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Objectives: This study examines the impact of a previously validated disability spectrum that accounts for compensatory strategies on depressive symptoms in older adults., Methods: This study was a secondary data analysis of 2011 through 2018 surveys from the National Health and Aging Trends Study (N = 7,609). The disability spectrum was categorized using a 5-level hierarchical scheme: fully able, successful accommodation, reduced activity, difficulty, and assistance for 12 mobility, self-care, and household activities. The individual fixed-effects panel model was used to examine the impact of this disability spectrum on depressive symptoms., Results: Depressive symptoms rose progressively with each successive category on the disability spectrum in descriptive analyses. In fixed-effects models, moving from "fully able" to "successful accommodation" was not associated with significant changes in depressive symptoms; this result held for all self-care and mobility activities. Moving from "fully able" to "reduced activity" was associated with a significant increase in depressive symptoms for 3 household activities (doing laundry, making hot meals, and shopping for groceries) but not for paying bills/banking or keeping track of medications. Going up 2 or more stages above "fully able" on the disability spectrum was associated with a significant increase in depressive symptoms across all 12 activities., Discussion: While limitations in a range of daily activities have harmful effects on mental health, using compensatory strategies that do not erode one's perception of autonomy can help older adults cope with the psychological detriments of late-life disability., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Patterns of healthy leisure are dependent upon age, but people with disabilities are particularly susceptible to passive and disengaged types of activities. This study evaluates how individuals with disabilities spend their time in passive, active, social, and isolated forms of leisure over the life course, and how these patterns vary by age., Method: I analyze nationally representative data from 70,165 respondents ages 15 and older in the 2008, 2010, and 2012-2016 American Time Use Survey. Linear regression models estimate the association between disability and leisure time, net of self-rated health and sociodemographic controls. Interactions between age and disability are also evaluated, as well as the robustness of results by sensory, cognitive, physical, and multiple disability status., Results: People with disabilities report significantly more, and poorer quality, leisure than people without disabilities. This includes more than 2 hr more time in passive leisure as well as a disproportionate amount of isolated leisure spent at home, alone. These differences are not fully explained by health and sociodemographic controls. The isolated leisure time of people with disabilities is most different from people without disabilities in later life-whereas differences in total and passive leisure time, by disability status, are greatest in midlife., Discussion: People with disabilities spend less time in health-promoting forms of leisure at all ages, but these patterns are unique across midlife and older age., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To investigate the occurrence of signs of altered psychomotor capacity (SAPC) associated with the violation of the dry law at the exits of nightclubs in the city of São Paulo, Brazil. Methods: Data from drivers participating in the Balada com Ciência project were used. Alcohol dosages were measured with breathalyzer test. The use of other drugs was obtained by interviewees' self-report. SAPC (speech, walking, glazed eyes, and alcohol odor) were verified by the interviewers at the time of the interview and categorized as "no sign" or "at least one sign". All measurements were evaluated at the exit of the nightclubs. The population description considered the sample weighting. Logistic regression analysis evaluated the association between the occurrence of SAPC, alcohol and other drugs use, controlling for sociodemographic variables. Results: At nightclubs, the SAPC among drivers are about 8 times higher when the breath alcohol concentration is above 0.05 mg/L if compared with those who did not drink alcohol, and about 30 times higher when the alcohol concentration was ≥ 0.34 mg/L in exhaled air. This finding is not generally verified in the literature for those who report the use of drugs inside nightclubs, which is interesting, since 20.4% of the interviewed population reported using drugs in the places surveyed. Conclusion: This study suggests the potential of using the Perham (2007) physical test for alcohol intoxication in sobriety checkpoints at the exit of nightclubs. However, the verification of these signs is not enough for the identification of drug use by drivers.

Background: Maintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown., Methods: We prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index)., Results: The mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004)., Conclusions: We found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.

Aim: There is accumulating evidence that participation in cognitive leisure activities might be related to a reduced risk of cognitive impairment. However, there is no consensus regarding the classification of cognitive leisure activities, and it cannot clearly define each activity and quantitatively evaluate the effect of it. In the present study, we propose a new classification method, and examine the relationship between reclassified cognitive leisure activities and cognitive function., Methods: The analysis included 4830 participants of the Chinese Longitudinal Healthy Longevity Survey, who were aged >80 years and free of cognitive impairment at 1998. They were followed up six times. Six cognitive leisure activities were mainly grouped into intrapersonal and interpersonal cognitive leisure activity by categorical principal component analysis. Cox proportional hazards analysis was used to evaluate the relationship between reclassified cognitive leisure activities and the risk of cognitive impairment., Results: After a median follow-up period of 16 years, 1763 participants suffered from cognitive impairment (Mini-Mental State Examination score <24). Reading newspapers or books, taking part in some social activities and sometimes playing cards or mahjong were associated with a decreased risk of cognitive impairment (P < 0.05 for all). In multivariable adjusted models, compared with those with lower intensities, the hazard ratios (95% confident intervals) of cognitive impairment were 0.86 (0.74-0.99) and 0.71 (0.60-0.83) for participants with high intensities of intrapersonal and interpersonal cognitive leisure activity, respectively., Conclusion: A high frequency of participation in intrapersonal and interpersonal cognitive leisure activities showed a lower risk of cognitive impairment among the oldest-old in China. Geriatr Gerontol Int 2019; 19: 1041-1047., (© 2019 Japan Geriatrics Society.)

The study sought to identify the prevalence of voice-related problems teaching basic education teachers and to analyze their association with the practice of physical activity. We used data from a phone survey of a representative sample (n = 6,510) of Educatel Study carried out between October 2015 and March 2016. The main data of this study were self-referred voice-related problems teaching, leisure-time physical activity (defined according to its intensity, duration and frequency) and potential confounding variables. The data was analyzed using Poisson regression models with robust variance. Around one fifth of teachers (20.5%) reported having had voice-related problems teaching, while approximately one third reported sufficient leisure-time physical activity (≥ 150 minutes/week) (37.8%). Both recommended physical activity volume and five or more days of physical activity per week (regardless of total volume) were inversely associated with voice-related problems teaching, both in bivariate models and in models adjusted for confounding variables (sex, age and working hours). Basic Education teachers have a high prevalence of voice-related problems teaching. Sufficient leisure-time physical activity and exercising five or more days a week are potential protective factors for reducing this problem.

Background: Nightclubs are venues in which excessive alcohol use and illegal drug consumption occur in addition to other high-risk behaviors, such as violence and sexual risk behaviors. Environmental factors common in nightclubs and the personal characteristics of patrons might increase the risk of these events. To better understand the relationship between these factors, typologies were formulated that clustered nightclubs according to definite profiles to identify differences to be taken into consideration in preventive interventions., Objectives: The present study aim was to construct a typology of nightclubs in São Paulo, Brazil., Methods: This typology was constructed using mixed methods research through the triangulation of several data sources as follows: 307 hours of ethnographic observation at 31 nightclubs, 8 focus group sessions with nightclub patrons (n = 34) and 30 semi-structured interviews with nightclub employees. Content analysis and qualitative typology were used., Results: Four nightclub types were defined based on four analyzed thematic axes (Intoxicating, Violent, Dancing and Highly Sexualized nightclubs). Excessive alcohol use was detected in almost all of the investigated nightclubs, and drug use was observed in approximately one-third of them. Triangulation of the data revealed a relationship among environmental factors (especially alcohol sales strategies and promotion and the availability of areas for sex) and a more considerable presence of high-risk behaviors., Conclusions: The study shows that nightclubs are settings in which high-risk behaviors are potentiated by facilitating environmental factors as well as by the lack of laws restricting excessive alcohol use stimulated by the promotion strategies applied at these venues.

Over the last few decades, public life has taken center stage in urban studies, but that is about to change. At times, indoor activities have been shown to matter more than what is publicly visible (they have been found to be more predictive of future crimes, for example). Until recently, however, data has not been available to study indoor activities at city scale. To that end, we propose a new methodology that relies on tagging information of geo-referenced pictures and unfolds in three main steps. First, we collected and classified a comprehensive set of activity-related words, creating the first dictionary of urban activities. Second, for both London and New York City, we collected geo-referenced Flickr tags and matched them with the words in the dictionary. This step produced both a systematic classification (our activity-related words were best classified in eleven categories) and two city-wide indoor activity maps which, when compared to open data of public amenities and sensory maps of smell and sound matched theoretical expectations. Third, we studied, for the first time, activities happening indoor in relation to neighborhood socio-economic conditions. We found the very same result for both London and New York City. In deprived areas, people focused on any of the activity types (leading to specialization), and it did not matter on which one they did so. By contrast, in well-to-do areas, people engaged not in one type of activity but in a variety of them (leading to diversification)., Competing Interests: The funder (Nokia Bell Labs) provided support in the form of salaries for authors DQ and LMA but this does not alter our adherence to PLOS ONE policies on sharing data and materials.

This study explored active aging for older Māori and non-Māori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Māori aged 80 to 90 and non-Māori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization's International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Māori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Māori men, and gardening for Māori women. Somewhat similar, activity preferences for non-Māori featured gardening, reading, and sports. Again, gendered differences showed for non-Māori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Māori and non-Māori. For Māori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Māori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

Importance: More research is required to clarify the association between physical activity and health in "weekend warriors" who perform all their exercise in 1 or 2 sessions per week., Objective: To investigate associations between the weekend warrior and other physical activity patterns and the risks for all-cause, cardiovascular disease (CVD), and cancer mortality., Design, Setting, and Participants: This pooled analysis of household-based surveillance studies included 11 cohorts of respondents to the Health Survey for England and Scottish Health Survey with prospective linkage to mortality records. Respondents 40 years or older were included in the analysis. Data were collected from 1994 to 2012 and analyzed in 2016., Exposures: Self-reported leisure time physical activity, with activity patterns defined as inactive (reporting no moderate- or vigorous-intensity activities), insufficiently active (reporting <150 min/wk in moderate-intensity and <75 min/wk in vigorous-intensity activities), weekend warrior (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions), and regularly active (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions). The insufficiently active participants were also characterized by physical activity frequency., Main Outcomes and Measures: All-cause, CVD, and cancer mortality ascertained from death certificates., Results: Among the 63 591 adult respondents (45.9% male; 44.1% female; mean [SD] age, 58.6 [11.9] years), 8802 deaths from all causes, 2780 deaths from CVD, and 2526 from cancer occurred during 561 159 person-years of follow-up. Compared with the inactive participants, the hazard ratio (HR) for all-cause mortality was 0.66 (95% CI, 0.62-0.72) in insufficiently active participants who reported 1 to 2 sessions per week, 0.70 (95% CI, 0.60-0.82) in weekend warrior participants, and 0.65 (95% CI, 0.58-0.73) in regularly active participants. Compared with the inactive participants, the HR for CVD mortality was 0.60 (95% CI, 0.52-0.69) in insufficiently active participants who reported 1 or 2 sessions per week, 0.60 (95% CI, 0.45-0.82) in weekend warrior participants, and 0.59 (95% CI, 0.48-0.73) in regularly active participants. Compared with the inactive participants, the HR for cancer mortality was 0.83 (95% CI, 0.73-0.94) in insufficiently active participants who reported 1 or 2 sessions per week, 0.82 (95% CI, 0.63-1.06) in weekend warrior participants, and 0.79 (95% CI, 0.66-0.94) in regularly active participants., Conclusions and Relevance: Weekend warrior and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause, CVD, and cancer mortality risks regardless of adherence to prevailing physical activity guidelines.

Objective: A systematic literature review was conducted to characterise the current state of knowledge concerning the definition, categorisation, and operationalisation of leisure activity in studies examining its possible role in preventing later-life cognitive decline. Following PRISMA guidelines for a systematic review, the study examined peer-reviewed empirical research publications focused on leisure activity, cognitive decline, and prevention., Methods: Searches in the PubMed/Medline reSEARCH, CINHAL, Ovid MEDLINE, Embase, Web of Science, PsychoINFO, ERIC Proquest, the Cochrane library, and PsycARTICLES databases for the years 2000 to 2011 identified 52 publications for inclusion., Results: The results are discussed and based on these findings are further interpreted using the Model of Human Occupation, which focuses on key factors identified in the review that are salient to associations between participation in leisure activities and prevention of dementia., Conclusions: While the findings support a growing consensus that participation in leisure activities might significantly contribute to prevention of dementia, it also identifies major hindrances to progress. Important limitations detected include a lack of theoretical underpinnings, and little consensus and standardisation in the measured key variables. The study reinforces the critical need to overcome these limitations to enable health care professionals (e.g. occupational therapists) to make evidence-based recommendations for increased participation in activities as a means of promoting health and preventing cognitive decline.

The importance of data in the social and behavioral domains to biomedical research is increasing, but ensuring the reusability of such data through standardization is not a trivial task. To start addressing this challenge, we developed a semantic model of the physical activity domain by reviewing 302 physical activity questions collected from standardized questionnaires and public data repositories. Our semantic model is comprised of activity keywords, qualifiers, response measures and context. We identified three types of contexts: active lifestyle, physical capacity, and environment. The majority (94%) of the 204 activity keywords extracted from the 302 questions were mapped to the UMLS Metathesaurus. Preliminary evaluation of our model with 309 additional activity questions showed that the majority of the questions were related to one of the three context categories. We also noted the need to expand context categories to incorporate the questions assessing psychological aspects of dealing with physical activities.

Some attributes of neighborhood environments are associated with physical activity among older adults. This study examined whether the associations were moderated by driving status. Older adults from neighborhoods differing in walkability and income completed written surveys and wore accelerometers (N = 880, mean age = 75 years, 56% women). Neighborhood environments were measured by geographic information systems and validated questionnaires. Driving status was defined on the basis of a driver's license, car ownership, and feeling comfortable to drive. Outcome variables included accelerometer-based physical activity and self-reported transport and leisure walking. Multilevel generalized linear regression was used. There was no significant Neighborhood Attribute × Driving Status interaction with objective physical activity or reported transport walking. For leisure walking, almost all environmental attributes were positive and significant among driving older adults but not among nondriving older adults (five significant interactions at p < .05). The findings suggest that driving status is likely to moderate the association between neighborhood environments and older adults' leisure walking.

Background: The purpose of this study was to evaluate cross-sectional and longitudinal associations between physical activity and triglyceride and HDLc levels in young male adults., Methods: We used information about males belonging 1982 Pelotas Birth Cohort. Physical activity in 4 domains (leisure time, transportation, household, and occupation) was assessed by self-report in participants of the cohort at ages of 18 and 23 years. Subjects were active if reached the recommendation of 150 min/week of moderate to vigorous physical activity. At 23 years of age, blood sample was collected, and triglycerides and HDLc levels estimated. Multivariate linear and Poisson regression were used to adjust the estimates for confounders., Results: Males who were inactive at 18 and active at 23 years had 41% lower risk (β = 0.59; 95% confidence interval: 0.40; 0.89) for borderline-high triglycerides (≥ 150 mg/dL) as compared with those who were inactive at both follow-ups. No association was found between changes of physical activity and HDLc level. In cross-sectional analyses, greater HDLc levels were found in active subjects in 4 domains, whereas there was no difference in HDL levels according physical activity during leisure time., Conclusion: Becoming active from adolescence to early adulthood reduced the risk for high triglycerides. Current physical activity was associated with greater HDLc levels.

Background: Nature-based tourism has recently become a topic of interest in health research. This study was aimed at examining relationships among nature-based tourism, stress, and the function of the autonomic nervous system (ANS)., Methods: Three hundred and twenty-two older adults living in Taichung City, Taiwan, were selected as participants. Data were collected by a face-to-face survey that included measures of the frequency of participation in domestic and international nature-based tourism and the stress and ANS function of these participants. The data were analyzed using a path analysis., Results: The results demonstrated that the frequency of participation in domestic nature-based tourism directly contributed to ANS function and that it also indirectly contributed to ANS function through stress reduction., Conclusions: Domestic nature-based tourism can directly and indirectly contribute to ANS function among older adults. Increasing the frequency of participation in domestic nature-based tourism should be considered a critical element of health programs for older adults., (© 2014 International Society of Travel Medicine.)

Objective: We aimed to assess the impact of self-reported physical activity on incidence and remission of snoring complaints in women., Methods: A population-based sample of 4851 women aged >20 years responded to questionnaires in years 2000 and 2010. Based on the responses, the women were categorized into low, medium, or high level of physical activity at baseline and at follow-up., Results: The prevalence of habitual snoring complaints increased from 7.6% at baseline to 9.2% in 2010 (P<.0001). After adjusting for age, body mass index (BMI), waist and neck circumference, weight gain, smoking status, alcohol dependence, and snoring status at baseline, reported physical activity level at baseline had a protective effect on habitual snoring complaints at follow-up. The adjusted odds ratio (OR) (95% confidence intervals) for complaints of habitual snoring was 0.7 (0.5-0.9) for the reported medium physical activity level and 0.5 (0.4-0.8) for the high activity level. When subdividing the population by changes in reported physical activity level over the follow-up period, an increase in physical activity was followed by a decrease in the complaint of snoring. Similarly a high level of reported physical activity only had a protective effect on snoring in participants who remained at a high or medium level., Conclusions: A low level of self-reported physical activity is a risk factor for future habitual snoring complaints in women, independent of weight, weight gain, alcohol dependence, and smoking. Increased physical activity can modify the risk., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: People with developmental disabilities are at high risk for a limited participation in leisure activities. The aim of this study was to investigate the participation in, preference for and interest in leisure activities of young and adults with developmental disabilities, and to examine the factors associated with leisure activity., Methods: A cross-sectional design was used with a convenience sample of 237 people aged 17 to 65, living in the community. Leisure participation was assessed with the Spanish version of Leisure Assessment Inventory. Percentages were calculated by types of activity, and repeated measures anovas were used to analyse the differences between types of activities, and mixed anovas to analyse the factors that explain differences in leisure activity participation, preference and interest., Results: Leisure social activities and recreation activities at home were mostly solitary and passive in nature and were identified as those being most commonly engaged in. Respondents expressed preference for more social and physical activity, and they were interested in trying out a large number of physical activities. Age and type of schooling determine participation in leisure activity. The results underscore the differences in leisure activity participation, preference and interest depending on the severity of the disability., Conclusions: The findings reveal interesting patterns of participation in leisure activities from the viewpoint of youngsters and adults with developmental disabilities. Leisure participation among people with developmental disabilities is likely to be more affected by environmental factors than by personal factors., (© 2012 The Author. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.)

Background: The relationship between stroke subtypes and physical activity is unclear., Methods: Using data from 13,069 men and women aged 45-64 years who participated in the Atherosclerosis Risk in Communities Study, physical activity was assessed by self-report using the Baecke questionnaire at baseline (1987-1989). The American Heart Association's ideal cardiovascular health guidelines served as a basis for the calculation of three physical activity categories: poor, intermediate, and ideal. Stroke and its subtypes were ascertained from physician review of medical records. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models., Results: During a median follow-up of 18.8 years, a total of 648 incident ischemic strokes occurred. Significant inverse associations were found between physical activity categories and total, total ischemic, and nonlacunar stroke in adjusted models (age, sex, race-center, education, cigarette-years). Compared with poor physical activity, the adjusted HR (95% CI) for ideal physical activity were 0.78 (0.62-0.97) for total, 0.76 (0.59-0.96) for total ischemic, 0.85 (0.51-1.40) for lacunar, 0.77 (0.47-1.27) for cardioembolic, and 0.71 (0.51-0.99) for nonlacunar stroke. Additional adjustments for waist-to-hip ratio, systolic blood pressure, antihypertensive medication, diabetes, left ventricular hypertrophy and laboratory parameters attenuated the HR. Further sex- and race-specific analyses revealed that the association was predominantly observed among males and among African-Americans., Conclusion: These data suggest a tendency toward a reduced risk of total, total ischemic, and nonlacunar stroke with higher levels of physical activity., (Copyright © 2012 S. Karger AG, Basel.)

Objective: The aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence., Methods: Helsinki Health Study cohort baseline questionnaire survey data were collected in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (>3 days) sickness absence spells were examined, using Poisson regression analysis., Results: Inactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR=0.80, 95% CI 0.65-0.97) and medically certified (RR=0.63, 95% CI 0.49-0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found., Conclusions: For reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Aims: This paper discusses the use of ethnographic approaches to explore how engagement with natural landscapes might benefit people's health., Methods: Drawing on a selected review of empirical research we identified 30 relevant research papers that utilised qualitative methods to explore health issues and engagement with nature. Three examples of 'alternative' - i.e. non-mainstream qualitative approaches - are used to illustrate how different methods can be used to explore people's experiences of engaging with nature for health., Results: While quantitative methods are dominant in health research, qualitative approaches are becoming more widely used. Approaches such as autoethnography can add value to nature and health studies by providing opportunities for researchers to be self-critical of their role as a researcher. Accompanied visits and visual ethnography can afford the researcher rich data about bodily movement, facial expressions and journeys, as well as dialogues associated with the meanings of nature for health., Conclusions: The paper concludes by suggesting that ethnographic methods can provide useful and important insights into why people engage with the natural environment and the range of health benefits they may gain from contact with nature.

Objectives: To develop a classification to describe leisure activities of elderly Hong Kong Chinese based on the functions fulfilled, namely: intellectual, physical, social, and recreational., Methods: A focus group comprising care-for-the-elderly professionals was invited to identify leisure activities commonly practised by elderly Chinese in Hong Kong. An independent panel of occupational therapists in the field of geriatrics and psychiatry was invited to classify the activities into physical, intellectual, social, and recreational categories based on their professional opinion in the context of local practice. The classification was then validated against the opinions of a non-depressed elderly convenience sample with relatively preserved cognition., Results: A total of 33 types of activities were identified, of which 13 were classified as intellectual, 8 as social, 9 as recreational, and 3 as physical. The 3 types of physical activities (mind-body exercise, strenuous aerobic exercise, and stretching and toning exercise) were further divided into different subtypes., Conclusions: An easy-to-understand classification of late-life leisure activities among Chinese has been developed.

Background: Determinants of public healthcare expenditures in type 2 diabetics are not well investigated in developing nations and, therefore, it is not clear if higher physical activity decreases healthcare costs. The purpose of this study was to analyze the relationship between physical activity and the expenditures in public healthcare on type 2 diabetes mellitus treatment., Methods: Cross-sectional study carried out in Brazil. A total of 121 type 2 diabetics attended to in two Basic Healthcare Units were evaluated. Public healthcare expenditures in the last year were estimated using a specific standard table. Also evaluated were: socio-demographic variables; chronological age; exogenous insulin use; smoking habits; fasting glucose test; diabetic neuropathy and anthropometric measures. Habitual physical activity was assessed by questionnaire., Results: Age (r = 0.20; p = 0.023), body mass index (r = 0.33; p = 0.001) and waist-to-hip ratio (r = 0.20; p = 0.025) were positively related to expenditures on medication for the treatment of diseases other than diabetes. Insulin use was associated with increased expenditures. Higher physical activity was associated with lower expenditure, provided medication for treatment of diseases other than diabetes (OR = 0.19; p = 0.007) and medical consultations (OR = 0.26; p = 0.029)., Conclusions: Type 2 diabetics with higher enrollment in physical activity presented consistently lower healthcare expenditures for the public healthcare system.

Purpose: The purpose of this study was to identify subgroup-sensitive physical activities (PA) using differential item functioning (DIF) analysis., Methods: A sub-unweighted sample of 1857 (men=923 and women=934) from the 2003-2004 National Health and Nutrition Examination Survey PA questionnaire data was used for the analyses. Using the Mantel-Haenszel, the simultaneous item bias test, and the ANOVA DIF methods, 33 specific leisure-time moderate and/or vigorous PA (MVPA) items were analyzed for DIF across race/ethnicity, gender, education, income, and age groups., Results: Many leisure-time MVPA items were identified as large DIF items. When participating in the same amount of leisure-time MVPA, non-Hispanic blacks were more likely to participate in basketball and dance activities than non-Hispanic whites (NHW); NHW were more likely to participated in golf and hiking than non-Hispanic blacks; Hispanics were more likely to participate in dancing, hiking, and soccer than NHW, whereas NHW were more likely to engage in bicycling, golf, swimming, and walking than Hispanics; women were more likely to participate in aerobics, dancing, stretching, and walking than men, whereas men were more likely to engage in basketball, fishing, golf, running, soccer, weightlifting, and hunting than women; educated persons were more likely to participate in jogging and treadmill exercise than less educated persons; persons with higher incomes were more likely to engage in golf than those with lower incomes; and adults (20-59 yr) were more likely to participate in basketball, dancing, jogging, running, and weightlifting than older adults (60+ yr), whereas older adults were more likely to participate in walking and golf than younger adults., Conclusions: DIF methods are able to identify subgroup-sensitive PA and thus provide useful information to help design group-sensitive, targeted interventions for disadvantaged PA subgroups., (© 2011 by the American College of Sports Medicine)

Purpose: Although independent relationships between sitting behaviors (mainly television viewing) and health outcomes have been reported, few studies have examined the measurement properties of self-report sitting questions. This study assessed gender-specific test-retest reliability and validity of a questionnaire that assessed time spent sitting on weekdays and weekend days: 1) traveling to and from places, 2) at work, 3) watching television, 4) using a computer at home, and 5) for leisure, not including television., Methods: Test-retest reliability of domain-specific sitting time (min x d(-1)) on weekdays and weekend days was assessed using data collected on two occasions (median = 11 d apart). Validity of domain-specific self-reported sitting time on weekdays and weekend days was assessed against log data and sedentary accelerometer data., Results: Complete repeat questionnaire and log data were obtained from 157 women (aged 51-59 yr) and 96 men (aged 45-63 yr). Reliability coefficients were high for weekday sitting time at work, watching television, and using a computer at home (r = 0.84-0.78) but lower for weekend days across all domains (r = 0.23-0.74). Validity coefficients were highest for weekday sitting time at work and using a computer at home (r = 0.69-0.74). With the exception of computer use and watching television for women, validity of the weekend-day sitting time items was low., Conclusions: This study confirms the importance of measuring domain- and day-specific sitting time. The measurement properties of questions that assess structured domain-specific and weekday sitting time were acceptable and may be used in future studies that aim to elucidate associations between domain-specific sitting and health outcomes.

Objective: We examined the associations of sitting time and television (TV) viewing time with continuously measured biomarkers of cardio-metabolic risk in Australian adults., Research Design and Methods: Waist circumference, BMI, resting blood pressure, triglycerides, HDL cholesterol, fasting and 2-h postload plasma glucose, and fasting insulin were measured in 2,761 women and 2,103 men aged > or =30 years (mean age 54 years) without clinically diagnosed diabetes from the 2004-2005 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multivariate linear regression analyses examined associations of self-reported sitting time and TV viewing time (hours per day) with these biomarkers, adjusting for potential confounding variables., Results: For both women and men, sitting time was detrimentally associated with waist circumference, BMI, systolic blood pressure, fasting triglycerides, HDL cholesterol, 2-h postload plasma glucose, and fasting insulin (all P < 0.05), but not with fasting plasma glucose and diastolic blood pressure (men only). With the exception of HDL cholesterol and systolic blood pressure in women, the associations remained significant after further adjustment for waist circumference. TV viewing time was detrimentally associated with all metabolic measures in women and all except HDL cholesterol and blood pressure in men. Only fasting insulin and glucose (men only) remained deleteriously associated with TV viewing time after adjustment for waist circumference., Conclusions: In women and men, sitting time and TV viewing time were deleteriously associated with cardio-metabolic risk biomarkers, with sitting time having more consistent associations in both sexes and being independent of central adiposity. Preventive initiatives aimed at reducing sitting time should focus on both nonleisure and leisure-time domains.

Background: Television viewing (TV viewing) is an important indicator of physical inactivity., Aim: To analyze the prevalence of different leisure time behaviors and TV viewing among healthy adults and their association with overweight., Material and Methods: Cross sectional survey in which 1061 females and 925 males aged 30 years old or more, answered a self administered questionnaire about physical activity Respondents were classified according to frequency participation in sports, walking, cycling and TV viewing. Body mass index (BMI) was derived from self reported weight and height., Results: Less than 30% of individuals participated regularly in sports and less than 15 and 5% reported a high frequency of walking and cycling, respectively. Subjects regularly engaged in sports had a lower BMI. After adjustments, low cycling frequency and high TV viewing were associated with overweight in men and women, respectively., Conclusions: The prevalence of physical inactivity during leisure time is high among Brazilian adults and associated to obesity.

Injuries are a leading cause of morbidity and mortality in the United States. Physicians are a trusted source that can disseminate information about the prevention of injury and violence. This study used the second Injury Control and Risk Survey to report the national prevalence of healthcare provider injury prevention counseling to adults. Results indicate that overall 1 in 5 adults who visited a healthcare provider received some counseling on injury prevention. Counseling prevalence varied by injury topic and patient demographic characteristics. Many people who could benefit from counseling are not receiving it, even among those who had visited a healthcare provider.

Physical inactivity is one of the most important public health issues in the U.S. and internationally. Increasingly, links are being identified between various elements of the physical-or built-environment and physical activity. To understand the impact of the built environment on physical activity, the development of high-quality measures is essential. Three categories of built environment data are being used: (1) perceived measures obtained by telephone interview or self-administered questionnaires; (2) observational measures obtained using systematic observational methods (audits); and (3) archival data sets that are often layered and analyzed with GIS. This review provides a critical assessment of these three types of built-environment measures relevant to the study of physical activity. Among perceived measures, 19 questionnaires were reviewed, ranging in length from 7 to 68 questions. Twenty audit tools were reviewed that cover community environments (i.e., neighborhoods, cities), parks, and trails. For GIS-derived measures, more than 50 studies were reviewed. A large degree of variability was found in the operationalization of common GIS measures, which include population density, land-use mix, access to recreational facilities, and street pattern. This first comprehensive examination of built-environment measures demonstrates considerable progress over the past decade, showing diverse environmental variables available that use multiple modes of assessment. Most can be considered first-generation measures, so further development is needed. In particular, further research is needed to improve the technical quality of measures, understand the relevance to various population groups, and understand the utility of measures for science and public health.

Physical activity is usually done in specific types of places, referred to as physical activity environments. These often include parks, trails, fitness centers, schools, and streets. In recent years, scientific interest has increased notably in measuring physical activity environments. The present paper provides an historical overview of the contributions of the health, planning, and leisure studies fields to the development of contemporary measures. The emphasis is on attributes of the built environment that can be affected by policies to contribute to the promotion of physical activity. Researchers from health fields assessed a wide variety of built environment variables expected to be related to recreational physical activity. Settings of interest were schools, workplaces, and recreation facilities, and most early measures used direct observation methods with demonstrated inter-observer reliability. Investigators from the city planning field evaluated aspects of community design expected to be related to people's ability to walk from homes to destinations. GIS was used to assess walkability defined by the 3Ds of residential density, land-use diversity, and pedestrian-oriented designs. Evaluating measures for reliability or validity was rarely done in the planning-related fields. Researchers in the leisure studies and recreation fields studied mainly people's use of leisure time rather than physical characteristics of parks and other recreation facilities. Although few measures of physical activity environments were developed, measures of aesthetic qualities are available. Each of these fields made unique contributions to the contemporary methods used to assess physical activity environments.

Background/objective: Outcomes research of therapeutic recreation (TR) activities and interventions for spinal cord injury (SCI) rehabilitation is made more difficult by a lack of uniform descriptions and the absence of a formal treatments classification system (taxonomy). The objective of this study was to describe a taxonomy developed by Certified Therapeutic Recreation Specialists., Methods: TR lead clinicians and researchers from 6 SCI rehabilitation centers developed a TR documentation system to describe the details of each TR session involving patients with SCI enrolled in the SCIRehab study. The SCIRehab study uses the practice-based evidence methodology, a rigorous observational methodology that examines current practice without introducing additional treatments, to capture details of each TR session for 1,500 SCI rehabilitation patients at 6 US inpatient SCI rehabilitation facilities. This may be the first attempt to document the many details of the TR rehabilitation process for patients with SCI., Results: The TR taxonomy consists of 6 activities (eg, leisure education and counseling, outings, and leisure skill work in center) and activity-specific interventions, as well as time spent on each activity. Activity descriptions are enhanced with additional details that focus on assistance needs for each activity, patient ability to direct care, and patient/family involvement, which may help to determine TR activity selection., Conclusion: Development and application of a TR taxonomy, which is comprehensive for patients with SCI and efficient to use, are feasible despite significantly different TR programs at the 6 SCIRehab centers.

This study aimed at establishing the cross-cultural equivalence of scales used to evaluate physical activity level and measure cardiorespiratory fitness, for further application in elderly subjects. Three scales were identified after systematic review: Veterans Physical Activity Questionnaire (VSAQ), Rating of Perceived Capacity (RPC), and Physical Activity Rating (PA-R). The model proposed by Herdman et al. was applied to analyze equivalence. Test-retest reliability was calculated in a sample of 12 elderly subjects (74.5 +/- 3.5 years) using Lin's concordance coefficient and intraclass correlation coefficient. Good reproducibility was detected in all scales except RPC. Due to the small sample size, hardly any conclusions can de drawn, but the results point to the need for changes in the original scale's structures. The findings also suggest the adequacy of the scale's Portuguese-language version, although further validity studies appear to be necessary.

The objective of this study was to characterize participation in leisure activities in children with cerebral palsy (CP) and identify determinants of greater involvement. Ninety-five children of school age (9y 7mo [SD 2y 1mo]) with CP were recruited, and participation was evaluated with the Children's Assessment of Participation and Enjoyment in a subset (67/95; 42 males, 25 females) who could actively participate in completion of the assessment. Most had mild motor dysfunction (Gross Motor Function Classification System: 59% level I, 23% level II, 18% levels III-V) and had a spastic subtype of CP (23 hemiplegia, 17 diplegia, 16 quadriplegia, 11 other). Biomedical, child, family and environmental predictor variables were considered in the analysis. Results demonstrated that these children were actively involved in a wide range of leisure activities and experienced a high level of enjoyment. However, involvement was lower in skill-based and active physical activities as well as community-based activities. Mastery motivation and involvement in rehabilitation services enhanced involvement (intensity and diversity) in particular leisure activities, whereas cognitive and behavioral difficulties, activity limitations, and parental stress were obstacles to participation.

Leisure as a tool for rehabilitating people with neuro-disabilities is well established. Yet, despite significant progress in this area, problems remain in the way leisure is used for this purpose. One, as yet, unresolved problem is how to determine which leisure activity or activities will be attractive to people with particular disabilities. Another is how to counteract the persistent, dominant public view that real personal worth is measured according to the work people do rather than the leisure they pursue. The third is to inform practitioners, many of whom are unaware of recent advances in leisure theory, about these advances, which can help them solve the first problem and adapt to the second. The main body of this paper presents such a theory - the serious leisure perspective. It synthesizes three main forms of leisure, showing, at once, their distinctive features, similarities, and interrelationships. The forms are serious, casual, and project-based leisure. A review of the research on neuro-rehabilitation follows. Some implications of the Perspective for neuro-rehabilitation are then presented, including ways practitioners can introduce clients to certain types of leisure, encourage them to pursue the types chosen, and help them develop an optimal leisure lifestyle.

Background: Although the benefits of leisure activities are well known, few instruments have been specifically designed to measure a person's engagement in their leisure activities and to assess the personal or environmental factors affecting their capacity to participate in leisure activities., Purpose: The purpose of this paper is to present the steps leading to the development of the Profil du Loisir between 1990 and 2002., Methods: The planning, construction, and validation of the tool were done according to the steps suggested by Benson and Clark (1982). The first versions were tested by occupational therapists on individuals with traumatic brain injuries., Results: The validation led to the development of the final version (3.0). The inter-rater reliability of the instrument was rated from acceptable (kappa 0.21-0.4) to very good (0.61-0.80) and the test-retest reliability was rated from acceptable to moderate (0.41-0.60)., Clinical Implications: The Profil du Loisir is a promising tool that invites occupational therapists to systematically consider and assess client leisure time in their practice.

Background: Population studies conducted in Sweden have revealed an association between attendance at cultural activities and health. Using data from US residents, we examined whether the association could be observed in the US., Methods: Participants in the current study included 1,244 individuals who participated in the 1998 General Social Survey., Results: A significant association between cultural activities and self-reported health (SRH) was observed, even after controlling for age, gender, marital status, race, number of children, subjective social class, employment status, household income, and educational attainment. Specifically, the more cultural activities people reported attending, the better was their SRH., Conclusion: The data confirm that an association between cultural activity and health is present in a US sample. The data do not mean that the association is causal, but they suggest that further longitudinal research is warranted.

Objective: The purpose of this study was to evaluate the violence content of the top-grossing PG-13 films of 1999 and 2000 to determine what percentage of it had potential for negative effects on young viewers and what percentage of it had potential for prosocial or beneficial effects., Methods: A large, multidimensional analytic instrument was designed for systematic coding of each act of violence and its contextualization by features that have been shown either to enhance or to protect against harmful effects that are associated with violent media exposure: perpetrators and victims of violence, motivation for violence, presence of weapons, degree of realism, and consequences of violence. Descriptive statistics by genre were performed for each film. An ordinal logistic regression model was used to examine the association between the seriousness of violence and weapons, motive, and genre., Results: In the sample of 77 PG-13 films, a total of 2251 violent actions were observed with roughly half (47%) of lethal magnitude. A total of 118 acts contained justified violence that were initiated by major characters and were extremely serious, and approximately two thirds of the films (49 [64%]) were rated PG-13 for reasons other than violence., Conclusions: Violence permeated nearly 90% of the films in our study. Although only a small subset of this content contained violence that was associated with negative effects, only 1 film contained violence that was associated with protective or beneficial effects.

Purpose: A new instrument measuring leisure time physical activity (LTPAI) in populations predominately engaging in low intensity activities and a new instrument measuring the Physical Activity at Home and Work (PAHWI) were designed., Methods: Patients with long-lasting pain and expert physiotherapists participated in the development of the two instruments. Test-retest reliability was evaluated for the LTPAI and the PAHWI. Construct validity was evaluated for the LTPAI by comparing it with an instrument measuring physical activities for older people, six-minute walk test and aerobic capacity., Population: 37 women with FM, with the mean age of 46 years (SD 8.4) and mean symptom duration of 11 years (SD 5.9) were recruited to the study., Results: The mean time that the study population spent in physical activities during leisure time was 5.2 hours (SD 4.0) a week. Satisfactory test-retest reliability was found for the total score of LTPAI (ICC 0.86, CI 0.79 - 0.93) and for the PAHWI (ICC 0.91, CI 0.82 - 9.96). A significant association between the LTPAI and the six-minute walk test (rs 0.40, p = 0.02) and another physical activity instrument (rs 0.39, p = 0.02) was found. As expected, LTPAI did not have any association with aerobic capacity., Conclusions: Face validity of the instruments was ensured during the development process. Satisfactory test-retest reliability was found for the LTPAI and the PAHWI. Significant but low associations were found between the LTPAI and the six-minute walk test and an instrument designed for older people, respectively, while no association was found between the LTPAI and aerobic capacity.

Background: Several physical activity measures used in U.S. surveillance systems lack estimates of reliability in this country. This information is needed among diverse populations of women and men, to aid in interpretation and use of the measures. The objective of this study was to document the test-retest reliability of several measures of physical activity and inactivity used in surveillance in a diverse adult population., Methods: Test and retest surveys were conducted over the telephone with 106 African-American and white women and men living in Forsyth County, North Carolina or Jackson, Mississippi in 2003. Physical activity and inactivity were self-reported using surveillance measures, such as from the Behavioral Risk Factor Surveillance System. Reliability was determined using kappa and intraclass correlation coefficients (ICCs) overall and separately by gender and race., Results: Thirteen percent of the participants met recommendations for physical activity, 44% were insufficiently active, and 43% were inactive. Reliability of the measures to categorize participants into these categories was 0.44 (95% confidence interval [CI]=0.27-0.58). The reliability of several categoric definitions of leisure activity ranged from 0.46 to 0.68. Occupational activity had substantial reliability (0.82, 95% CI=0.72-0.89), while any transportation activity (0.27, 95% CI=0.09-0.44) and walking (0.40, 95% CI=0.23-0.55) were lower. Indicators of inactivity categorized at >7 hours/week included time per week on the computer (0.83, 95% CI=0.57-0.78) and time per week watching television (0.40, 95% CI=0.22-0.54). Some gender and racial differences were noted in the reliability estimates., Conclusions: In conclusion, this study provides estimates of test-retest reliability for several physical activity and inactivity measures used for surveillance purposes. Validity data, coupled with the reliability estimates reported here and elsewhere, can aid in interpretation and use of these measures in surveillance, as well as in epidemiologic studies.

Studies that relate change in physical activity to change in health-related quality of life in the general population are needed to confirm associations suggested by cross-sectional studies. In the present study, cross-sectional as well as longitudinal associations between leisure time physical activity and health-related quality of life were studied in an apparently healthy population. The present study showed cross-sectional associations between at least moderately intense leisure time physical activity and general health perceptions, vitality, physical functioning and role limitations due to physical health problems. No associations were present for total leisure time physical activity. Change in leisure time physical activity was associated with change in social functioning in men as well as in women, irrespective of the intensity of physical activity. Only in men, change in total leisure time physical activity was associated with change in vitality and general mental health. In our study, cross-sectional associations were not confirmed by longitudinal analyses. Cross-sectional associations were mainly found for physical components of health-related quality of life, whereas longitudinal associations were predominantly observed for mental components of health-related quality of life. Confirmation of our results by those of other studies is needed in order to quantify health promotion messages.

Objectives: We examined young adult smoking patterns and receptivity to cigarette advertising to assess vulnerability to tobacco marketing strategies., Methods: We obtained data from a telephone survey of 12,072 Massachusetts adults., Results: Smokers aged 18 to 30 years were more likely than older adults to smoke only occasionally and to consume fewer than 10 cigarettes per day. They also were more receptive to cigarette marketing and were more likely to be frequent patrons of bars and clubs., Conclusions: Many young adult smokers are in the initiation phase of smoking and are likely to undergo a transition to either nonsmoking or heavier smoking. If unimpeded by regulation, tobacco promotion in bars and clubs is likely to lead to increased adult smoking prevalence.

Background: Diabetes is the seventh leading cause of death among South Carolinians. The benefit of physical activity on the control and prevention of diabetes has been established. This study determined the prevalence of leisure-time physical activity among South Carolinians with and without diabetes and compared the physical activity of those with diabetes between 1990 and 2000., Methods: Data from the South Carolina Behavioral Risk Factor Surveillance System were used to classify adults with and without diabetes into categories of physical activity., Results: Physical inactivity was higher among South Carolinians with diabetes (42%) than in those without (27%). A comparison of physical activity in diabetics between 1990 and 2000 demonstrated a slight decrease (2%) in physical inactivity., Conclusion: The decrease in physical inactivity among diabetics is encouraging; however, further promotion of physical activity is recommended to encourage diabetics to engage in physical activity on a regular basis.

Efforts to characterize nonoccupational noise exposures have focused primarily on infrequent, episodic events. Few studies have assessed noise levels resulting from routine daily activities. In the current study, 112 construction workers wore datalogging noise dosimeters and simultaneously completed activity logs during two phases of data collection. The 81 subjects monitored in phase 1 received logs listing numerous preselected occupational and nonoccupational activities, while the 31 subjects monitored in phase 2 used free-field logs and reported nonoccupational activities in greater detail. Nearly all of the 221,439 1-min intervals of nonoccupational L(eq) level and activity reporting were below 70 dBA; only a small percentage exceeded 80 dBA. The primary contributor to nonoccupational noise exposure was traveling in a car or bus, while time at home contributed the least. One hundred seventy 24-h L(eq) levels were computed from the 1-min noise level data. The percentage of phase 2 workday L(eq(24)) levels which exceeded 80 dBA was higher than that of the nonworkday levels. The mean L(eq(24)) level of phase 2 workdays was higher than that of nonworkdays, and the difference was statistically significant. Routine nonoccupational noise exposures contributed much less to total noise dose than occupational exposures in the subjects evaluated.

Purpose: Secondary prevention interventions, including hospital clinics, can help patients improve their risk factors and lifestyles after an acute cardiac event. This study aimed to investigate the long-term behavioral outcomes of attending and nonattending patients consecutively enrolled in a trial of a family-based clinic providing screening, advice, and support 3 months after hospital admission. The study also aimed to identify predictors of long-term smoking status, dietary habit, and physical activity., Methods: Semistructured interviews were conducted an average of 30 months after the acute cardiac event with 83 of the 103 nonattending patients and a random sample of 96 patients who had attended the clinic. Behavioral outcomes were investigated, and self-reported risk factors at the time of the acute illness were documented., Results: The patients who had attended the clinic were significantly more likely than nonattenders to report positive dietary changes and, among former smokers, successful cessation of smoking. Furthermore, they reported being more physically active than nonattenders. Using logistic regression, clinic attendance was identified as a significant and independent predictor of all three outcomes., Conclusions: The results of this observational study suggest that attendance at a secondary prevention clinic facilitates maintenance of improved long-term health behaviors, although this finding is based on self-report. Factors possibly responsible for favorable outcomes include strong physician advice and support from a multidisciplinary team of health professionals. Furthermore, the timing of the intervention may have been appropriate for enrollment in a secondary prevention clinic.

Social, physical and intellectual activities are thought to facilitate cognitive performance and slow the rate of age associated cognitive decline, but little is known about this association in younger adulthood. We used multiple regression to test the association between two kinds of activity at 36 years-physical exercise and spare-time activity-and verbal memory at 43 and 53 years in 1919 males and females enrolled in the MRC National Survey of Health and Development (the British 1946 birth cohort). Both kinds of activities were significantly and positively associated with memory performance at 43 years, after controlling for sex, education, occupational social class, IQ at 15 years, and recurrent ill health and significant mental distress. Furthermore, physical exercise at 36 years (but not spare-time activity) was associated with a significantly slower rate of decline in memory from 43 to 53 years, after controlling for the same factors, with evidence that continuing physical exercise after 36 years was important for protection. We conclude that physical exercise and spare-time activity are significantly associated with benefit to memory in midlife, although these two kinds of voluntary activity may exert their effects on cognition via different paths.

Aims: The aim of the present study was to examine the association of leisure time, occupational and household physical activity, as well as a combination of these (total activity), with four major risk factors for cardiovascular disease., Methods: Cross-sectional data from the Work, Lipids and Fibrinogen (WOLF) study were used. The study population consisted of 10413 employed persons from two regions in Sweden, 7168 men and 3245 women, aged 19 to 70 years., Results: The adjusted prevalence ratio (PR) of having low high density lipoprotein (HDL) cholesterol levels was 0.54 (95% confidence interval (C.I.) 0.46-0.65) for men and 0.55 (95% C.I. 0.41-0.73) for women who were involved in leisure time physical activity on a regular basis compared with persons with a more sedentary lifestyle. The adjusted PR of having elevated plasma fibrinogen was also significantly lower among those with regular leisure time physical activity. Occupational and household physical activity showed different associations among men and women. Women with high self-perceived household physical activity had an adjusted PR of 1.33 (95% C.I. 1.05-1.68) of having low HDL cholesterol levels. Total activity showed strong beneficial associations with several cardiovascular risk factors. Overweight persons seemed to have relatively more benefit from their physical activity with regard to cardiovascular risk factors than leaner persons. Smokers did not have as strong relative decrease in plasma fibrinogen with increasing activity level as non-smokers., Conclusion: Leisure time, as well as total physical activity, was associated inversely with cardiovascular risk factors, particularly HDL cholesterol, in both men and women.