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The activPAL is a valid measure of step counts and posture, but its ability to determine physical activity intensity is unclear. This study tested the criterion validity of the activPAL using its built-in linear cadence-metabolic equivalents (METs) equation (activPAL-linear) versus an individualized height-adjusted curvilinear cadence-METs equation (activPAL-curvilinear) to estimate intensity-related physical activity. Forty adults (25±6 years, 23.3±4.1 kg/m 2 ) wore an activPAL during a 7-stage progressive treadmill walking protocol (criterion: indirect calorimetry). A sub-sample (n=32) wore the device during free-living conditions for 7-days (criterion: PiezoRxD monitor). In the laboratory, the activPAL-linear overestimated METs during slow walking (1.5-3.0 miles•hour -1 ) but underestimated METs during fast walking (3.5-4.5 miles•hour -1 ) (all, p<0.001). In the free-living condition, the activPAL-linear overestimated time in light-intensity activity and underestimated moderate-intensity activity (both, p<0.001), but did not register any vigorous-intensity activity. In contrast, the activPAL-curvilinear estimated values statistically equivalent to indirect calorimetry for treadmill stages 1-6 (1.5-4.0 miles•hour -1 ) and to the PiezoRxD determined light- and moderate-intensity activity during free-living. We present a simple, data processing technique that uses an alternative curvilinear cadence-MET equation that improves the ability of the activPAL to measure intensity-related physical activity in both laboratory and free-living settings.

Background: Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgery-induced weight loss improves CRF, but the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training program on CRF after bariatric surgery., Methods: Fifty-eight severely obese patients (46.1 ± 6.1 kg/m 2 , 78% women) were randomly assigned to either an exercise group (n = 39) or usual care (n = 19). Exercise training was conducted from the 3rd to the 6th months after surgery. Anthropometric measurements, abdominal and mid-thigh computed tomographic scans, resting echocardiography, and maximal cardiopulmonary exercise testing was performed before bariatric surgery and 3 and 6 months after surgery., Results: Weight, fat mass, and fat-free mass were reduced significantly at 3 and 6 months, without any additive impact of exercise training in the exercise group. From 3 to 6 months, peak aerobic power (V̇O 2peak ) increased significantly (P < 0.0001) in both groups but more importantly in the exercise group (exercise group: from 18.6 ± 4.2 to 23.2 ± 5.7 mL/kg/min; control group: from 17.4 ± 2.3 to 19.7 ± 2.4 mL/kg/min; P value, group × time = 0.01). In the exercise group, determinants of absolute V̇O 2peak (L/min) were peak exercise ventilation, oxygen pulse, and heart rate reserve (r 2  = 0.92; P < 0.0001), whereas determinants of V̇O 2peak indexed to body mass (mL/kg/min) were peak exercise ventilation and early-to-late filling velocity ratio (r 2  = 0.70; P < 0.0001)., Conclusions: A 12-week supervised training program has an additive benefit on cardiorespiratory fitness for patients who undergo bariatric surgery., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the shortcoming of BMI as a measurement of adiposity in patients with familial partial lipodystrophy (FPLD)., Methods: Two different matching procedures were used to compare 55 FPLD versus control patients with severe obesity (N = 548 patients) to study the relationship between body weight, fat distribution, and metabolic diseases, such as diabetes mellitus, hypertriglyceridemia, and nonalcoholic steatohepatitis. In MATCH1, the patients with FPLD were matched to controls with obesity (OCs) by truncal mass, and in MATCH2, the patients with FPLD were matched to OCs with respect to glucose control., Results: With MATCH1, the FPLD group had worse glycemic control (hemoglobin A1c 8.2% ± 1.6% vs. 5.9% ± 0.9%), higher triglycerides (884 ± 1,190 mg/dL vs. 139 ± 79 mg/dL), and lower leptin (20.5 ± 15.8 ng/mL vs. 41.9 ± 29.4 ng/mL, P < 0.001 for all comparisons). In MATCH2, metabolic comorbidity-matched FPLD patients had significantly lower BMI compared with OCs (29.5 ± 5.7 kg/m 2 vs. 38.6 ± 5.2 kg/m 2 , P < 0.001)., Conclusions: Patients with FPLD with similar truncal mass have worse metabolic profiles than non-FPLD OCs. The differential BMI between the FPLD and OCs, when matched for their metabolic comorbidities, approximates 8.6 BMI units., (© 2021 The Obesity Society.)

Background: Cardiac rehabilitation (CR) is recommended for patients with coronary (CAD) and peripheral (PAD) artery disease. However, no study has compared changes in cardiorespiratory fitness (VO 2peak ) or exercise prescription progression among PAD, CAD, and concomitant PAD and CAD (BOTH). The objectives of this study were to 1) compare change in VO 2peak among patients with PAD, CAD, and BOTH, and 2) examine progression in exercise prescription parameters in a comprehensive 6-month cardiac rehabilitation (CR) program., Methods: A retrospective analysis of patient data recorded from 2006 to 2017 from a large urban hospital was conducted. Patients with PAD (n = 63) and BOTH (n = 164) were included in the analyses. Patients with CAD (n = 63) were matched to PAD by sex (36.5% female), age (69 years), smoking status, diabetes, and year in program., Results: There were significant improvements in VO 2peak from baseline to 6 months in all groups (CAD +2.7 ± 3.4 mL⋅kg -1 ⋅min -1 , PAD +2.4 ± 3.8 mL⋅kg -1 ⋅min -1 , BOTH +1.8 ± 3.1 mL⋅kg -1 ⋅min -1 ; all P < 0.001). Between-group differences were significant between PAD and CAD as well as between CAD and BOTH (P = 0.001). Walking distance, duration, and pace increased for all groups over 6 months (P < 0.001), with a significant difference in pace between CAD and BOTH (P = 0.006)., Conclusions: Patients with PAD, CAD, and BOTH had significant improvements in VO 2peak following a 6-month CR program. However, despite similar prescribed walking distance and duration, improvements in VO 2peak were mitigated in PAD and BOTH compared with CAD. These results support benefits of CR for patients diagnosed with PAD, but alternate exercise strategies should be explored for patients with PAD., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Michalickova, D, Minic, R, Kotur-Stevuljevic, J, Andjelkovic, M, Dikic, N, Kostic-Vucicevic, M, Slanar, O, and Djordjevic, B. Changes in parameters of oxidative stress, immunity, and behavior in endurance athletes during a preparation period in winter. J Strength Cond Res 34(10): 2965-2973, 2020-The current study monitored markers of immunological and oxidative status in 9 male elite endurance athletes: V[Combining Dot Above]O2max: 68 ± 11 ml·kg·min, age: 24 ± 2.5 years, and training loads: 128 ± 21 metabolic equivalents-h·wk during a 3-month preparation period in winter (January-March). Self-rated state of moods evaluation (by Profile of Mood States questionnaire) was performed, and blood samples were collected at the beginning and end of the study. Spectrophotometric methods and enzyme-linked immunosorbent assay were used for parameters' determination. The level of concanavalin A (ConA)-stimulated interferon-γ (IFN-γ) from peripheral blood mononuclear cells (PBMCs) was increased (562 [147-852] vs. 1,097 [451-1842] pg·ml, p = 0.013). Also, the level of transforming growth factor-1 (TGF-β1) in serum was elevated (2.5 [1.4-5.1] vs. 7.2 [4.9-8.2] ng·ml, p = 0.015). There was no change in the level of peptidoglycan (PGN)-stimulated interleukin (IL)-10 from PBMCs. There were no significant changes in PBMCs proliferation/viability on stimulation with ConA and PGN during the study. No changes in superoxide dismutase, prooxidative-antioxidative balance, total oxidant status (TOS), and thiobarbituric acid reactive substances were observed along the study. Total antioxidant status (TAS) was increased (910 ± 174 vs. 1,090 ± 102 μmol·L, p = 0.018), and activity of paraoxonase (PON1) was decreased (523 ± 295 vs. 335 ± 183 U·L, p = 0.003) at the end of the study. Advanced oxidation protein products were increased (25 ± 7.9 vs. 42 ± 7.6 μmol·L, p = 0.011). The self-rated sense of vigor significantly declined (20 ± 2.1 vs. 14 ± 3.4, p = 0.045). In conclusion, 3 months of regular training in winter induced prominent changes in cytokines, biomarkers of oxidative stress, and antioxidative enzyme activity. These changes might increase susceptibility of athletes to disease and muscle damage and consequently lead to performance reduction.

Background: The school gives access to children, regardless of age, ethnicity, gender and socio-economic class and can be identified as the key environment in which to promote children's physical activity (PA). The guidelines of the European Union recommend accumulating at least 10-min bouts of PA to reach the daily 60 min. Active breaks (ABs) led by teachers inside the classroom represent a good strategy to promote PA. The aim of this pilot and feasibility study was to evaluate the feasibility and effectiveness in terms of PA level of an AB programme in children aged 8-9 years attending primary school. Methods: A pre-post quasi-experimental pilot and feasibility study was performed in two primary school classes, one of which was assigned to a 14-week AB intervention (AB group) and the other to the control group (CG). At baseline and at follow-up, children were monitored for sedentary and motor activity during an entire week using ActiGraph Accelerometer (ActiLife6 wGT3X-BT). The satisfaction of children and teachers was assessed by self-administered questionnaires. Results: In the pre-post comparison, AB group ( n = 16) showed a reduction in the minutes spent in weekly sedentary activity (-168.7 min, p > 0.05), an increase in the number of step counts (+14,026.9, p < 0.05) and in time spent in moderate to vigorous PA (MVPA): weekly MVPA: +64.4 min, daily MVPA: +8.05 min, percentage of MVPA: +0.70%. On the contrary, CG showed a worsening in all variables. ANCOVA analysis, after adjusting for baseline values, showed significant differences between the AB group and CG for time spent in MVPA, percentage of MVPA and step counts. The satisfaction of children and teachers was good. Teachers were able to adapt the AB protocol to the needs of the school curriculum, thus confirming the feasibility of the AB programme. Conclusions: This pilot and feasibility study showed the feasibility and effectiveness of the AB protocol and represented the basis for a future controlled trial.

Background: Physical activity might be directly or indirectly linked to the risk of colorectal cancer and the prognosis of patients with colorectal cancer., Objective: This study aimed to elucidate whether preoperative physical activity plays a role in reducing short-term postoperative complications and improving long-term survival of patients with colorectal cancer., Design: This was a retrospective analysis of prospectively collected data., Settings: This study was conducted at a department of colorectal surgery in a tertiary teaching hospital between January 1995 and December 2016., Patients: Patients who underwent curative resection for stage I to III primary colorectal cancer were enrolled. According to the preoperative leisure-time weekly metabolic equivalent of task values, patients were divided into 2 groups: the metabolic equivalent of task <12 group and the metabolic equivalent of task ≥12 group. A 1:1 propensity score matching was used to reduce imbalance and selection biases based on 6 covariates, namely, age, sex, BMI, tumor location, tumor stage, and adjuvant chemotherapy administration., Main Outcome Measures: χ tests were used to analyze short-term postoperative complications. Kaplan-Meier analyses were used to evaluate disease-free survival and overall survival., Results: In the matched cohort patients, significant differences in overall postoperative complications and mortality were observed in favor of the metabolic equivalent of task ≥12 group, although there was no difference in any single item of postoperative morbidity. The results of the Kaplan-Meier analysis and log-rank test demonstrated a significant survival benefit in the metabolic equivalent of task ≥12 group compared with the metabolic equivalent of task <12 group both for disease-free and overall survival., Limitations: This study is limited by its retrospective nature., Conclusions: This single-institute study provides evidence of the association of preoperative leisure-time physical activity with short-term postoperative morbidity and mortality, as well as long-term survival. See Video Abstract at http://links.lww.com/DCR/B189. ASOCIACIÓN DE ACTIVIDAD FÍSICA DE TIEMPO LIBRE PREOPERATORIA CON RESULTADOS A CORTO Y LARGO PLAZO DE PACIENTES SOMETIDOS A RESECCIÓN CURATIVA POR CÁNCER COLORRECTAL EN ESTADIO I-III: UN ANÁLISIS DE COINCIDENCIA DE PUNTAJE DE PROPENSIÓN ANTECEDENTES: LA ACTIVIDAD FíSICA PUEDE ESTAR DIRECTA O INDIRECTAMENTE RELACIONADA CON EL RIESGO DE CÁNCER COLORRECTAL Y EL PRONÓSTICO DE LOS PACIENTES CON CÁNCER COLORRECTAL.: Este estudio tuvo como objetivo dilucidar si la actividad física preoperatoria desempeña un papel en la reducción de las complicaciones postoperatorias a corto plazo y en mejorar la supervivencia a largo plazo de los pacientes con cáncer colorrectal.Este fue un análisis retrospectivo de datos recolectados prospectivamente.Este estudio se realizó en un departamento de cirugía colorrectal en un hospital universitario terciario entre Enero de 1995 y Diciembre de 2016.Se incluyeron pacientes sometidos a resección curativa por cáncer colorrectal primario en estadio I-III. De acuerdo con el equivalente metabólico semanal en el tiempo libre de los valores de la tarea preoperatorio, los pacientes se dividieron en dos grupos: el equivalente metabólico del grupo de tarea <12 y el equivalente metabólico del grupo de tarea ≥ 12. Se utilizó una coincidencia de puntaje de propensión 1: 1 para reducir los desequilibrios y los sesgos de selección basados en seis covariables, principalmente, edad, sexo, índice de masa corporal, ubicación del tumor, estadio del tumor y administración de quimioterapia adyuvante.Las pruebas de Chi-cuadrado se utilizaron para analizar las complicaciones postoperatorias a corto plazo. Los análisis de Kaplan-Meier se utilizaron para evaluar la supervivencia libre de enfermedad y la supervivencia general.en los pacientes de la cohorte emparejada, se observaron diferencias significativas en las complicaciones postoperatorias generales y la mortalidad a favor del equivalente metabólico del grupo de tareas ≥ 12, aunque no hubo diferencias en ningún elemento único de morbilidad postoperatoria. Los resultados del análisis de Kaplan-Meier y la prueba de log-rank demostraron un beneficio de supervivencia significativo en el equivalente metabólico del grupo tarea ≥ 12 en comparación con el equivalente metabólico del grupo tarea <12 tanto para la supervivencia libre de enfermedad como para la supervivencia general.Este estudio está limitado por su naturaleza retrospectiva.Este estudio de instituto único proporciona evidencia de la asociación de la actividad física preoperatoria en el tiempo libre con la morbilidad y mortalidad postoperatorias a corto plazo, así como la supervivencia a largo plazo. Consulte Video Resumen en http://links.lww.com/DCR/B189. (Traducción-Dr. Yesenia Rojas-Kahlil).

Background: Protected areas are important attractions for promoting healthy life habits. Consequently, to date, a number of studies have examined the association between visitors' characteristics and physical activities. However, little is known about the specific users inclined exclusively to have sedentary behavior during a visit. Thus, using the Alt Pirineu Natural Park (Spain) as a case study, the aim of this study is to determine the influence of sociodemographic, trip, motivational, and opinion descriptors on the likelihood of participating in sedentary behavior while visiting a protected natural area., Methods: The data used were randomly collected from visitors through an onsite structured questionnaire (N = 628)., Results: Metabolic equivalent consumption was used to empirically distinguish the sedentary (22.6%) from the active (77.4%) visitor groups. A logistic regression analysis indicated that the trip and motivational descriptors explained the highest degree of the overall variation in reporting sedentary behavior., Conclusion: The study contributed to documenting the information about visitors' behavior in protected areas, and the findings may aid park managers in developing effective management strategies for promoting and enhancing physical activity in protected natural areas.

Background: The purpose was to assess metabolic equivalent (MET) values of common daily activities in middle-age and older adults in free-living environments and compare these with MET values listed in the compendium of physical activities (CPA)., Methods: Sixty participants (mean age = 71.5, SD = 10.8) completed a semistructured protocol of sitting, lying, self-paced walking, and 4 self-selected activities in their residences. Oxygen consumption was measured using portable indirect calorimetry, to assess METs for each activity relative to VO 2 at rest (VO 2 during activity/VO 2 at rest). Measured MET values for 20 different activities were compared with those in the CPA, for the total sample and for participants aged 55-64, 65-74, and 75-99 years., Results: Measured METs for sitting, walking, sweeping, trimming, and laundry were significantly different from the CPA values. Measured MET values for sedentary activities were lower in all age groups, and those for walking and household activities were higher in the youngest age group, than the CPA values. For gardening activities, there was a significant decline in measured METs with age., Conclusions: Some measured MET values in older people differed from those in the CPA. The values reported here may be useful for future research with younger, middle-age, and older-old people.

Naugle, KE, Carey, C, Ohlman, T, Godza, M, Mikesky, A, and Naugle, KM. Improving active gaming's energy expenditure in healthy adults using structured playing instructions for the Nintendo Wii and Xbox Kinect. J Strength Cond Res 33(2): 549-558, 2019-Professionals work constantly to increase energy expenditure and improve cardiovascular outcomes. A newer form of physical activity used to improve cardiovascular outcomes and increase energy expenditure while also providing entertainment is active gaming. The purpose was to determine energy expenditure and enjoyment levels during participation in different games played with a directed set of instructions designed to enhance movement. Twenty-one adults completed 6 sessions (1 familiarization and 5 experimental) on separate days. During 4 of the experimental sessions, participants played 1 of 4 active games for two 15-minute periods. Two active games were from Xbox Kinect and 2 were from Nintendo Wii. During the first period, participants played at a self-selected level of activity. During the second period, participants were given specific instructions for play during both active and down times within games. Participants wore a portable gas analyzer to measure energy expenditure. Resting energy expenditure was measured during session 6. Outcome measures were analyzed with 4 Game × 2 Period repeated-measures analyses of variance. Energy expenditure, measured in metabolic equivalents (METS), was greatest while playing Kinect Fighter Within. METS, enjoyment levels, and percentage of time spent in whole-body activity were greater during the period with specific instructions compared to the self-selected levels of activity, regardless of active game. When played at a self-selected level of activity, energy expenditure during the active games was similar to that of light physical activity. However, energy expenditure improved during the second period of game play showing that specific instructions created energy expenditure of moderate intensity.

Background and Objectives: Accurately assessing energy expenditure (EE) of people with different body weight is essential to facilitate weight management. The aim of this study was to measure basal energy expenditure (BEE), resting energy expenditure (REE) and to explore the true 1 MET value for young Chinese adults with different body weight., Methods and Study Design: A total of 251 young Chinese adults were divided into three groups: the normal weight group, the overweight group and the obese group. Their BEE, REE and 1 MET values were measured by Cortex Metamax 3B (MM3B). Multiple linear regressions and correlation analysis were used to examine factors that influence EE in Chinese population., Results: The mean measured BEE and REE of young Chinese adults with normal weight, overweight and obesity was 1429, 1609, 1778 kcal/day and 1522, 1712, 1885 kcal/day, respectively. The EE per kilogram body weight decreased with the increasing body weight. The mean oxygen consumption in the three group was 3.78, 3.47, 3.21 mL/kg/min respectively. There was no significant difference in BEE and REE after adjustment for fat-free mass (FFM). The significant influencing factors were body mass index (BMI) and sex in BEE, FFM and BMI in REE in Chinese population., Conclusions: BEE and REE were significantly different for different body weights while these differences disappeared after adjustment for FFM, and people with different body weights may have different 1 MET values. Further studies should be conducted to obtain more accurate daily energy requirement and 1MET value for specific Chinese populations.

The oxygen uptake efficiency slope (OUES) is a well-established substitute for maximum oxygen uptake ((Equation is included in full-text article.)O2 max) in submaximal exercise effort among adolescents and adults. Few studies have analyzed the exercise capacity (EC) and OUES of children aged 4 to 6 (preschoolers). Body fat has been proved to negatively affect EC among schoolchildren. The purposes of this study were to assess the capacity of preschoolers in achieving (Equation is included in full-text article.)O2 max and evaluate the correlation of peak metabolic equivalent (peak MET) and peak oxygen consumption (peak O2) with OUES. We also evaluated if body fat affected EC among preschoolers.Forty-three preschoolers under the ramped Bruce protocol of treadmill exercise testing had been retrospectively studied. The criteria for achieving (Equation is included in full-text article.)O2 max included respiratory exchange ratio (RER) >1.1, heart rate (HR) >85% of age-predicted maximum, and HR >200 bpm. OUES was calculated by the 75% (OUES-75) and the entire (OUES-100) duration of the testing and normalized by body surface area. Body fat was measured using vector bioelectrical impedance analysis. The fat mass (FM) index and fat-free mass index (FFMI) were defined as FM or FFM (kg) divided by height squared (m), respectively.The mean age of the participants was 5.70 ± 0.56. Seventy-nine percent of preschoolers met at least 1 criterion, 36.84% met 2 criteria, and none met all 3 criteria for (Equation is included in full-text article.)O2. OUES-75 was moderately positively correlated with peak MET (P = .034; Spearman's rho = 0.324) and peak O2 (P <.001; Spearman's rho = 0.667). OUES-100 was moderately to highly positively correlated with peak MET (P <.001; Spearman's rho = 0.592) and peak O2 (P <.001; Spearman's rho = 0.825). There were moderate to high positive correlations between FFMI and peak O2 (P <.001; Spearman's rho = 0.668), OUES-75 (P <.001; Spearman's rho = 0.642), and OUES-100 (P < .001; Spearman's rho = 0.670).None of the preschoolers reached all 3 criteria for (Equation is included in full-text article.)O2max. OUES-75 and OUES-100 might be indicators of peak O2 at submaximal effort. Preschoolers with higher FFMI had better EC during treadmill exercise testing.

Background: Protected natural areas provide a promising opportunity for improving healthy life habits through engagement in a variety of physical activities (PAs). As visitors to protected natural areas do not behave as a homogenous group, it is necessary to better understand the association between their characteristics and the level of activities engaged in. Using Alt Pirineu Natural Park (Spain) as a case study, the purpose of this work is to examine the influence of visitors' sociodemographic and trip characteristics on the likelihood of the visitors engaging in distinct PA intensities., Methods: Data were systematically collected from visitors (N = 1427) by means of self-administered questionnaires using a face-to-face approach., Results: To identify distinct groups of PA intensities reported activities of visitors were classified following the Compendium of PA and metabolic equivalent consumption. Three groups were identified and labeled as follows: light PA group (16.8%), moderate PA group (63.9%), and vigorous PA group (19.3%). A logistic regression analysis indicated that the capacity of selected descriptors to predict group membership was positively associated with the increment in PA intensities., Conclusion: The study findings may aid park managers in developing effective management strategies for promoting health-enhancing PA in protected natural areas.

The purpose of the study was to identify and compare validity parameters of different absolute intensity thresholds in METs, using relative intensity classification as criterion measure. Convenience sampling was used to recruit total of 112 adults. The participants carried out an incremental maximal cycle ergometer test and asked to perform nine free-living activities. The oxygen uptake was measured by a VO2000® gas analyser throughout the tests. The intensity thresholds were identified using Receiver Operator Characteristic (ROC) curve analysis, having relative intensity categories as criterion measure. A total of 103 participants attended the two visits. Among 54 men and 49 women, the mean (± SD) ages were 36.1 (± 11.1) and 33.9 (± 10.6) years, respectively. The intensity thresholds identified were 4.9 METs for moderate and 6.8 METs for vigorous physical activity. In conclusion, the physical activity thresholds, generated according to the entire sample, were higher and presented improved specificity when compared to thresholds currently recommended. Moreover, these parameters presented relatively high accuracy, even when applied to specific groups such as sex, age, nutritional status and physical fitness., Competing Interests: The authors have declared that no competing interests exist.

Peak metabolic equivalent (MET) is the most reliable indicator of cardiorespiratory fitness (CRF). The aim of this study was to examine the association between CRF indicated by peak MET and body mass index (BMI) or fat mass index (FMI) in Taiwanese children and adolescents (C-A). Data of 638 C-A aged 10-18 that received symptom-limited treadmill exercise testing was analyzed. Anthropometry-body composition was measured by vector bioelectrical impedance analysis. BMI was defined as body weight (kg)/body height (m)² and FMI was defined as fat mass (kg)/body height (m)². BMI was grouped by Taiwanese obesity cut-off points. FMI Class-I was categorized by percentage of body fat. FMI Class-II used the reference values from Korean C-A. Excess adiposity was defined as (1) "overweight" and "obesity" by BMI, (2) greater than the sex- and age-specific 75th percentile of whole subjects by FMI Class-I, and (3) greater than 95th percentiles of reference value by FMI Class-II. Boys had significantly higher fat mass and FMI, and had more excess adiposity than girls (all p < 0.05). Both boys and girls with excess adiposity (by any definition) had lower MET at anaerobic threshold (AT MET) and peak MET (all p < 0.001). BMI and FMI were significantly negatively associated with both AT MET and peak MET significantly (all p < 0.001). FMI (95% CI: -0.411~-0.548) correlated with peak MET more than BMI (95% CI: -0.134~ -0.372) did. Excess adiposity affected CRF negatively. It is concluded that weight management should start early in childhood., Competing Interests: This study was the authors’ own work. There are no conflicts of interest or competing financial interests to be declared in this article.

The main purpose of the present study was to compare the reference metabolic equivalent (MET) value and observed resting oxygen uptake (VO 2 ) for defining cardiorespiratory fitness (VO 2max ) and characterizing the energy cost of treadmill running. A heterogeneous cohort of 114 healthy men volunteered to participate. In Part 1 of the study, 114 men [mean±SD, age: 24±5 years; height: 177.1±7.9 cm; body mass: 75.0±10.0 kg] visited the laboratory twice for assessment of resting and maximal VO 2 values to compare the reference MET value vs. observed resting VO 2 and to investigate the association between resting VO 2 and VO 2max . In Part 2, 14 of the 114 men visited the laboratory once more to perform a 30-min bout of running at 8.0 km∙h -1 /8.3 METs. The mean observed resting VO 2 of 3.26 mL·kg -1 ·min -1 was lower than the reference MET value of 3.5 mL·kg -1 ·min -1 (P<0.001). Resting and maximal VO 2 values relative to total body mass and fat-free mass were positively correlated (R=0.71 and 0.60, respectively; P<0.001). The maximal MET and energy cost of treadmill running were consequently underestimated when calculated using the reference MET value only for those with low VO 2max (P=0.005 to P<0.001). In conclusion, the reference MET value considerably overestimated observed resting VO 2 in men with low VO 2max , resulting in underestimations of the maximal MET, exercise intensity prescription, and the energy cost of running., Competing Interests: Conflict of Interest: The authors report no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To determine the effect of <3 Mets (Metabolic Equivalent of Tasks) of physical activity on zero postoperative days for improving hemodynamic and respiratory parameters of patients after cardiac surgeries., Study Design: Randomized control trial., Place and Duration of Study: BARMWTHospital, Rawalpindi, from March to August 2015., Methodology: Arandomized controlled trial was conducted on 174 CABG and valvular heart disease patients undergoing cardiac surgical procedures. After selection of sample via non-probability purposive sampling, they were randomly allocated into interventional group (n=87) and control group (n=87). Treatment protocol for experimental group was ≤3 Mets of physical activity, i.e. chest physiotherapy, sitting over edge of bed, standing and sitting on chair at bedside, on zero postoperative day but the control group was treated with conventional treatment on first postoperative day. Pre- and post-treatment assessment was done in control and interventional groups on both zero and first postoperative days. Data was analyzed on SPSS version 21., Results: The patients' mean age was 51.86 ±13.76 years. Male to female ratio was 132:42. Statistically significant differences in respiratory rate and SpO2 (p=0.000 and 0.000, respectively) were found between both groups. Among ABG's, PCO2 and pH showed significant differences with p values of 0.039 and <0.001, respectively. No significant differences were observed between both groups regarding electrolytes (Na+, K+, Cl-, p-values of 0.361, 0.575 and 0.120 respectively) and creatinine (p=0.783). Marked improvement in oxygen saturation, dyspnea and a fall in systolic BPwas seen in interventional group. There was also observed to be a reduction in the length of ICU stay among interventional group patients as frequency with percentage of total stay was compared to control group., Conclusion: Early physical activity (≤3 METS) post-cardiac surgeries prevent respiratory complications through improvement in dyspnea, respiratory rate, and oxygen saturation.

Objectives: Triaxial accelerometry is commonly used to estimate oxygen uptake (VO 2 ) and energy expenditure in health and fitness studies. We tested the correlation of a triaxial accelerometer in terms of a summation of vector magnitudes with gravity subtracted (SVMgs) and measured VO 2 for different daily physical activities., Design: Original research, cross-sectional., Methods: Twenty volunteers wore a triaxial accelerometer on both wrists while performing 12 assigned daily physical activities for 6min for each activity. The VO 2 was determined by indirect calorimetry using a portable metabolic measurement system. The last 3min of each activity was assumed to represent steady-state. The VO 2 measured during these periods was averaged and converted into metabolic equivalents (METs)., Results: The range of VO 2 for all activities was 0.18-3.2L/min (0.8-12.2 METs). Significant differences in SVMgs existed between accelerometer placements on the dominant (120.9±8.7gmin) versus non-dominant hand (99.9±6.8gmin; P=0.016) for the lowest levels of physical activity defined as <1.5 METs. Piecewise linear regression model using 6 METs as the transition point showed similar significant correlations for the non-dominant wrist (r 2 =0.85; P<0.001) and the dominant wrist (r 2 =0.86; P<0.001). Using the non-dominant wrist below 6 METs, the slope of the relationship between SVMgs and METs was 105.3±4.3 (95% CI 96.9 to 113.7) indicating an increase in SVMgs of approximately 100 units for every MET increase in oxygen uptake., Conclusions: Wrist-worn triaxial accelerometry reliably predicted energy expenditure during common physical activities <6 METs. More consistent correlations were found when the accelerometer was worn on the non-dominant wrist rather than the dominant wrist., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Purpose: To describe exercise training workloads, estimated as metabolic equivalents of task (METs) both upon exit from cardiac rehabilitation (CR) and as the change in MET level following CR, stratified by age, sex, initial MET level, number of sessions completed, and qualifying event at entry into CR., Methods: A retrospective study involving 8319 (31% female) patients who completed ≥9 exercise training sessions in the early outpatient CR program at Henry Ford Hospital. Exercise training MET levels achieved during CR were estimated on the basis of the speed and grade recorded from a treadmill. Exercise training METs at the start of CR were defined as the average of the second and third sessions, whereas MET level upon exit from CR was determined from the average of the last 2 patient encounters., Results: The overall mean MET level while training just prior to exit from CR was 3.9 ± 1.4 (4.1 ± 1.4 and 3.3 ± 1.0 in men and women, respectively). The mean change in METs after CR was 1.3 ± 1.1 (+45% ± 37%) and 0.9 ± 0.7 (+40% ± 32%) in men and women, respectively., Conclusions: In a large and demographically diverse cohort of patients who participated in CR, increases in mean workload (ie, METs) during exercise training were observed that approximated 45% in men and 40% in women. These data could be considered when establishing benchmarks for program-related performance outcome measures.

Background: Even when meeting guidelines for physical activity (PA), considerable sedentary time may be included. This study in primary school children investigated the relationships between objectively evaluated sedentary and PA times at different intensities using triaxial accelerometry that discriminated between ambulatory and non-ambulatory PA. The relationships between subjectively evaluated screen time (i.e. time spent viewing television and videos, playing electronic games, and using personal computers) and objectively evaluated sedentary and PA times were examined., Methods: Objectively evaluated sedentary and PA times were assessed for 7 consecutive days using a triaxial accelerometer (Active style Pro: HJA-350IT) in 426 first to sixth grade girls and boys. Metabolic equivalents [METs] were used to categorize the minutes of sedentary time (≤1.5 METs), light PA (LPA, 1.6-2.9 METs), moderate-to-vigorous PA (MVPA,  ≥3.0 METs) and vigorous PA (VPA,  ≥6.0 METs). The physical activity level (PAL) was calculated using the mean MET value. Subjectively evaluated screen time behaviors were self-reported by participants and parents acting together. The associations between PA and sedentary and screen time variables were examined using partial correlation analyses., Results: After adjustment for age, body weight and wearing time, objectively evaluated sedentary time correlated strongly with non-ambulatory and total LPA and PAL, moderately with ambulatory LPA, non-ambulatory or total MVPA, and weakly with ambulatory MVPA, ambulatory, non-ambulatory or total VPA. Subjectively evaluated screen time was not associated significantly with objectively evaluated sedentary and PA times or PAL. On average, each reduction of 30 min in daily sedentary time was associated with 6 or 23 min more of MVPA or LPA, respectively., Conclusions: These findings show that higher daily sedentary time may be compensated mainly by lower LPA, while the association between sedentary time and MVPA was moderate. Therefore, improving MVPA and reducing sedentary time are important in primary school children.

Purpose: The correlation between chronic kidney disease (CKD) and increased cardiovascular disease-related mortality is well established. Cardiac rehabilitation (CR) improves exercise capacity, quality of life, and risk factors in patients with coronary artery disease (CAD). Data on the benefits of CR in patients with CKD are sparse. The purpose of this study was to compare outcomes after CR in patients with CAD but normal renal function, versus those with CAD and CKD., Methods: We studied 804 patients with CAD entering an exercise-based CR program. Demographics, risk factors, exercise capacity in metabolic equivalent levels (METs), and estimated glomerular filtration rate (GFR) were recorded before and after the 3-month CR program. Use of polyunsaturated fatty acid (PUFA) was determined by medical records review. Stage III-V CKD (GFR <60 mL/min/1.73 m) was present in 170 patients at baseline., Results: After CR, METs improved in all patients, although increases in patients with a GFR 30 to 59 mL/min/1.73 m (Δ1.6) and a GFR <30 (Δ1.2) were smaller than those in patients with a GFR ≥60 (Δ2.6, P < .05 vs GFR 30-59 and GFR <30). In patients with a GFR ≥60 mL/min/1.73 m, PUFA use was associated with a 20% greater increase in MET levels compared with nonusers (Δ3.0 vs Δ2.5, P = .02); and in patients with a GFR 30 to 59, PUFA use was associated with 30% increase in MET level compared with nonusers (Δ2.0 vs Δ1.4, P = .03). These observations persisted after multivariable adjustment for baseline MET level, demographics, and risk factors., Conclusions: Potential mitigation by PUFA of the smaller improvement in exercise capacity with decreasing GFR requires confirmation in prospective randomized trials.

Background: The Micra transcatheter pacemaker was designed to have similar functionality to conventional transvenous VVIR pacing systems. It provides rate adaptive pacing using a programmable 3-axis accelerometer designed to detect patient activity in the presence of cardiac motion., Objective: The purpose of this study was to evaluate the system's performance during treadmill tests to maximum exertion in a subset of patients within the Micra Transcatheter Pacing Study., Methods: Patients underwent treadmill testing at 3 or 6 months postimplant with algorithm programming at physician discretion. Normalized sensor rate (SenR) relative to the programmed upper sensor rate was modeled as a function of normalized workload in metabolic equivalents (METS) relative to maximum METS achieved during the test. A normalized METS and SenR were determined at the end of each 1-minute treadmill stage. The proportionality of SenR to workload was evaluated by comparing the slope from this relationship to the prospectively defined tolerance margin (0.65-1.35)., Results: A total of 69 treadmill tests were attempted by 42 patients at 3 and 6 months postimplant. Thirty tests from 20 patients who completed ≥4 stages with an average slope of 0.86 (90% confidence interval 0.77-0.96) confirmed proportionality to workload. On an individual test basis, 25 of 30 point estimates (83.3%) had a normalized slope within the defined tolerance range (range 0.46-1.08)., Conclusion: Accelerometer-based rate adaptive pacing was proportional to workload, thus confirming rate adaptive pacing commensurate to workload is achievable with an entirely intracardiac pacing system., (Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Energy consumption, i. e., the metabolic equivalent of task (MET), provides a precise assessment of physical activity (PA). Studies on social inequalities of PA have hardly used this possibility, however. Methods: The analyses are based on the 'Motorik-Modul (MoMo) of the KiGGS study (German Health Interview and Examination Survey for Children and Adolescents) conducted between 2003 and 2006 (n=1 757; age group 11-17 years). PA has been assessed in 3 settings (sport club in school, other sport club, leisure time). 3 dependent variables were distinguished by combining the following criteria: at least 21 MET-hours per week, intensity between 3 and 6 METs, at least 7 hours a week. The main independent variables are: type of school and socioeconomic status (SES) of the parents. 'Two part models' have been used to assess social difference in PA among those who are physically active. Results: PA is much more common in the higher SES groups. Looking at the MET-hours, though, there are just little differences among those who are physically active (regressions coefficient for low vs. high SES: 1.15; 95% conf. interv. 0.99-1.33). Conclusion: Social differences can be seen mainly for the proportion of adolescents being physically active, not for the extent of PA among those who are physically active. Therefore, the central request should be to increase the proportion of adolescents performing any PA in the low SES group., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To determine whether sex modifies the relationship between fitness and mortality., Patients and Methods: We included 57,284 patients without coronary artery disease or heart failure who completed a routine treadmill exercise test between 1991 and 2009. We determined metabolic equivalent tasks (METs) and linked patient records with mortality data via the Social Security Death Index. Multivariable Cox regression was used to determine the association between sex, fitness, and all-cause mortality., Results: There were 29,470 men (51.4%) and 27,814 women (48.6%) with mean ages of 53 and 54 years, respectively. Overall, men achieved 1.7 METs higher than women (P<.001). During median follow-up of 10 years, there were 6402 deaths. The mortality rate for men in each MET group was similar to that for women, who achieved an average of 2.6 METs lower (P=.004). Fitness was inversely associated with mortality in both men (hazard ratio [HR], 0.84 per 1 MET; 95% CI, 0.83-0.85) and women (HR, 0.83 per 1 MET; 95% CI, 0.81-0.84). This relationship did not plateau at high or low MET values., Conclusion: Although men demonstrated 1.7 METs higher than women, their survival was equivalent to that of women demonstrating 2.6 METs lower. Furthermore, higher MET values were associated with lower mortality for both men and women across the range of MET values. These findings are useful for tailoring prognostic information and lifestyle guidance to men and women undergoing stress testing., (Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objective: Energy expenditure (EE) in active videogames (AVGs) is a component for assessing its benefit for cardiovascular health. Existing evidence suggests that AVGs are able to increase EE above rest and when compared with playing passive videogames. However, the association between body movement and EE remains unclear. Furthermore, for goal-directed game design, it is important to know the contribution of body segments to EE. This knowledge will help to acquire a certain level of exercise intensity during active gaming. Therefore, the purpose of this study was to determine the best predictors of EE from body segment energies, acceleration, and heart rate during different game situations., Materials and Methods: EE and body segment movement of 17 subjects, aged 22.1 ± 2.5 years, were measured in two different AVGs. In randomized order, the subjects played a handheld-controlled Nintendo(®) Wii™ tennis (NWT) game and a whole body-controlled Sony EyeToy(®) waterfall (ETW) game. Body segment movement was analyzed using a three-dimensional motion capture system. From the video data, mean values of mechanical energy change and acceleration of 10 body segments were analyzed., Results: Measured EE was significantly higher in ETW (7.8 ± 1.4 metabolic equivalents [METs]) than in NWT (3.4 ± 1.0 METs). The best prediction parameter for the more intense ETW game was the energy change of the right thigh and for the less intense hand-controlled NWT game was the energy change of the upper torso. Segment acceleration was less accurate in predicting EE., Conclusion: The best predictors of metabolic EE were the thighs and the upper torso in whole body and handheld-controlled games, respectively. Increasing movement of these body segments would lead to higher physical activity intensity during gaming, reducing sedentary behavior.

Objective: This study was designed to assess physiologic responses and hedonics (i.e., liking) during prolonged physically interactive videogame play., Materials and Methods: Participants (n = 24) completed three 30-minute videogame conditions on separate days in a random order. During two of the conditions participants played physically interactive videogames (Nintendo of America, Inc. [Redmond, WA] "Wii™ Fit" "Basic Run" and "Basic Step"). During the third condition participants played a traditional/sedentary game ("Tanks!"), which required minimal physical movement for gameplay. Oxygen consumption (VO2) was assessed using indirect calorimetry throughout each condition and averaged every 5 minutes. Liking was assessed via visual analog scale at the 15- and 30-minute time points during each condition., Results: Mean VO2 was significantly (P < 0.001) greater during "Basic Run" (16.14 ± 5.8 mL/kg/minute, 4.6 ± 1.7 metabolic equivalents [METs]) than either "Basic Step" (11.4 ± 1.7 mL/kg/minute, 3.3 ± 0.5 METs) or the traditional/sedentary videogame (5.39 ± 1.0 mL/kg/minute, 1.5 ± 0.1 METs). "Basic Step" was also greater (P < 0.001) than the traditional/sedentary game. VO2 did not significantly (P = 0.25) fluctuate across the 30-minute session for any game. In other words, participants maintained a consistent physiologic intensity throughout each 30-minute condition. There were no differences (P ≥ 0.20) across gaming conditions or time for liking., Conclusions: Participants achieved and maintained moderate-intensity physical activity (≥3.0 METs) during both 30-minute physically interactive videogame conditions. Furthermore, because liking was similar across all gaming conditions, participants may be willing to substitute the physically interactive videogames in place of the traditional/sedentary game.

Objective: To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI)., Patients and Methods: This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwent clinical treadmill stress testing in the Henry Ford Health System from January 1, 1991, through May 31, 2009, and suffered MI during follow-up (MI event proportion, 3.4%; mean time from the exercise test to MI, 6.1±4.3 years). Exercise capacity was categorized on the basis of peak metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more METs. Early mortality was defined as all-cause mortality within 28, 90, or 365 days of MI. Multivariable logistic regression models were used to assess the effect of EC on the risk of mortality at each time point post-MI adjusting for baseline demographic characteristics, cardiovascular risk factors, medication use, indication for stress testing, and year of MI., Results: The 28-day EM rate was 10.6% overall, and 13.9%, 10.7%, 6.9%, and 6.0% in the less than 6, 6 to 9, 10 to 11, and 12 or more METs categories, respectively (P<.001). Patients who died were more likely to be older, be less fit, be nonobese, have treated hypertension, and have a longer duration from baseline to incident MI (P<.05). Adjusted regression analyses revealed a decreased risk of EM with increasing EC categories. A 1-MET higher EC was associated with an 8% to 10% lower risk of mortality across all time points (28 days: odds ratio [OR], 0.92; 95% CI, 0.87-0.98; P=.006; 90 days: OR, 0.90; 95% CI, 0.86-0.95; P<.001; 365 days: OR, 0.91; 95% CI, 0.87-0.94; P<.001)., Conclusion: Higher baseline EC was independently associated with a lower risk of early death after a first MI., (Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Background: The evaluation of coronary artery disease (CAD) can be performed with stress test and myocardial SPECT tomography., Aim: To assess the predictive value of myocardial SPECT using stress test for cardiovascular events in patients with good exercise capacity., Material and Methods: We included 102 males aged 56 ± 10 years and 19 females aged 52 ± 10 years, all able to achieve 10 METs and ≥ 85% of the theoretical maximum heart rate and at least 8 min in their stress test with gated 99mTc-sestamibi SPECT. Eighty two percent of patients were followed clinically for 33 ± 17 months., Results: Sixty seven percent of patients were studied for CAD screening and the rest for known disease assessment. Treadmill stress test was negative in 75.4%; 37% of patients with moderate to severe Duke Score presented ischemia. Normal myocardial perfusion SPECT was observed in 70.2%. Reversible defects appeared in 24.8% of cases, which were of moderate or severe degree (> 10% left ventricular extension) in 56.6%. Only seven cases had coronary events after the SPECT. Two major (myocardial infarction and emergency coronary revascularization) and 5 minor events (elective revascularization) ere observed in the follow-up. In a multivariate analysis, SPECT ischemia was the only statistically significant parameter that increased the probability of having a major or minor event., Conclusions: Nearly a quarter of our patients with good exercise capacity demonstrated reversible defects in their myocardial perfusion SPECT. In the intermediate-term follow-up, a low rate of cardiac events was observed, being the isotopic ischemia the only significant predictive parameter.

Objective: The objective of this study is to examine the association between occupational physical activity and leisure-time physical activity among US women in the Sister Study., Methods: We conducted a cross-sectional study of 26,334 women who had been employed in their current job for at least 1 year at baseline (2004-2009). Occupational physical activity was self-reported and leisure-time physical activity was estimated in metabolic equivalent hours per week. Log multinomial regression was used to evaluate associations between occupational (sitting, standing, manually active) and leisure-time (insufficient, moderate, high) activity. Models were adjusted for age, race/ethnicity, education, income, geographic region, and body mass index., Results: Only 54% of women met or exceeded minimum recommended levels of leisure-time physical activity (moderate 32% and high 22%). Women who reported sitting (prevalence ratio (PR)=0.82, 95% confidence interval (CI): 0.74-0.92) or standing (PR=0.84, 95% CI: 0.75-0.94) most of the time at work were less likely to meet the requirements for high leisure-time physical activity than manually active workers. Associations were strongest among women living in the Northeast and the South., Conclusion: In this nationwide study, low occupational activity was associated with lower leisure-time physical activity. Women who are not active in the workplace may benefit from strategies to promote leisure-time physical activity., (Published by Elsevier Inc.)

Background: Energy required for able-bodied individuals to perform common activities is well documented, whereas energy associated with daily activities among people with spinal cord injury (SCI) is less understood., Objective: To determine energy expended during several basic physical tasks specific to individuals with paraplegia due to motor-complete SCI., Methods: Sixteen adults with motor-complete SCI below T2 level and duration of paraplegia greater than 3 months were included. Oxygen consumption (VO2), caloric expenditure, and heart rate were measured at rest and while participants performed lower body dressing (LBD), pop-over transfers (POTs), and manual wheelchair propulsion (MWP) at a self-selected pace. These data were used to calculate energy expenditure in standard metabolic equivalents (METs), as defined by 1 MET = 3.5 mL O2/kg/min, and in SCI METs using the conversion 1 SCI MET = 2.7 mL O2/kg/min., Results: VO2 at rest was 3.0 ± 0.9 mL O2/kg/min, which equated to 0.9 ± 0.3 standard METs and 1.1 ± 0.4 SCI METs in energy expenditure. LBD required 3.2 ± 0.7 METs and 4.1 ± 0.9 SCI METs; POTs required 3.4 ± 1.0 METs and 4.5 ± 1.3 SCI METs; and MWP required 2.4 ± 0.6 METs and 3.1 ± 0.7 SCI METs., Conclusions: Resting VO2 for adults with motor-complete paraplegia is 3.0 mL O2/kg/min, which is lower than standard resting VO2 in able-bodied individuals. Progressively more energy is required to perform MWP, LBD, and POTs, respectively. Use of the standard METs formula may underestimate the level of intensity an individual with SCI uses to perform physical activities.

Objectives: To cross-validate the existing peak rate of oxygen consumption (VO2peak) prediction equations in Dutch law enforcement officers and to determine whether these prediction equations can be used to predict VO2peak for groups and in a single individual. A further objective was to report normative absolute and relative VO2peak values of a sample of law enforcement officers in the Netherlands., Material and Methods: The peak rate of oxygen consumption (ml×kg-1×min-1) was measured using a maximal incremental bicycle test in 1530 subjects, including 1068 male and 461 female police officers. Validity of the prediction equations for groups was assessed by comparing predicted VO2peak with measured VO2peak using paired t-tests. For individual differences limits of agreement (LoA) were calculated. Equations were considered valid for individuals when the difference between measured and predicted VO2peak did not exceed ±1 metabolic equivalent (MET) in 95% of individuals., Results: None of the equations met the validity criterion of 95% of individuals having ±1 MET difference or less than the measured value. Limits of agreement (LoAs) were large in all predictions. At the individual level, none of the equations were valid predictors of VO2peak (ml×kg-1×min-1). Normative values for Dutch law enforcement officers were presented., Conclusions: Substantial differences between measured and predicted VO2peak (ml×kg-1×min-1) were found. Most tested equations were invalid predictors of VO2peak at group level and all were invalid at individual levels., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Persons with Down syndrome (DS) have altered heart rate modulation and very low aerobic fitness. These attributes may impact the relationship between metabolic equivalent units (METs) and the heart rate index (HRindex-the ratio between heart rate during activity and resting heart rate), thereby altering the HRindex thresholds for moderate- and vigorous-intensity physical activity. This study examined whether the relationship between METs and HRindex differs between persons with and without DS and attempted to develop thresholds for activity intensity based on the HRindex for persons with DS. METs were measured with portable spirometry and heart rate with a monitor in 18 persons with DS (25 ± 7 years; 10 women) and 18 persons without DS (26 ± 5 years; 10 women) during 6 over-ground walking trials, each lasting 6min, at the preferred walking speed and at 0.5, 0.75, 1.0, 1.25, and 1.5m/s. The relationship between METs and HRindex in the two groups was analyzed with multi-level modeling with random intercepts and slopes. Group, HRindex, and the square of HRindex were significant predictors of METs (p<0.001; R(2)=0.65). Absolute percent error did not differ significantly between groups across speeds (DS: 19.6 ± 14.4%; non-DS: 21.0 ± 14.5%). Bland-Altman plots demonstrated somewhat greater variability in the difference between actual and predicted METs in participants with than without DS. The HRindex threshold for moderate-intensity activity was 1.32 and 1.20 for persons with and without DS, respectively. The HRindex threshold for vigorous-intensity activity was 1.80 and 1.65 for persons with and without DS, respectively. Persons with DS have an altered relationship between METs and HRindex and higher HRindex thresholds for moderate- and vigorous-intensity physical activity., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To investigate the relationship among metabolic equivalents of an exercise stress test (METs of EST), demographic parameters (age, body weight, height, BMI), peak oxygen consumption (VO(2) peak), and six-minute walk distances (6MWD) determined from a six-minute walk test (6MWT)., Material and Method: Exercise capacity was estimated by a 6MWT and EST at the sixth week post operation in post coronary artery bypass graft (post CABG n = 17) and post percutaneous coronary intervention (post PCI, n = 13)patients., Results: METs of EST showed: high correlation (p

Accurate and easy-to-use methods to assess free-living energy expenditure in response to physical activity in young children are scarce. In the present study, we evaluated the capacity of (1) 4 d recordings obtained using the Actiheart (mean heart rate (mHR) and mean activity counts (mAC)) to provide assessments of total energy expenditure (TEE) and activity energy expenditure (AEE) and (2) a 7 d activity diary to provide assessments of physical activity levels (PAL) using three sets of metabolic equivalent (MET) values (PALTorun, PALAdolph and PALAinsworth) in forty-four and thirty-one healthy Swedish children aged 1·5 and 3 years, respectively. Reference TEE, PALref and AEE were measured using criterion methods, i.e. the doubly labelled water method and indirect calorimetry. At 1·5 years of age, mHR explained 8 % (P= 0·006) of the variation in TEE above that explained by fat mass and fat-free mass. At 3 years of age, mHR and mAC explained 8 (P= 0·004) and 6 (P= 0·03) % of the variation in TEE and AEE, respectively, above that explained by fat mass and fat-free mass. At 1·5 and 3 years of age, average PALAinsworth values were 1·44 and 1·59, respectively, and not significantly different from PALref values (1·39 and 1·61, respectively). By contrast, average PALTorun (1·5 and 3 years) and PALAdolph (3 years) values were lower (P< 0·05) than the corresponding PALref values. In conclusion, at both ages, Actiheart recordings explained a small but significant fraction of free-living energy expenditure above that explained by body composition variables, and our activity diary produced mean PAL values in agreement with reference values when using MET values published by Ainsworth.

Background: Research has shown network social capital associated with a range of health behaviours and conditions. Little is known about what social capital inequalities in health represent, and which social factors contribute to such inequalities., Methods: Data come from the Montreal Neighbourhood Networks and Healthy Aging Study (n=2707). A position generator was used to collect network data on social capital. Health outcomes included self-reported health (SRH), physical inactivity, and hypertension. Social capital inequalities in low SRH, physical inactivity, and hypertension were decomposed into demographic, socioeconomic, network and psychosocial determinants. The percentage contributions of each in explaining health disparities were calculated., Results: Across the three outcomes, higher educational attainment contributed most consistently to explaining social capital inequalities in low SRH (% C=30.8%), physical inactivity (15.9%), and hypertension (51.2%). Social isolation, contributed to physical inactivity (11.7%) and hypertension (18.2%). Sense of control (24.9%) and perceived cohesion (11.5%) contributed to low SRH. Age reduced or increased social capital inequalities in hypertension depending on the age category., Conclusions: Interventions that include strategies to reduce socioeconomic inequalities and increase actual and perceived social connectivity may be most successful in reducing social capital inequalities in health.

Background: Submaximal stress testing or achieving <85% maximum predicted heart rate (MPHR) may lead to nondiagnostic results and indeterminate outcomes. High exercise capacity (≥ 10 metabolic equivalents, METS) is a predictor of favorable prognosis. The purpose of this study was to evaluate the prognostic value of submaximal or high exercise capacity stress echocardiography., Methods: We evaluated 1781 patients (55 ± 13 years; 59% male) undergoing treadmill stress echocardiography divided into 811 patients with submaximal (<85% MPHR) and 970 patients with high exercise capacity (≥ 10 METS). Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on 5-point scale of wall motion. Abnormal stress echocardiography was defined as stress-induced ischemia (wall-motion score of ≥ 1 grade). Follow-up (3.3 ± 1.5 years) for nonfatal myocardial infarction (MI) (n = 40) and cardiac death (n = 52) were obtained., Results: By univariate analysis, echocardiographic variables of ejection fraction, peak wall-motion score index (WMSI) and number of new ischemic wall-motion abnormalities were significant predictors of cardiac events. Cumulative survival was significantly worse in patients with abnormal (ischemic) versus normal (nonischemic) stress echocardiography in submaximal (4.4%/year vs. 1.3%/year, P < 0.0001) and high exercise capacity (1.5%/year vs. 0.2%/year, P < 0.0001) studies. Multivariate Cox proportional hazards analysis identified number of new ischemic wall-motion abnormalities as the strongest predictor of cardiac events (P < 0.05) in both groups., Conclusions: Despite normal stress echocardiography, the inability to achieve 85% MPHR conferred a higher, intermediate cardiac event rate of 2.9%/year. The ability to achieve 9 minutes (≥ 10 metabolic equivalents, METS) conferred an overall low cardiac event rate of 0.4%/year. However, the absence or presence of ischemia by stress echocardiography was able to further risk stratify patients with either submaximal or high exercise capacity studies., (© 2013, Wiley Periodicals, Inc.)

Accurate estimation of daily total energy expenditure (EE)is a prerequisite for assisted weight management and assessing certain health conditions. The use of wearable sensors for predicting free-living EE is challenged by consistent sensor placement, user compliance, and estimation methods used. This paper examines whether a single ear-worn accelerometer can be used for EE estimation under free-living conditions.An EE prediction model as first derived and validated in a controlled setting using healthy subjects involving different physical activities. Ten different activities were assessed showing a tenfold cross validation error of 0.24. Furthermore, the EE prediction model shows a mean absolute deviation(MAD) below 1.2 metabolic equivalent of tasks. The same model was applied to a free-living setting with a different population for further validation. The results were compared against those derived from doubly labeled water. In free-living settings, the predicted daily EE has a correlation of 0.74, p 0.008, and a MAD of 272 kcal day. These results demonstrate that laboratory-derived prediction models can be used to predict EE under free-living conditions [corrected].

Background: Neighborhoods can be an important feature of the built environment influencing physical activity; however, neighborhood poverty and violence may pose significant barriers for youth physical activity. We conducted a community survey of 107 households with youth 3-12 years of age in select neighborhoods of the city of Newark, New Jersey, a highly impoverished and racially/ethnically segregated city of the United States., Results: The majority of sampled households did not have access to a park, and nearly 60% of youth were not engaged in a team or organized physical activity program. Hearing gunshots and seeing drug deals in the neighborhood were reported by 74% and 56%, respectively, of study participants. In adjusted regression models, a 1-unit increase in self-reported neighborhood safety was associated with perceptions that parks were safe for youth to use (OR = 1.7, CI = 1.3, 2.3) and increased odds of youth using parks (OR = 1.3, CI = 1.0, 1.6). Self-reported neighborhood violence was marginally associated with lower levels of Metabolic Equivalent (MET)-min/week of moderate PA (β = -54.25, P = .05)., Conclusion: To ensure national goals of increased physical activity and use of outdoor spaces, addressing the neighborhood contexts under which the most vulnerable of our youth live will be required.

Background: Self-efficacy has been found to be an important precondition for behavioral change in sedentary people. The current study examined the effectiveness and added value of including a 15-minute self-efficacy coaching at the start of a 12-week lifestyle physical activity (PA) program., Methods: Participants were randomly assigned to a standard-intervention group (without additional self-efficacy coaching, N = 116) or extra-intervention group (with additional self-efficacy coaching, N = 111). Body mass index (BMI), cardiovascular fitness, self-reported PA, and self-efficacy beliefs were assessed at baseline and immediately after the intervention period. Perceived adherence to the PA program was assessed postintervention., Results: At posttest, a significant increase in cardiovascular fitness and decrease in BMI were found in both groups. Significant intervention effects emerged on PA behavior, self-efficacy, and program adherence, in favor of the extra-intervention group. Self-efficacy mediated the intervention effect on program adherence whereas no evidence was found for its role as mediator of PA change., Conclusions: Adding a 15-minute self-efficacy coaching at the start of a lifestyle PA program is a promising strategy to enhance the intervention effects on PA behavior, self-efficacy beliefs, and program adherence. However, the role of self-efficacy as mediator of the intervention effect on in PA was not fully supported.

Though the positive link between physical activity and maternal health is well documented, physical activity declines during pregnancy and, internationally, rural mothers are less likely than urban mothers to engage in physical activity. Some evidence suggests that self-efficacy is related to sustained engagement in physical activity. The purpose of this study was to examine self-efficacy, perceived benefits, and knowledge of safe exercise among 88 rural pregnant women in a southeastern region of the United States. Exercise self-efficacy was significantly related to maternal age and gestation. Women over age 26 years, and those in the second and third trimesters, scored significantly higher than younger women or those in the first trimester. Fifty-two percent (n = 46) of participants perceived that activity would decrease energy levels, 37.5% (n = 33) did not know that exercise can decrease the risk of gestational diabetes, and 47.6% (n = 41) were unaware that a mother who is overweight is more likely to have an overweight child. Results confirm a need for education to improve women's knowledge about health benefits and safety information related to physical activity during pregnancy., (© 2013 Wiley Publishing Asia Pty Ltd.)

The aim of this study was to compare the energy expenditure (EE) estimations of activity-specific prediction equations (ASPE) and of an artificial neural network (ANNEE) based on accelerometry with measured EE. Forty-three children (age: 9.8 ± 2.4 yr) performed eight different activities. They were equipped with one tri-axial accelerometer that collected data in 1-s epochs and a portable gas analyzer. The ASPE and the ANNEE were trained to estimate the EE by including accelerometry, age, gender, and weight of the participants. To provide the activity-specific information, a decision tree was trained to recognize the type of activity through accelerometer data. The ASPE were applied to the activity-type-specific data recognized by the tree (Tree-ASPE). The Tree-ASPE precisely estimated the EE of all activities except cycling [bias: -1.13 ± 1.33 metabolic equivalent (MET)] and walking (bias: 0.29 ± 0.64 MET; P < 0.05). The ANNEE overestimated the EE of stationary activities (bias: 0.31 ± 0.47 MET) and walking (bias: 0.61 ± 0.72 MET) and underestimated the EE of cycling (bias: -0.90 ± 1.18 MET; P < 0.05). Biases of EE in stationary activities (ANNEE: 0.31 ± 0.47 MET, Tree-ASPE: 0.08 ± 0.21 MET) and walking (ANNEE 0.61 ± 0.72 MET, Tree-ASPE: 0.29 ± 0.64 MET) were significantly smaller in the Tree-ASPE than in the ANNEE (P < 0.05). The Tree-ASPE was more precise in estimating the EE than the ANNEE. The use of activity-type-specific information for subsequent EE prediction equations might be a promising approach for future studies.

Background: We sought to identify extensive ischemia on exercise echocardiography (ExE) relative to workload in patients without known coronary artery disease and to investigate whether ExE is useful in predicting outcomes in those with high exercise capacity (≥10 metabolic equivalents [METs]) plus a maximal test (≥85% of their maximal age-predicted heart rate [MAPHR])., Methods and Results: The analysis was performed on 4269 patients who underwent ExE, of whom 3995 achieved ≥85% of their MAPHR. These patients were divided according to the reached workload (<7, 7-9, or ≥10 METs) and compared for ExE results. Outcomes in the group achieving ≥10 METs plus ≥85% of their MAPHR (n=2221) were specifically assessed. Ischemia was defined as new/worsening wall motion abnormalities with exercise. ExE results were different between groups because the METs were lower. Still, among patients achieving ≥10 METs plus ≥85% of their MAPHR, 9.3% had extensive ischemia and 6% multiterritory disease. During follow-up in this subgroup, 108 patients died and 42 had a major cardiac event. Annualized mortality and major cardiac event rates were 0.84% and 0.32% in patients without ischemia versus 2.26% and 0.84% in those with ischemia, respectively (P<0.001 and P=0.002, respectively). Ischemia was an independent predictor of mortality (hazard ratio, 1.88; 95% confidence interval, 1.23-2.89; P=0.004) and major cardiac event (hazard ratio, 2.39; 95% confidence interval, 1.22-4.71; P=0.01)., Conclusions: Patients without known coronary artery disease achieving ≥10 METs plus ≥85% of their MAPHR may still have ischemia. However, the low event rates even in those with ischemia limit the usefulness of imaging for assessing outcomes in this group.

Aim: Cardiac rehabilitation is a key part in the treatment of coronary artery disease (CAD) by its anti-infammatory effects. However, the effect of exercise training programs on salivary concentrations of high-sensitivity C-reactive protein (hs-CRP) in patients with coronary artery disease has not been well studied. The objective of this study was to evaluate the effect of phase III cardiac rehabilitation on serum and salivary levels of hs-CRP, in relation to the anthropometric measurements of obesity and the relationship between salivary and serum levels of hs-CRP in CAD male patients., Materials and Methods: Forty male volunteers (45-75 years) with CAD participated in 6 to 8 weeks of moderate intensity aerobic exercise training consisting of 45 minutes sessions of treadmill, stationary bicycle and arm ergometer. Anthropometric measurements of obesity, serum level of hs-CRP, stimulated and nonstimulated salivary level of hs-CRP were measured at the beginning, in the middle and at the end of exercise sessions., Results: All anthropometric measurements increased (p < 0.05) following cardiac rehabilitation except waist-hip ratio. Serum hs-CRP level reduced by 36% independent to the anthropometric measurements changes. Stimulated and nonstimulated salivary hs-CRP level decreased 68 and 54%, respectively, after 24 sessions of cardiac rehabilitation. Nonstimulated salivary hs-CRP levels correlated to serum levels of hs-CRP at baseline and after 24 sessions (p < 0.05)., Conclusion: Phase III cardiac rehabilitation seems to be effective to improve serum and salivary hs-CRP concentrations independent of anthropometric measurements., Clinical Significance: Nonstimulated salivary hs-CRP measurement could be a surrogate for blood measurement of hs-CRP during cardiac rehabilitation in male patients with CAD.

Purpose: This study aimed to measure the metabolic cost (METs) of walking activities in older adults, to examine the relationship between accelerometer output and METs across walking activities, and to compare measured MET values in older adults with the MET values in the compendium., Methods: Twenty older adults (mean age = 75, range = 60-90 yr) completed eight walking activities (five treadmill based, three free living) for 6 min each. Oxygen consumption (V˙O2) and resting metabolic rate (RMR) were measured using a portable metabolic system, and motion was recorded using a waist-mounted ActiGraph accelerometer (GT3X; ActiGraph, Pensicola, FL). Energy expenditure across activities was defined as kilocalories per minute and measured as METs (V˙O2 / RMR) and standard METs (V˙O2 / 3.5 mL·kg-1·min-1). Mixed modeling was used to assess differences in counts per minute and kilocalories per minute by weight status, sex, comorbidity status, and functional status. Linear regression analysis was applied to develop a prediction equation for kilocalories per minute. Energy costs of walking were subsequently compared with METs in the compendium of physical activities., Results: Average measured RMR was 2.6 mL·kg-1·min-1, 31.6% less than the standard RMR of 3.5 mL·kg-1·min-1. On average, standard METs were 71% lower than the measured METs across all walking activities. Measured MET levels differed from previously reported values in the literature and values listed in the compendium, resulting in misclassification of activity intensities for 60% of the walking conditions. Average counts for the walking activities ranged from 809 (treadmill = 1.5 mph) to 4593 counts per minute (treadmill = 3.5 mph). Previous regression equations consistently overestimate all activities compared with the measured energy cost in this sample of older adults., Conclusion: This study identifies the need for equations and cut points specific to older adults.

The aim of this study was to explore the possibility of identifying clusters of children's games based on estimated energy expenditures and (or) intensity when performed in a guided active play format. The study also investigated whether the identified active play game clusters were repeatable when the games were performed on different days. Children (9.7 ± 1.1 years; n = 12) were assessed for oxygen consumption, heart rate, energy expenditure (EE), and metabolic equivalent (MET) on a treadmill (at 4, 6, and 8 km·h(-1) (0% grade)). HR and ActiGraph GT1M accelerometer (ACC) generated linear regression equations were used to estimate EE. The ACC (3 s epochs) were used for estimating METs in assigning percent time at medium-vigorous physical activity (%MVPA) of 10 self-paced games. The results showed a consistent range of EEs (ACC-equation) from 13.57 kcal·(5 min)(-1) to 25.00 kcal·(5 min)(-1) (p < 0.05); EEs (HR-equation) from 29.72 to 42.49 kcal·(5 min)(-1) (p < 0.05); and %MVPA from 10% to 34% (p < 0.05) (from ACC equations) across all games. These were reproducible from day to day (p > 0.05). This study confirms the existence of active play children's game clusters that might be useful in formatting guided active play in a dose-response manner for children.

The health benefits of a physically active lifestyle across a person's lifespan have been established. If there is any single physical activity behaviour that we should measure well and promote effectively, it is ambulatory activity and, more specifically, walking. Since public health physical activity guidelines include statements related to intensity of activity, it follows that we need to measure and promote free-living patterns of ambulatory activity that are congruent with this intent. The purpose of this review article is to present and summarize the potential for using cadence (steps/minute) to represent such behavioural patterns of ambulatory activity in free-living. Cadence is one of the spatio-temporal parameters of gait or walking speed. It is typically assessed using short-distance walks in clinical research and practice, but free-living cadence can be captured with a number of commercially available accelerometers that possess time-stamping technology. This presents a unique opportunity to use the same metric to communicate both ambulatory performance (assessed under testing conditions) and behaviour (assessed in the real world). Ranges for normal walking cadence assessed under laboratory conditions are 96-138 steps/minute for women and 81-135 steps/minute for men across their lifespan. The correlation between mean cadence and intensity (assessed with indirect calorimetry and expressed as metabolic equivalents [METs]) based on five treadmill/overground walking studies, is r = 0.93 and 100 steps/minute is considered to be a reasonable heuristic value indicative of walking at least at absolutely-defined moderate intensity (i.e. minimally, 3 METs) in adults. The weighted mean cadence derived from eight studies that have observed pedestrian cadence under natural conditions was 115.2 steps/minute, demonstrating that achieving 100 steps/minute is realistic in specific settings that occur in real life. However, accelerometer data collected in a large, representative sample suggest that self-selected walking at a cadence equivalent to ≥100 steps/minute is a rare occurrence in free-living adults. Specifically, the National Health and Nutrition Examination Survey (NHANES) data show that US adults spent ≅4.8 hours/day in non-movement (i.e. zero cadence) during wearing time, ≅8.7 hours at 1-59 steps/minute, ≅16 minutes/day at cadences of 60-79 steps/minute, ≅8 minutes at 80-99 steps/minute, ≅5 minutes at 100-119 steps/minute, and ≅2 minutes at 120+ steps/minute. Cadence appears to be sensitive to change with intervention, and capitalizing on the natural tempo of music is an obvious means of targeting cadence. Cadence could potentially be used effectively in epidemiological study, intervention and behavioural research, dose-response studies, determinants studies and in prescription and practice. It is easily interpretable by researchers, clinicians, programme staff and the lay public, and therefore offers the potential to bridge science, practice and real life.

Background: The activPAL has been identified as an accurate and reliable measure of sedentary behaviour. However, only limited information is available on the accuracy of the activPAL activity count function as a measure of physical activity, while no unit calibration of the activPAL has been completed to date. This study aimed to investigate the criterion validity of the activPAL, examine the concurrent validity of the activPAL, and perform and validate a value calibration of the activPAL in an adolescent female population. The performance of the activPAL in estimating posture was also compared with sedentary thresholds used with the ActiGraph accelerometer., Methodologies: Thirty adolescent females (15 developmental; 15 cross-validation) aged 15-18 years performed 5 activities while wearing the activPAL, ActiGraph GT3X, and the Cosmed K4B2. A random coefficient statistics model examined the relationship between metabolic equivalent (MET) values and activPAL counts. Receiver operating characteristic analysis was used to determine activity thresholds and for cross-validation. The random coefficient statistics model showed a concordance correlation coefficient of 0.93 (standard error of the estimate = 1.13). An optimal moderate threshold of 2997 was determined using mixed regression, while an optimal vigorous threshold of 8229 was determined using receiver operating statistics. The activPAL count function demonstrated very high concurrent validity (r = 0.96, p<0.01) with the ActiGraph count function. Levels of agreement for sitting, standing, and stepping between direct observation and the activPAL and ActiGraph were 100%, 98.1%, 99.2% and 100%, 0%, 100%, respectively., Conclusions: These findings suggest that the activPAL is a valid, objective measurement tool that can be used for both the measurement of physical activity and sedentary behaviours in an adolescent female population.

Purpose: Patients with exercise capacity of <5 metabolic equivalents (METs) are considered to have a high risk of death. The aim of this study was to determine age-related differences in physical activity associated with an exercise capacity of ≥5 METs in chronic heart failure (CHF) outpatients., Methods: We enrolled 157 stable CHF patients (79.6% men, age 60.3 ± 11.5 years). Patients were divided into two age-based groups (middle-aged, <65 years, n = 97) and (older-aged, ≥65 years, n = 60). Peak oxygen uptake (peak (V)O(2)) was assessed by cardiopulmonary exercise testing. We further divided patients into groups according to exercise capacity: ≥5 METs and <5 METs. Physical activity was assessed by measuring the average number of steps/day for 1 week with an electronic pedometer., Results: Receiver-operating characteristic curves were used to select cutoff values for steps associated with an exercise capacity of ≥5 METs in the middle- and older-aged patients. Cutoff values of 6045 steps in the middle-aged and 6070 steps in the older-aged patients were determined., Conclusions: Both middle- and older-aged CHF patients with exercise capacity of ≥5 METs completed approximately 6000 steps/day. This could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients., Implications for Rehabilitation: • Middle-aged and older-aged chronic heart failure (CHF) patients with a measured exercise capacity of ≥5 METs completed approximately 6000 steps/day as measured by electronic pedometer. • This amount of steps could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients.