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Background: Regular physical activity is crucial for healthy aging, but older adults are the least active age group. This study explored the feasibility, acceptability, and efficacy of a multilevel mHealth intervention for increasing physical activity of older adults living in a retirement community. Methods: Participants included 54 older adults (mean age = 81.2 y, 77.8% female, 98.1% white) living in a retirement community. Participants received a Fitbit Zip and access to a multilevel mHealth physical activity intervention (MapTrek Residential) for 8 weeks. Physical activity (in steps per day) and intervention compliance (days worn) were measured objectively with the Fitbit for 12 weeks (8-wk intervention plus 4-wk follow-up). Psychosocial outcomes (social support, self-efficacy, and outcome expectations) were assessed at baseline and 8 weeks. Acceptability outcomes were assessed with an open-ended process evaluation survey and focus groups. Descriptive statistics and linear mixed models were used to examine intervention effects. Results: Participants increased daily steps from 5438 steps per day at baseline (95% CI, 4620 to 6256) to 6201 steps per day (95% CI, 5359 to 7042) at week 8 (P <.0001) but this was not maintained at 12 weeks (P =.92). Conclusions: Our multilevel mHealth physical activity intervention was effective for increasing physical activity older adults over 8 weeks. Additional research focused on maintaining physical activity gains with this approach is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The authors examined the relationship between mother and child activity. Methods: The authors compared moderate–vigorous physical activity (MVPA) and sedentary time of low-income mothers with obesity and their 6- to 12-year-old children on week (WD) and weekend (WE) days. A total of 196 mother–child pairs wore accelerometers simultaneously for a week. Mothers completed questionnaires. Spearman correlation and multivariate regression were used. Results: WE MVPA (accelerometry) was significantly correlated between mothers with children aged 6–7 (rs =.35) and daughters (rs =.27). Self-reported maternal PA time spent with one of their children was significantly correlated with the WE MVPA of all children (rs =.21) and children aged 8–10 (rs =.22) and with the WD MVPA of all children (rs =.15), children aged 8–10 (rs =.23), aged 11–12 (rs =.52), and daughters (rs =.37), and inversely correlated to the WD sedentary time of all children (rs = −.21), children aged 8–10 (rs = −.30), aged 11–12 (rs = −.34), daughters (rs = −.26), and sons (rs = −.22). In multivariate regression, significant associations were identified between reported child–mother PA time together and child MVPA and sedentary time (accelerometry). Conclusions: Mothers may influence the PA levels of their children with the strongest associations found in children aged 6–7 and daughters. Mother–child coparticipation in PA may lead to increased child MVPA and decreased sedentary behavior. [ABSTRACT FROM AUTHOR]

Purpose: Determining fitness is important when assessing adolescents with type 1 diabetes mellitus (T1DM). Submaximal tests estimate fitness, but none have been validated in this population. This study cross-validates the Ebbeling and Nemeth equations to predict fitness (VO2max (ml/kg/min)) in adolescents with Tl DM. Methods: Adolescents with T1DM (n = 20) completed a maximal treadmill test using indirect calorimetry. Participants completed one 4-min stage between 2.0 and 4.5 mph and 5% grade (Ebbeling/Nemeth protocol). Speed and grade were then increased until exhaustion. Predicted VO2max was calculated using the Ebbeling and Nemeth equations and compared with observed VO2max using paired / tests Pearson correlation coefficients, 95% confidence intervals, coefficients of determination (R²), and total error (TE) were calculated. Results: The mean observed VO2max was 47.0 ml/kg/min (SD = 6.9); the Ebbeling and Nemeth mean predictions were 42.4 (SD = 9.4) and 43.5 ml/kg/min (SD = 6.9), respectively. Paired t tests resulted in statistically significant (p < .01) mean differences between observed and predicted VO2max for both predictions. The association between the Ebbeling prediction and observed VO2max was r = .90 (95% CI = 0.76, 0.96), R² = .81, and TE = 6.5 ml/kg/ min. The association between the Nemeth prediction and observed V02max was r= .81 (95% CI = 0.57,0.92), R²= .66, and TE = 5.6 ml/kg/min. Conclusion: The Nemeth submaximal treadmill protocol provides a better estimate of fitness than the Ebbeling in adolescents with T1DM. [ABSTRACT FROM AUTHOR]

Abstract Background Tracking studies determine the stability and predictability of specific phenomena. This study examined tracking of TV viewing (TV) and video game use (VG) from middle childhood through early adolescence after adjusting for moderate and vigorous physical activity (MVPA), percentage of body fat (% BF), and maturity. Methods TV viewing and VG use were measured at ages 5, 8, 11, and 13 (n = 434) via parental- and self-report. MVPA was measured using the Actigraph, % BF using dual-energy x-ray absorptiometry, and maturity via Mirwald predictive equations. Generalized Estimating Equations (GEE) were used to assess stability and logistic regression was used to predict children "at risk" for maintaining sedentary behaviors. Additional models examined tracking only in overfat children (boys ≥ 25% BF; girls ≥ 32% BF). Data were collected from 1998 to 2007 and analyzed in 2010. Results The adjusted stability coefficients (GEE) for TV viewing were 0.35 (95% CI = 0.26, 0.44) for boys, 0.32 (0.23, 0.40) for girls, and 0.45 (0.27, 0.64) for overfat. For VG use, the adjusted stability coefficients were 0.14 (0.05, 0.24) for boys, 0.24 (0.10, 0.38) for girls, and 0.29 (0.08, 0.50) for overfat. The adjusted odds ratios (OR) for TV viewing were 3.2 (2.0, 5.2) for boys, 2.9 (1.9, 4.6) for girls, and 6.2 (2.2, 17.2) for overfat. For VG use, the OR were 1.8 (1.1, 3.1) for boys, 3.5 (2.1, 5.8) for girls, and 1.9 (0.6, 6.1) for overfat. Conclusions TV viewing and VG use are moderately stable throughout childhood and predictive of later behavior. TV viewing appears to be more stable in younger children than VG use and more predictive of later behavior. Since habitual patterns of sedentarism in young children tend to continue to adolescence, early intervention strategies, particularly to reduce TV viewing, are warranted.

Osteoporosis is characterized by a loss of bone density and strength resulting in increased risk of fracture. One promising method for preventing fractures is participation in bone-strengthening physical activity. While the importance of mechanical loading for bone health is understood, assessment strategies are limited. Most researchers measure metabolic loads rather than mechanical loads, but not all activities that improve metabolic health increase bone strength. The osteogenic properties of physical activity (e.g., magnitude of the load, rate at which the load is applied, dynamic and odd nature of the load, duration of loading session, and breaks between sessions) have not traditionally been directly measured in health outcomes and surveillance research. The lack of research in this area has slowed our understanding of exactly what dose of bone-strengthening physical activity to recommend to the public as well as how to prescribe exercise to reduce the risk of fractures. To understand the influence of mechanical loading on bone adaptation, measurement methods must capture multiple physical activity dimensions (intensity, frequency, and time). Advancements in accelerometer technology now allow for the measurement of these dimensions. It is time that the lessons learned from using accelerometers in cardiometabolic health outcomes research be applied to musculoskeletal health. [ABSTRACT FROM AUTHOR]

Introduction: Physical inactivity, hereafter inactivity, is a serious health problem among U.S. veterans, hereafter veterans. Inactive adults are at risk for adverse cardiac events and premature mortality. Specifically, among veterans, inactivity has been associated with a 23% increase in mortality. In order to increase physical activity among veterans, we developed Veterans Affairs (VA) MapTrek, a mobile-phone-based web app that allows users to take a virtual walk in interesting locations around the world while tracking their progress against that of others like themselves on an interactive map. Steps are counted by a commercially available Fitbit triaxial accelerometer, and users see their progress along a predefined scenic path overlaid on Google Maps. The objective of this study was to determine the effectiveness of VA MapTrek to increase physical activity in a population of veterans at risk for obesity-related morbidity., Materials and Methods: We recruited overweight and obese veterans obtaining care at the Iowa City Veterans Affairs Health Center. Half of the veterans were assigned to participate in VA MapTrek. Each week, participants were assigned virtual walking races (Monday through Saturday), which followed a predetermined route that is displayed on Google Maps. The participant's position on the map is automatically updated each time their Fitbit syncs to their phone. In addition, challenges were issued periodically. Veterans in the control group were only given a Fitbit. We regressed daily step counts on the days of the week, the days since the start of the intervention period, whether the user was in the VA MapTrek or Control group, and an interaction between the study group and the days since the start of the intervention period. We included subject-specific random intercepts and subject-specific random slopes. This model was estimated using Bayesian Hamiltonian Monte Carlo using Stan's No-U-Turns sampler. We set vague, uniform priors on all the parameters., Results: We enrolled 276 participants, but only 251 (102 in the control group and 149 in the VA MapTrek group) contributed data during the intervention period. Our analysis suggests an 86.8% likelihood that the VA MapTrek intervention led to a minimum increase of 1,000 daily steps over the 8-week period, compared to the control group. Throughout the 8-week intervention, we project that VA MapTrek participants would have taken an extra 96,627 steps, equivalent to 77.8 additional kilometers (km) (48.3 additional miles), assuming an average of 1,242 steps per km (2,000 steps per mile)., Conclusions: Our study underscores the potential of VA MapTrek as an intervention for promoting walking among veterans who face elevated risks of obesity and cardiac issues. Rural veterans are a high-risk population, and new interventions like VA MapTrek are needed to improve veterans' health., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Background: Early detection of diabetic foot ulcers can improve outcomes. However, patients do not always monitor their feet or seek medical attention when ulcers worsen. New approaches for diabetic-foot surveillance are needed. The goal of this study was to determine if patients would be willing and able to regularly photograph their feet; evaluate different foot-imaging approaches; and determine clinical adequacy of the resulting pictures., Methods: We recruited adults with diabetes and assigned them to Self Photo (SP), Assistive Device (AD), or Other Party (OP) groups. The SP group photographed their own feet, while the AD group used a selfie stick; the OP group required another adult to photograph the patient's foot. For 8 weeks, we texted all patients requesting that they text us a photo of each foot. The collected images were evaluated for clinical adequacy. Numbers of (i) submitted and (ii) clinically useful images were compared among groups using generalized linear models and generalized linear mixed models., Results: A total of 96 patients consented and 88 participated. There were 30 patients in SP, 29 in AD, and 29 in OP. The completion rate was 77%, with no significant differences among groups. However, 74.1% of photographs in SC, 83.7% in AD, 92.6% in OP were determined to be clinically adequate, and these differed statistically significantly., Conclusions: Patients with diabetes are willing and able to take photographs of their feet, but using selfie sticks or having another adult take the photographs increases the clinical adequacy of the photographs. Level of Evidence: II ., Competing Interests: Disclosures: Chris Anthony is a McKinsey & Company paid advisor/ consultant. John Femino has two competing interests- Arthrex and Integra. All other authors report that no competing interests exist., (Copyright © The Iowa Orthopaedic Journal 2020.)

Background: Squats and lunges are commonly prescribed rehabilitation exercises used to improve performance across a wide spectrum of patient populations. However, biomechanical studies have mainly examined young, normal weight populations performing these exercises at a difficulty level potentially too challenging for obese individuals. Understanding how obesity and different levels of difficulty affect lower extremity biomechanics could help to inform rehabilitation approaches used for obese individuals., Purpose: The purpose of this study was to analyze and compare the lower extremity kinematics and kinetics in obese and normal weight females during performance of progressively more difficult squat and lunge exercises., Study Design: Cross-sectional study design., Methods: Ten obese females (mean age, 37.4 years; BMI 39.2 ± 3.7 kg/m(2)) and ten normal-weight, age-matched female controls (38.1 years, BMI < 23 kg/m(2)) volunteered for the study. Each group performed two exercises, each in three different iterations: squatting at three standardized knee angles (60°, 70°, and 80°) and lunging at three standardized distances (1.0, 1.1, and 1.2 times tibial length). Three dimensional motion analysis using infrared markers and force plates was used to calculate range of motion as well as hip, knee, ankle and support moments (normalized for body weight). A repeated measures ANOVA model was used to determine between and within group differences., Results: Support moments were higher in obese females for squat 70° (p=0.03) and 80° (p=0.01). Ankle extensor moments were higher in obese females for squat 80° (p=0.04). During lunge at all levels (1.0, 1.1, and 1.2), hip extensor moments were higher in obese subjects (p=0.004, 0.003, and 0.007 respectively). Within group, the support moments were significantly higher during squat 80° than squat 60° (p=0.01) in obese females. A non-linear relationship was found between hip moments and BMI during squat 60°, 70°, and 80°., Conclusion: During two commonly prescribed rehabilitation exercises (squat and lunge), there were significantly greater support moments in obese individuals compared to normal controls. The non-linear associations between kinetic and anthropometric measures make the assessment of how best to approach exercise in obese individuals challenging., Level of Evidence: Level 3.

This study examined the association between physical activity (PA) and bone mineral content (BMC; gram) from middle childhood to middle adolescence and compared the impact of vigorous-intensity PA (VPA) over moderate- to vigorous-intensity PA (MVPA). Participants from the Iowa bone development study were examined at ages 5, 8, 11, 13, and 15 years (n = 369, 449, 452, 410, and 307, respectively). MVPA and VPA (minutes per day) were measured using ActiGraph accelerometers. Anthropometry was used to measure body size and somatic maturity. Spine BMC and hip BMC were measured via dual-energy x-ray absorptiometry. Sex-specific multi-level linear models were fit for spine BMC and hip BMC, adjusted for weight (kilogram), height (centimeter), linear age (year), non-linear age (year(2)), and maturity (pre peak height velocity vs. at/post peak height velocity). The interaction effects of PA × maturity and PA × age were tested. We also examined differences in spine BMC and hip BMC between the least (10th percentile) and most (90th percentile) active participants at each examination period. Results indicated that PA added to prediction of BMC throughout the 10-year follow-up, except MVPA, did not predict spine BMC in females. Maturity and age neither modify the PA effect for males nor females. At age 5, the males at the 90th percentile for VPA had 8.5% more hip BMC than males in the 10th percentile for VPA. At age 15, this difference was 2.0%. Females at age 5 in the 90th percentile for VPA had 6.1% more hip BMC than those in the 10th percentile for VPA. The age 15 difference was 1.8%. VPA was associated with BMC at weight-bearing skeletal sites from childhood to adolescence, and the effect was not modified by maturity or age. Our findings indicate the importance of early and sustained interventions that focus on VPA. Approaches focused on MVPA may be inadequate for optimal bone health, particularly for females.