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Background: Cataracts may increase risk for falls but studies on this topic from low- and middle-income countries (LMICs) are scarce. Therefore, we examined the cross-sectional association between self-reported visual symptoms (suggesting cataract) and self-reported injurious falls in nationally representative samples of adults aged ≥ 65 years from five LMICs (China, Ghana, India, Mexico, and Russia). Methods: Data from the WHO Study on global AGEing and adult health (SAGE) were analysed. Self-reported information on past 12-month fall-related injury and cataract based on symptoms were collected. Multivariable logistic regression and meta-analyses were conducted to assess associations. Results: Data on 13,101 people aged ≥ 65 years were analysed [mean (SD) age 72.5 (11.3) years; 45.2% males]. The overall prevalence of self-reported fall-related injury and visual symptoms (suggesting cataract) were 4.9% and 29.4%, respectively. There was a positive association between self-reported visual symptoms (suggesting cataract) and fall-related injury (i.e., OR > 1) in all five countries but statistical significance was reached in three: China (OR = 1.60; 95% CI = 1.08–2.35), India (OR = 1.96; 95% CI = 1.15–3.35), and Russia (OR = 3.58; 95% CI = 2.06–6.24). The pooled OR including all five countries based on a meta-analysis was OR = 1.88 (95% CI = 1.32–2.68). Conclusions: Self-reported visual symptoms (suggesting cataract) were associated with higher odds for self-reported injurious falls among older adults in LMICs. Expanding availability of cataract surgery in LMICs may also have the additional benefit of reducing falls among older people.

ABSTRACTOver a 30-year period, we have authored five versions of the textbook Psychology of Physical Activity. This provides us with more than three decades of experience to reflect on the field of the psychology of physical activity. Typically, the book has been structured around the three themes of determinants/correlates and theory, mental health outcomes, and behaviour change interventions. In the current paper, we delimit our reflections to physical activity correlates and barriers, and the use of theory. Overall, the field has expanded greatly. Physical activity is central to most national preventive health policy initiatives and is now highly visible. Over the 30 years of our book writing, we have seen trends in the correlates and barriers for physical activity that reflect an increasing recognition of the different types and intensities of physical activity, some reflecting in a “systems thinking” approach that recognises the natural complexity of the behaviour and its settings. But further work is recommended in gaining clarity on the frequently stated barrier of “lack of time” and assumed physical activity correlate of enjoyment. Moreover, the move to a dual-process approach to theory is one that will continue to develop but may need more work in its application to behaviour change. A reflection across recent editions of the book suggest that some good progress has been made, but not universally so.

OBJECTIVE--To investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance (IGT). [...]

Globally, 2.2 billion people live with some form of vision impairment and/or eye disease. To date, most systematic reviews examining associations have focused on a single eye disease and there is no systematic evaluation of the relationships between eye diseases and diverse physical and mental health outcomes. Moreover, the strength and reliability of the literature is unclear. We performed an umbrella review of observational studies with meta analyses for any physical and/or mental comorbidities associated with eye disease. For each association, random-effects summary effect size, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence from convincing to weak. 34 studies were included covering 58 outcomes. No outcomes yielded convincing evidence, six outcomes yielded highly suggestive results (cataract positively associated with type 2 diabetes, open-angled glaucoma positively associated with myopia and diabetes, diabetic retinopathy positively associated with cardiovascular disease and cardiovascular mortality, and retinopathy of prematurity positively associated with chorioamnionitis), eight outcomes yielded suggestive results (diabetic retinopathy positively associated with all-cause mortality and depression, diabetic macular oedema positively associated with dyslipidaemia, cataract positively associated with gout, nuclear sclerosis positively associated with all-cause mortality, open angled glaucoma positively associated with migraine and hypertension, and age-related macular degeneration positively associated with diabetes), and 18 outcomes yielded weak evidence. Results show highly suggestive or suggestive evidence for associations between several types of eye diseases with several comorbid outcomes. Practitioners and public health policies should note these findings when developing healthcare policies.

Background: Little is known about the association between cataract and multimorbidity. Therefore, the aim of the present study was to examine the relationship between cataract and chronic conditions and multimorbidity in a large representative sample of Spanish adults. Methods: This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23,089 adults aged ≥15 years from Spain [54.1% female; mean (standard deviation) age 53.4 (18.9) years]. Cataract and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of at least two physical and/or mental chronic conditions (excluding cataract). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic and negative binomial regression analyzes were conducted to assess associations. Results: The prevalence of cataract and multimorbidity was 12.5% and 56.5%, respectively. All chronic conditions were significantly more frequent in individuals with than in those without cataract. Overall, there was a positive relationship between cataract and multimorbidity [odds ratio (OR) = 2.77; 95% confidence interval (CI): 2.39–3.21]. In addition, cataract was significantly associated with the number of chronic conditions in the whole population [incidence rate ratio (IRR) = 1.34; 95% CI: 1.29–1.38]. Conclusions: Cataract is positively associated with chronic conditions and multimorbidity in adults. Interventions specifically designed for those with cataract to reduce or manage co-occurring chronic conditions and multimorbidity are urgently required.

Background:: Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association. Methods:: Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations. Results:: Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38–1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45–2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67–2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA. Conclusions:: In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.

ObjectivesTo determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness.DesignPooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity.ParticipantsData for 6621 children and adolescents aged 4–18 years from 20 trials were included.Main outcome measuresPeak oxygen consumption (VO2PeakmL/kg/min) and minutes of moderate and vigorous physical activity.ResultsInterventions modestly improved students’ cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness.ConclusionsFuture interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Background: There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs). Methods: Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression. Results: Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87–1.40), 1.69 (1.25–2.27), and 3.38 (1.69–6.77), respectively. The estimates for females and males were similar. Conclusions: The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.

Cardiac rehabilitation is a key component in the secondary prevention of cardiovascular disease. However, uptake and adherence to programmes is suboptimal, especially for patients with heart failure. Traditionally, cardiac rehabilitation programmes have involved moderate-intensity continuous training; however, there is growing evidence that high-intensity interval training can produce equal or superior effects in both healthy and diseased populations. High-intensity interval training has already been shown to be both safe and effective, but the optimal protocols and delivery mechanisms are yet to be determined. Despite this, high-intensity interval training has the potential to offer an alternative mechanism of cardiac rehabilitation delivery to patients with heart failure, with the possibility of overcoming some of the challenges usually faced (such as patients' lack of time) in implementing successful cardiac rehabilitation programmes. This article aims to summarise the current knowledge surrounding the inclusion of high-intensity interval training in cardiac rehabilitation programmes, specifically focusing on those patients living with heart failure.

A study was conducted to examine the effect of different epoch lengths on derived levels of physical activity in both a child and an adolescent sample. The results strongly recommended a short epoch for child and adolescent samples to obtain a 'real' picture of young people's physical activity behavior and to prevent accumulation of counts reflecting the average activity level for longer epochs used.

Aims of this study were: (i) to examine relationships between free bus travel and wellbeing, and (ii) to assess the extent to which these associations can be explained by two key potential mediators: social isolation and physical activity.

Examines the behavioral epidemiology of physically active and sedentary behaviors of children. Attribution of television watching and low physical activity with the sedentary behavior of children; Contention of the author that the increase in physical activity results in the decrease of targeted sedentary behavior; Necessity for continued recognition of the complexity of human behavior.

There is growing concern over the effects of sedentary lifestyles on the health of young people. Recent rapid increases in juvenile obesity have received a great deal of attention in the scientific and popular press and have been attributed partly to television viewing, computer games and other sedentary behaviours. These are thought to compete with physical activity. There is a ‘moral panic’ concerning the ‘couch kids’ culture in modern western society. Project STIL (Sedentary Teenagers and Inactive Lifestyles) at Loughborough University is investigating ‘what young people do’ and focuses on active and inactive pursuits chosen in their leisure time. The following issues are addressed in this paper with specific reference to young people: how do we define ‘sedentary behaviour’ and do key sedentary behaviours displace physical activity? Are key sedentary behaviours obesogenic? What are the secular trends for children and youth for TV viewing? Our results for young people suggest that:1. TV viewing and video-game playing are largely uncorrelated with physical activity, suggesting that there is time for both2. meta-analytic findings show that body fatness is not related in any clinically meaningful way with key sedentary behaviours3. although more children and youth have greater access to TVs than in previous generations, the amount of TV watched per head has not changed for 40 years.Preliminary findings from Project STIL suggest that inactivity is more complex than we sometimes think. Indeed, measures of ‘couch potato-ism’, such as TV viewing, may be inappropriate markers of inactivity.

This paper is concerned with the reconstruction, at the departmental level, of a university assessment policy that required a shift from norm-referenced assessment to criterion-referenced assessment (CRA). As such, it provides an account of a change process driven by a centralised policy imperative and yet implemented and driven also from a bottom-up process. A wide range of data was gathered using action research methods. Individual and focus group interviews were conducted with staff and students, participant journals were kept and successive drafts of criteria and standards, and samples of students' responses were collected. The data suggested that a top-down policy can be successfully combined with a departmental-driven process, if financial and time considerations are addressed and a collaborative process amongst staff is sustained. The use of action learning, as a tool for change, appeared to assist participants to begin to own a top-down policy.

AbstractScreen media (television, computers, and videogames) use has been linked to multiple child outcomes, including obesity. Parents can be an important influence on children's screen use. There has been an increase in the number of instruments available to assess parenting in feeding and physical activity contexts, however few measures are available to assess parenting practices regarding children's screen media use. A working group of screen media and parenting researchers convened at the preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity (ISBNPA) annual meeting, “Parenting Measurement: Current Status and Consensus Reports,” to identify and prioritize issues in assessing screen media parenting practices. The group identified that screen media use can pose different risks for children, depending on their age and developmental stage, across physiologic, psychosocial, and development outcomes. With that in mind, a conceptual framework of how parents may influence their child's screen-viewing behaviors was proposed to include the screen media content, context of viewing, and amount viewed. A research agenda was proposed to prioritize a validation of the framework and enhance the ability of researchers to best assess parenting influences across the three domains of content, context and amount of children's screen media use.