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The Evolution of Physical Activity and Health Research in China: A Bibliometric Analysis of Study Areas and Sex Balance in Authorship

Kaiyue Zhang, Diana Morales, Junshi Chen, Wenhua Zhao, Anne Tang, Eduardo Kohn, Ding Ding, Andrea Ramirez Varela, Michael Pratt, and Pedro C. Hallal

Background: This article evaluates the evolution of physical activity and health research in China through a bibliometric analysis focused on number of publications, study areas, and sex balance in authorship. Methods: A systematic review was conducted by the Global Observatory for Physical Activity for “physical activity and health” publications between 1950 and 2019. Here, we focus on the 610 Chinese publications identified, defined as those in which data collection took place in China. We assessed the number of publications, classified them into 5 areas (1) surveillance, (2) correlates and determinants, (3) health consequences, (4) interventions, and (5) policy, and analyzed female participation in authorship. Results: The first Chinese publication identified in the review was in 1990. Since, the average number of physical activity and health publications increased from one per year in the 1990s to 7.6 per year in the 2000s, and to 47 per year in the 2010s. Most publications focused on the correlates and determinants (38.7%) and the health consequences of physical activity (35.9%). Physical activity policy accounted for 2.3% of the publications. In the 1990s, 64% of the publications included at least one female author; this proportion increased to 90% in the 2010s. Conclusion: Despite a slow start, China’s research on physical activity and health has grown rapidly since 2000. The distribution of publications by study areas and female participation in authorship is similar to that observed globally, with fewer publications focused on interventions and policy as compared with other topics.

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Physical Activity Among Utah Cancer Survivors: Analysis From a Population-Based Statewide Survey

Morgan M. Millar, Sandra L. Edwards, Rachel R. Codden, Blessing S. Ofori-Atta, Kimberly A. Herget, Marjorie E. Carter, Anne C. Kirchhoff, Adriana M. Coletta, and Carol Sweeney

Background: Regular physical activity improves cancer survivors’ health-related quality of life and physical function. We estimated the proportion of Utah cancer survivors meeting U.S. Department of Health and Human Services guidelines for weekly physical activity (aerobic plus strength exercise) and identify sociodemographic, cancer, and health-related factors associated with meeting guidelines. Methods: Survivors randomly sampled from Utah Cancer Registry records were surveyed from 2018 to 2022 to ascertain physical activity. We calculated the percent of survivors meeting guidelines and conducted logistic regression to assess predictors of meeting guidelines. Analyses were weighted to account for complex survey sample design and nonresponse and age adjusted. Results: Among Utah cancer survivors, 20.7% (95% CI, 18.5%–23.2%) met guidelines for both aerobic activity and strength exercise. 22.4% reported no aerobic exercise in a typical week, and 59.4% reported no strength exercise. Survivors 75 or older were less likely to meet physical activity guidelines than those under 55 (adjusted odds ratio: 0.40; 95% CI, 0.25–0.65). Survivors with a bachelor’s degree or higher were more likely to meet physical activity guidelines than those without a college degree. Individuals with poorer overall health were less likely to report sufficient physical activity. Individuals treated with both chemotherapy and radiation had decreased odds of meeting guidelines compared to no treatment (adjusted odds ratio: 0.54; 95% CI, 0.29–0.99). Conclusions: Most Utah cancer survivors, and particularly those who received multiple modes of adjuvant treatment, are not participating in sufficient physical activity to improve longevity and quality of life after cancer.

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Reactions From the Experts: Implications of Open-Source ActiGraph Counts for Analyzing Accelerometer Data

Alexander H.K. Montoye, Samuel R. LaMunion, Jan C. Brønd, and Kimberly A. Clevenger

In 2022, it became possible to produce ActiGraph counts from raw accelerometer data without use of ActiLife software. This supports the availability and use of transparent, open-source methods for producing physical behavior outcomes from accelerometer data. However, questions remain regarding the implications of the availability of open-source ActiGraph counts. This Expert Question and Answer paper solicited and summarized feedback from several noted physical behavior measurement experts on five questions related to open-source counts. The experts agreed that open-source, transparent, and translatable methods help with harmonization of accelerometer methods. However, there were mixed views as to the importance of open-source counts and their place in the field moving forward. This Expert Question and Answer provides initial feedback, but more research both within this special issue and to be conducted moving forward will help to inform whether and how open-source counts will be accepted and adopted for use for device-based physical behavior assessments.

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Spaced Use of Social Media Apps Among Motor Practice Trials Impacts Performance Without Influencing Mental Fatigue and Motor Learning

Marina Gonçalves Leal, José Eduardo dos Martírios Luz, Ana Kariele da Silva Santos, Cicero Luciano Alves Costa, Paulo Felipe Ribeiro Bandeira, Cassio de Miranda Meira Jr, and Giordano Marcio Gatinho Bonuzzi

We aimed to investigate the impact of smartphone use during intertrial intervals within a distributed practice regime on mental fatigue, performance, and learning of a balance motor skill. One hundred and thirty-six participants were randomly divided into two groups: the smartphone use group (SMARTPHONE) and the control group (CONTROL). The SMARTPHONE accessed social media during the rest periods within a distributed practice of a balance task, whereas the CONTROL rested passively during the rest periods. The participants practiced the toe-touch task. The participants underwent a pretest consisting of one trial. Subsequently, the participants were engaged in practice, completing six trials interspersed with 2-min intervals of either rest or smartphone use. Following the practice phase, a posttest was conducted, and after 24 hr, we administered a retention test and a transfer test. The number of touches and the number of errors (contacting the ground with the free leg to regain balance) were performance measures. We evaluated the participants’ mental fatigue after the practice session using a visual analog scale. The groups demonstrated similar mental fatigue after practice. Our results suggest that using social media on smartphones during rest periods within a distributed practice impairs performance but not motor learning.

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A Novel Behavioral Intervention to Enhance Physical Activity for Older Veterans in a Skilled Nursing Facility

Julie A. Stutzbach, Kristine S. Hare, Allison M. Gustavson, Danielle L. Derlein, Andrea L. Kellogg, and Jennifer E. Stevens-Lapsley

Physical activity levels during skilled nursing facility (SNF) rehabilitation fall far below what is needed for successful community living and to prevent adverse events. This feasibility study’s purpose was to evaluate the feasibility, acceptability, and preliminary effectiveness of an intervention designed to improve physical activity in patients admitted to SNFs for short-term rehabilitation. High-Intensity Rehabilitation plus Mobility combined a high-intensity (i.e., high weight, low repetition), progressive (increasing in difficulty over time), and functional resistance rehabilitation intervention with a behavioral economics-based physical activity program. The behavioral economics component included five mobility sessions/week with structured goal setting, gamification, and loss aversion (the idea that people are more likely to change a behavior in response to a potential loss over a potential gain). SNF physical therapists, occupational therapists, and a mobility coach implemented the High-Intensity Rehabilitation plus Mobility protocol with older Veterans (n = 18) from a single SNF. Participants demonstrated high adherence to the mobility protocol and were highly satisfied with their rehabilitation. Treatment fidelity scores for clinicians were ≥95%. We did not observe a hypothesized 40% improvement in step counts or time spent upright. However, High-Intensity Rehabilitation plus Mobility participants made clinically important improvements in short physical performance battery scores and gait speed from admission to discharge that were qualitatively similar to or slightly higher than historical cohorts from the same SNF that had received usual care or high-intensity rehabilitation alone. These results suggest a structured physical activity program can be feasibly combined with high-intensity rehabilitation for SNF residents following a hospital stay.

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A Practice Guide for Physical Therapists Prescribing Physical Exercise for Older Adults

Frederico M. Baptista, Rosa Andias, Nelson P. Rocha, and Anabela G. Silva

Introduction: Physical activity and exercise are protective factors for physical and cognitive decline in older adults, but recent studies reveal that a large percentage of this population do not practice exercise at the levels recommended by international guidelines. The frequency, intensity, type, time, volume, and progression (FITT-VP) principles are a widely used method for prescribing physical exercise, allowing the development of a personalized exercise program that meets the needs of each individual. Objectives: This masterclass is intended to serve as a professional application tool for physical therapists who prescribe physical exercise for older adults. We present a section for each FITT-VP principle to facilitate handling these principles individually when prescribing exercise for this population. Methods: Review of the scientific literature and international guidelines on the prescription of physical exercises for older adults. Results: Aerobic, mobility, resistance, balance, and flexibility exercises, as well as functional training, should be included in an exercise program for older adults, which should be progressed using different methods for each of the exercise modalities. Conclusions: An exercise program for older adults should integrate different exercise modalities. Exercise progression should be performed following the FITT-VP principles and some specific progression factors recommended for each exercise modality. Significance: Considering the challenge faced by clinicians in designing a viable exercise program for older adults that responds to international recommendations, with this masterclass we hope to help physical therapists to plan an exercise program that is feasible and at the same time, responds to the expected needs of this population.

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Criterion Validity and Reliability of 2 Brief Physical Activity Questionnaires in Ethnically Diverse Adults

Norberto N. Quiles, David Uher, Anoop Balachandran, Alexis Ortiz, and Carol Garber

Purpose: The study compares moderate- to vigorous-intensity physical activity (MVPA) as evaluated by the Exercise Vital Signs (EVS) and Physical Activity Vital Signs (PAVS) questionnaires to accelerometry, and evaluates the reliability of the questionnaires in ethnically diverse adults. Methods: Ninety-nine participants (mean age 38.1 y; 49.5% women; Hispanics 43.8%; European American 18.8%; African American 14.6%) were included in the analyses. Participants wore an accelerometer at the hip for at least 7 days and completed the EVS and PAVS questionnaires at the beginning (T1) and at the end (T2) of the 7 days. Associations between the questionnaires and accelerometry were examined using Spearman rho. The reliability of the questionnaires was evaluated using intraclass correlation coefficient. Sensitivity and specificity were also calculated. Results: Weak positive correlations were observed between the accelerometer MVPA and the EVS MVPA at T2 (ρ = .263, P = .013), and the PAVS MVPA at T2 (ρ = .327, P = .003). The sensitivity of the EVS and PAVS was 73.2% and 82.6%, respectively. The specificity for each questionnaire was 35.3%. The reliability for the EVS questionnaire (intraclass correlation coefficient = .855; 95% CI, .791–.901; P < .001) was good, while the reliability of the PAVS questionnaire (intraclass correlation coefficient = .652; 95% CI, .511–.758; P < .001) was moderate. Conclusion: Caution should be used when utilizing the EVS and PAVS questionnaires in ethnically diverse adults.

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Exploring the Lived Experiences of Physical Activity in Community-Dwelling Adults Living With Dementia and Their Carers

Joanna Blackwell and Mo Ray

People living with dementia have the same right to well-being as anyone else, including physical activity. Yet, physical activity levels among people with dementia are lower than in the general population, and while the physical activity health benefits are well established, little is known about how people living with dementia experience physical activity. To explore these physical activity experiences, we visited six community settings in one English county and conducted informal interviews with 18 people who were either living with dementia and community dwelling (n = 4), caring for or who had cared for someone with dementia (n = 10), or providing a support service for people living with dementia and their carers (n = 4). Findings highlight both the challenges and facilitators presented by organized groups, service provider skills and qualities, and environmental factors. Additionally, these factors were influential in shaping the physical activity experience of people living with dementia. The findings may be relevant for people providing or planning support services, commissioners, policymakers, and researchers.

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Process Evaluation of a Scaled-Up School-Based Physical Activity Program for Adolescents: Physical Activity 4 Everyone

Matthew Mclaughlin, Jed Duff, Elizabeth Campbell, Tom McKenzie, Lynda Davies, Luke Wolfenden, John Wiggers, and Rachel Sutherland

Background: Physical Activity 4 Everyone (PA4E1) is a whole-school physical activity program, with demonstrated efficacy (2012–2014). PA4E1 was adapted (scaled-up) and tested in a scale-up trial (2017–2020). This process evaluation study of the scale-up trial had 2 aims. First, to describe the acceptability, appropriateness, and feasibility of PA4E1 in the scale-up trial, from the perspective of school staff involved in the program management and delivery. Second, to generate themes that may explain school staff assessments of acceptability, appropriateness, and feasibility. Methods: Data were collected at various time points throughout the 2-year implementation phase. Online surveys were collected from In-School Champions, Head Physical Education teachers, Principals, and Physical Education teachers (quantitative data). Focus groups and interviews were conducted with In-School Champions, Principals, and Physical Education teachers (qualitative data). Existing published data on website engagement, adaptations, modifications, and the scale-up trial primary outcome (implementation of physical activity practices) were triangulated with the quantitative and qualitative during analysis, to generate themes. Results: School staff delivering PA4E1 reported it was highly acceptable, appropriate, and feasible. Seven themes were generated relating to acceptability, appropriateness, and feasibility. The themes related to how the program was funded, the delivery modes of implementation support, the identification of easy-wins, the recruitment of the right in-school champion, facilitating principal buy-in, mitigating the impact of school staff turnover, and engaging the whole school. Conclusions: Recommendations are made to inform future adaptations for PA4E1 and potentially school-based physical activity programs more generally. The findings may inform future scalability assessments of the suitability of programs for scale-up.

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Active Learning Through Video Conferencing to Maintain Physical Activity Among Older Adults: A Pilot Randomized Controlled Trial

Kazuki Uemura, Tsukasa Kamitani, Atsuya Watanabe, Hiroshi Okamoto, Kenshi Saho, and Minoru Yamada

This randomized pilot trial investigated the feasibility of an active learning physical activity intervention through video conferencing and its preliminary effects. Participants comprised community-dwelling older adults who could use e-mail. The intervention group underwent a 12-week active learning intervention via video conferencing to promote a healthy lifestyle, particularly physical activity. The control group received information via e-mail once per week. The amount of physical activity and sedentary behavior was measured using an accelerometer at baseline, postintervention, and 24-week postintervention (36 weeks). Of the 31 participants, 29 were eligible and randomized into two groups (15 for the intervention and 14 for the control). Adherence to the intervention was 83%–100% (mean, 97%). Compared with the control group, the intervention group showed moderate maintenance effects on total physical activity and sedentary behavior at 36 weeks. Active learning physical activity intervention through video conferencing was found to be feasible and contributed to the prevention of physical activity decline in older adults.