1475). Three groups of physical activity trajectories between 1 and 4 years were identified: low, medium, and high. No association between physical activity at 1, 2, and 4 years and chronic stress at age 4 was observed. However, children in the “high” physical activity trajectory presented low cortisol concentration; the magnitude of the regression coefficient was slightly larger in girls (β = −0.125; 95% confidence interval, −0.326 to 0.074) than boys (β = −0.051; 95% confidence interval, −0.196 to 0.09). Conclusion: There was no clear association between physical activity and chronic stress in early childhood. Trajectories models suggest that higher activity throughout early childhood may positively impact chronic stress; however, more studies are needed to confirm that hypothesis.

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Maternal Physical Activity Patterns in the 2015 Pelotas Birth Cohort: From Preconception to Postpartum

Luciana Tornquist, Debora Tornquist, Gregore Iven Mielke, Mariângela Freitas da Silveira, Pedro Curi Hallal, and Marlos Rodrigues Domingues

Background: Motherhood has been associated with reduced leisure-time physical activity (LTPA) levels. We aim to assess maternal LTPA patterns from preconception to 4 years postpartum. Methods: The study was developed with mothers from the Pelotas 2015 Birth Cohort, Southern Brazil (n = 4273). LTPA data were self-reported for preconception, antenatal, and 3, 12, 24, and 48 months postpartum. Information on LTPA referring to preconception (3 mo before pregnancy) and each gestational trimester was retrospectively collected in perinatal. The prevalence of active mothers was calculated according to recommendations (≥150 min/wk). We described changes in LTPA between follow-ups and estimated the probability of mothers being active according to previous LTPA. We used group-based trajectory analysis to identify patterns of LTPA throughout the follow-ups. Results: The prevalence of active mothers during leisure time decreased in pregnancy and postpartum compared with preconception. At 12 months postpartum, LTPA levels rose again, but at 48 months, the rates of active mothers still had not returned to preconception levels. Prior LTPA engagement was an important determinant of the maintenance of LTPA. Trajectory analysis identified 4 patterns of maternal LTPA, and ∼80% of mothers were allocated to the “always inactive” group. Higher education and income, working outside the home, multiple births, and participating in the PAMELA study intervention were associated with a higher probability of mothers not being included in this predominantly inactive group. Conclusions: Motherhood is associated with declining rates of women meeting physical activity recommendations during pregnancy and early postpartum.

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Physical Activity During Adolescence and Mental Health in Early Adulthood: Findings From the 1993 Pelotas Birth Cohort Study

Bruna Gonçalves Cordeiro da Silva, Ana Maria Baptista Menezes, Helen Gonçalves, Charles Phillipe de Lucena Alves, Felipe Mendes Delpino, Rafaela Costa Martins, and Fernando César Wehrmeister

Background: Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood. Methods: Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18 years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22 years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals. Results: Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300 min/wk) and total PA at 11 years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33–0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41–0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18 years and between PA and anxiety after controlling for potential confounders. Conclusions: Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.

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Accelerometry Measured Movement Behaviors in Middle-Aged and Older Adults: Cross-Sectional Analysis of the ELSA-Brasil Study

Danilo de Paula, Inácio Crochemore-Silva, Rosane Harter Griep, Bruce Bartholow Duncan, and Maria Inês Schmidt

Background: Little investigation of accelerometry assessed movement behaviors and physical inactivity was carried out in middle-aged and older adults in low-middle-income countries. Objective: Describe accelerometry-measured movement behaviors and prevalence of physical inactivity in middle-aged and older adults. Methods: We collected raw accelerometry data during the third visit (2017–2019) of ELSA-Brasil, a large-scale multicenter Brazilian cohort. Participants wore an ActiGraph wGT3X-BT on the waist for 24 hours for 7 days and documented sleep in a diary. Results: Nine thousand two hundred and seventy-nine participants had valid data (73.4% of the eligible cohort). Overall activity was higher for men (11.82mg; 95% confidence interval [CI], 11.7 to 11.93) than women (10.69mg; 95% CI, 10.6 to 10.77) and lower in older groups—women (−0.12mg/y; 95% CI, −0.13 to −0.11), men (−0.16mg/y; 95% CI, −0.17 to −0.14). Participants were more active from noon to midnight. Distribution of movement behaviors varied with sex and age, and sleep duration was longer in older individuals. Overall, 14.4% (95% CI, 13.7 to 15.1) were inactive, with inactivity being more frequent in women (16.4%; 95% CI, 15.4 to 17.4) than men (12.2%; 95% CI, 11 to 13). Higher rates were observed in the oldest. Retirement was associated with a higher prevalence of physical inactivity in both sexes. Conclusion: Women were less active than men. Older individuals showed a high prevalence of physical inactivity, probably related to transition into retirement. These findings strengthen evidence for public policies promoting physical activity by emphasizing the need to target women, older individuals, and those transitioning to retirement to improve and/or maintain physical activity levels throughout the course of their lives.