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Objective: The objective of this study was to pool, harmonise and re-analyse national accelerometer data from adults in four European countries in order to describe population levels of sedentary time and physical inactivity., Methods: Five cross-sectional studies were included from England, Portugal, Norway and Sweden. ActiGraph accelerometer count data were centrally processed using the same algorithms. Multivariable logistic regression analyses were conducted to study the associations of sedentary time and physical inactivity with sex, age, weight status and educational level, in both the pooled sample and the separate study samples., Results: Data from 9509 participants were used. On average, participants were sedentary for 530 min/day, and accumulated 36 min/day of moderate to vigorous intensity physical activity. Twenty-three percent accumulated more than 10 h of sedentary time/day, and 72% did not meet the physical activity recommendations. Nine percent of all participants were classified as high sedentary and low active. Participants from Norway showed the highest levels of sedentary time, while participants from England were the least physically active. Age and weight status were positively associated with sedentary time and not meeting the physical activity recommendations. Men and higher-educated people were more likely to be highly sedentary, while women and lower-educated people were more likely to be inactive., Conclusions: We found high levels of sedentary time and physical inactivity in four European countries. Older people and obese people were most likely to display these behaviours and thus deserve special attention in interventions and policy planning. In order to monitor these behaviours, accelerometer-based cross-European surveillance is recommended.

Background: There is growing evidence for the positive effects of exercise training programs on balance control in Parkinson disease (PD). To be effective, balance training needs to be specific, progressive, and highly challenging. Little evidence exists, however, for how people with PD-related balance impairments perceive highly challenging and progressive balance training programs with dual-task components., Objective: The purpose of this study was to explore and describe perceptions of a highly challenging balance training program among people with mild to moderate PD., Design: This study was qualitative in nature. In-depth interviews were conducted with 13 individuals with mild to moderate PD who had participated in a highly challenging balance training program. Interview transcripts were analyzed using qualitative content analysis, with an inductive approach., Results: The analysis revealed 3 subthemes concerning participants' perceptions of highly challenging and progressive balance training: (1) movement to counter the disease, (2) dual-task training in contrast to everyday strategies, and (3) the struggle to maintain positive effects. The first subtheme reflects how physical activity was used as a short-term and long-term strategy for counteracting PD symptoms and their progression. The second subtheme incorporates the described experiences of being maximally challenged in a secure and supportive group environment, circumstances that stood in contrast to participants' everyday lives. The third subtheme describes participants' long-term struggle to maintain program effects on cognitive and physical function in the face of disease progression. Interpretation of the underlying patterns of these subthemes resulted in one overarching theme: training at the limits of balance capacity causes a rethinking motor and cognitive resources., Limitations: The findings of this study cannot be considered to reflect the beliefs of those with weaker or negative beliefs concerning physical activity or be transferred to those at more severe stages of the disease., Conclusions: Findings from this study suggest that being pushed to the limits of balance capacity provoked people with mild to moderate PD to rethink their individual motor and cognitive resources, a process that was further enabled by the PD-specific group setting., (© 2017 American Physical Therapy Association)

Objectives: The aim of the study was to examine the relationship between employment status and job activity level with physical activity (PA) and sedentary time, stratified by gender and country., Design: Cross-sectional study design., Methods: Data from working age adults (18-65 years) from two cross-sectional studies, the Swedish 2001-2002 and 2007-2008 Attitude Behavior and Change Study (ABC; n=1165) and the 2003-2006 US National Health and Nutrition Examination Survey (NHANES; n=4201), were stratified by employment status (employed and not employed) and job activity level (active, sedentary and mixed). PA in counts×min(-1) and time spent in sedentary, low and moderate or higher intensity were measured with accelerometers. Analyses were conducted in 2012-2013., Results: In NHANES, the employed had significantly higher counts×min(-1) and spent more time in moderate or higher intensity PA than those not employed. In ABC, no significant differences were observed between employed and unemployed. Adults with active versus sedentary occupations had higher counts×min(-1) and less sedentary time in both the USA and Sweden and in both men and women. For example, counts×min(-1) were 20-40% greater in active versus sedentary jobs., Conclusions: Employment status is related to PA and sedentary time among men and women in the USA but not in Sweden. Among the employed, occupational PA is associated with total PA and sedentary time for both genders and in both countries. Comparisons of PA levels based on objective measurements can refine understanding of country differences in activity., (Copyright © 2015 Sports Medicine Australia. All rights reserved.)

Background: Physical activity (PA) is associated with health benefits, already in childhood. However, little is known about actual levels, patterns and gender differences in PA level in very young children. This study examines Chinese one-year-old children and their parents' PA levels and patterns, and assesses the correlations between children's PA level and gender, body mass index standard deviation score (BMI SDS), parental BMI and parental PA level., Methods: Data from 123 families participating in the Early STOPP China study were used. Families were recruited based on parental BMI and were classified as either high-risk or low-risk of obesity. Parents and children wore an ActiGraph GT3X+ to assess the average PA levels. PA levels and hourly patterns during weekdays and weekends were examined as were correlations with gender, BMI SDS, parental BMI and parental PA levels., Results: There were no significant differences in children's averaged PA between risk groups, genders, or between weekdays and weekends. Children's peak average activity level was at 7 pm and they were least active at 3 pm (p<0.001). Both mothers and fathers demonstrated a similar PA pattern as their children, although paternal PA level was consistently lower than that of mothers and children. No significant association was found between children's PA and their gender, BMI SDS, parental BMI or paternal PA levels. Maternal PA was found positively associated with child PA (p<0.05)., Conclusion: PA in one-year-old Chinese children vary over the day but weekdays and weekends are similar. At this age, children's PA is not related to gender, BMI SDS, parental BMI or paternal PA. Larger scale studies with more contextual information are needed to improve the understanding of our findings.

Recommendations for physical activity have been prepared by Professional Associations for Physical Activity and approved by the Swedish Society of Medicine in 2011. All adults are recommended regular aerobic and muscle strengthening physical activity. Lowest recommended dose (intensity x time) of aerobic physical activity is 150 minutes at moderate or 75 minutes at high intensity per week. More health benefits are achieved if the dose is higher than the lowest recommended dose. Longer periods of sedentary behavior should be avoided. Elderly are also recommended balance training. The benefits of physical activity outweigh the risks. The Swedish National Board of Health and Welfare recommends that the healthcare system offer counselling with the adjunct of exercise on prescription or a pedometer to persons with insufficient physical activity, i.e. less than the lowest recommended dose in the current recommendations for physical activity.

To make individualized counseling possible, valid and reliable measures of physical activity are necessary. In health care, quality must be continuously secured and developed. Follow-up of life-style habits such as physical activity does not differ from monitoring of other treatment in the health care setting.  After counseling and appropriate period of time, evaluation should be done to assess if there has been any change in the physical activity level. For assessment and evaluation of physical activity in routine clinical practice the National Board for Health and Social Welfare indicator questions regarding physical activity are recommended. For a more detailed assessment and evaluation of physical activity and sedentary behavior comprehensive validated instruments/diaries should be used. For precise and objective assessment and evaluation of both physical activity and sedentary behavior, movement sensors are recommended.

Objective: To define accelerometer cut points for different walking speeds in older adults with mild to moderate Parkinson's disease., Method: A volunteer sample of 30 older adults (mean age 73; SD 5.4 years) with mild to moderate Parkinson's disease walked at self-defined brisk, normal, and slow speeds for three minutes in a circular indoor hallway, each wearing an accelerometer around the waist. Walking speed was calculated and used as a reference measure. Through ROC analysis, accelerometer cut points for different levels of walking speed in counts per 15 seconds were generated, and a leave-one-out cross-validation was performed followed by a quadratic weighted Cohen's Kappa, to test the level of agreement between true and cut point-predicted walking speeds., Results: Optimal cut points for walking speeds ≤ 1.0 m/s were ≤ 328 and ≤ 470 counts/15 sec; for speeds > 1.3 m/s, they were ≥ 730 and ≥ 851 counts/15 sec for the vertical axis and vector magnitude, respectively. Sensitivity and specificity were 61%-100% for the developed cut points. The quadratic weighted Kappa showed substantial agreement: κ = 0.79 (95% CI 0.70-0.89) and κ = 0.69 (95% CI 0.56-0.82) for the vertical axis and the vector magnitude, respectively., Conclusions: This study provides accelerometer cut points based on walking speed for physical-activity measurement in older adults with Parkinson's disease for evaluation of interventions and for investigating links between physical activity and health.

Objectives: The aim of this study was to investigate changes over six years in physical activity and sedentary behavior assessed with accelerometry in a representative sample of Swedish adults., Design: A longitudinal study over six years., Methods: The cohort consisted of 1172 participants (46% males) in 2002 and 511 participants (46% males) in 2008, of which 478 (45% males) had valid data on both occasions. Mean (SD) age at baseline was 45 (15) years. To analyze changes over time, a mixed linear model for average intensity physical activity (counts/min) and time in sedentary behavior and light- and moderate- or higher-intensity physical activity was conducted, stratified for sex and age, and adjusted for BMI, education, self-rated health and Δ wear time., Results: Over a six year period no significant changes were seen in the total cohort for average intensity and time in moderate- or higher intensity physical activity. A significant decrease in average intensity physical activity was found for men (p=0.006) and those aged 60+ years at baseline (p<0.001). A significant increase (26 min/day) for sedentary time in the total cohort (p<0.001) and for time in moderate or higher intensity physical activity among women (p<0.001) and those aged 40-59 years at baseline (p=0.014) was found over the follow-up period., Conclusions: The overall increase in sedentary time and decrease in average physical activity among men and the elderly are of concern, since they might result in an elevated risk of developing chronic diseases., (Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Decreased movement ability, one of the hallmarks of Parkinson disease (PD), may lead to inadequate physical activity (PA) and excessive time spent in sedentary behaviors-2 factors associated with an elevated risk for lifestyle-related diseases, poor management of PD, and premature death. To identify the extent to which people with PD are physically active, a comprehensive characterization of PA in this population is needed., Objective: The study objective was to describe levels and patterns of PA and sedentary behaviors in elderly people with PD., Design: This cross-sectional study involved a free-living setting and 53 men and 42 women (mean age=73.4 years) with mild to moderate idiopathic PD., Methods: Time spent in PA and sedentary behaviors was assessed for 1 week with accelerometers., Results: Mean daily step counts were 4,765; participants spent 589 minutes in sedentary behaviors, 141 minutes in low-intensity activities, 30 minutes in moderate-intensity lifestyle activities, and 16 minutes in moderate- to vigorous-intensity ambulatory activities. No differences were found between weekdays and weekend days. Patterns were characterized by a rise in total PA in the morning, peaking between 10 am and 3 pm, and a gradual decline toward the late evening. The proportion achieving 150 minutes of moderate- to vigorous-intensity PA per week was 27%, and 16% achieved 7,000 or more steps per day., Limitations: Nonrandomized selection of participants may limit the generalizability of the results., Conclusions: Physical activity levels were generally low, in terms of both total volume and intensity, with only minor variations over the course of a day or between days. These results emphasize the need to develop strategies to increase PA and reduce time spent in sedentary behaviors in elderly people with mild to moderate PD., (© 2015 American Physical Therapy Association.)

Objective: To test whether youths who engage in vigorous physical activity are more likely to have lean bodies while ingesting relatively large amounts of energy. For this purpose, we studied the associations of both physical activity and adiposity with energy intake in adolescents., Study Design: The study subjects were adolescents who participated in 1 of 2 cross-sectional studies, the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study (n = 1450; mean age, 14.6 years) or the European Youth Heart Study (EYHS; n = 321; mean age, 15.6 years). Physical activity was measured by accelerometry, and energy intake was measured by 24-hour recall. In the HELENA study, body composition was assessed by 2 or more of the following methods: skinfold thickness, bioelectrical impedance analysis, plus dual-energy X-ray absorptiometry or air-displacement plethysmography in a subsample. In the EYHS, body composition was assessed by skinfold thickness., Results: Fat mass was inversely associated with energy intake in both studies and using 4 different measurement methods (P ≤ .006). Overall, fat-free mass was positively associated with energy intake in both studies, yet the results were not consistent across measurement methods in the HELENA study. Vigorous physical activity in the HELENA study (P < .05) and moderate physical activity in the EYHS (P < .01) were positively associated with energy intake. Overall, results remained unchanged after adjustment for potential confounding factors, after mutual adjustment among the main exposures (physical activity and fat mass), and after the elimination of obese subjects, who might tend to underreport energy intake, from the analyses., Conclusion: Our data are consistent with the hypothesis that more physically active and leaner adolescents have higher energy intake than less active adolescents with larger amounts of fat mass., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Objective: Conduct a scoping review to identify and map the literature that has evaluated the effects of health promotion interventions aimed at physical activity and/or dietary behavior, implemented by the occupational health services., Methods: A search for peer-reviewed articles was conducted (up to February 2013) through electronic databases, hand searching of key journals, and reference lists. A methodological quality assessment was performed., Results: Fourteen studies were included, describing 10 interventions. The main component was counseling of individuals with known cardiovascular disease risk factors. Intervention effects were reported for dietary behavior, physical activity, sedentary behavior, and biological risk factors., Conclusions: Results are promising, especially with regard to interventions containing counseling targeting individuals at risk. High-quality studies using objective measures to assess behavioral outcomes and the (cost)-effectiveness of interventions containing counseling, PA on prescription, and multilevel interventions are needed.

Background: Poor to moderate validity of self-reported physical activity instruments is commonly observed in young people in low- and middle-income countries. However, the reasons for such low validity have not been examined in detail. We tested the validity of a self-administered daily physical activity record in adolescents and assessed if personal characteristics or the convenience level of reporting physical activity modified the validity estimates., Methods: The study comprised a total of 302 adolescents from an urban and rural area in Ecuador. Validity was evaluated by comparing the record with accelerometer recordings for seven consecutive days. Test-retest reliability was examined by comparing registrations from two records administered three weeks apart. Time spent on sedentary (SED), low (LPA), moderate (MPA) and vigorous (VPA) intensity physical activity was estimated. Bland Altman plots were used to evaluate measurement agreement. We assessed if age, sex, urban or rural setting, anthropometry and convenience of completing the record explained differences in validity estimates using a linear mixed model., Results: Although the record provided higher estimates for SED and VPA and lower estimates for LPA and MPA compared to the accelerometer, it showed an overall fair measurement agreement for validity. There was modest reliability for assessing physical activity in each intensity level. Validity was associated with adolescents' personal characteristics: sex (SED: P=0.007; LPA: P=0.001; VPA: P=0.009) and setting (LPA: P=0.000; MPA: P=0.047). Reliability was associated with the convenience of completing the physical activity record for LPA (low convenience: P=0.014; high convenience: P=0.045)., Conclusions: The physical activity record provided acceptable estimates for reliability and validity on a group level. Sex and setting were associated with validity estimates, whereas convenience to fill out the record was associated with better reliability estimates for LPA. This tendency of improved reliability estimates for adolescents reporting higher convenience merits further consideration.

People with ID have an increased risk for unhealthy diets, physical inactivity and weight disturbances. The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity, targeting both caregivers and residents, in community residences for people with ID. A three component intervention based on Social Cognitive Theory was developed, including: (1) appointment of a health ambassador in each community residence attending network meetings, (2) a study circle for caregivers, and (3) a health course for the residents. The intervention lasted for 12-16 months and allowed for some local tailoring. A cluster randomised controlled trial, randomised at residence level, was conducted to evaluate the effects of the intervention. Thirty community residences for people with mild or moderate ID in Stockholm County, Sweden, were included. A total of 130 participants, 74 women and 56 men aged 20-66 years, entered, and 129 participants completed the study. The primary outcome was physical activity, measured by pedometry. Secondary outcomes were BMI, waist circumference, dietary quality measured by digital photography, satisfaction with life assessed with a scale, and work routines assessed with a questionnaire. Outcomes were related to intervention fidelity. A positive intervention effect was found on physical activity, with an average increase of 1608 steps/day among participants in the intervention group (P=0.045). The effect size was 0.29 (Cohen's d). The type of residence was found to be an effect moderator. A positive intervention effect was found as well on work routines, with an average increase of 7.1 percentage points on a self-assessment scale among residences in the intervention group (P=0.016). No significant effects were found on BMI, waist circumference, dietary quality, or satisfaction with life. In conclusion, this innovative intervention was effective in improving physical activity and work routines. It is likely that even greater effects could be achieved by improvements in implementation strategies, leading to higher fidelity., (Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: To be able to draw any conclusions regarding the health effects of occupational physical activity (OPA), more information is needed regarding valid measures to assess OPA. Aims were to compare OPA as assessed with the International Physical Activity Questionnaire long version (IPAQ-L) with OPA assessed with an accelerometer and to assess the contribution of OPA to total PA., Methods: Working adults (n = 441; mean age = 49.4 yrs; 44% males) wore an accelerometer for 7 days in free-living situations and completed the IPAQL. Comparisons were made between IPAQ-L-work and accelerometer data limited to working time (Moderate and Vigorous PA (accelerometer-MVPA-work) and average intensity). Subgroup analyses were performed., Results: Spearman correlation was r = .46 (P < .01) between IPAQ-L-work and accelerometer-MVPA-work. Correlations ranged from r = .27 to r = .55 in respectively obese and overweight subjects. The contribution of IPAQ-L-work to IPAQ-total was 24.7%., Conclusions: The IPAQ-L work domain is a moderately good measure of time spent on MVPA at work and can be used to assess the contribution of OPA to total PA. This study provides valuable information regarding the use of the IPAQ-L in assessing work domain specific PA, and underscores the importance of assessing OPA, as it can contribute for a substantial part to total PA.

Context: The quality of methodological papers assessing physical activity instruments depends upon the rigor of a study's design., Objectives: We present a checklist to assess key criteria for instrument validation studies., Process: A Medline/PubMed search was performed to identify guidelines for evaluating the methodological quality of instrument validation studies. Based upon the literature, a pilot version of a checklist was developed consisting of 21 items with 3 subscales: 1) quality of the reported data (9 items: assess whether the reported information is sufficient to make an unbiased assessment of the findings); 2) external validity of the results (3 items: assess the extent to which the findings are generalizable); 3) internal validity of the study (9 items: assess the rigor of the study design). The checklist was tested for interrater reliability and feasibility with 6 raters., Findings: Raters viewed the checklist as helpful for reviewing studies. They suggested minor wording changes for 8 items to clarify intent. One item was divided into 2 items for a total of 22 items., Discussion: Checklists may be useful to assess the quality of studies designed to validate physical activity instruments. Future research should test checklist internal consistency, test-retest reliability, and criterion validity.

The use of physical activity monitors in population-based research has increased dramatically in the past decade. In this report, we review the major purpose for using physical activity monitors in different types of population-based studies (i.e., surveillance, intervention, association studies) and discuss the strengths and weaknesses for the various behavioral outcomes derived from monitors for each study type. We also update and extend previous recommendations for use of these instruments in large-scale studies, particularly with respect to selecting monitor systems in the context of technological advances that have occurred in recent years. The current state of the science with respect to optimal measurement schedules for use of physical activity monitors is also discussed. A checklist and flowchart are provided so that investigators have more guidance when reporting key elements of monitor use in their studies.

Background: Recent epidemiologic evidence points to the health risks of prolonged sitting, that are independent of physical activity, but few papers have reported the descriptive epidemiology of sitting in population studies with adults., Purpose: This paper reports the prevalence of "high sitting time" and its correlates in an international study in 20 countries., Methods: Representative population samples from 20 countries were collected 2002-2004, and a question was asked on usual weekday hours spent sitting. This question was part of the International Prevalence Study, using the International Physical Activity Questionnaire (IPAQ). The sitting measure has acceptable reliability and validity. Daily sitting time was compared among countries, and by age group, gender, educational attainment, and physical activity., Results: Data were available for 49,493 adults aged 18-65 years from 20 countries. The median reported sitting time was 300 minutes/day, with an interquartile range of 180-480 minutes. Countries reporting the lowest amount of sitting included Portugal, Brazil, and Colombia (medians ≤180 min/day), whereas adults in Taiwan, Norway, Hong Kong, Saudi Arabia, and Japan reported the highest sitting times (medians ≥360 min/day). In adjusted analyses, adults aged 40-65 years were significantly less likely to be in the highest quintile for sitting than adults aged 18-39 years (AOR=0.796), and those with postschool education had higher sitting times compared with those with high school or less education (OR=1.349). Physical activity showed an inverse relationship, with those reporting low activity on the IPAQ three times more likely to be in the highest-sitting quintile compared to those reporting high physical activity., Conclusions: Median sitting time varied widely across countries. Assessing sitting time is an important new area for preventive medicine, in addition to assessing physical activity and sedentary behaviors. Population surveys that monitor lifestyle behaviors should add measures of sitting time to physical activity surveillance. Moreover, the use of objective measures to capture the spectrum of sedentary (sitting) and physical activity behaviors is encouraged, particularly in low- and middle-income countries commencing new surveillance activities., (Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.)

The purpose was to compare data obtained from a modified, long, self-administered version of the International Physical Activity Questionnaire (IPAQ-A) with objective data obtained in parallel from Actigraph accelerometers, and VO(2)max in adolescents. The study comprised a total of 2018 adolescents (46% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity was assessed over seven consecutive days by accelerometry and expressed as min/day of moderate, vigorous, and moderate to vigorous (MVPA) physical activity (PA). PA was also assessed with the IPAQ-A. VO(2)max was estimated from a 20-m shuttle run test. Poor to fair correlations between the two methodologies were found for the whole study sample and when stratified by age and gender (r(s) = 0.08-0.26, p < 0.01). On average, the self-reported time spent in moderate PA was higher compared to the time measured with the accelerometer, while the differences between both instruments were less clear for vigorous intensity. Adolescents reporting high levels of PA (3rd tertile IPAQ-A) also showed higher levels of PA (accelerometers) in all the study variables (moderate, vigorous and MVPA), compared to adolescents reporting low PA (1st tertile IPAQ-A) (all p < 0.001). Both methods were moderately correlated with estimated VO(2)max. Within the HELENA-study, the IPAQ-A showed the modest comparability with the accelerometer data for assessing PA in each intensity level and was the highest for vigorous intensity. Both instruments are able to detect the adolescents with the highest cardio respiratory fitness, which are the most active adolescents., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Background: Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. Therefore it is important to investigate associations between dietary and physical activity behavior, the two most important lifestyle behaviors influencing our energy balance and body composition. The objective of the present study is to describe the relationship between energy, nutrient and food intake and the physical activity level among a large group of European adolescents., Methods: The study comprised a total of 2176 adolescents (46.2% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Dietary intake and physical activity were assessed using validated 24-h dietary recalls and self-reported questionnaires respectively. Analyses of covariance (ANCOVA) were used to compare the energy and nutrient intake and the food consumption between groups of adolescents with different physical activity levels (1st to 3rd tertile)., Results: In both sexes no differences were found in energy intake between the levels of physical activity. The most active males showed a higher intake of polysaccharides, protein, water and vitamin C and a lower intake of saccharides compared to less active males. Females with the highest physical activity level consumed more polysaccharides compared to their least active peers. Male and female adolescents with the highest physical activity levels, consumed more fruit and milk products and less cheese compared to the least active adolescents. The most active males showed higher intakes of vegetables and meat, fish, eggs, meat substitutes and vegetarian products compared to the least active ones. The least active males reported the highest consumption of grain products and potatoes. Within the female group, significantly lower intakes of bread and cereal products and spreads were found for those reporting to spend most time in moderate to vigorous physical activity. The consumption of foods from the remaining food groups, did not differ between the physical activity levels in both sexes., Conclusion: It can be concluded that dietary habits diverge between adolescents with different self-reported physical activity levels. For some food groups a difference in intake could be found, which were reflected in differences in some nutrient intakes. It can also be concluded that physically active adolescents are not always inclined to eat healthier diets than their less active peers., (© 2011 Ottevaere et al; licensee BioMed Central Ltd.)

Objectives: This study aims to review systematically the repeatability and validity of questionnaires used to assess occupational physical activity among healthy adults., Methods: We searched PubMed and Embase using occupational, work-related, job-related, physical activity, motor activity, and questionnaires as keywords. Two reviewers independently performed article selection, data extraction, and quality assessment. The methodological quality and results of the studies were evaluated based on an existing checklist. The level of evidence and repeatability, criterion, and construct validity were rated., Results: We included 31 papers describing 30 questionnaires in the review. Repeatability was assessed in 22 studies, 11 used appropriate measures to assess 12 questionnaires. Intra-class correlation coefficients and weighted Cohen's kappa ranged between 0.43-0.95. Six studies used appropriate measures to assess criterion validity of 13 questionnaires. One questionnaire, the Tecumseh Self Administered Occupational Physical Activity Questionnaire (TOQ), showed good criterion validity against a physical activity (PA) record. Eighteen studies used appropriate measures to assess the construct validity of 23 questionnaires. Comparison included those against accelerometers, maximal oxygen uptake, questionnaires, and body composition measures. None showed good construct validity., Conclusions: There is strong evidence for good reliability of four questionnaires. None of the reviewed questionnaires showed good criterion validity compared to objective measures. Compared to PA records, moderate-to-good validity was observed for two questionnaires. Objective measures of occupational PA are needed.

Objective: To modify the self-administered, short version of the International Physical Activity Questionnaire (IPAQ) for adults to be used in the elderly (aged 65 years and above), and to validate this modified IPAQ for the elderly (IPAQ-E)., Design: A direct validity study using accelerometer-measured physical activity (PA) as the criterion measure, and an indirect criterion validity study using high-sensitivity C-reactive protein (hs-CRP) as a biological marker of activity., Setting: Organisations for retired persons in Sweden., Subjects: The direct validity study consisted of fifty-four participants and the indirect criterion validity study consisted of 359 participants. All participants were retired persons (66-91 years) living independently., Results: All self-reported activity domains (sitting, walking, moderate and vigorous) were positively correlated with the corresponding variable objectively assessed by an accelerometer (ρ = 0·277-0·471), but a systematic error was observed. The specificity of IPAQ-E to identify low-active participants was 85 %, and the sensitivity to identify the more active participants was 81 %. A main effect of IPAQ-E category (Low, Moderate or High) was observed for hs-CRP (P = 0·041)., Conclusions: We found this modified version of IPAQ, the IPAQ-E, to be well accepted by our sample of socially active elderly. It provided acceptable estimates of PA, well in line with other questionnaires, even though it had a systematic error. The IPAQ-E was able to identify an expected response of a biomarker (hs-CRP) to PA. We recommend the use of the IPAQ-E to classify participants aged 65 years and above into PA categories, to rank individuals or to identify individuals meeting certain PA criteria.

Background: Refugee women have a high risk of coronary heart disease with low physical activity as one possible mediator. Furthermore, cultural and environmental barriers to increasing physical activity have been demonstrated. The aim of the study was to evaluate the combined effect of an approximate 6-month primary health care- and community-based exercise intervention versus an individual written prescription for exercise on objectively assessed cardiorespiratory fitness in low-active refugee women., Methods: A controlled clinical trial, named "Support for Increased Physical Activity", was executed among 243 refugee women recruited between November 2006 and April 2008 from two deprived geographic areas in southern Stockholm, Sweden. One geographic area provided the intervention group and the other area the control group. The control group was on a higher activity level at both baseline and follow-up, which was taken into consideration in the analysis by applying statistical models that accounted for this. Relative aerobic capacity and fitness level were assessed as the two main outcome measures., Results: The intervention group increased their relative aerobic capacity and the percentage with an acceptable fitness level (relative aerobic capacity > 23 O2 mlxkgxmin-1) to a greater extent than the control group between baseline and the 6-month follow-up, after adjusting for possible confounders (P = 0.020)., Conclusions: A combined primary health-care and community-based exercise programme (involving non-profit organizations) can be an effective strategy to increase cardiorespiratory fitness among low-active refugee women., Trial Registration: ClinicalTrials.gov ID: NCT00747942.

This study compares levels and patterns of objectively assessed physical activity in Sweden and the United States by using identical accelerometer metrics. Data of adult respondents with > or =4 days with > or =10 hours per day of accelerometer wear from Sweden (2001-2002, n = 1,172) and the United States (2003-2004, n = 2,925) were compared. Outcomes reported by age and body mass index within sex include accelerometer counts per minute and amounts and bouts of activity at different intensities, that is, sedentary, low, lifestyle, and moderate or higher intensity physical activity. The mean counts per minute were 375 (95% confidence interval (CI): 360, 390) and 377 (95% CI: 363, 391) for Swedish and US males, respectively, and 363 (95% CI: 347, 379) and 298 (95% CI: 289, 307) for Swedish and US females. Older respondents and those with higher body mass index had lower activity levels. Swedish and US males spent 36 (95% CI: 34, 38) and 33 (95% CI: 31, 36) minutes per day, and Swedish and US females spent 32 (95% CI: 29, 34) and 19 (95% CI: 17, 21) minutes per day in moderate or higher intensity physical activity. Older Swedes were more active in moderate or higher intensity activities than were older US respondents. However, younger Swedish males had more sedentary behavior time than did younger US males. These results provide a framework for international comparisons of physical activity levels and patterns, and they represent strong evidence for the importance of investment in objective measurement of physical activity.

Physical inactivity and its accompanying adverse sequelae (e.g., obesity and diabetes) are global health concerns. The single most commonly reported physical activity in public health surveys is walking (Centers for Disease Control and Prevention, 2000; Rafferty, Reeves, McGee, & Pivarnik, 2002). As evidence accumulates that walking is important for preventing weight gain (Levine et al., 2008) and reducing the risk of diabetes (Jeon, Lokken, Hu, & van Dam, 2007), there is increased need to capture this behavior in a valid and reliable manner. Although the disadvantages of a self-report methodology are well known (Sallis, & Saelens, 2000), it still represents the most feasible approach for conducting population-level surveillance across developed and developing countries. The International Physical Activity Questionnaire (IPAQ) was created and evaluated as a standardized instrument for this purpose. Although two versions of the IPAQwere designed and evaluated (short: nine items; and long: 31 items), the short form was recommended for population monitoring (Craig et al., 2003). However, it has not been recommended for intervention or research studies that require precise physical activity quantification to examine changes in physical activity at the individual level. IPAQ was also not intended to replace instruments that are more responsive to individual changes in activity level, such as objective measures. In addition to walking behaviors, IPAQ also assesses time spent in moderate- and vigorous-intensity activity as well as sitting behaviors, although the latter is not the focus of this analysis. Aggregated IPAQ data have been previously validated compared to accelerometers, and overall reliability was confirmed across 12 countries (Craig et al., 2003). Previous research showed criterion validity Spearman correlations with a median of 0.30 and test-retest reliability Spearman correlations clustered around 0.8 (Craig et al., 2003). The purpose of this study, however, was to reanalyze these data with respect to validity (again compared to an accelerometer) and test-retest reliability specifically for population monitoring of walking.

Introduction: Strong evidence suggests a link between physical inactivity and chronic disease prevalence in the adult population. To target the right groups for interventions in a population, accurate assessment of physical activity is important. The objective of this study was to assess the levels and pattern of physical activity and inactivity in an adult population sample using an objective method., Methods: In total, 1114 adults (56% women, 45+/-15 yr), randomly recruited from the Swedish population across a year, used an accelerometer (Actigraph MTI) for seven consecutive days. Inactivity was defined as <100 counts per minute, and cutoff values for moderate and vigorous activity were 1952-5724 and >5724 counts per minute, respectively. Average intensity was measured as counts per minute., Results: The adults were active in at least moderate-intensity activity for a median (intraquartile range) of 31 (18-47) min.d(-1). Fifty-two percent accumulated 30 min.d(-1) of at least moderate-intensity physical activity. Only 1% achieved those 30 min from three or more bouts of at least 10 min. Average intensity, moderate and vigorous physical activity was lower with higher age or body mass index (BMI). Men spent more time than women in moderate and vigorous physical activity, but there was no gender difference in average intensity. The variation in inactivity could not be explained by gender, age, or BMI., Conclusion: Objectively obtained estimates of physical activity yielded lower values and a different activity pattern compared with those obtained by commonly used self-reports. This highlights the need to better understand the nature and measurement issues of health-enhancing physical activity of adults.

Background: The desirable effects of physical activity in individuals with Parkinson's disease are well-known, although according to results from previous studies factors associated with objectively assessed physical activity are not fully investigated. Objective: To investigate demographic, disease-related and mobility-related factors that associate with objectively measured physical activity, in a sample of older adults with mild to moderate Parkinson's disease. Methods: Demographic, disease-related and mobility-related factors were gathered by interview from a total of 91 older adults with Parkinson's disease, followed by an evaluation of balance control using the Mini-BESTest. After initial testing, participants wore a tri-axial accelerometer during a week of free-living. Correlation analysis and multiple linear regression was used to investigate factors associated with total PA, represented by total activity counts, and time in brisk walking. Results: Motor impairment, physical function, body mass index and dyskinesia contributed to the variance of total physical activity, explaining 34%of the variance, while physical function and balance control were significant factors associated with brisk walking, explaining 22 %. Conclusions: This study identified factors that have not been shown to associate with objectively measured physical activity previously, such as dyskinesia, balance control and self-rated physical function. The findings also demonstrated that associated factors differ, depending on the activity behavior being investigated. However, other factors than those included in this study may also be of importance. [ABSTRACT FROM AUTHOR]

Abstract: The purpose was to compare data obtained from a modified, long, self-administered version of the International Physical Activity Questionnaire (IPAQ-A) with objective data obtained in parallel from Actigraph accelerometers, and VO2max in adolescents. The study comprised a total of 2018 adolescents (46% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity was assessed over seven consecutive days by accelerometry and expressed as min/day of moderate, vigorous, and moderate to vigorous (MVPA) physical activity (PA). PA was also assessed with the IPAQ-A. VO2max was estimated from a 20-m shuttle run test. Poor to fair correlations between the two methodologies were found for the whole study sample and when stratified by age and gender (r s =0.08–0.26, p <0.01). On average, the self-reported time spent in moderate PA was higher compared to the time measured with the accelerometer, while the differences between both instruments were less clear for vigorous intensity. Adolescents reporting high levels of PA (3rd tertile IPAQ-A) also showed higher levels of PA (accelerometers) in all the study variables (moderate, vigorous and MVPA), compared to adolescents reporting low PA (1st tertile IPAQ-A) (all p <0.001). Both methods were moderately correlated with estimated VO2max. Within the HELENA-study, the IPAQ-A showed the modest comparability with the accelerometer data for assessing PA in each intensity level and was the highest for vigorous intensity. Both instruments are able to detect the adolescents with the highest cardio respiratory fitness, which are the most active adolescents. [Copyright &y& Elsevier]