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Exercise represents a physiological stimulus that initiates the coordinated responses of hypothalamic–pituitary axis and sympathetic nervous system. Aims of the study were: 1) to analyze the response of GH, cortisol and prolactin to acute exercise in healthy children with normal GH response to stimulation tests 2) to evaluate the reliability of physical exercise as a screening test for GH secretion. Forty-four children (mean age 9.35 ± 2.69 years, range 4–13.7) underwent standardized Bruce’s test on treadmill. Twenty-nine children were pre-pubertal (nine females and 20 males) and 15 children were pubertal (ten females and five males). Exercise elicited a peak secretion of all the analyzed hormones. GH showed the highest mean percentage increase (558%), followed by prolactin (178%) and cortisol (23%). In 19/44 children (43.2%), GH peak did not reach the cut-off level of 8 ng/ml, considered as the normal GH response to stimulation tests. Despite a wide inter-individual variability, both GH peak and GH increase from baseline were higher in pubertal children than in pre-pubertal ones (GH peak: 13.49 ± 10.28 ng/ml versus 6.6 ± 4.09 ng/ml—p

Objectives: This cross-sectional study examines the association between perceived sidewalk conditions and neighborhood participation among older adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: Between 2013–2016, 14,233 REGARDS participants completed a second in-home visit. Using logistic regression, we cross-sectionally examined if perceived severity of sidewalk problems was associated with going into the neighborhood less than once compared to 1–7 times per week. Results: The analytic sample included participants ( N = 9863) with nonmissing data. The likelihood of going into the neighborhood less than one time per week was greater among participants who reported minor (OR = 1.15; 95% CI: 1.00, 1.33), somewhat serious (OR = 1.41; 95% CI: 1.17, 1.70), and very serious (OR = 1.65; 95% CI: 1.38, 1.98) sidewalk problems in their neighborhood compared to those reporting no sidewalk problems, independent of demographic, socioeconomic, and impairment characteristics. Discussion: Perceived sidewalk problems appear to deter neighborhood participation among older adults.

It is necessary to effectively assess functional mobility for appropriate prosthetic prescription and post-amputation rehabilitation. As part of this process, patients' ability for variable cadence and community ambulation are assessed in-clinic, often through visual assessments and without objective standards. The purpose of this study was to explore the clinical viability of using wearable sensors to characterize the functional mobility of people with lower limb amputation. We collected inertial measurement unit (IMU) and global positioning system (GPS) data over two weeks, from 17 individuals with lower limb amputation and 14 healthy non-amputee controls. We calculated stride-by-stride cadence, walking speed and stride lengths, along with whether they occurred in or out of the home. Self-selected walking speed was also assessed in the lab. Compared to the lab, both groups walked slower and with a lower cadence during their daily lives. There were no differences in cadence variability between groups or between strides taken in and out of the home. Both groups walked faster and with greater stride lengths away from the homes. The results suggest that functional capacity measured in the lab was not necessarily reflected in routine walking during daily life. The walking measures derived in this approach can be used to aid in the prosthetic prescription process or in the assessment of different interventions.

Descrizione della relazione tra classificazione NOHL definita durante la drug-induced sleep endoscopy e AHI iniziale in pazienti con OSAS da moderato a grave, e valutazione dei risultati ottenuti con dispositivi orali.La drug-induced sleep endoscopy (DISE) è ampiamente riconosciuta come un valido strumento per la diagnosi e la pianificazione del trattamento della sindrome delle apnee ostruttive (OSAS), in quanto consente una visualizzazione diretta dei siti e pattern di collasso delle vie aeree superiori (VAS). In letteratura sono state proposte molteplici classificazioni per descrivere gli eventi osservati duranti la DISE, fra cui la NOHL (Nasopharynx cavity and walls, Oropharynx, Hypopharynx, Larynx) classification (Vicini 2012). Lo studio si prefigge gli obiettivi di identificare quali strutture anatomiche, definite secondo la classificazione NOHL, sono più rappresentate nel collasso delle VAS in pazienti con OSAS da moderato (15 ≤ AHI ≤ 30) a grave (AHI30), e valutare il risultato del trattamento con dispositivi orali (OA), in termini di riduzione dell’AHI. Il gruppo studio è composto da 35 pazienti (29 M, 6 F, età media 50,6, BMI medio 26) con diagnosi polisonnografica di OSAS da moderato a severo, sottoposti a DISE e classificati secondo la classificazione NOHL per individuare le sedi anatomiche e i pattern di collasso più frequentemente riportati. I pazienti sono stati successivamente indirizzati a terapia con Mandibular Advancing Devices (MAD), ed è stato valutato il risultato del trattamento in termini di riduzione dell’AHI. Nel campione esaminato, le strutture anatomiche più frequentemente coinvolte nel collasso delle VAS risultano essere il nasofaringe (N) e la base lingua (H), con indice di correlazione 0,35 (p0,04), mentre non è stata evidenziata significatività per l’area retropalatale (O) e la laringe (L). L’analisi descrittiva ha evidenziato inoltre un collasso multisede in tutti i pazienti, con coinvolgimento di più strutture nella meccanica ostruttiva. In tutti i pazienti è stata osservata una riduzione dell’AHI dopo terapia con MAD (p0,00), sebbene in alcuni casi non completamente risolutiva della patologia.Nowadays, drug-induced sleep endoscopy is widely recognised as a valid tool for diagnosis and treatment planning of obstructive sleep apnoea syndrome (OSAS), as it allows a direct visualisation of sites and patterns of collapse of the upper airways (UA). Various classifications have been proposed in the literature to describe the events observed during DISE, including the NOHL (Nasopharynx cavity and walls, Oropharynx, Hypopharynx, Larynx) classification. This study was aimed at assessing which anatomical structures, according to the NOHL Classification, were most frequently involved in UA collapse in patients with moderate to severe OSAS, and evaluating treatment results with oral appliances (OA), in terms of AHI reduction. The study group consisted of 35 patients (29 M, 6 F, mean age 50.6, average BMI 26) with polysomnographic diagnosis of moderate to severe OSAS, subjected to DISE and classified according to the NOHL classification to identify the anatomical sites and patterns of UA collapse most frequently reported. Patients were subsequently addressed to mandibular advancing device (MAD) therapy and treatment results in terms of AHI reduction were evaluated. In the sample examined, the anatomical structures most frequently involved in the collapse of the UA were the nasopharynx cavity and walls and tongue base, with a correlation index of 0.35 (p0.04), while no significance was found for the retro-palatal area or larynx. Descriptive analysis revealed multilevel collapse in all patients, involving multiple anatomical structures in obstructive mechanics. In all patients, AHI reduction was observed after treatment with MAD (p0.00).

Background and Purpose: We examined differences in the volume and pattern of physical activity (PA) and sedentary behavior between adults with and without stroke. Methods: We studied cohort members with an adjudicated or self-reported stroke (n=401) and age-, sex-, race-, region of residence-, and body mass index-matched participants without a history of stroke (n=1203) from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Sedentary behavior (total volume and bouts), light-intensity PA, and moderate-to-vigorous-intensity PA were objectively measured for 7 days via hip-worn accelerometer. Results: Sedentary time (790.5±80.4 versus 752.4±81.9 min/d) and mean sedentary bout duration (15.7±12.6 versus 11.9±8.1 min/d) were higher and PA (light-intensity PA: 160.5±74.6 versus 192.9±73.5 min/d and moderate-to-vigorous-intensity PA: 9.0±11.9 versus 14.7±17.0 min/d) lower for stroke survivors compared with controls ( P P Conclusions: Stroke survivors accrued a lower volume of PA, higher volume of sedentary time, and exhibited accrual patterns of more prolonged sedentary bouts and shorter, lower intensity activity breaks compared with persons without stroke.

BackgroundFew studies have examined the moderating role of neighbourhood environments on the relation between psychosocial factors and physical activity, and results of these studies are mixed. This study examined this relationship in 636 fifth to seventh graders from South Carolina, USA.MethodsFrom 2010 to 2013, children and their parent/guardian completed annual self-reported surveys assessing psychosocial factors, and children wore accelerometers for 1 week each year. Neighbourhood environments were classified as supportive or non-supportive for physical activity (PA) based on in-person audits of facilities near children’s homes and windshield surveys of children’s streets. Growth curve analyses were completed to assess the moderating effect of the neighbourhood physical activity environment (NPAE) on the relation between psychosocial factors and total physical activity (TPA) over time.ResultsSignificant interactions on TPA were found for (1) time, NPAE and parent-reported parent support for PA; (2) time, NPAE and child-reported equipment in the home; (3) child-reported parental support for PA and time; (4) child-reported parental support for PA and NPAE; (5) PA self-schema and time and (6) child-reported parental encouragement and time. Parental support and a supportive NPAE were important for TPA, especially as children transitioned to middle school, whereas home equipment and a supportive NPAE were important for fifth graders’ TPA.ConclusionConsistent with the socioecological model, PA behaviour was dependent on interacting effects across levels of influence. Generally, both a supportive NPAE and positive psychosocial factors were needed to support TPA. Factors influencing PA across multiple levels should be addressed in PA interventions.

BackgroundThere have been mixed findings regarding the relationship between walkability and level of physical activity in adults.MethodsParticipants from The REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort (N=7561) were used to examine the association between Walk Score and physical activity measured via accelerometry. The subsample included geographically diverse adults, who identified as black or white, and were over the age of 45. Linear regression was used to examine the direct effects, as well as the interaction, of Walk Score by sex, age and race.ResultsThe majority of participants lived in a ‘Very Car-Dependent’ location (N=4115). Only 527 lived in a location that was ‘Very Walkable/Walker’s Paradise’. Living in a location with a Walk Score of ‘Very Car-Dependent’ compared with ‘Very Walkable/Walker’s Paradise’ was associated with 19% (0.81; 95% CI 0.73 to 0.90) lower predicted minutes of moderate to vigorous physical activity per day, after adjustment for covariates. There was no evidence of statistically significant interactions between Walk Score and sex, age or race (p>0.05).ConclusionAccumulated daily time in moderate to vigorous physical activity was higher for participants living in neighbourhoods designated as ‘Very Walkable/Walker’s Paradise’. This effect was not moderated by sex, age or race of participants.

Background Few studies have assessed objectively measured physical activity (PA), active transportation, psychological distress and neighborhood perceptions among residents of a neighborhood before and after substantial improvements in its physical environment. Also, most research-to-date has employed study designs subject to neighborhood selection, which may introduce bias in reported findings. We built upon a previously enrolled cohort of households from two low-income predominantly African American Pittsburgh neighborhoods, matched on socio-demographic composition including race/ethnicity, income and education. One of the two neighborhoods received substantial neighborhood investments over the course of this study including, but not limited to public housing development and greenspace/landscaping. We implemented a natural experiment using matched intervention and control neighborhoods and conducted pre-post assessments among the cohort. Our comprehensive assessments included accelerometry-based PA, active transportation, psychological distress and perceptions of the neighborhood, with assessments conducted both prior to and following the neighborhood changes. In 2013, we collected data from 1003 neighborhood participants and in 2016, we re-interviewed 676 of those participants. We conducted an intent to treat analysis, with a difference-in-difference estimator using attrition weighting to account for nonresponse between 2013 and 2016. In addition, we derived an individual-level indicator of exposure to neighbourhood investment and estimated effect of exposure to investment on the same set of outcomes using covariate-adjusted models. Results We observed no statistically significant differences in activity, psychological distress, satisfaction with one’s neighborhood as a place to live or any of the other measures we observed prior to and after the neighborhood investments between the intervention and control neighborhoods or those exposed vs not exposed to investments. Conclusions Using this rigorous study design, we observed no significant changes in the intervention neighborhood above and beyond secular trends present in the control neighborhood. Although neighborhood investment may have other benefits, we failed to see improvement in PA, psychological distress or related outcomes in the low-income African American neighborhoods in our study. This may be an indication that improvements in the physical environment may not directly translate into improvements in residents’ physical activity or health outcomes without additional individual-level interventions. It is also possible that these investments were not dramatic enough to spur change within the three year period. Additional studies employing similar design with other cohorts in other settings are needed to confirm these results. Trial registration Trial Registration is not applicable since we did not prospectively assign individuals to a health-related intervention.

Background Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how use of a powered prosthesis influences everyday physical activity and mobility. Methods Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants’ metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthesis use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson’s correlations. Results Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed in-lab (p = 0.145) and in daily life (p = 0.226), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium-sized effects for device comparisons. With the powered prosthesis, participants had increased self-reported ambulation (g = 0.682) and decreased frustration (g = 0.506). Conclusions There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription. Trial registration: https://clinicaltrials.gov, #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982

Background Epidemiological studies utilize residential histories to assess environmental exposure risk. The validity from using commercially-sourced residential histories within national longitudinal studies remains unclear. Our study assessed predictors of non-agreement between baseline addresses from the commercially-sourced LexisNexis database and participants in the national longitudinal study, REasons for Geographic and Racial Differences in Stroke (REGARDS). Additionally, we assessed differences in stroke risk by neighborhood socioeconomic score (nSES) based on participant reported address compared to nSES from LexisNexis/REGARDS matched baseline address. Methods From January 2003–October 2007, REGARDS enrolled 30,239 black and white adults aged 45 and older within the continental United States and collected their baseline address. ArcGIS Desktop 10.5.1 with ESRI 2016 Business Analyst Data was used to geocode baseline addresses from LexisNexis and REGARDS. Logistic regression was used to estimate the likelihood that LexisNexis address matched REGARDS baseline address for each participant. Survival analysis was used to estimate association between nSES and incident stroke. Results Approximately 91% of REGARDS participants had a LexisNexis address. Of these geocoded addresses, 93% of REGARDS baseline addresses matched LexisNexis addresses. Odds of agreement between LexisNexis and REGARDS was higher for older-aged participants (OR = 1.02 per year, 95% CI: 1.01, 1.02), blacks compared to whites (OR = 1.16, 95% CI: 1.05, 1.29), females compared to males (OR = 1.15, 95% CI: 1.04, 1.26), participants with an income of $34k-74k compared to an income less than $20k (OR = 1.62, 95% CI: 1.39, 1.89). Odds of agreement were lower for residents in Midwest compared to residents in the south (OR = 0.82, 95% CI: 0.73, 0.94). No significant differences in nSES-stroke associations were observed between REGARDS only and LexisNexis/REGARDS matched addresses; however, differences in interactions were observed. Conclusion Agreement between LexisNexis and REGARDS addresses varied by sociodemographic groups, potentially introducing bias in studies reliant on LexisNexis alone for residential address data., Highlights • Approximately 9% of REGARDS participants did not have a LexisNexis address history available. • Of participants with both REGARDS and LexisNexis addresses available, 93% of these addresses matched. • Agreement between REGARDS and LexisNexis address varied by socio-demographics—potentially biasing environmental exposures. • Compared to LexisNexis, REGARDS addresses may be valuable in detecting interactions contributing to stroke disparities.

The built environment (BE) has been associated with health outcomes in prior studies. Few have investigated the association between neighborhood walkability, a component of BE, and hypertension. We examined the association between neighborhood walkability and incident hypertension in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Walkability was measured using Street Smart Walk Score based on participants' residential information at baseline (collected between 2003 and 2007) and was dichotomized as more (score ≥70) and less (score N = 2,515) had incident hypertension. In adjusted analysis, neighborhood walkability (Walk Score ≥70) was associated with a lower risk of incident hypertension (RR [95%CI]: 0.85[0.74, 0.98], P = 0.02), with similar but non-significant trends in race and age strata. In secondary analyses, living in a more walkable neighborhood was protective against being hypertensive at both study visits (OR [95%CI]: 0.70[0.59, 0.84], P < 0.001). Neighborhood walkability was associated with incident hypertension in the REGARDS cohort, with the relationship consistent across race groups. The results of this study suggest increased neighborhood walkability may be protective for high blood pressure in black and white adults from the general US population.

Physical exercise benefits cognitive functioning and can protect against neurodegeneration. Neighborhood environments may be pivotal to physically active aging, and thus help shape older adults' cognitive function. This mixed-methods study investigated where older adults exercised outside the home, and whether availability of these neighborhood sites was associated with cognitive function. We thematically analyzed qualitative data from semi-structured interviews in 2015 with 125 older adults (mean age = 71) in the Minneapolis (MN) metropolitan area. Results identified nearby public parks, fitness/sports amenities, and walkable destinations as motivators for recreational exercise and active transit among participants. These findings informed quantitative analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national sample of older Black and white Americans (n = 21,151; mean age at assessment = 67; data collected 2006–2017). We used generalized additive multilevel models to examine whether neighborhood features that qualitative participants identified as encouraging physical activity were associated with elevated levels of cognitive function. Results indicated that residing in neighborhoods with greater availability of local parks, access to recreational amenities, and business density was associated with higher levels of cognitive function. We found no evidence to suggest a significant association between availability of these neighborhood resources and rate of cognitive decline. This study identifies specific neighborhood active aging infrastructure that may support cognitive function among older adults aging in place.

Objective: Research demonstrates mastery motivational climates are effective in increasing children’s physical activity (PA) and fundamental movement skills (FMS). In this study, we evaluated the effects of different types of mastery climate physical education (PE) lessons on PA and FMS. Methods: Participants in this 10-week randomized trial (N = 45, mean age = 9.0±0.5years, 48.9% boys) were randomly assigned to one of 3 mastery climate PE lessons: (1) FMS, (2) PA, or (3) FMS + PA. We conducted one-way ANCOVAs to determine differences between lessons on percentage of time spent in PA levels and changes in FMS scores. Results: There was a statistically significant effect of lesson type on moderate-to-vigorous PA (MVPA; F(2,40) = 7.730, p 2, 38 = 3.431, p =.043) and total FMS score (F2, 38 = 4.993, p =.027). Post hoc analyses revealed children receiving the FMS lesson had significantly higher MVPA levels compared to other lessons and higher VPA levels compared to the PA lesson (all ps

(1) Background: Few studies have examined the relationship between neighborhood socioeconomic deprivation (SED) and weight-related outcomes in youth, controlling for weight-related behaviors. Hence, the purpose of this study was to examine the association between neighborhood SED, weight status, and fat mass in a diverse sample of youth, before and after controlling for physical activity and diet. (2) Methods: The sample included 828 youth from the Transitions and Activity Changes in Kids study. Neighborhood SED was expressed as an index score at the census tract of residence. Height, weight, and body composition were measured and used to calculate fat mass index (FMI) and weight status. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (min/h) were measured via accelerometry. Diet quality was assessed via the Block Food Screener for Kids. Multilevel regression models were employed to examine these relationships. (3) Results: Neighborhood SED was significantly associated with FMI and weight status before and after controlling for MVPA, sedentary behavior, and diet. Notably, youth residing in the most deprived neighborhoods had significantly higher FMI and were 30% more likely to be overweight/obese (OR = 1.30, 95% CI = 1.03&ndash, 1.65). (4) Conclusions: Greater neighborhood SED was consistently and significantly associated with higher fat mass index and increased likelihood of overweight/obesity among youth.

Background Improving the neighborhood environment may help address chronic disease and mortality. To identify neighborhood features that are predictors of health, objective assessments of the environment are used. Multiple studies have reported on cross-sectional assessments of health-related neighborhood features using direct observation. As study designs expand to better understand causation and predictors of change, there is a need to test whether direct observation methods are adequate for longitudinal assessment. To our knowledge, this is the first study to report on the reliability of repeated measurements of the neighborhood environment, and their stability, over time. Methods The Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) study conducted longitudinal assessments in two low-income, African American neighborhoods at three waves (years 2012, 2015, 2017). The PHRESH audit tool is a modification of earlier validated tools, with an emphasis on environment features relevant for physical activity, sleep, and obesogenic behaviors. Trained data-collector pairs conducted direct observations of a 25% sample of street segments in each neighborhood. At each wave, we audited a sub-sample of street segments twice and assessed reliability using percentage inter-observer agreement and krippendorf’s alpha statistics. Stability of these items was assessed as exhibiting moderate or high agreement at every time point. Results Across waves, a majority (81%) of the items consistently demonstrated moderate to high agreement except for items such as public/communal space, amount of shade, sidewalk features, number of traffic lanes, garden/flower bed/planter, art/statue/monument, amount of trash, and physical disorder. The list of items with poor agreement includes features that are easy to miss (e.g. flower bed/planter), hard to assess from outside (e.g. public/communal space), or may change quickly (e.g. amount of trash). Conclusion In this paper, we have described implementation methods, reliability results and lessons learned to inform future studies of change. We found the use of consistent methods allowed us to conduct reliable, replicable longitudinal assessments of the environment. Items that did not exhibit stability are less useful for detecting real change over time. Overall, the PHRESH direct observation tool is an effective and practical instrument to detect change in the neighborhood environment.

ObjectiveTo summarize overall patterns of the impact of neighborhood socioeconomic status (nSES) on stroke incidence and uncover potential gaps in the literature, we conducted a systematic review of studies examining the association between nSES and stroke incidence, independent of individual SES.MethodsFour electronic databases and reference lists of included articles were searched, and corresponding authors were contacted to locate additional studies. A keyword search strategy included the 3 broad domains of neighborhood, SES, and stroke. Eight studies met our inclusion criteria (e.g., nSES as an exposure, individual SES as a covariate, and stroke incidence as an outcome). We coded study methodology and findings across the 8 studies.ResultsThe results provide evidence for the overall nSES and stroke incidence association in Sweden and Japan, but not within the United States. Findings were inconclusive when examining the nSES-stroke incidence association stratified by race. We found evidence for the mediating role of biological factors in the nSES-stroke incidence association.ConclusionsHigher neighborhood disadvantage was found to be associated with higher stroke risk, but it was not significant in all the studies. The relationship between nSES and stroke risk within different racial groups in the United States was inconclusive. Inconsistencies may be driven by differences in covariate adjustment (e.g., individual-level sociodemographic characteristics and neighborhood-level racial composition). Additional research is needed to investigate potential intermediate and modifiable factors of the association between nSES and stroke incidence, which could serve as intervention points.

Background: The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children’s physical activity, though the term “physical activity desert” has not come into wide use. Methods: This exploratory study operationalized the term “physical activity desert” and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities. Results: Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children. Conclusion: Children living in a “no park” zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of “physical activity desert.” Future studies of physical activity deserts should be undertaken in larger and more diverse samples.

IntroductionData supports that motor skills are an underlying mechanism that influence physical activity along with perceived motor and physical competence, but the relationship between motor skills and physical activity during the early years is unclear. The goal of this study, Promoting Activity and Trajectories of Health (PATH) for Children, is to examine and compare the immediate (pre-test to post-test) and sustained (3-year follow-up) effect of an intervention on motor performance, physical activity and perceived physical competence to a control condition (ie, standard practice) in preschool-age children.Methods and analysisThe PATH study is a two-cohort, randomised cluster clinical trial. 300 children between the ages of>3.5 to 5 years of age will be randomised to the motor skill intervention (n=153) or control (n=147) condition. Each assessment involves a measure of motor skill performance; product and process, seven consecutive days of physical activity monitoring and perceived physical competence. These measures will be assessed before and after the intervention (pre-test to post-test) and then each academic year across 3 years, grades kindergarten, first grade and second grade (3-year follow-up). To assess the clustered longitudinal effect of the intervention on outcome measures, random-effects models (eg, mixed model regression, growth curve modelling and structural equation modelling) will be used. The PATH study addresses gaps in paediatric exercise science research. Findings hold the potential to help shape public health and educational policies and interventions that support healthy development and active living during the early years.Ethics and disseminationEthical approval for this study was obtained through the Health Sciences and Behavioral Sciences Institutional Review Board, University of Michigan (HUM00133319). The PATH study is funded by the National Institutes of Health. Findings will be disseminated via print, online media, dissemination events and practitioner and/or research journals.Trial registration numberNHLBI ClinicalTrials.gov Identifier,NCT03189862. Registered 17 August 2017,https://clinicaltrials.gov/ct2/show/NCT03189862

Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neighborhood economic conditions can be characterized differently but studies have not identified which characterizations are most predictive of incident stroke. Previous work has suggested that the income distribution within the population may be more relevant for chronic disease than the absolute value of median income of the population. This project aims to estimate the effects of neighborhood income and neighborhood income inequality on incidence stroke. Hypothesis: Neighborhood income inequality and absolute neighborhood income will predict incident stroke above and beyond demographic characteristics and individual socioeconomic status. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national longitudinal study of black and white older adults (N=29,443). Baseline median household income and the Gini coefficient of income inequality at the Census Tract level were obtained from the 2000 decennial census. Both variables were standardized to have a mean of 0 and a standard deviation of 1; z-score of median household income was multiplied by -1 (representing neighborhood income deprivation) to allow for comparability. Using Cox Proportional Hazards analysis we examined the risk of stroke associated with these exposures in separate models. Model 1 was unadjusted, Model 2 was adjusted for demographic characteristics (age, race, sex, marital status), and Model 3 was adjusted for individual socioeconomic characteristics (household income and education). Results: Within Model 1, neighborhood income deprivation (HR: 1.18; 95% CI 1.11-1.24) and neighborhood income inequality (HR: 1.10; 95% CI: 1.05-1.16) were both significantly associated with risk of stroke. The association persisted in Model 2: neighborhood income deprivation (HR: 1.13; 95% CI 1.07-1.20) and neighborhood income inequality (HR: 1.06; 95% CI: 1.00-1.11). Within Model 3, neighborhood income deprivation maintained its positive association (HR: 1.06; 95% CI 1.00-1.13), while neighborhood income inequality was no longer predictive of stroke risk (HR:1.04; 95% CI 0.99-1.10). Conclusions: Neighborhood income deprivation and neighborhood income inequality were similar predictors of incident stroke. The effect of absolute economic resources in a Census Tract was slightly larger than the relative economic standards within a Census Tract. There is a need to investigate other characterizations of neighborhood economic conditions, such as residential income segregation. The findings from this project suggest that there are multiple policy levels that can be used to decrease incident stroke, through decreasing income inequality and improving the absolute economic conditions of deprived neighborhoods.

Introduction: Prior studies have investigated the relationship between neighborhood income and incident hypertension but have lacked participant-level details or studied specific subpopulations. We assessed the relationship between neighborhood income and incident hypertension accounting for individual level factors in the racially and geographically diverse REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Hypothesis: Low neighborhood income is associated with increased hypertension incidence. Methods: REGARDS recruited 30,239 white and black adults aged ≥45y from the contiguous US in 2003-7 with follow-up between 2013-6. We excluded individuals with baseline hypertension (≥130/80 mm Hg or using antihypertension medications, n=22,325), missing follow-up (n=3,365) and not residing at the same address for ≥5 years (n=1,075). Neighborhood income was measured within 1 and 5 km buffers around the participant’s home using a spatial overlay of census tract-level median household income, and then classified into tertiles. We used Poisson regression to calculate risk ratio for incident hypertension adjusting for demographic, socioeconomic, and health habit factors. Results: Among the 3,474 individuals (58% women, 24% black, mean age 62y), 1,499 individuals (43%) developed hypertension. After adjusting for individual-level risk factors, the incident rate ratio of hypertension for individuals living in low-income neighborhoods was 1.16 (95% CI 1.04, 1.31) and middle-income was 1.12 (95% CI 1.01, 1.25) as compared to high income, when neighborhood was defined as a 1 km buffer. The result was similar but not significant in middle-income for the 5 km buffer neighborhoods (Table 1). There were no significant interactions with age, gender, or race (p-interaction > 0.1). Conclusions: In REGARDS, neighborhood income was associated with incident hypertension. Understanding the specific social and environmental inequities associated with hypertension will require further study.

Numerous studies have focused on the role of neighborhood socioeconomic status in childhood obesity and physical activity, but few studies have examined the effect of neighborhood socioeconomic changes over time and the interaction between family and neighborhood SES on childhood obesity and physical activity. This study measured neighborhood socioeconomic histories between 2000 and 2010 and examined the associations between neighborhood socioeconomic histories and childhood obesity, as well as physical activity. The moderating role of family poverty status was also examined. Using the Healthy Communities Study (2013–2015), we measured obesity indicators (objectively measured body mass index z-score and waist circumference) and a physical activity indicator (self-reported moderate-to-vigorous physical activity) for a cohort of 4114 children. Multilevel linear regression models were used to examine the associations between neighborhood socioeconomic histories between 2000 and 2009–2013 and body-mass index z-score, waist circumference, and moderate-to-vigorous physical activity. Results showed that higher-income children in consistently high socioeconomic neighborhoods had lower measured BMIz and WC and engaged in more moderate-to-vigorous physical activity than higher-income children in consistently low socioeconomic neighborhoods. Additionally, low-income children in consistently moderate socioeconomic neighborhoods reported a lower level of moderate-to-vigorous physical activity than low-income children in consistently low socioeconomic neighborhoods. The findings indicate that considering both family and neighborhood socioeconomic status may help elucidate the underlying differences in childhood obesity and physical activity levels by socioeconomic status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11524-020-00427-9) contains supplementary material, which is available to authorized users.

Purpose: The purpose of this study was to compare the acute effects of video game breaks and intermittent exercise breaks, performed at varying intensities, on math performance in preadolescent children. Methods: A total of 39 children (18 males and 21 females; aged 7–11 y) completed 4 experimental conditions in random order: 8 hours of sitting interrupted with 20 two-minute low-, moderate-, or high-intensity exercise breaks or 20 two-minute sedentary computer game breaks. The intensity of exercise breaks for the low-, moderate-, and high-intensity conditions corresponded with 25%, 50%, and 75% of heart rate reserve, respectively. Math performance was assessed 3 times throughout each condition day using a 90-second math test consisting of 40 single-digit addition and subtraction questions. Results: There were no significant differences in percent change in math scores (correct answers out of attempted) by condition [low: −1.3 (0.8), moderate: 0.1 (1.3), high: −1.8 (0.7), and computer: −2.5 (0.8); P > .05]. There were significant differences in percent change in math scores over the course of the condition days with lower math scores reported at end-of-day test compared with midday test [−2.4 (0.5) vs −0.4 (0.3); P = .01]. There were no significant condition × time, time × age, condition × age, or condition × time × age interactions (all Ps > .05). Conclusion: Action-based video game and exercise breaks elicit the same level of math performance in children; however, time of day may impact this relationship. These findings may have important implications for instructional time in elementary classrooms.

Background Residential environments may significantly influence youth physical activity (PA). However, few studies have examined detailed street quality attributes via observational audits in relation to context-specific PA among youth. Objectives The objective of this study was to explore whether the overall quality of street environments, as well as specific attributes, was associated with neighbourhood-based and street-based PA within a national sample of youth in the Healthy Communities Study. Methods Data were collected from 4616 youth from 130 communities across the USA. Youth PA in the neighbourhood and on the participant's street was captured using 7-d recall interviews. Windshield survey observational audits documented five street quality variables: burned, boarded up or abandoned residential units, litter, overall condition of residences, street type and presence of sidewalks in good condition. Results Youth with no litter on their street reported significantly lower neighbourhood-based PA and youth living on a side street, cul-de-sac, dead-end or one-way street reported greater neighbourhood-based PA. No significant associations were detected for the overall street quality index or with street-based PA. Conclusions Specific street quality attributes may be associated with youth PA. Further research and collaboration between diverse disciplines and agencies should focus on understanding and improving street quality to promote youth PA and health.

Background Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited. Objectives The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities. Methods Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self-report and parental report in samples of children in each community (total n = 5138). Associations between composite indices of community programmes and policies and indicators of total and moderate-to-vigorous physical activity were examined without and with adjustment for demographic factors. Results An index reflecting the 6-year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate-to-vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non-Hispanic children but was negative for Hispanic children. Conclusions Community initiatives to promote physical activity in children were positively associated with children's physical activity in non-Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub-group.

Purpose: The purpose of this study was to compare the effects of intermittent activity performed at varying intensities and of prolonged sitting on physical activity compensation. Methods: A total of 33 children (14 boys and 19 girls; age 7–11 y; 24% overweight/obese; 61% nonwhite) completed 4 experimental conditions in random order: 8 hours of sitting interrupted with 20 two-minute low-, moderate-, or high-intensity activity breaks or 20 two-minute sedentary computer game breaks. Physical activity energy expenditure (PAEE) was assessed via accelerometry to establish baseline PAEE and throughout each condition day (8-h in-lab PAEE, out-of-lab PAEE, and 3-d postcondition). Results: Compared with baseline PAEE, total daily PAEE was significantly higher during the high-intensity condition day (153 ± 43 kcal, P = .03), unchanged during the low-intensity (−40 ± 23 kcal, P > .05) and moderate-intensity condition days (−11 ± 18 kcal, P > .05), and decreased in response to prolonged sitting (−79 ± 22 kcal, P = .03). There were no significant differences in PAEE 3-day postcondition across conditions (P > .05). Conclusion: Despite the varying levels of PAEE accumulated during the 8-hour laboratory conditions, out-of-lab PAEE during each condition day and 3-day postcondition did not change from the baseline. These findings provide preliminary evidence that spontaneous physical activity in children does not change in response to intermittent activity or prolonged sitting.

Social support and social networks can elucidate important structural and functional aspects of social relationships that are associated with health-promoting behaviors, including Physical Activity (PA) and weight. A growing number of studies have investigated the relationship between social support, social networks, PA and obesity specifically among African Americans; however, the evidence is mixed and many studies focus exclusively on African American women. Most studies have also focused on either functional or structural aspects of social relationships (but not both) and few have objectively measured moderate-to-vigorous physical activity (MVPA) and body mass index (BMI). Cross-sectional surveys of adult African American men and women living in two low-income predominantly African American neighborhoods in Pittsburgh, PA (N = 799) measured numerous structural features as well as functional aspects of social relationships. Specifically, structural features included social isolation, and social network size and diversity. Functional aspects included perceptions of social support for physical activity from the social network in general as well as from family and friends specifically. Height, weight, and PA were objectively measured. From these, we derived Body Mass Index (BMI) and moderate-to-vigorous physical activity (MVPA). All regression models were stratified by gender, and included age, income, education, employment, marital status, physical limitations, and a neighborhood indicator. Greater social isolation was a significant predictor of lower BMI among men only. Among women only, social isolation was significantly associated with increased MVPA whereas, network diversity was significantly associated with reduced MVPA. Future research would benefit from in-depth qualitative investigations to understand how social networks may act to influence different types of physical activity among African Americans, as well as understand how they can be possible levers for health promotion and prevention., Highlights • Contributes to research on the social environment and physical activity among African Americans. • Social isolation was associated with lower BMI among men. • Social isolation was associated with more physical activity among women. • More social network diversity was associated with less physical activity among women.

OBJECTIVE: The ActiGraph is commonly used for measuring sedentary behavior, but the best data processing technique is not established for sedentary adults with chronic illness. The purpose of this study was to process ActiGraph vertical axis and vector magnitude data with multiple combinations of filters, non-wear algorithm lengths, and cut-points and to compare ActiGraph estimates to activPAL-measured sedentary time in sedentary adults with chronic obstructive pulmonary disease. APPROACH: This study was a secondary analysis of adults ≥50 years (N=59; Mean age: 69.4 years; N= 31 males) with chronic obstructive pulmonary disease. Participants wore ActiGraph GT9X and activPAL3 for 7 days. ActiGraph vertical axis and vector magnitude data were processed using combinations of filters (normal, low frequency extension), non-wear algorithm lengths (60, 90, 120 minutes), and cut-points for sedentary behavior previously validated in older adults (two for vertical axis and three for vector magnitude data). The Bland-Altman method was used to assess concordance between sedentary time measured with 30 ActiGraph techniques and activPAL-measured sedentary time. MAIN RESULTS: Agreement between the two devices was moderate to strong for all techniques; concordance correlations ranged from 0.614–0.838. Limits of agreement were wide. The best overall technique was vector magnitude data with low frequency extension filter, 120-minute non-wear algorithm, and

Background: The purpose of this study was to examine the acute effects of intermittent physical activity (2-min bouts of varying intensities) on psychological mood and enjoyment in elementary school-age children and to examine the effect of weight status on these psychological outcomes. Methods: A total of 39 children (healthy weight, n = 26; overweight/obese, n = 13) completed 4 experimental conditions in random order, which consisted of 8 hours of sitting interrupted with 20 two-minute low­-, moderate-, or high-intensity activity breaks or 20 two-minute screen-time breaks. Mood was assessed using the Feeling Scale immediately following each break. Enjoyment was assessed using the Physical Activity Enjoyment Scale immediately following 10 and 20 breaks. Results: Mood was significantly higher during the sedentary versus active conditions (P P P P = .02). Enjoyment was significantly higher after completing the active versus sedentary conditions (P = .02). Conclusion: These findings suggest that both healthy weight and overweight/obese children felt better immediately after engaging in screen-time breaks but subsequently rated the activity breaks as more enjoyable compared with screen-time breaks.

Background and Purpose— Stroke is the leading cause of serious, long-term disability in the United States, and the number of stroke survivors is projected to rise. Physical functioning status may be compromised in survivors living in low socioeconomic status environments in comparison to higher socioeconomic status environments. Higher socioeconomic status environments may include benefits in the built environment such as sidewalks, accessible transit, or low traffic volume. Investigation is needed to understand the effects of the socioenvironmental context on trajectories of stroke survivors’ physical health-related quality of life (PH-QOL) over time. Methods— Participants from the REGARDS (REasons for Geographic and Racial Differences in Stroke) study enrolled in the ancillary Caring for Adults Recovering from the Effects of Stroke project completed the SF-12 around 6 to 12, 18, 27, and 36 months poststroke. Measures of area-level income, wealth, education, and employment at the census tract level were combined to represent participants’ neighborhood socioeconomic status. Linear mixed models were used to predict trajectories of PH-QOL over time, controlling for individual characteristics. Results— The average trajectory of PH-QOL was flat over time. However, women and younger stroke survivors had better trajectories over time than men and older stroke survivors. Higher neighborhood socioeconomic status was significantly associated with better PH-QOL across all time points (β=1.73; 95% CI, 0.17–3.30), after controlling for demographic variables and severity of stroke. Conclusions— Our findings demonstrate that neighborhood socioeconomic status, sex, and age are associated with the poststroke recovery process. The results of this study suggest the importance of evaluating the environment surrounding stroke survivors when they return to their home communities. Future research should identify specific features of the environment within different socioeconomic status neighborhoods to better understand how they contribute to PH-QOL among stroke survivors.

Introduction: Over the past decade, studies on associations between built environments and health outcomes have exponentially increased, particularly regarding walkability. Some studies have shown associations between walkability and lower blood pressure, as well as other cardiometabolic risk factors. Objective: The purpose of this study was to investigate associations between objectively measured neighborhood walkability and incidence of hypertension in older adults in a national cohort study in the United States. Methods: Neighborhood walkability was measured by Walk Score, and scores were generated for participants in the Reasons for Geographical and Racial Differences in Stroke Study (REGARDS, n=30,172). Descriptive statistics were reported by the categories of Walk Score: Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Associations between walkability and blood pressure were tested both cross-sectionally and longitudinally. Covariates included age, race, sex, geographical region, income, education, health behaviors (i.e., smoking, alcohol use, exercise), and cardiovascular comorbidities (i.e., dyslipidemia, diabetes). Linear models tested associations between Walk Score and systolic and diastolic blood pressure. Logistic regression models tested associations between Walk Score and incident, prevalent, and treated hypertension. Results: In adjusted analyses, Walk Score category was not associated with incident hypertension in the entire cohort. However, among white participants, a higher Walk Score category was associated with a lower odds of incident hypertension. In secondary analyses, higher Walk Score category was associated with lower odds of treated hypertension (OR 0.87, 95% CI 0.78-0.97, p=0.03). Higher Walk Score was linearly associated with higher diastolic blood pressure cross-sectionally in black participants but not among the entire cohort (P-interaction=0.02). Conclusions: We found limited evidence that higher walkability was an important contributor to hypertension. Further studies are needed to understand the associations between walkability and cardiovascular health outcomes. A better understanding of the relationship between residential features and hypertension could potentially help redefine intervention strategies for cardiovascular disease risk reduction.

Background and Aims: The role of socioeconomic status in stroke has been difficult to study due to differences at both the individual and neighborhood level. We therefore sought to examine the role of neighborhood socioeconomic status on risk of stroke in two countries: the United States (US) and France. Methods: We used the REasons for Geographic and Racial Differences in Stroke (REGARDS) study in the US and the 3-City (3C) study in France. In both studies, we used a factor analysis to combine various socioeconomic indicators collected by the governments of the two countries (in France IRIS and in the US the census) into a score indicating the level of neighborhood disadvantage. We limited the analysis to those free from stroke at baseline and used combined outcome of ischemic or hemorrhagic stroke. Cox models were used to model the association between neighborhood deprivation and risk of stroke; all models were adjusted for components of the Framingham Stroke Risk Score (REGARDS also adjusted for race), dietary pattern, individual income and education. Results: There were 802 strokes in REGARDS in 17996 participants and 326 strokes in 3C in 7647 participants. In both studies neighborhood deprivation was associated with lower individual income and educational attainment as well as higher BMI and systolic blood pressure. Only in the REGARDS study was neighborhood deprivation associated with greater risk of stroke. In REGARDS, comparing the 5 th quintile to the 1 st quintile the hazard ratio (HR) and 95% CI was 1.36 (1.09, 1.72). In the 3C study comparing the 5 th quintile to the 1 st quintile, the HR (95% CI) was 1.04 (0.73, 1.47). Conclusion: In the REGARDS study neighborhood deprivation was associated with risk of stroke but these findings were not seen in the 3C study. Future work to further evaluate the role of diet and individual socio-economic status in mediating the findings observed in France could help to better explain the differences in these two studies.

Little is known concerning the type of activity that should be substituted for sedentary time and its potentially most hazardous form (prolonged sedentary bouts) to impart health benefit. We used isotemporal substitution techniques to examine whether 1) replacing total sedentary time with light-intensity or moderate to vigorous physical activity (LIPA or MVPA) or 2) replacing prolonged sedentary bouts with shorter sedentary bouts is associated with reductions in all-cause mortality risk. Participants (n = 7,999) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort of US adults aged ≥45 years, were studied. Sedentary time was measured by accelerometry between 2009 and 2013. There was a beneficial association with mortality risk for replacing total sedentary time with both LIPA (per 30 minutes, hazard ratio (HR) = 0.83; 95% confidence interval (CI): 0.80, 0.87) and MVPA (per 30 minutes, HR = 0.65; 95% CI: 0.50, 0.85). Similarly, there was a beneficial association for replacing prolonged sedentary-bout time with LIPA and MVPA but not for replacement with shorter sedentary bouts (per 30 minutes, HR = 1.00; 95% CI: 0.96, 1.03). These findings suggest short sedentary bouts still carry mortality risk and are not a healthful alternative to prolonged sedentary bouts. Instead, physical activity of any intensity is needed to mitigate the mortality risks incurred by sedentary time.

Background The relationship between intention and behavior has been well researched, but most studies fail to capture dynamic, time-varying contextual factors. Ecological momentary assessment through mobile phone technology is an innovative method for collecting data in real time, including time-use data. However, only a limited number of studies have examined day-level plans to be physically active and subsequent physical activity behavior using real-time time-use data to better understand this relationship. Objective This study aims to examine whether plans to be physically active (recorded in advance on an electronic calendar) were associated with objectively assessed physical activity (accelerometry), to identify activities that replaced planned periods of physical activity by using the mobile app Life in a Day (LIAD), and to test the feasibility and acceptability of LIAD for collecting real-time time-use data. Methods The study included 48 university students who were randomly assigned to 1 of 3 protocols, which were defined by 1, 3, or 5 days of data collection. Participants were asked to record their planned activities on a Google Calendar and were provided with mobile phones with LIAD to complete time-use entries in real time for a set of categories (eg, exercise or sports, eating or cooking, school, or personal care). Participants were instructed to wear an accelerometer on their nondominant wrist during the protocol period. A total of 144 days of protocol data were collected from the 48 participants. Results Protocol data for 123 days were eligible for analysis. A Fisher exact test showed a statistically significant association between plans and physical activity behavior (P=.02). The congruence between plans and behavior was fair (Cohen κ=0.220; 95% CI 0.028-0.411). Most participants did not plan to be active, which occurred on 75.6% (93/123) of days. Of these 93 days, no physical activity occurred on 76 (81.7%) days, whereas some physical activity occurred on 17 (18.3%) days. On the remaining 24.4% (30/123) of days, some physical activity was planned. Of these 30 days, no physical activity occurred on 18 (60%) days, whereas some physical activity occurred on 12 (40%) days. LIAD data indicated that activities related to screen time most often replaced planned physical activity, whereas unplanned physical activity was often related to active transport. Feasibility analyses indicated little difficulty in using LIAD, and there were no significant differences in feasibility by protocol length. Conclusions Consistent with previous literature, physical activity plans and physical activity behaviors were linked, but not strongly linked. LIAD offers insight into the relationship between plans and behavior, highlighting the importance of active transport for physical activity and the influence of screen-related behaviors on insufficient physical activity. LIAD is a feasible and practical method for collecting time-use data in real time.

Objectives Health disparities between subgroups may be partially due to differences in lifestyle behaviors such as sedentariness and physical activity. To obtain a more accurate description of these two lifestyle behaviors, accelerometry was employed among a large sample of white and black adults (ages 49–99 years) living in the United States. Design Cross-sectional. Methods 7967 participants from the REasons for Geographic and Racial Differences in Stroke cohort wore an Actical™ accelerometer ≥10 h/day for ≥4 days. Time (mean minutes/day and proportion of total wear time) spent in sedentary behavior, light intensity physical activity, and moderate-vigorous intensity physical activity was compared by sex, age, body mass index, race, and geographic location. Results Proportion of total wear time spent in sedentary behavior was 75–90%, light intensity physical activity was 10–23%, and moderate-vigorous intensity physical activity was 0–1.7% across subgroups. Mean moderate-vigorous intensity physical activity was 0–16 min/day and associated with 3–12% accumulating ≥150 min/wk using a 10-min bout criterion. Persons ≥85 years, those classified obese, persons living in the southeastern United States, and black women were the most inactive. The proportion achieving at least one 10-min bout of moderate-vigorous intensity physical activity per week was only 36%. The number of 10-min bouts/week was 1.5 ± 0.08 bouts/week. The distribution of weekly moderate-vigorous intensity physical activity was similar across nearly all subgroups with a distinct reverse J-shaped configuration. Conclusions The vast majority of white and black midlife and older adults in this study engaged sparingly in moderate-vigorous intensity physical activity, accumulated tremendous amounts of sedentary behavior, and seldom engaged in continuous bouts of health-enhancing physical activity.

The purposes of this study were to examine patterns of objectively measured sedentary behavior in a national cohort of US middle-age and older adults and to determine factors that influence prolonged sedentary behavior.We studied 8096 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a population-based study of black and white adults 45 yr or older. Seven-day accelerometry was conducted. Prolonged sedentary behavior was defined as accumulating 50% or more of total sedentary time in bouts of 30 min or greater.The number of sedentary bouts greater than or equal to 20, 30, 60, and 90 min were 8.8 ± 2.3, 5.5 ± 1.9, 1.9 ± 1.1, and 0.8 ± 0.7 bouts per day, respectively. Sedentary bouts greater than or equal to 20, 30, 60, and 90 min accounted for 60.0% ± 13.9%, 48.0% ± 15.5%, 26.0% ± 15.4%, and 14.2% ± 12.9% of total sedentary time, respectively. Several factors were associated with prolonged sedentary behavior in multivariate-adjusted models (odds ratio [95% confidence interval]): older age (65-74 yr: 1.99 [1.55-2.57]; 75 yr or older: 4.68 [3.61-6.07] vs 45-54 yr), male sex (1.41 [1.28-1.56] vs female), residence in nonstroke belt/buckle region of the United States (stroke belt: 0.87 [0.77-0.98]; stroke buckle: 0.86 [0.77-0.95] vs non-belt/buckle), body mass index (BMI) (overweight: 1.33 [1.18-1.51]; obese: 2.15 [1.89-2.44] vs normal weight), winter (1.18 [1.03-1.35] vs summer), and low amounts of moderate-to-vigorous physical activity (MVPA) [0 min·wk: 2.00 [1.66-2.40] vs ≥150 min·wk).In this sample of US middle-age and older adults, a large proportion of total sedentary time was accumulated in prolonged, uninterrupted bouts of sedentary behavior as almost one-half was accumulated in sedentary bouts greater than or equal to 30 min. Several sociodemographic (age, sex, and BMI), behavioral (MVPA), environmental (region), and seasonal factors are associated with patterns of prolonged sedentary behavior.

We examined individual and environmental influences on park use among residents of two low-income predominantly African American neighborhoods to identify determinants of park use in lower-income urban neighborhoods. We analyzed data from interviews of 1003 individuals randomly selected from the neighborhoods, systematic observations of neighborhood parks, and police-recorded crime incidence within a .5-mi buffer around each park. Most participants (82.4%) had previously visited a neighborhood park, and nearly half (46.2%) had visited one in the past month. However, only 8.5% of participants were aware of their closest park. Compared with the parks closest to home, parks that participants reported visiting most were larger and had more amenities and features and fewer incivilities and reported crimes of a serious nature. Park use among residents of lower-income neighborhoods may be increased by offering more amenities and features and ensuring the presence of a well-appointed park within easy walking distance of residents' homes.

The purpose of this study was to (1) describe children’s walking behaviors in 5th to 7th grade and change over time and (2) examine associations between walking behaviors and Walk Score®. Participants consisted of n = 586 students from the Transitions and Activity Changes in Kids (TRACK) Study. Children reported any walking behavior (e.g., exercise and transportation) over the past five days. Walk Score was calculated based on children’s home address. Descriptive statistics summarized walking behaviors by gender and time, and repeated measure mixed models examined the relationship between walking behaviors and Walk Score. Approximately 46.8% and 19.2% of 5th grade children reported walking for exercise and transportation, respectively, and these percentages declined through 7th grade. Girls reported higher levels of total walking behavior and walking for exercise than boys (p < 0.001). Girls with a higher Walk Score had 63% higher odds of reporting walking for transportation than girls with a lower Walk Score (OR = 1.63, 95% CI = 1.02, 2.62). Walking behaviors among children were infrequent with significant declines over time, and of the nine associations examined with Walk Score, only one was significant. Efforts should prioritize frequent walking behavior and community design to increase children’s physical activity.

Introduction The IOM recommends schools adopt a Whole-of-School (WOS) approach—one that is comprehensive, coordinated, and provides opportunities for students to be active before, during, and after school. This study examined, in a nationally representative sample of secondary students in the conterminous U.S., (1) the degree of implementation of a WOS approach and (2) the association between WOS implementation and student physical activity. Methods A WOS index—based on six school practices—was calculated using self-reported school administrator data gathered in 2010 and 2011 (N=1,031). Student-level data were obtained from nationally representative samples of eighth-, tenth-, and 12th-grade students during the same years (eighth grade, n schools =96, n students =3,689; tenth/12th grades, n schools =178, n students =4,670). Multilevel Poisson models were estimated in 2013–2014 to examine the relationship between the WOS index and self-reported physical activity. Results Few students attended schools with high WOS index scores. Middle school students attending schools with higher WOS index scores were physically active for at least 60 minutes on more days than students attending schools with lower WOS index scores (exp[β]=1.031, 95% CI=1.008, 1.054). The WOS index score was not associated with physical activity among high school students. Conclusions This study finds that many schools are not offering the full array of practices comprising a WOS approach to physical activity, especially at the high school level. Yet, middle school students could have increased physical activity levels if schools were to implement a WOS approach to physical activity.

AB Purpose: The objective of this study is to report methodological details and feasibility of conducting an accelerometer ancillary study in a large US cohort being followed for stroke and cognitive decline. Methods: Reasons for Geographic and Racial Differences in Stroke is a national population-based study of 30,239 blacks and whites, age >=45 yr, enrolled January 2003 to October 2007. Baseline evaluations were conducted through computer-assisted telephone interview and an in-home visit. Participants are followed by computer-assisted telephone interview every 6 months. Starting with May 2009 follow-up, contingent on accelerometer availability, participants were invited to wear an accelerometer for 7 d. Device inventory was 1150. Accelerometer, instructions, log sheet, and stamped addressed return envelope were mailed to consenting participants. Postcard acknowledgement and reminders and two calls or less were made to encourage compliance. Results: Between May 2009 and January 2013, 20,076 were invited to participate; 12,146 (60.5%) consented. Participation rates by race-sex groups were similar: black women, 58.6%; black men, 59.6%; white women, 62.3%; and white men, 60.5%. The mean age of the 12,146 participants to whom devices were shipped was 63.5 +/- 8.7 yr. Return rate was 92%. Of 11,174 returned, 1187 were not worn and 14 had device malfunction, and of 9973 with data, 8096 (81.2%) provided usable data, defined as >=4 d of 10+ h of wear time, ranging from 74.4% among black women to 85.2% among white men. Conclusions: Using mail and telephone methods, it is feasible to obtain objective measures of physical activity from a sizeable proportion of a national cohort of adults, with similar participation rates among blacks and whites. Linked with the clinical health information collected through follow-up, these data will allow future analyses on the association between objectively measured sedentary time, physical activity, and health outcomes.

Background: Despite the recognised contribution of the stroma to breast cancer development and progression, the effective targeting of the tumor microenvironment remains a challenge to be addressed. We previously reported that normal fibroblasts (NFs) and, notably, breast cancer-associated fibroblasts (CAFs) induced epithelial-to-mesenchymal transition and increases in cell membrane fluidity and migration in well- (MCF-7) and poorly-differentiated (MDA-MB-231) breast cancer cells. This study was designed to better define the role played, especially by CAFs, in promoting breast tumor cell migration. Methods: Fibroblast/breast cancer cell co-cultures were set up to investigate the influence of NFs and CAFs on gene and protein expression of Stearoyl-CoA desaturase 1 (SCD1), the main enzyme regulating membrane fluidity, as well as on the protein level and activity of its transcription factor, the sterol regulatory element-binding protein 1 (SREBP1), in MCF-7 and MDA-MB-231 cells. To assess the role of SREBP1 in the regulation of SCD1 expression, the desaturase levels were also determined in tumor cells treated with an SREBP1 inhibitor. Migration was evaluated by wound-healing assay in SCD1-inhibited (by small-interfering RNA (siRNA) or pharmacologically) cancer cells and the effect of CAF-conditioned medium was also assessed. To define the role of stroma-derived signals in cancer cell migration speed, cell-tracking analysis was performed in the presence of neutralising antibodies to hepatocyte growth factor, transforming growth factor-β or basic fibroblast growth factor. Results: A two to three fold increase in SCD1 mRNA and protein expression has been induced, particularly by CAFs, in the two cancer cell lines that appear to be dependent on SREBP1 activity in MCF-7 but not in MDA-MB-231 cells. Both siRNA-mediated and pharmacological inhibition of SCD1 impaired tumor cells migration, also when promoted by CAF-released soluble factors. Fibroblast-triggered increase in cancer cell migration speed was markedly reduced or abolished by neutralising the above growth factors. Conclusion: These results provide further insights in understanding the role of CAFs in promoting tumor cell migration, which may help to design new stroma-based therapeutic strategies.

Characterization of tissue surrounding glioblastoma (GBM) is a focus for translational research because tumor recurrence invariably occurs in this area. We investigated the expression of the progenitor/ stem cell markers GD3 ganglioside and NG2 proteoglycan in GBM, peritumor tissue (brain adjacent to tumor, BAT) and cancer stem-like cells (CSCs) isolated from GBM (GCSCs) and BAT (PCSCs). GD3 and NG2 immunohistochemistry was performed in paired GBM and BAT specimens from 40 patients. Double-immunofluorescence was carried out to characterize NG2-positive cells of vessel walls. GD3 and NG2 expression was investigated in GCSCs and PCSCs whose tumorigenicity was also evaluated in Scid/bg mice. GD3 and NG2 expression was higher in tumor tissue than in BAT. NG2 decreased as the distance from tumor margin increased, regardless of the tumor cell presence, whereas GD3 correlated with neoplastic infiltration. In BAT, NG2 was coexpressed with a-smooth muscle actin (α-SMA) in pericytes and with nestin in the endothelium. Higher levels of NG2 mRNA and protein were found in GCSCs while GD3 synthase was expressed at similar levels in the 2 CSC populations. PCSCs had lower tumorigenicity than GCSCs. These data suggest the possible involvement of GD3 and NG2 in pre/pro-tumorigenic events occurring in the complex microenvironment of the tissue surrounding GBM.

Purpose. This study examined the effects of 4-week, daily 6-minute coordinated-bilateral physical activity (CBPA) breaks in classroom on attention and concentration in school-aged children. Methods. Participants (n=116) in fifth grade from two elementary schools were assigned to three groups: two intervention groups (n= 60) and one control group (n = 56). All three groups were pre- and post-tested with the d2 Test of Attention (d2 test). One intervention group (n = 31) took part in six minutes of daily classroom-based coordinated-bilateral physical activity (CBPA) break for four weeks. Another intervention group (n = 29), the Fitbit Only (Fitbit-O), wore Fitbits per day during a school, five days per week for four weeks without CBPA breaks. A 2 × 3 ANOVA was conducted, followed by the post hoc comparisons. Results. The CBPA showed significant increases in processing speed (F1 = 6.876, p = .010), focused attention (F1 = 10.688, p = .002), concentration performance (F1 = 26.46, p = .000), and attention span (F1 = 14.090, p = .000) over the control, but not in accuracy (Error %). The CBPA showed significant improvement in concentration performance (F1 = 24.162, p = .000) and attention span (F1 = 6.891, p = .011), compared to the Fitbit-O. No significant changes in all five attention parameters were found between the Fitbit-O and the control. Conclusion. It was concluded that daily brief coordinated-bilateral activities can improve attention and concentration in fifth-grade students over the course of four weeks.

Background Although crime and perceived safety are associated with obesity and body mass index (BMI), the pathways are less clear. Two likely pathways by which crime and perceived safety may impact obesity are through distress and physical activity. Methods We examined data from 2013 to 2014 for 644 predominantly African-American adults (mean age 57 years; 77% female) living in low-income Pittsburgh, PA neighborhoods, including self-reported perceptions of safety and emotional distress, interviewer-measured height/weight, and physical activity measured via accelerometry. We used secondary data on neighborhood crime from 2011 to 2013. We built a structural equation model to examine the longitudinal direct and indirect pathways from crime to BMI through perceived safety, distress and physical activity. Results Long-term exposure to crime was positively associated with lack of perceived safety (β = 0.11, p = 0.005) and lack of perceived safety was positively associated with BMI (β = 0.08, p = 0.03). The beneficial association between physical activity and BMI (β = −0.15, p

Background Low-income African American adults are disproportionately affected by obesity and are also least likely to engage in recommended levels of physical activity (Flegal et al. JAMA 303(3):235-41, 2010; Tucker et al. Am J Prev Med 40(4):454-61, 2011). Moderate-to-vigorous physical activity (MVPA) is an important factor for weight management and control, as well as for reducing disease risk (Andersen et al. Lancet 368(9532):299-304, 2006; Boreham and Riddoch J Sports Sci 19(12):915-29, 2001; Carson et al. PLoS One 8(8):e71417, 2013). While neighborhood greenspace and walkability have been associated with increased MVPA, evidence also suggests that living in areas with high rates of crime limits MVPA. Few studies have examined to what extent the confluence of neighborhood greenspace, walkability and crime might impact MVPA in low-income African American adults nor how associations may vary by age and sex. Methods In 2013 we collected self-reported data on demographics, functional limitations, objective measures of MVPA (accelerometry), neighborhood greenspace (geographic information system), and walkability (street audit) in 791 predominantly African-American adults (mean age 56 years) living in two United States (U.S.) low-income neighborhoods. We also acquired data from the City of Pittsburgh on all crime events within both neighborhoods. Exposure: To examine cross-sectional associations of neighborhood-related variables (i.e., neighborhood greenspace, walkability and crime) with MVPA, we used zero-inflated negative binomial regression models. Additionally, we examined potential interactions by age (over 65 years) and sex on relationships between neighborhood variables and MVPA. Results Overall, residents engaged in very little to no MVPA regardless of where they lived. However, for women, but not men, under the age of 65 years, living in more walkable neighborhoods was associated with more time engaged in MVPA in (β = 0.55, p = 0.007) as compared to their counterparts living in less walkable areas. Women and men age 65 years and over spent very little time participating in MVPA regardless of neighborhood walkability. Neither greenspace nor crime was associated with MVPA in age-sex subgroups. Conclusions Neighborhood walkability may play a stronger role on MVPA than accessible greenspace or crime in low-income urban communities. Walkability may differentially impact residents depending on their age and sex, which suggests tailoring public health policy design and implementation according to neighborhood demographics to improve activity for all. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3959-z) contains supplementary material, which is available to authorized users.