Search

Objective: Emerging research supports the role of chronic stress in chronic disease development. This scoping review aimed to map the field of research exploring relationships between chronic stress and the development of arthritis in adult populations. Methods: Five electronic databases were systematically searched without publication limits based on three key concepts: stress, arthritis and adults. Eligible qualitative studies investigated individuals’ perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by two independent reviewers and data were narratively synthesised. Results: Of 1819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods and 45 used quantitative methods. Studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorised as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self‐reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development. Conclusion: Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease aetiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiological framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions. Refereed/Peer-reviewed

Sit-stand workstations are growing in popularity, however limited guidelines exist regarding optimal schedules of sitting and standing. This was the first known study to observe sit-stand workstation schedules when postural change is based on maintaining musculoskeletal discomfort within 'acceptable' levels. Fourteen healthy adults new to sit-stand workstations completed computer-based work at a sit-stand desk for half a workday. Participants changed between standing and sitting postures each time discomfort reached the maximum acceptable threshold. On average, the amount of standing and sitting was greatest in the first standing (median 40 minutes, interquartile range 40 minutes) and sitting (median 30 minutes, interquartile range 115 minutes) bouts. Average durations spent standing and sitting were lower in all consecutive bouts. Stand-sit ratios indicated an equal amount of standing to sitting or somewhat less standing. The schedules had substantial inter-participant variability. Future studies should consider that optimal schedules may vary with regard to time and be individual-specific.Refined guidelines are needed regarding effective use of sit-stand workstations. This study proposed a novel method of investigating potentially optimal schedules, in which postural change was based on reaching a threshold of musculoskeletal discomfort. The findings suggest that an optimal schedule may vary with time and be individual-specific.

To report the prevalence of MRI features commonly associated with posterior ankle impingement syndrome in elite ballet dancers and athletes and to compare findings between groups. Thirty-eight professional ballet dancers (47.4% women) were age- and sex-matched to 38 elite soccer or cricket fast bowler athletes. All participants were training, playing, and performing at full workload and underwent 3.0-T standardised magnetic resonance imaging of one ankle. De-identified images were assessed by one senior musculoskeletal radiologist for findings associated with posterior ankle impingement syndrome (os trigonum, Stieda process, posterior talocrural and subtalar joint effusion-synovitis, flexor hallucis longus tendon pathology and tenosynovitis, and posterior ankle bone marrow oedema). Imaging scoring reliability testing was performed. Posterior talocrural effusion-synovitis (90.8%) and subtalar joint effusion-synovitis (93.4%) were common in both groups, as well as the presence of either an os trigonum or Stieda process (61.8%). Athletes had a higher prevalence of either os trigonum or Stieda process than dancers (74%, 50% respectively, P = 0.03). Male athletes had a higher prevalence of either os trigonum or Stieda process than male dancers (90%, 50% respectively, P = 0.01), or female athletes (56%, P = 0.02). Posterior subtalar joint effusion-synovitis size was larger in dancers than athletes (P = 0.02). Male and female dancers had similar imaging findings. There was at least moderate interobserver and intraobserver agreement for most MRI findings. Imaging features associated with posterior impingement were prevalent in all groups. The high prevalence of os trigonum or Stieda process in male athletes suggests that this is a typical finding in this population.

Background Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle plantarflexion. The relationship between clinical and imaging findings in PAIS has not been established. Purpose To investigate the relationship between clinical and imaging features in PAIS by reviewing the literature comparing symptomatic patients to asymptomatic controls. Material and Methods A systematic literature search was performed to identify all English-language articles that compared imaging features in patients diagnosed with PAIS to imaging in an asymptomatic control group. Results A total of 8394 articles were evaluated by title and abstract, and 156 articles were read in full text. No articles compared imaging findings to an asymptomatic control group, thus no articles met the inclusion criteria. Conclusion This systematic review found no published research that compared the imaging findings of people diagnosed with PAIS to asymptomatic people. Until this information is available, imaging features in people with posterior ankle impingement should be interpreted with caution.

Introduction: Fatigue is a frequent and debilitating symptom for people with end-stage kidney disease (ESKD) receiving dialysis. Ecological momentary assessment (EMA) allows real-time data capture of day-to-day and diurnal variations. EMA has been used to study haemodialysis-related fatigue but not in people receiving peritoneal dialysis who are unique in their physical, environmental and logistical characteristics. The aim of this study is to explore the real-time associations between fatigue and mood (EMA mobile application) and objective physical activity levels (accelerometry) in people with EKSD receiving peritoneal dialysis. Method: A 7-day intensive longitudinal study will be conducted. People receiving peritoneal dialysis within South Australia will be invited to participate. Five times throughout the day, participants will be prompted to answer 18 questions relating to fatigue (Visual Analogue Scale to Evaluate Fatigue Severity) and a single question for mood (Visual Analogue Mood Scale). Participants will continuously wear a GENEActiv accelerometer to capture physical activity levels during the 7-day period. At the completion of the data collection, participants will answer questions to evaluate the feasibility and acceptability of using EMA. Discussion: This study will be the first to explore the real-time relationships between fatigue, mood and physical activity in people with ESKD receiving peritoneal dialysis. Understanding the fluctuations people experience and the relationships between mood and physical activity and fatigue will inform clinical management and well-being intervention development.

Background: The standing broad jump (SBJ) is an excellent functional measure of explosive lower-body strength that is significantly related to health among children and adolescents. Objectives: The aim of this study was to estimate national (country-level) and international (pooled global data) temporal trends in SBJ performance for children and adolescents, and to examine the relationships between national trends in SBJ performance and national trends in health-related and socioeconomic/demographic indicators. Methods: Data were obtained from a systematic search of studies reporting temporal trends in SBJ performance for 9- to 17-year-olds, and by examining national fitness datasets. Sample-weighted regression models estimated trends at the study/dataset-country-sex-age level, with national and international trends estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in SBJ performance and national trends in health-related and socioeconomic/demographic indicators. Results: Data from 34 studies/datasets were extracted to estimate trends for 10,940,801 children and adolescents from 24 high-, 4 upper-middle-, and 1 low-income countries between 1960 and 2017. Collectively, there was a negligible (per decade) improvement in SBJ performance of 1.73 cm (95% CI 1.71–1.75), 0.99% (95% CI 0.97–1.01) or a standardized effect size of 0.07 (0.07–0.07) over the entire period, with the rate of improvement steady from the 1960s to the 1980s, slowing in the 1990s, before declining. Sex- and age-related temporal differences were negligible. Trends differed between countries, with most countries experiencing declines. National trends in SBJ performance were not significantly related to national trends in health-related and socioeconomic/demographic indicators. Conclusions: SBJ performance of children and adolescents has declined since 2000 (at least among most of the countries in this analysis) and is suggestive of a modern decline in functional explosive lower-body strength. Growing recognition of the importance of muscular fitness as a marker of population health highlights the need for continued tracking of temporal trends in SBJ, especially among low- and lower-middle-income countries for which temporal data are lacking. Refereed/Peer-reviewed

Background: Patients receiving dialysis have reduced physical function, which is associated with unfavorable clinical outcomes and decreased quality of life. The authors aimed to identify and explore modifiable physical factors associated with physical function for patients receiving dialysis. Methods: Searches were performed in MEDLINE, Embase, Ovid Emcare, and The Cochrane Library in October 2018. Etiological studies involving dialysis populations that report association or predictive statistics between a modifiable physical factor and physical function were eligible for inclusion. Predictor variables were (1) modifiable via exercise and (2) considered an impairment in the International Classification of Functioning, Disability and Health. Results: Of 5384 titles screened, 23 studies were included. Thirteen studies focused on physical activity levels and muscle strength and the relationship with physical function while 2 studies investigated sedentary behavior. Twenty-one studies focused on hemodialysis populations. Studies related to physical activity levels displayed a moderately strong relationship with physical function, whereas muscle strength displayed a predominantly weak to moderate relationship. Conclusions: Physical activity levels, sedentary behavior levels, and muscle strength are related to physical function status for patients receiving dialysis. There is a need for robust longitudinal data to confirm the results of this investigation and for more focus on populations receiving peritoneal dialysis.

Background: Dyspnoea is a common, disabling symptom of people living with end‐stage kidney disease (ESKD), which may persist despite optimal management. Dyspnoea assessments can be grouped according to the instruments that assess domains related to: sensory‐perception (intensity, sensory quality), affective distress (unpleasantness) and impact/burden (function, quality of life). Objectives: To describe dyspnoea assessment in adults with ESKD receiving renal replacement therapy (RRT). Design: Systematic review. Methods: Five databases were searched. Primary studies reporting an assessment of dyspnoea in adults with ESKD receiving RRT were included. Studies were excluded where participants with ESKD had received palliative/conservative treatment (no dialysis) or renal transplant. Conference abstracts, protocols, commentaries and/or images were excluded. Two independent reviewers screened and extracted the data. Descriptive analysis summarised the (1) number and type of instruments used to assess dyspnoea; (2) which dyspnoea domains to be assessed and (3) rationale and context for dyspnoea assessment. Results: From 2,234 records screened, 28 studies were eligible for inclusion (observational n = 22 and experimental n = 6). Across studies, 12 different instruments were identified (dyspnoea‐specific n = 3, subscale of a comprehensive instrument n = 9). Most instruments (n = 11, 92%) assessed a single domain (intensity n = 6, unpleasantness n = 6 and impact/burden n = 5). Studies reported a rationale for measuring dyspnoea (n = 26) as either a characteristic of the participant cohort (n = 14) or as an outcome (n = 14). Conclusions: Surprisingly, a few primary studies reported assessment of dyspnoea in people with ESKD receiving RRT. When assessed, there was a predominance of unidimensional instruments. As dyspnoea is associated with adverse clinical outcomes, routine dyspnoea assessment may improve management and relieve suffering. Refereed/Peer-reviewed

Objective: To estimate national and international temporal trends in handgrip strength for children and adolescents, and to examine relationships between trends in handgrip strength and trends in health-related and sociodemographic indicators. Methods: Data were obtained through a systematic search of studies reporting temporal trends in the handgrip strength for apparently healthy 9–17-year-olds, and by examining large national fitness datasets. Temporal trends at the country–sex–age level were estimated by sample-weighted regression models relating the year of testing to mean handgrip strength.International and national trends were estimated by a post-stratifed population-weighting procedure. Pearson’s correlation squantifed relationships between national trends in handgrip strength and national trends in health-related/sociodemographic indicators. Results: 2,216,320 children and adolescents from 13 high-, 5 upper-middle-, and 1 low-income countries/special administrative regions between 1967 and 2017 collectively showed a moderate improvement of 19.4% (95% CI 18.4–20.4) or 3.8% perdecade (95% CI 3.6–4.0). The international rate of improvement progressively increased over time, with more recent values(post-2000) close to two times larger than those from the 1960s/1970s. Improvements were larger for children (9–12 years)compared to adolescents (13–17 years), and similar for boys and girls. Trends difered between countries, with relationships between national trends in handgrip strength and national trends in health-related/sociodemographic indicators negligible to-weak and not statistically signifcant. Conclusions: There has been a substantial improvement in absolute handgrip strength for children and adolescents since 1967. There is a need for improved international surveillance of handgrip strength, especially in low- and middle-income ountries, to more confdently determine true international trends. Refereed/Peer-reviewed

Failure to master age-appropriate fundamental movement skills (FMS) at a young age can limit motor skill competence affecting health. Assessments often have issues with feasibility and implementation in a field setting. As such, the purpose of this study was to investigate the validity and feasibility of the Athletic Skills Track (AST), in a pre-school setting. For the validation study sixty-five 3–6 year old children (25 boys and 40 girls) from five pre-schools across Adelaide, Australia participated. Correlations and linear regression analysis (adjusted for age and gender) were used to investigate the association between the time to complete the AST and the raw score of the Test of Gross Motor Development 2 (TGMD-2). For the feasibility study pre-school staff completed a semi-structured interview regarding the feasibility of the AST. The AST took less than a minute per child and the TGMD-2 around 20 minutes for two children. There was a strong negative correlation (r = −0.63, p < 0.01) between the AST scores and the TGMD-2 scores. All five staff reported strengths of the AST to be its short administration time, setup and appropriateness. These results suggest that the AST could be a feasible and valid method of FMS assessment in Australian pre-schools. Refereed/Peer-reviewed

Background Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. Objective This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. Methods In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets. Results Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. Conclusions In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance.

To report the prevalence of MRI features commonly associated with posterior ankle impingement syndrome in elite ballet dancers and athletes and to compare findings between groups.Thirty-eight professional ballet dancers (47.4% women) were age- and sex-matched to 38 elite soccer or cricket fast bowler athletes. All participants were training, playing, and performing at full workload and underwent 3.0-T standardised magnetic resonance imaging of one ankle. De-identified images were assessed by one senior musculoskeletal radiologist for findings associated with posterior ankle impingement syndrome (os trigonum, Stieda process, posterior talocrural and subtalar joint effusion-synovitis, flexor hallucis longus tendon pathology and tenosynovitis, and posterior ankle bone marrow oedema). Imaging scoring reliability testing was performed.Posterior talocrural effusion-synovitis (90.8%) and subtalar joint effusion-synovitis (93.4%) were common in both groups, as well as the presence of either an os trigonum or Stieda process (61.8%). Athletes had a higher prevalence of either os trigonum or Stieda process than dancers (74%, 50% respectively, P = 0.03). Male athletes had a higher prevalence of either os trigonum or Stieda process than male dancers (90%, 50% respectively, P = 0.01), or female athletes (56%, P = 0.02). Posterior subtalar joint effusion-synovitis size was larger in dancers than athletes (P = 0.02). Male and female dancers had similar imaging findings. There was at least moderate interobserver and intraobserver agreement for most MRI findings.Imaging features associated with posterior impingement were prevalent in all groups. The high prevalence of os trigonum or Stieda process in male athletes suggests that this is a typical finding in this population.

usc Objectives: to compare the deep hip external rotator (DHER) muscle (piriformis, gemelli, quadratus femoris (QF)) cross-sectional area (CSA) in dancers and athletes and evaluate the relationship between DHER size and hip pain. Study design: cross-sectional study. Setting: elite ballet and sport. Participants: 33 professional ballet dancers and 33 age and sex-matched athletes. Main outcome measures: CSAs of piriformis, gemelli and QF on magnetic resonance imaging (MRI). Hip pain scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): Hip pain was categorised as ‘yes’ if HAGOS pain score was 0.05), and CSAs were not associated with hip pain. Male and female dancers had similar sized DHER muscles. In athletes, CSA of piriformis was 55% (p = 0.02, Cohen's d(95%CI) = 0.98 (0.26,1.71)) and the gemelli were 34% (p = 0.03, Cohen's d(95%CI) = 0.98 (0.26,1.70)) larger in men than women; QF was 36% larger (p = 0.08, Cohen's d(95%CI) = 0.77 (0.06,1.48)). Conclusion: although ballet dancers perform in external rotation, their DHER are no larger than athletes and muscle size was not associated with hip pain. Refereed/Peer-reviewed

OBJECTIVE: In high-performance sport, the use of self-report measures is expanding. The exploration of wellness states in response to training and performance requires further investigation for professional ballet dancers and athletes. This study therefore aimed to: compare wellness scores between professional ballet dancers and athletes in training and performance; report frequency of self-reported modified participation during training and performance; and report frequency of self-reported inability to participate due to pain and illness in dancers and athletes. METHODS: Fourteen professional ballet dancers (mean 26 yrs, SD 2.6) and 14 sex- and age-matched professional athletes (mean 27.7 yrs, SD 2.9) recorded daily wellness (fatigue, stress, sleep quality and quantity), participation (full, rest, modified, or unable to participate) and activity (performance, training) into a wellness application on their smart phone over a 4-month period. Mixed factorial ANOVAs were conducted to assess the interaction between group (ballet dancers and athletes) and activity (performance and training) on the dependent variables (stress, fatigue, sleep quality, and sleep quantity). RESULTS: Stress and fatigue levels were higher for both dancers and athletes during performance compared to training periods. Dancers recorded lower sleep quantity than athletes, with no difference in sleep quality. Modified participation appears more common in dancers compared to athletes. Dancers and athletes were rarely unable to train or perform/compete over the 4 months. CONCLUSION: Self-reported wellness scores appear sensitive to activity type and can provide valuable information to guide intervention and recovery strategies. Further research on the impact of poor wellness on performance, illness, and injury in professional ballet is warranted.

Introduction: Previous studies have linked short sleep duration, poor sleep quality, and late sleep timing with lower health-related quality of life (HRQoL) in children. However, almost all studies relied solely on self-reported sleep information, and most studies were conducted in high-income countries. To address these gaps, we studied both device-measured and self-reported sleep characteristics in relation to HRQoL in a sample of children from 12 countries that vary widely in terms of economic and human development. Methods: The study sample included 6,626 children aged 9-11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Waist-worn actigraphy was used to measure total sleep time, bedtime, wake-up time, and sleep efficiency on both weekdays and weekends. Children also reported ratings of sleep quantity and quality. HRQoL was measured by the KIDSCREEN-10 survey. Multilevel regression models were used to determine the relationships between sleep characteristics and HRQoL. Results: Results showed considerable variation in sleep characteristics, particularly duration and timing, across study sites. Overall, we found no association between device-measured total sleep time, sleep timing or sleep efficiency, and HRQoL. In contrast, self-reported ratings of poor sleep quantity and quality were associated with HRQoL. Conclusions: Self-reported, rather than device-based, measures of sleep are related to HRQoL in children. The discrepancy related to sleep assessment methods highlights the importance of considering both device-measured and self-reported measures of sleep in understanding its health effects. (c) 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

We estimated international/national temporal trends in sit-ups performance for children and adolescents, and examined relationships between national trends in sit-ups performance and national trends in health-related/sociodemographic indicators. Data were obtained by systematically searching studies reporting on temporal trends in sit-ups performance for apparently healthy 9–17 year-olds, and by examining nationally representative fitness datasets. Trends at the country-sex-age level were estimated by sample-weighted regression models relating the testing year to mean sit-ups performance. International/national trends were estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in sit-ups performance and national trends in health-related/sociodemographic indicators. A total of 9,939,289 children and adolescents from 31 countries/special administrative regions between 1964 and 2017 collectively showed a large improvement of 38.4% (95% CI: 36.8 to 40.0) or 7.1% per decade (95% CI: 6.8 to 7.4). Large international improvements were experienced by all age and sex groups, with the rate of improvement slowing from 1964 to 2000, stabilizing near zero until 2010, before declining. Trends differed between countries, with national trends in vigorous physical activity a strong, positive correlate of national trends in sit-ups performance. More sit-ups data are needed from low- and middle-income countries to better monitor trends in muscular fitness. Refereed/Peer-reviewed

The aim of the current study was to identify different playing styles within 2015–16 English Premier League season. Game-related variables were allocated to the “moments of play” framework, and multidimensional game styles were investigated using cluster analysis and related to finishing position. Totally, 96 game-related variables were allocated into one of five discrete “moments of play”; set pieces (SP), established offence (EO), transition to offence (TO), transition to defence (TD) and established defence (ED). Moments of play variables were z-score transformed. The game-specific mean z-score for the five moments was used as K-means cluster analysis inputs. Relationships between game style clusters and finishing position were investigated using chi-square analysis. Three game style clusters were identified: (1) moderately favouring ED and prevalent among lower-ranked teams (n = 270 games); (2) dominant in TO and TD (n = 241) and represented by the top team, (3) strong in EO and SP and characterised by higher ranked teams (games n = 249). Success for the top-ranked team was associated with the dominance in transition moments. Higher ranked teams demonstrate control of EO and SP, whereas lower ranked teams clustered for poor performance in all moments except ED. Game style varies across teams, however, it also aggregates relative to finishing position Refereed/Peer-reviewed

Context: Abdominal musculature underpins core stability, which can allow for optimal performance in many activities of daily living (eg, walking and rising from a chair). Therefore, assessment of the abdominal muscles poses as an important consideration for clinicians in order to identify people at risk of injury or functional decline. Objective: This study aimed to build on the limited amount of knowledge surrounding abdominal muscle strength assessments by investigating the validity and reliability of hand-held dynamometry (HHD) for the assessment of isometric abdominal flexion strength. Study Design and Participants: Comparative analysis for validity and test–retest reliability was employed on a cohort of apparently healthy individuals. HHD was compared with the criterion, isokinetic dynamometry, through an isometric contraction of trunk flexion on both instruments. Hand-held dynamometry assessments only were performed on a subsequent day for reliability analysis. The peak values for all assessments were recorded. Results: A total of 35 participants were recruited from the University of South Australia and the general public. Comparative analysis between the HHD and isokinetic dynamometer showed good agreement (intraclass correlation coefficients = .82), with the Bland–Altman plots confirming no proportional bias. Reliability analysis for the HHD reported good consistency (intraclass correlation coefficients = .87). Conclusion: HHD together with the participant setup (supine, trunk flexed, and supported at 25° with the legs horizontal and remaining unfixed) is a valid and reliable tool to assess isometric abdominal flexion strength.

Objective: No studies have objectively measured habitual usage of sit-stand workstations. Methods: Eighteen full-time office workers participated (47.9 ± 9.2 years, 61% female). Sitting time was objectively measured (activPAL, 24 h/7 days), and time at desk, desk position, and perceptions of desk use were self-reported. Results: Participants sat for 39% of their daily workstation time, and changed workstation position twice daily. The most common reasons for standing included back pain (44%) and tiredness (22%). The majority of participants received no workstation occupational health (72%) or educational (61%) information. Workstation standing time had a significant moderate correlation with total daily standing time (P = 0.02). Conclusion: Office workers with sit-stand workstations rarely change desk position, and there is no relationship between the time spent sitting at the workstation, and total daily sitting time. Education about the workstations was limited. Refereed/Peer-reviewed

To assess the association between clinical features and magnetic resonance imaging (MRI) findings in posterior ankle impingement syndrome (PAIS) and to compare the prevalence of imaging findings between participants with and without a clinical diagnosis of PAIS.Case-control study.Elite ballet and sport.Eighty-two male (54%) and female participants comprising ballet dancers (n = 43), cricket fast bowlers (n = 24), and football (soccer) players (n = 15).Clinical: posterior ankle pain on body chart, passive plantarflexion pain provocation test. Patient-reported outcome measures: Oslo Sports Trauma Research Center Overuse Injury Questionnaire, Foot and Ankle Ability Measure Sports subscale.Imaging findings including posterior ankle bone marrow edema, os trigonum (± bone marrow edema, and increased signal at synchondrosis), Stieda process (± bone marrow edema), talocrural and subtalar joint effusion-synovitis size, flexor hallucis longus tendinopathy, and tenosynovitis identified as present or absent on 3.0-Tesla MRI.Imaging findings were not associated with posterior ankle pain or a positive ankle plantarflexion pain provocation test. Imaging findings were not associated with patient-reported outcome measures. Imaging findings did not differ between PAIS-positive and PAIS-negative groups. Os trigonum and Stieda process were prevalent despite clinical status.The lack of association between imaging findings and clinical features questions the role of imaging in PAIS. Clinicians should rely primarily on clinical assessment in the diagnosis and management of patients with PAIS.

BACKGROUND Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. OBJECTIVE This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. METHODS In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets. RESULTS Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. CONCLUSIONS In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance.

Background Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods This multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance. Trial registration The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).

Background: the aim of this study was to explore the associations between use of time and momentary hedonic affect (‘enjoyment’) in adults in the peri-retirement period. Methods: a total of 124 adults [61 males, 63 females; age 62 (4) years] completed a computerised use-of-time recall on 4 days at each of four time points (3–6 months pre-, 3, 6 and 12 months post-retirement), as well as surveys regarding self-reported health, well-being, sleep quality and loneliness. They reported how much they enjoyed each activity on a 0–10 scale. An individual Enjoyment Index was calculated as the time-weighted average of each participant's enjoyment ratings. Time-weighted enjoyment ratings were also calculated for nine mutually exclusive and exhaustive activity domains (Sleep, Chores, Work, Social, Screen Time, Self-care, Quiet Time, Transport, Physical Activity) and sub-domains. Results: the mean (±SD) Enjoyment Index was 7.43 ± 0.61, and was significantly and positively associated with well-being (P = 0.003 to P < 0.0001) and sleep quality (P = 0.03 to P < 0.0001), and negatively associated with loneliness (P = 0.003 to P < 0.0001). Mean Enjoyment Index values increased significantly (P < 0.0001) from pre-retirement (7.19 ± 0.82) to post-retirement (7.46 ± 0.89, 7.42 ± 0.91 and 7.49 ± 0.89 at 3, 6 and 12 months post-retirement). There were significant differences in enjoyment across domains, with Physical Activity (7.86 ± 1.11) and Social (7.66 ± 0.85) being the most enjoyable, and Work (7.10 ± 0.89) and Chores (7.09 ± 0.85) the least enjoyable. Conclusion: enjoyment of everyday activities increased after retirement and remained elevated for at least 12 months. Work appears to constitute a relative hedonic deficit Refereed/Peer-reviewed

Fundamental movement skill (FMS) assessment in preschools allows for early intervention; however it is unclear what assessments are feasible. The purpose of this review is to systematically review the feasibility of FMS assessments for pre-school aged children. The search was conducted across four databases, MEDLINE, Scopus, ERIC and SportsDiscus. Search terms included synonyms of "fundamental movement skills" and "pre-school children". Inclusion criteria were: (i) FMS assessment; (ii) feasibility data; (iii) assessment of children aged three to six years; (iv) assessment of typically developing children; and (v) peer reviewed full text publications in English. Feasibility concepts (administration time, equipment, space, assessment type, item, training, qualification) were each coded as 'poor = 1ʹ, 'average = 2ʹ and 'good = 3ʹ; potential total of 21. A total of 330 full text articles were considered but a quarter (n = 86) were excluded due to no feasibility data. Sixty-five studies using 13 different FMS assessments were included. The Athletic Skills Track and DEMOST-PRE assessments were most feasible (18/21) and the Test of Gross Motor Development and Movement Assessment Battery for Children were common but among the least feasible (12-14/21). This review allows pre-school staff to choose a FMS assessment based on feasibility. Future studies need to present feasibility of assessments. Refereed/Peer-reviewed

BACKGROUND: Retirement is a life transition involving an obligatory change in how people use their time. Because there are strong associations between use of time and health, different changes in time use following retirement may have different impacts on mental health. METHODS: 105 participants were followed from 6 months before retirement to 12 months after retirement. At each time-point, use of time was quantified using a validated computerised 24-hour recall. Depression, anxiety and stress were assessed using the Depression, Anxiety and Stress Scales (DASS21), well-being with the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), life satisfaction with the Australian Unity Personal Well-being Index (AUPWI), and self-esteem with the Rosenberg Self-Esteem Scale. Time-use data were analysed using compositional data analysis, which treats the 24-h day as a holistic "activity composition" rather than as individual activity domains. Time flow analytics were used to map patterns of change in time use from pre-retirement to post-retirement. Regression analysis was used to determine whether changes in the activity composition were significantly associated with changes in mental health. Compositional isotemporal substitution models were used to illustrate dose-response relationships between changes in time use and conditional changes in mental health for individual activity domains, such as sleep, screen time and physical activity. RESULTS: Following retirement, time no longer spent in work flowed mainly to household chores, sleep, screen time and quiet time (e.g. reading). Mental health improved overall. Changes in the activity composition were significantly related to conditional changes in DASS21 total score, depression, stress, and self-esteem, but not to anxiety, well-being or life satisfaction. Replacing work time with physical activity or sleep was associated with positive changes in mental health. Effect sizes for 60-minute substitutions ranged from -0.15 to +0.31. CONCLUSION: Following retirement, replacing work with physical activity, and to a lesser extent sleep, is associated with better mental health. ispartof: PLOS ONE vol:13 issue:6 ispartof: location:United States status: published

Purpose/objective Cardiac rehabilitation aims to reduce the likelihood of recurrent cardiac events through physical activity (PA) and education. There is limited understanding about the predictors of physical activity behavior in rural adults beyond rehabilitation. This study explored predictors of regular physical activity in rural adults, 6-12 months post cardiac rehabilitation. Research Method/Design: A self-report questionnaire (quantitative cross-sectional design) was mailed to a simple random sample of rural South Australians who previously participated in cardiac rehabilitation (n = 315). Regression modeling was adjusted for physical activity history and gender to examine psychological, social, and environmental predictors of (a) current leisure-time physical activity, self-reported through the Godin Leisure Time Exercise Questionnaire expressed as the Leisure Score Index (LSI) and the weekly frequency of physical activity bouts that cause sweating ("sweat frequency"), and (b) stage of physical activity behavior change according to the Transtheoretical Model of Behavior Change ("Stage of PA change"). Results All measures of self-efficacy (barriers, task, and relapse), social assimilation, and self-regulation predicted LSI, whereas all measures of self-efficacy and self-regulation predicted both "Stage of PA change" and "sweat frequency." Self-regulation explained the highest percentage of explained variance in LSI (31.6%) and "sweat frequency" (12.5%). Home social support additionally predicted "Stage of PA change"; there were no environmental predictors of any of the outcome measures. Conclusion Similar to urban populations, the predictors of post-cardiac-rehab physical activity among rural adults predominantly emanate from the psychological domain. Findings support the need to strengthen the focus of cardiac rehabilitation program design on self-management skills and behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Refereed/Peer-reviewed

All rights reserved. Background: prolonged sedentary behaviour has been associated with a number of chronic health conditions. This issue is compounded by inactivity increasing with age.Objective: this systematic review aimed to identify evidence regarding changes in sedentary behaviours as people move into retirement.Search strategy and selection criteria: nine databases (Ageline, CINAHL, Cochrane, Embase, MEDLINE, ProQuest, PubMed, SportDiscus and Web of Science) were searched in May 2014. Search terms included retirement, time use and a range of sedentary behaviours, with no date limit. Articles were selected and appraised for risk of bias by two independent reviewers. Due to the variations in measures used for reporting, data synthesis of results was qualitative.Results: two studies measured total sitting time and reported declines across retirement. Several studies examined self-reported time spent in specific sedentary leisure activities and generally reported increases in duration, prevalence or frequency (television: 7/9 studies; reading: 4/6 studies). Few other sedentary behaviours were considered.Conclusions: changes in sedentary time across retirement are currently poorly understood with varying patterns of change identified by different study methodologies (total sitting time versus specific leisure sedentary activities). Future research that simultaneously investigates changes in a comprehensive range of sedentary behaviours across retirement is required. To date, findings suggest that interventions aimed at improving the health of this population need to be targeted at specific sedentary behaviours to provide maximum benefit. Refereed/Peer-reviewed

This study aimed to investigate how daily use of time changes across the retirement transition and how these changes may differ according to socio-demographic characteristics.This longitudinal cohort study was based on interviews with 124 people at pre-retirement and at three, six and 12 months after retirement.The Multimedia Activity Recall for Children and Adults (MARCA), a computer-assisted telephone interview, measured use of time. Random effects mixed modelling (REMM) was used to examine time use changes across retirement, and ANCOVA to investigate the extent of the change by sex, education and health.Apart from the decrease in time spent in work across retirement (-122min/day, p0.001), less time was also spent in both active and passive transport (-26min/day, p0.001). There were significant increases in time spent on Chores (+55min/day, p0.001), Screen time (+32min/day, p0.001), Sleep (+32min/day, p0.001), Quiet time (+17min/day, p=0.02), Self-care (+8min/day, p=0.01) and Physical activity (+7min/day, p=0.01). There was little variation in change between sex, education and health sub-groups. Most changes occurred at retirement, with time use patterns fairly stable between three and 12 months post-retirement.The small amount of time spent in physical activity, combined with less time spent in active transport and increased time spent watching television, indicate the need for a more active lifestyle.

Objective : To describe New Zealand adolescent time use clusters and correlate cluster profiles. Methods : Data were from the cross-sectional 2008/2009 National Survey of Children and Young People's Physical Activity and Dietary Behaviours, which surveyed a random sample of 10–16 year-old New Zealanders (study subset n=679). Time use data were collected using the Multimedia Activity Recall for Children and Adults, and collapsed into 17 age-adjusted variables for sex-specific cluster analysis. Cluster associations with socio-demographic, anthropometric, physical activity and dietary variables were analysed. Results : Three time use clusters were discovered for both boys and girls. For boys, the Techno-active cluster was characterised by high levels of team sports and TV; the Quiet movers cluster by transport (active and passive) and quiet time; and the Social studious cluster by reading, study activities and social interaction. The boys’ clusters were associated with ethnicity. The girls’Social sporty cluster was characterised by sports and social interaction; the Screenie tasker cluster by TV, computer, chores and work; and the Super studious cluster by reading, study and school-based activities. The girls’ time use cluster membership was associated with weight status and serves of extra foods. Conclusions : Distinct sex-specific time use clusters and correlate profiles exist among NZ adolescents. Implications : These findings may assist the development of targeted time use interventions to improve adolescent health and well-being.

Background: How people use their time has health implications, but use of time may be influenced by factors such as age, sex, education and health. Objective: This study aimed to provide detailed information on the daily activity patterns of older working people. Study design: 139 older Australian adults (aged 50-79 years) undertook comprehensive interviews on their use of time. This paper presents a cross-sectional analysis of the baseline findings from a longitudinal study. Main outcome measures: Use of time was measured using the Multimedia Activity Recall for Children and Adults (MARCA), administered via computer-assisted phone interview. Activity patterns were described, and compared on the basis of sex, education and health status. Results: The main activities undertaken were sleep (mean 466 min/day), work (mean 233 min/day) and chores (mean 160 min/day), with little time spent on physical activity (mean 13 min/day). Women spent more time doing chores (p < 0.001) while men spent more time on vigorous activities (p < 0.001). Participants with "fair" health spent less time on inside chores (p = 0.05) and grooming (p = 0.02) than healthier participants. Conclusions: Healthy lifestyle interventions for older workers should aim to increase physical activity levels by targeting specific activities, depending on sex and health status. Refereed/Peer-reviewed

Objective: To establish the effectiveness of walking alone and walking compared to other non-pharmacological management methods to improve disability, quality of life, or function in adults with chronic low back pain. Data sources: A systematic search of the following databases was undertaken: Medline, Embase, CINAHL, Scopus, Pedro, SportDiscus, Cochrane Central Register of Controlled Trials. The following keywords were used: ‘back pain’ or ‘low back pain’ or ‘chronic low back pain’ and ‘walk*’ or ‘ambulation’ or ‘treadmill*’ or ‘pedometer*’ or ‘acceleromet*’ or ‘recreational’ and ‘disability’ or ‘quality of life’ or ‘function*’. Review methods: Primary research studies with an intervention focus that investigated walking as the primary intervention compared to no intervention or any other non-pharmacological method in adults with chronic low back pain (duration >3 months). Results: Seven randomised controlled trials involving 869 participants were included in the review. There was no evidence that walking was more effective than other management methods such as usual care, specific strength exercises, medical exercise therapy, or supervised exercise classes. One study found over-ground walking to be superior to treadmill walking, and another found internet-mediated walking to be more beneficial than non-internet-mediated walking in the short term. Conclusion: There is low quality evidence to suggest that walking is as effective as other non-pharmacological management methods at improving disability, function, and quality of life in adults with chronic low back pain.

Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPERO (registration number CRD42014010155). Level of Evidence Therapy, level 2a. J Orthop Sports Phys Ther 2016;46(6):431-442. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6449.

Objective To evaluate and discuss the accuracy of submaximal exercise–based equations to predict maximum oxygen uptake ( V ˙ o 2 max), validated using direct gas analysis, in older apparently healthy adults. Data Sources Studies were identified by searching 5 electronic databases and manually scanning reference lists of included articles from the respective inception of each database through April 2015. Study Selection Studies were included if they used at least 1 submaximal exercise–based variable in the prediction, the actual V ˙ o 2 max was directly measured using a gas analysis device, and if participants were apparently healthy older adults (mean age ≥65y). Eligible studies were required to report at least 1 validity statistic (eg, Pearson product-moment correlation [ r ]) and either a predicted and measured V ˙ o 2 max value or a directional significant difference between the measured and predicted V ˙ o 2 max values. No limits were placed on year of publication, but only full-text, published articles in the English language were included. Data Extraction Nine articles and 13 equations were retained from the systematic search strategy. If the same prediction equation was used across multiple trials, data from the most accurate trial were reported. Data Synthesis Submaximal equations predicted directly measured V ˙ o 2 max with a moderate to strong correlation strength ( r range, 0.4–0.9). Predicted V ˙ o 2 max significantly differed from directly measured in 2 of the 13 equations. The preferred mode of ergometry was walking or running (7 equations); a stepping protocol was the most accurate ( R 2 =0.9, not significant between predicted and measured V ˙ o 2 max). Conclusions Factors to consider when choosing a submaximal exercise–based equation are the accuracy of the equation, the population tested, the mode of ergometry, the equipment availability, and the time needed to conduct familiarization sessions.

Background: Obese adolescents achieve less moderate to vigorous physical activity (MVPA) than normal-weight adolescents, but the nature and extent of the deficit is unclear. This study aimed to describe differences in MVPA across weight status categories by domain of activity (sport, play, and active transport) and specific activity-sets (e.g. team sports, playground games, and chores) using minutes of activity, estimated intensity, and estimated energy expenditure as metrics of MVPA. Conclusion: More than two-thirds of the difference in energy expenditure between obese and normal-weight Australian adolescents was because of lower participation in sport. Strategies for engaging obese adolescents in sport may help to redress deficits in energy expenditure. Method: Anthropometric, use-of-time, and pedometer data were collected on a random sample of 2,200 Australian children aged 9-16 years. Minutes of activity, intensity metabolic equivalents of tasks (METs), and energy expenditure (MET.min) within each domain were estimated using an energy cost compendium. Results: Obese adolescents reported 174 MET.min/d lower MVPA energy expenditure than normal-weight peers (p < .0001), more than accounting for the entire difference in total daily energy expenditure (154 MET.min/d). Of this difference, 121 MET.min/d was associated with lower sports participation (p < .0001) and 45 MET.min/d with less free play (p = .03). There were no differences in minutes of active transport or in reported activity intensity across weight status categories in sport, free play, or active transport. The differences in MVPA participation between obese and normal-weight adolescents were largely because of different levels of participation in team sports, cycling, partner sports (boys), and dancing (girls). Refereed/Peer-reviewed

Risk factors for adolescent overweight and obesity include low levels of physical activity, high levels of sedentary behavior, low fruit and vegetable intake, and low socioeconomic position (SEP). To date, the vast majority of research investigating associations between lifestyle behaviors and weight status analyze dietary and time use factors separately. Our research aimed to describe Australian youth time use and diet clusters and explore relationships with weight status and SEP (parental education and income). Cluster analysis of the National Children’s Nutrition and Physical Activity Survey data from Australians aged 9 to 16 years (random sample n = 1,853) was conducted. Time use data (17 age-adjusted time use variables) and dietary data (7 age-adjusted diet variables) were collected via 24-hour recalls. Two clusters were associated with a reduced frequency of overweight and obesity (the boys’ Active Sitter and girls’ Healthy Academic clusters) and one with an increased frequency of overweight and obesity (the boys’ Unhealthy cluster). Of these three clusters, two demonstrated associations with parental income and/or parental education level. The boys’ Unhealthy cluster was associated with low SEP status (parental income and education), and the girls’ Healthy Academic cluster was associated with high parental income. Not all unhealthy adolescent clusters were associated with overweight and obesity. The findings suggest sex-specific diet and activity clusters can be used to identify at-risk subgroups and inform multifaceted interventions to address overweight and obesity. Refereed/Peer-reviewed

Background:To date, most health-related time-use research has investigated behaviors in isolation; more recently, however, researchers have begun to conceptualize behaviors in the form of multidimensional patterns or clusters.Methods:The study employed 2 techniques: radar graphs and centroid vector length, angles and distance to quantify pairwise time-use cluster similarities among adolescents living in Australia (N = 1853) and in New Zealand (N = 679).Results:Based on radar graph shape, 2 pairs of clusters were similar for both boys and girls. Using vector angles (VA), vector length (VL) and centroid distances (CD), 1 pair for each sex was considered most similar (boys: VA = 63°, VL = 44 and 50 units, and CD = 48 units; girls: VA = 23°, VL = 65 and 85 units, and CD = 36 units). Both methods employed to determine similarity had strengths and weaknesses. Conclusions: The description and quantification of cluster similarity is an important step in the research process. An ability to track and compare clusters may provide greater understanding of complex multidimensional relationships, and in relation to health behavior clusters, present opportunities to monitor and to intervene.

Many equations to predict maximal oxygen uptake (V̇O2max) from submaximal exercise tests have been proposed for young people, but the composition and accuracy of these equations vary greatly. The purpose of this systematic review was to analyze all submaximal exercise-based equations to predict V̇O2max measured via direct gas analysis for use with young people. Five databases were systematically searched in February 2013. Studies were included if they used a submaximal, exercise-based method to predict V̇O2max; the actual V̇O2max was gas analyzed; participants were younger than 18 years; and equations included at least one submaximal exercise-based variable. A meta-analysis and narrative synthesis were conducted. Sixteen studies were included. The mean equation validity statistic was strong, r = .786 (95% CI 0.747–0.819). Subgroup meta-analysis suggests exercise mode may contribute to the overall model, with running- and walking-based predictive equations reporting the highest mean r values (running r = .880; walking r = .821) and cycling the weakest (r = .743). Selection of the most appropriate equation should be guided by factors such as purpose, logistic limitations, appropriateness of the validation sample, the level of study bias, and the degree of accuracy. Suggestions regarding the most accurate equation for each exercise mode are provided.

Objectives This systematic review aimed to (i) report the accuracy of submaximal exercise-based predictive equations that incorporate oxygen uptake (measured via open circuit spirometry) to predict maximal oxygen uptake ( V ˙ O 2 max ) and (ii) provide a critical reflection of the data to inform health professionals and researchers when selecting a prediction equation. Design Systematic review. Methods A systematic search of MEDLINE, EMBASE (via OvidSP), CINAHL, SPORTDiscus™ (via EBSCO Host) and Scopus databases was undertaken in February 2013. Studies were required to report data on healthy participants aged 18–65y. Following tabulation of extracted data, a narrative synthesis was conducted. Results From a total of 7597 articles screened, 19 studies were included, from which a total of 43 prediction equations were extracted. No significant difference was reported between the measured and predicted V ˙ O 2 max in 28 equations. Pearson's correlation coefficient between the predicted and measured V ˙ O 2 max ranged from r =0.92 to r =0.57. The variables most commonly used in predictive equations were heart rate ( n =19) and rating of perceived exertion ( n =24). Conclusions Overall, submaximal exercise-based equations using open circuit spirometry to predict V ˙ O 2 max are moderately to highly accurate. The heart rate and rating of perceived exertion methods of predicting V ˙ O 2 max were of similar accuracy. Important factors to consider when selecting a predictive equation include: the level of exertion required; participant medical conditions or medications; the validation population; mode of ergometry; time and resources available for familiarisation trials; and the level of bias of the study from which equations are derived.

Objective To describe time use clusters and correlate-cluster profiles of Australian youth. Design Secondary analysis of cross-sectional national survey. Methods Data were from the National Children's Nutrition and Physical Activity Survey, a random sample (n = 1853) of 9–16 years old Australians (February–August 2007). Time use data were collected using the Multimedia Activity Recall for Children and Adults, and collapsed into 17 age-adjusted variables for sex-specific cluster analysis. Cluster associations with socio-demographic, anthropometric, health and dietary variables were analysed. Results For boys (n = 930), the Social tasker cluster was characterised by social interaction and chores & work, the Techno-active cluster by team sport and TV and the Techno-studious cluster by video games and study. Average daily pedometer steps, age and remoteness were significant cluster correlates. For the girls (n = 923), the Social screenie cluster was characterised by TV and social interaction, the Quiet actives cluster by quiet time and non-team sport and the Techno-studious cluster by video games and study. Pedometer steps, age, parental income and education, parent–child age difference, “extra foods”, fat and fruit intakes were significant correlates. Conclusions Distinct sex-specific time use clusters and profiles exist among Australian youth. These findings may assist the development of targeted time use interventions to improve health and well-being.

Purpose: Recent research suggests that patterns or clusters of time use may affect health in ways that cannot be explained by the effect of individual behaviors alone. The aim of this research was to systematically review the literature examining adolescent time use clusters and associated correlates. Conclusions: Despite the between-study differences, consistent cluster and cluster-correlate patterns were still evident. Cluster analysis of adolescent time use behaviors appears to be an emerging and useful classification technique, one which may have implications for targeted health-related interventions. Methods: Systematic searches of six online databases for relevant observational studies were conducted. At least two authors reviewed abstract and full text selection meeting eligibility criteria. Included studies were quality scored, had data extracted, and cluster types and cluster associations interpreted. Results: Nineteen studies were identified for inclusion, and 18 of them investigated cluster-correlate associations. Twenty-nine cluster types were identified, characterized by both individual (e.g., church) and co-occurring behaviors (e.g., physical activity and screen [technoactive]). Nineteen correlate categories were identified (e.g., socioeconomic and weight status). Consistent patterns of cluster-correlate association were found. For example, the technoactive cluster type is more likely to be male and to have low school orientation. Refereed/Peer-reviewed

The way an individual uses one’s time can greatly affect his or her health. The purpose of this article was to examine the cross-sectional cross-elasticity relationships for use of time domains in a sample of Australian adolescents. This study analyzed 24-hour recall time use data collected using the Multimedia Activity Recall for Children and Adults (N = 2,200). Using simple linear regression, the authors calculated the difference in time devoted to a reference activity (i.e., screen time, sleep, or social) given 1 hour extra in the time devoted to a criterion activity (i.e., physical activity). The most elastic activities were screen time and school-related time. Every additional hour committed to physical activity was associated with 32 minutes less screen time. This relationship was more pronounced in obese adolescents (−56 minutes screen time) compared with normal (−31 minutes) and overweight (−27 minutes) adolescents. Promising behavior patterns exist, with screen time appearing as a highly elastic behavior. Refereed/Peer-reviewed

Adolescents engage in a complex range of low energy-consuming and active behaviours not easily captured by single behavioural measures. This study aims to describe the associations among adolescent active and low energy behaviours. Data were obtained from adolescents aged 12-16 years (n = 1532) participating in a nationally representative survey. Thirty-nine variables measuring activities were stratified by sex and age and then analysed using principal components analysis with Varimax rotation. Four components were derived for younger girls (21.7% of the variance) and younger boys (20.2%), six for older girls (29.7%) and five for older boys (25.6%). Academic-related behaviours positively correlated with each other and negatively with television use for all age-sex groups. Computer use correlated positively with academic-related behaviours for older boys but negatively with active behaviours for younger boys and girls. Active behaviours correlated positively with each other. For older girls, low energy expenditure, household-based behaviours were negatively correlated with active behaviours. Computer use appears to differ across age groups, and leisure and academic use should be differentiated. The positive associations among different active behaviours and their negative associations with home-based, low energy expenditure behaviours are of interest for intervention development. Refereed/Peer-reviewed