Exploring Activity Patterns In Chronic Low Back Pain Patients Using Accelerometry-based Step Count Data

Cognitive impairment represents a major public health challenge affecting older adults' health and quality of life. Dietary diversity and physical activity are important modifiable lifestyle factors; however, previous studies have pre-dominantly relied on single time-point assessments, neglecting longitudinal behavioral changes. This study investigated the association between joint longitudinal trajectory patterns of dietary diversity and physical activity and cognitive function in older adults. Using data from four waves (2008-2018) of the Chinese Longitudinal Healthy Longevity Survey, we included 1,826 older adults aged ≥65 years with normal baseline cognitive function. Latent class growth analysis identified distinct trajectory patterns of dietary diversity score (DDS) and physical activity (PA) from 2008 to 2014, which were cross-classified into joint trajectory groups. Cognitive impairment (education-stratified MMSE cutoffs) and continuous MMSE scores in 2018 served as outcomes. Modified Poisson regression and multivariable linear regression examined associations between joint trajectories and cognitive function. Two DDS trajectories (high-stable: 53.5%; low-stable: 46.5%) and two PA trajectories (high: 37.2%; low: 62.8%) formed four joint trajectory groups. Over 10-year follow-up, cognitive impairment incidence was 18.1%. Compared with the "High DDS and High PA" reference group, the "High DDS and Low PA" group (RR = 1.48, 95% CI: 1.10-2.01) and "Low DDS and Low PA" group (RR = 1.41, 95% CI: 1.03-1.93) showed significantly elevated cognitive impairment risks. For continuous MMSE scores, the "High DDS and Low PA" group (β = -1.12, 95% CI:-1.94 to -0.30) and "Low DDS and Low PA" group (β = -1.20, 95% CI: -2.04 to -0.36) demonstrated significantly poorer cognitive function. Sensitivity analyses confirmed these findings. Maintaining high dietary diversity with regular physical activity was associated with optimal cognitive function. Physical inactivity emerged as an independent risk factor for cognitive decline that favorable dietary habits could not fully offset. These findings support integrated cognitive health strategies combining dietary intervention with physical activity promotion.

Despite recognition of the important influence of environmental determinants on physical activity patterns, minimal empirical research has been done to assess the impact of environmental/contextual determinants of physical activity. This article aims to investigate environmental and sociodemographic determinants of physical activity and inactivity patterns among subpopulations of US adolescents. We define environmental determinants as modifiable factors in the physical environment that impose a direct influence on the opportunity to engage in physical activity. The present research examines environmental and sociodemographic determinants of physical activity and inactivity with the implication that these findings can point toward societal-level intervention strategies for increasing physical activity and decreasing inactivity among adolescents. The study population consists of nationally representative data from the 1996 National Longitudinal Study of Adolescent Health on 17 766 US adolescents enrolled in US middle and high schools (including 3933 non-Hispanic blacks, 3148 Hispanics, and 1337 Asians). Hours/week of inactivity (TV/video viewing and video/computer games) and times/week of moderate to vigorous physical activity were collected by questionnaire. Outcome variables were moderate to vigorous physical activity and inactivity, which were broken into categories (physical activity: 0-2 times/week, 3-4 times/week, and >/=5 times/week; inactivity: 0-10 hours/week, 11-24 hours/week, and >/=25 hours/week). Sociodemographic and environmental correlates of physical activity and inactivity were used as exposure and control variables and included sex, age, urban residence, participation in school physical education program, use of community recreation center, total reported incidents of serious crime in neighborhood, socioeconomic status, ethnicity, generation of residence in the United States, presence of mother/father in household, pregnancy status, work status, in-school status, region, and month of interview. Logistic regression models of high versus low and medium physical activity and inactivity were used to investigate sex and ethnic interactions in relation to environmental and sociodemographic factors to examine evidence for the potential impact of physical education and recreation programs and sociodemographic factors on physical activity and inactivity patterns. Moderate to vigorous physical activity was lower and inactivity higher for non-Hispanic black and Hispanic adolescents. Participation in school physical education programs was considerably low for these adolescents and decreased with age. Participation in daily school physical education (PE) program classes (adjusted odds ratio [AOR]: 2.21; confidence interval [CI]: 1.82-2.68) and use of a community recreation center (AOR: 1.75; CI: 1.56-1.96) were associated with an increased likelihood of engaging in high level moderate to vigorous physical activity. Maternal education was inversely associated with high inactivity patterns; for example, having a mother with a graduate or professional degree was associated with an AOR of.61 (CI:.48-.76) for high inactivity. High family income was associated with increased moderate to vigorous physical activity (AOR: 1.43; CI: 1.22-1.67) and decreased inactivity (AOR:.70; CI:.59-.82). High neighborhood serious crime level was associated with a decreased likelihood of falling in the highest category of moderate to vigorous physical activity (AOR:.77; CI:.66-.91). These results show important associations between modifiable environmental factors, such as participation in school PE and community recreation programs, with activity patterns of adolescents. Despite the marked and significant impact of participation in school PE programs on physical activity patterns of US adolescents, few adolescents participated in such school PE programs; only 21.3% of all adolescents

Background: Self-efficacy is the belief that one is able to respond to demands of a stressful situation and it has both direct and indirect effects on health. The study objective is to investigate the amount of variance in patient-reported physical function (PF) that is explained by self-efficacy compared to clinician-reported disability and other patient-reported domains of health, and evaluate whether self-efficacy mediates the relationship between PF and other domains of health. Methods: Observational cohort study of 248 patients who were seen in a cerebrovascular clinic 3/18/20 - 7/7/20 and completed the following patient-reported outcome measures (PROMs) as part of the routine office visit: PROMIS PF, general self-efficacy, fatigue, and pain interference. Linear regression models were constructed to determine the amount of variance (adjusted R 2 ) in PROMIS PF score explained by the modified Rankin Scale (mRS) and additional PROM scores. The mRS and individual PROMs were added separately to a base model adjusted for demographic characteristics. Mediation analysis was conducted to determine the extent to which self-efficacy mediated the relationship between PF and other PROMs. Results: Mean age of study cohort was 61.5 (SD=13.5) years and 48.4% were female. The base model explained 4.5% of the variance of PF. Adding PROMIS fatigue resulted in the largest increase in the proportion of variance explained (adj R 2 = 47.7%), followed by PROMIS self-efficacy (40.7%), PROMIS pain interference (38.7%), and mRS (26.6%). Self-efficacy significantly mediated the relationship between fatigue and PF (standardized indirect effect: 0.11 (bias-corrected 95% CI: 0.05-0.18), 20.9% of total effect) and pain interference and PF (standardized indirect effect 0.10 (95% CI: 0.06-0.17), 27.1% of total effect). Conclusion: PROMIS self-efficacy explains more variance in stroke patients’ perceived physical function than their disability. This suggests that interventions to improve self-efficacy could have a significant effect on patient’s perceived health. Patients’ fatigue, despite being partially mediated by self-efficacy, was a large contributor to self-reported PF and should be included as part of an evaluation of patient’s physical health.

Background: Clinical management of chronic pain often includes recommendations to engage in physical activity (PA), though there are little data on the interplay between pain symptoms and key aspects of PA participation (e.g., intensity and bout duration) among older adults. Herein we investigate the longitudinal relationships between changes in PA behavior and changes in pain intensity and interference among low-active older adults with obesity and chronic pain. Methods: Participants (N = 41) were enrolled in two randomized pilot trials wherein they were assigned to an intervention focused on participation in frequent PA across the day, or to a low-contact control. Participants completed the 3-item PROMIS pain intensity scale and 8-item PROMIS pain interference scale before and after the interventions. Participants also wore an ActivPAL accelerometer for 7days before and during the final week of the interventions. Results: A series of linear regression analyses demonstrated that increased time spent stepping at a high-light intensity in very short bouts was associated with increased pain intensity scores. By contrast, increased time spent stepping at a high-light intensity in bouts of 5-20min was associated with reductions in pain intensity and interference scores. Increased time spent stepping at a moderate intensity overall was associated with reduced pain intensity scores, and time spent stepping at a moderate intensity for 10-20min associated with reduced pain interference. Conclusion: These findings suggest older adults with chronic pain may benefit by moving at high-light or moderate intensities in brief bouts of at least 5min in duration.

Diabetic retinopathy (DR), the leading cause of vision loss in elderly individuals, coupled with limited treatment options, has prompted efforts to identify modifiable risk factors associated with DR. The purpose of this study was to explore the associations between the “weekend warrior” (WW) physical activity (PA) pattern and DR risk in U.S. adults and to examine how Hb levels mediate this relationship. Cross-sectional study data were obtained from nationally representative NHANES data from 2007 to 2018. The PA pattern was categorized as inactive, insufficiently active, WW, or regularly active (RA). The study ultimately included 6145 U.S. adults, including 1043 participants with DR and 5102 participants with DM but not DR. Multivariate logistic regression modelling indicated that both the WW (OR = 0.631, 95% CI = 0.487–0.818, P < 0.001) and RA (OR = 0.738, 95% CI = 0.574–0.959, P = 0.018) PA patterns were significant protective factors against DR compared with the inactive PA pattern. Moreover, compared to the RA and insufficiently active PA patterns, WW did not show a significant association with DR, whereas the inactive PA pattern (OR = 1.355, 95% CI = 1.054–1.742, P = 0.018) was a risk factor. Mediation analysis revealed a significant partial mediation effect of Hb level on the association between PA pattern and DR risk, with a mediation ratio of 5.95%. Our study revealed that the WW and RA PA patterns are protective factors against DR and that Hb levels mediate this association. In comparison, the WW PA pattern is the most cost effective for DR prevention.

The global decline in adolescent physical activity (PA) levels has become a major public health concern, contributing to an increased risk of non-communicable diseases and impaired psychosocial development. Emerging evidence indicates significant ethnic disparities in PA patterns and sedentary behavior (SB) profiles among adolescents. Within the unique geographical and cultural context of the Tibetan Plateau, understanding behavioral differences between Tibetan and Han Chinese adolescents is crucial for designing effective, targeted health interventions. Therefore, this study aimed to examine ethnic-specific differences in PA levels and SB patterns among Tibetan and Han Chinese adolescents residing in Xizang. A total of 1,256 Tibetan and Han Chinese adolescents participated in this study. PA and SB were objectively measured using accelerometers. Data collection was segmented into four distinct periods: weekdays versus weekends, and in-school versus out-of-school time on weekdays. Ethnic differences in activity patterns were analyzed using one-way analysis of covariance, adjusting for age, body mass index (BMI), socioeconomic status (SES), and accelerometer wear time. On weekdays, Tibetan boys engaged in significantly more moderate-to-vigorous physical activity (MVPA) (44.1 ± 16.3min/day) than Han Chinese boys (35.3 ± 10.9min/day; p = 0.011, η2 = 0.011). Tibetan girls also exhibited significantly more sedentary time (654.1 ± 123.2min/day) than Han Chinese girls (613.0 ± 103.8min/day; p = 0.001, η2 = 0.018). On weekends, Tibetan boys recorded more MVPA (43.0 ± 27.1min/day) than Han Chinese boys (35.3 ± 20.2min/day; p = 0.003, η2 = 0.014) and greater sedentary time (561.0 ± 172.8min/day) compared to Han Chinese boys (514.1 ± 175.6min/day; p < 0.05). During school hours, Tibetan boys spent less time in SB (423.7 ± 112.2min/day) than Han Chinese boys (450.8 ± 102.0min/day; p = 0.011, η2 = 0.011). Out of school, Tibetan boys engaged in more MVPA (20.0 ± 7.9min/day) than Han Chinese boys (15.2 ± 6.1min/day; p < 0.01, η2 = 0.088), and Tibetan girls showed higher MVPA levels (20.5 ± 8.3min/day) than Han Chinese girls (15.8 ± 6.2min/day; p < 0.01, η2 = 0.060). Both Tibetan boys (645.5 ± 117.2min/day) and girls (672.5 ± 123.8min/day) had significantly more sedentary time than Han Chinese boys (639.4 ± 117.7min/day) and girls (594.0 ± 102.9min/day; p < 0.01, η2 = 0.180; p < 0.01, η2 = 0.207). This comparative analysis revealed clear ethnic differences in activity patterns. Tibetan adolescents exhibited higher overall PA levels and total sedentary time compared to Han Chinese adolescents. However, Tibetan adolescents tended to interrupt sedentary periods more frequently, whereas Han Chinese adolescents were more likely to engage in prolonged, uninterrupted SB.

Our purpose in this study was to examine the patterns of physical activity and demographic characteristics associated with those patterns in Korean immigrants in the United States. Participants were 197 women, and the International Physical Activity Questionnaire was utilized. The inactive pattern was the most frequent pattern in all domains of physical activity except household physical activity. There were differences among the patterns of physical activity that were associated with variations in demographic characteristics. Health care providers who serve immigrants should assess physical activity level and demographic characteristics of the immigrants to enhance their physical activity.

Environmental factors including seasonal changes are important to guide physical activity (PA) programs to achieve or sustain weight loss. The goal was to determine seasonal variability in the amount and patterns of free-living PA in women. PA was measured in 57 healthy women from metropolitan Nashville, TN, and surrounding counties (age: 20 to 54 years, body mass index: 17 to 48 kg/m2) using an accelerometer for 7 consecutive days during 3 seasons within 1 year. PA counts and energy expenditure (EE) were measured in a whole-room indirect calorimeter and used to model accelerometer output and to calculate daily EE and intensity of PA expressed as metabolic equivalents (METs). PA was lower in winter than in summer (131+/-45 vs. 144+/-54x10(3) counts/d; P=.025) and in spring/fall (143+/-48x10(3) counts/d; P=.027). On weekends, PA was lower in winter than in summer by 22,652 counts/d (P=.008). In winter, women spent more time in sedentary activities than in summer (difference 35 min/d; P=.007) and less time in light activities (difference -29 min/d, P=.018) and moderate or vigorous activities (difference -6 min/d, P=.051). Women living in the southeastern United States had lower PA levels in winter compared with summer and spring/fall, and the magnitude of this effect was greater on weekends than weekdays.

Purpose To determine if preoperative physical and psychological health risk factors are influential on physical function and satisfaction scores in a cohort of relatively younger adults one year post-total knee arthroplasty. Methods Sixty-five patients were recruited pre- and one year post-total knee arthroplasty. Physical (i.e., body mass index, sex, physical activity level, number of comorbidities) and psychological (i.e., depression, expectations, pain inference) health risk factors were obtained pre-total knee arthroplasty and compared to Patient-Reported Outcomes Measurement Information System physical function computerized adaptive testing and satisfaction scores one year post-total knee arthroplasty. Results Bootstrap inclusion fraction methods were performed to compare the stability of each predictor variable prior to final regression analyzes. Poorer preoperative physical activity level (standardized regression coefficient = 0.37; p < 0.01), pain interference (standardized regression coefficient = –0.24; p = 0.03) and greater comorbidities (standardized regression coefficient = –0.27; p = 0.01) resulted in worse physical function scores one year post-total knee arthroplasty. Greater preoperative comorbidities (odds ratio = 0.63; p < 0.01) resulted in worse satisfaction scores one year post-total knee arthroplasty. No other predictor variable had any relationship on either clinical outcome (p > 0.05). Conclusion Younger adults with greater comorbidities, lower physical activity level and higher pain interference scores preoperatively reported poorer functional recovery one year post-total knee arthroplasty. Understanding how preoperative status of younger adults undergoing total knee arthroplasty may lead to better improved surgical decision making and health care delivery for this vulnerable and growing patient subgroup. Implications for Rehabilitation Projections estimate total knee arthroplasty in relatively younger adults (<65 years) will make up the majority of surgical procedures performed in the United States within the next two decades, however little is known in this patient population. This study provides evidence that relatively younger adults with greater comorbidities, lower physical activity level and higher pain interference scores preoperatively result in poorer functional recovery one year post-total knee arthroplasty. The results also suggest greater comorbidities identified preoperatively have the largest influence on one year satisfaction scores in younger adults post-total knee arthroplasty. Modifiable characteristics such as improving physical activity level, incorporating pain management strategies and reducing comorbidities preoperatively or adopting into postoperative rehabilitative care may influence the postoperative physical function and satisfaction scores in relatively younger adults undergoing total knee arthroplasty.

Examining Pain Subgroups One and Five Years After Spinal Cord Injury: The Importance of Depression in Chronic Pain.

Objectively measured physical activity level and sedentary behavior in Norwegian children during a week in preschool.

To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p=0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p=0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r=-0.18, p=0.048) and higher physical function scores (r=0.22, p=0.03). Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.

Introduction: Despite the importance of physical activity (PA) for cardiovascular health, there is a scarcity of data on objectively measured PA in women with myocardial infarction (MI). We aim to describe 24-hour PA patterns and examine their variation by demographic and psychological factors in women with MI. Methods: Participants were enrolled in an ongoing multicenter trial of stress management in women with a history of MI. Participants completed self-reported psychological measures and 7-days of wrist-actigraphy monitoring (GT3X, Actigraph) at baseline (≥2 months post-MI). PA volumes were defined as the average vector magnitude (VM) counts per minute (cpm), a metric incorporating movement across all three axes of the accelerometer. This approach minimizes loss of information related to use of cut-points and describes accumulated 24-hour PA volumes. Hourly VM cpm were plotted to visualize 24-hour PA patterns and compared by age groups, race, elevated depressive symptoms (Patient Health Questionnaire-9 ≥5), and high stress levels (top quartile of Perceived Stress Scale-10). Due to the skewness, VM cpm were log-transformed and linear regression analysis was conducted to identify correlates of overall 24-hour PA. Results: Analyses included 85 participants (age = 59.9 ± 13.0, 20% African American, 16% participating in cardiac rehabilitation, 70% elevated depressive symptoms, 25% high stress). Patterns of PA across 24 hours differed by age, race, stress and depressive symptoms (Figure 1). For example, African American women with MI had peak PA later in the day than non-African American women, and less PA overall. Women with high (vs. low) stress had less PA overall and a less pronounced evening drop in PA, which may affect sleep. Those with elevated (vs. low) depressive symptoms showed lower PA levels, especially during the late afternoon and evening. After adjusting for age, race and cardiac rehabilitation, overall 24-hour PA volumes (log of average VM cpm) were significantly lower with higher stress (b = -0.26, p = 0.02) and elevated depressive symptoms (b = -0.22, p = 0.04). Conclusion: These findings may be considered to identify women with MI who may benefit from interventions to increase PA, which could reduce risk of recurrent CVD. Our data on timing of PA may be helpful in the tailored design of such programs.

ObjectiveWe evaluate change in low back pain (LBP) intensity and interference as the mechanism by which chiropractic care affects other biopsychosocial factors in US active-duty military members.DesignWe conducted secondary, exploratory...

To improve physical function, physical activity (PA) guidelines for older adults recommend completing PA in bouts of 10min or more. Spontaneous PA (< 10min) can also benefit older adults. However, a paucity of research exists examining if shorter bouts of PA are associated with greater physical function. To determine the association between various patterns of PA and the likelihood of greater physical function in older adults. Older adults from the 2003-2004 and 2005-2006 cycles of the National Health and Nutrition Examination Survey were included for analysis. PA lasting 1, 5, 10, 30, and 60min was quantified using accelerometers. Physical function was assessed using a Likert scale reflecting the self-reported capability to complete 11 tasks. A single function score was then computed using factor analysis. Logistic regression analyses calculated the association between PA bout length and the likelihood of above average function. PA performed in 1-min (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03), 5-min (OR 1.02; CI 1.01-1.03), or 10-min bouts (OR 1.02; CI 1.01-1.03) was associated with greater physical function following adjustment for confounders. When scaled to represent an accumulation of 10min of MVPA, likelihoods increased for both 1-min ([OR] 1.25; 95% [CI] 1.11-1.39) and 5-min (OR 1.22; 95% CI 1.08-1.37) bouts. Our findings suggest bouts of PA lasting 10min or shorter in duration are associated with greater physical function in older adults.