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Background: Greater time spent sedentary is linked with increased risk of breast, colorectal, ovarian, endometrial, and prostate cancers. Given steadily increasing rates of mobile phone ownership, mobile phone interventions may have the potential to broadly influence sedentary behavior across settings., Objective: The purpose of this study was to examine the short-term impact of a mobile phone intervention that targeted sedentary time in a diverse community sample., Methods: Adults participated in a quasi-experimental evaluation of a mobile phone intervention designed to reduce sedentary time through prompts to interrupt periods of sitting. Participants carried mobile phones and wore accelerometers for 7 consecutive days. Intervention participants additionally received mobile phone prompts during self-reported sitting and information about the negative health impact of prolonged sedentariness. The study was conducted from December 2012 to November 2013 in Dallas, Texas. Linear mixed model regression analyses were conducted to evaluate the influence of the intervention on daily accelerometer-determined estimates of sedentary and active time., Results: Participants (N=215) were predominantly female (67.9%, 146/215) and nonwhite (black: 50.7%, 109/215; Latino: 12.1%, 26/215; other: 5.6%, 12/215). Analyses revealed that participants who received the mobile phone intervention had significantly fewer daily minutes of sedentary time (B=-22.09, P=.045) and more daily active minutes (B=23.01, P=.04) than control participants., Conclusions: A simple mobile phone intervention was associated with engaging in less sedentary time and more physical activity. Findings underscore the potential impact of mobile phone interventions to positively influence sedentary behavior and physical activity.

Objective: To examine the cross-sectional relationships between standing time, obesity, and metabolic syndrome alongside and independent of leisure-time physical activity (LTPA)., Participants and Methods: The primary study sample consisted of 7075 adult patients (aged 20-79 years) from Cooper Clinic (Dallas, Texas). In this cross-sectional study we assessed the associations between reported standing time and directly measured obesity (body mass index ≥ 30), elevated waist circumference (men: ≥ 102 cm; women: ≥ 88 cm), body fat percentage (men: ≥ 25%; women ≥ 30%), and metabolic syndrome (yes/no). In addition, the joint associations of standing and LTPA on each outcome were examined. Multivariable logistic regression adjusting for confounders was used for statistical analyses., Results: Standing a quarter of the time or more was significantly associated with reduced odds of an elevated body fat percentage in men (P < .001) and a reduced likelihood of obesity (P < .009) and abdominal obesity (P=.04) in women. In addition, joint association analyses indicated that compared with the reference group (ie, not meeting the physical activity guidelines/standing almost none of the time), men and women who met the physical activity guidelines had lower odds of all obesity outcomes and metabolic syndrome with incremental additions of standing time (ie, a dose-response relationship)., Conclusion: Standing a quarter of the time per day or more is associated with reduced odds of obesity. The inverse relationship of standing to obesity and metabolic syndrome is more robust when combined with health-promoting LTPA. Prospective studies are warranted to confirm these findings and establish a causal relationship., (Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Background: For optimal health benefits, moderate- to vigorous-intensity physical activity (MVPA) is recommended in sustained bouts lasting ≥10 min. However, short spurts of MVPA lasting <10 min are more common in everyday life. It is unclear whether short spurts of MVPA further protect against the development of hypertension and obesity in middle-age adults beyond bouted MVPA., Methods: Objectively measured physical activity was collected in the Coronary Artery Risk Development in Young Adults study at the 20-yr (2005-2006) examination, and blood pressure and BMI were collected at the 20- and 25-yr (2010-2011) examinations. Time spent in MVPA was classified as either bouted MVPA, i.e., ≥10 continuous minutes or short spurts of MVPA, i.e., <10 continuous minutes. To examine the association of short spurts of MVPA with incident hypertension and obesity over 5 yr, we calculated risk ratios adjusted for bouted MVPA and potential confounders., Results: Among 1531 and 1251 participants without hypertension and obesity, respectively, at year 20 (age, 45.2 ± 3.6 yr; 57.3% women; body mass index, 29.0 ± 7.0 kg·m(-2)), 14.8% and 12.1% developed hypertension and obesity by year 25. Study participants in the highest tertile of short spurts of MVPA were 31% less likely to develop hypertension 5 yr later (risk ratio = 0.69 (0.49-0.96)) compared with those in the lowest tertile. There was no statistically significant association of short spurts of MVPA with incident obesity., Conclusions: These findings support the notion that accumulating short spurts of MVPA protects against the development of hypertension but not obesity in middle-age adults.

Background: A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors., Methods: We analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors., Results: Respondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors., Conclusion: We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)

Objective: To evaluate the measurement properties of the Transtheoretical Model (TTM) questionnaire for sedentary behaviors among college students and to examine the validity and reliability of the developed TTM questionnaire., Methods: Overall, 225 college students were recruited. For the 2-week test-retest reliability, a random sub-sample (N = 108) of the participants was used., Results: Statistically significant differences were found across the stages on the tests of concurrent (χ(2) = 25.0, p < .001) and construct (p < .01) validity. In addition, the internal consistency reliability (Cronbach alphas from .73 to .88) and test-retest reliability (intra-class correlation coefficients ranging from .80 to .94) were high for the questionnaires., Conclusions: These results demonstrate high validity and reliability of the TTM questionnaire when applied to sedentary behavior.

Objective: Scant evidence exists pertaining to objectively measured sedentary time and dietary quality among adults. Therefore, we examined the relationships between sedentary time, physical activity, and dietary quality., Methods: Cross-sectional analyses of a 4,910 US adults from two cycles (2003-2006) of the National Health and Nutrition Examination Survey. The primary independent variables were sedentary time and physical activity (continuous and categorical), while the outcomes were overall dietary quality (Healthy Eating Index (HEI) 2010), fruit and vegetable scores, and empty caloric intake (kcal)., Results: Multivariable analyses revealed that a 1min increase in daily sedentary behavior was associated with a 0.2kcal decrease in empty calories (-0.18, 95% CI=-0.34, -0.03); however, sedentary time was not significantly related to overall dietary quality (HEI) and fruit and vegetable intake. In comparison, a 1min increase in daily moderate-to-vigorous intensity physical activity was related to a 0.1 higher HEI score (0.08, 95% CI=0.04, 0.11), a 0.01 higher fruit score (0.01, 95% CI=0.01, 0.02), and conversely a 1.3kcal decrease in empty calories (-1.35, 95% CI=-2.01, -0.69). In addition, meeting physical activity guidelines was associated with a 2.8 point higher HEI score (2.82, 95% CI=1.40, 4.25), a 0.5 point higher fruit score (0.51, 95% CI=0.31-0.71), and 37.4 fewer empty calories (-37.43, 95% CI=-64.86, -9.10)., Conclusions: Physical activity is significantly related to better overall dietary quality, while sedentary behavior is not. Findings suggest the need to promote physical activity and encourage adherence to dietary guidelines jointly, whereas sedentary behavior and overall dietary quality might need to be targeted independently., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Research has shown that recent post-treatment breast cancer survivors face significant challenges around physical activity as they transition to recovery. This review examined randomized controlled trials targeting physical activity behavior change in breast cancer survivors <5 years post-treatment and described (1) characteristics of interventions for breast cancer survivors as well as (2) effect size estimates for these studies. A systematic search was conducted following PRISMA guidelines with Medline, PubMed, PsycINFO, CINAHL, and Scopus databases. Data were abstracted for primary intervention strategies and other details (e.g., setting, duration, theory use). A subgroup analysis was conducted to assess intensity of exercise supervision/monitoring and intervention effectiveness. The search produced 14 unique behavior intervention trials from the US and abroad published 2005-2013. The mean sample size was 153 participants per study. All interventions included moderate-intensity activities plus various behavioral change strategies. Most interventions were partially or entirely home based. The overall standardized mean difference was 0.47 (0.23, 0.67) with p < 0.001. Most interventions were effective in producing short-term behavior changes in physical activity, but varied greatly relative to intervention strategies and intensity of supervision/monitoring. Highly structured interventions tended to produce larger behavior change effects overall, but many larger effect sizes came from interventions supported by phone counseling or e-mail. We observed that 'more' may not be better in terms of direct supervision/monitoring in physical activity behavior interventions. This may be important in exploring less resource-intensive options for effective behavior change strategies for recent post-treatment survivors.

Purpose: Wrist-worn accelerometer devices measure sleep in free-living settings. Few studies, however, have investigated whether these devices can also measure waking movement behavior (e.g., total movement volume, physical activity). The purpose of this study was to investigate the ability of a wrist-worn Actiwatch 2 sleep monitor to rank total movement volume and physical activity levels compared with a waist-worn ActiGraph GT1M accelerometer and self-reported leisure time physical activity, respectively. In addition, we compared temporally matched activity measured via the ActiGraph GT1M and Actiwatch 2 over the study week., Methods: A subset of women from the Healthy Women Study (n = 145; age, 73.3 ± 1.7 yr) wore an Actiwatch 2 on their nondominant wrist and an ActiGraph GT1M on their dominant hip for seven consecutive days. Participants recorded their leisure time physical activity in a 7-d diary and completed the past year version of the Modifiable Activity Questionnaire. Analyses were conducted for all wake periods and separately for active periods when both devices were worn., Results: Spearman rank-order correlation coefficients for total movement volume between the Actiwatch 2 and ActiGraph GT1M were significant for wake periods (r = 0.47, P < 0.001) and, to a lesser extent, for active periods (r = 0.26, P < 0.01). However, the Actiwatch 2 did not rank participant's physical activity levels similarly to self-reported leisure time physical activity estimates (κ ≤ 0.05, P > 0.05). Multilevel model analyses comparing temporally matched activity measured via the ActiGraph GT1M and Actiwatch 2 suggest that the two devices yielded similar levels of activity during wake periods (B = 0.90; SE, 0.008; P < 0.001) and during active periods (B = 0.81; SE, 0.01; P < 0.001)., Conclusions: A wrist-worn Actiwatch 2 may be useful for ranking total movement volume and for assessing the pattern of activity over a day in older women. However, our data do not support using a wrist-worn Actiwatch 2 device for measuring physical activity.

Background: Sleep and physical activity are both important for cognition. However, few cognitive function studies include comprehensive measurement of both sleep and physical activity. The purpose of this study was to examine the independent and interactive associations of sleep and physical activity in relation to cognitive function in older women., Methods: A subset of 121 women from the Healthy Women Study, mean age 73.3 ± 1.7 years, wore an actigraphy sleep monitor, physical activity accelerometer, and kept sleep and physical activity diaries for 7 consecutive days. Executive function was measured with the Digit Symbol Substitution Test and the Trail Making Test B. Verbal fluency was assessed with a word generation task., Results: In adjusted models, greater actigraphy-assessed sleep efficiency was associated with more correct responses on the Digit Symbol Substitution Test (β = 0.35, SE = 0.15, p < 0.02). Sleep was not associated with verbal fluency. A significant interaction (p < 0.05) was observed between accelerometer-assessed physical activity and actigraphy-assessed sleep efficiency. Specifically, lower sleep efficiency was associated with poorer performance on both the Digit Symbol Substitution Test and the Trail Making Test B among women with low levels of physical activity but not among women with high levels of physical activity., Conclusions: Our findings suggest that greater levels of physical activity may attenuate the negative impact of poor sleep on executive function in older women, with the clearest effects observed using direct measurements of sleep and physical activity., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Arterial stiffness is associated with cardiovascular events and mortality. Lifestyle factors such as physical activity (PA) may reduce arterial stiffness. The purpose of this study is to determine the impact of change in PA on 1-year change in arterial stiffness in 274 overweight/obese sedentary young adults. The Slow Adverse Vascular Effects of excess weight (SAVE) trial was a study evaluating the relationships between weight loss, dietary sodium, and vascular health. PA was measured with the ActiGraph AM7164 accelerometer. Intensity of activity was determined using established cut-points. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV) using an automated device. Analysis of covariance compared changes in total accelerometer counts, minutes/day in light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and sedentary time, by categories of change in baPWV. Models were adjusted for time since baseline visit, age, sex, race, homeostatis model of assessment of insulin resistance, mean arterial pressure, heart rate, and weight change. Total accelerometer counts and time spent in MVPA increased from baseline to 12 months while time spent in LPA significantly decreased. Mean baPWV was similar at each time point. Those who showed decreased baPWV also showed an increase in total accelerometer counts per day and time spent in MVPA in the fully adjusted models (p<0.001). Changes in sedentary time and time spent in LPA were not associated with changes in baPWV. These results indicate that even modest increases in MVPA can reduce arterial stiffness, a risk factor for future cardiovascular events., Competing Interests: NONE, (© The Author(s) 2014.)

Background: The association of physical fitness with cognitive function in children and adolescents is unclear. The purpose of this ecological study was to describe the association between academic achievement, body mass index (BMI), and cardiovascular fitness (CVF) in a large sample of elementary, middle, and high school students in Texas., Methods: FITNESSGRAM(®) results for 2,550,144 students were matched with standardized composite academic test (TAKS) results from 2008 to 2009. Analyses were conducted on the percent of students meeting TAKS standards by BMI and CVF quintiles. Analyses of variance with Tukey adjustment examined differences between the most favorable 5th quintile (referent) and all other quintiles., Results: The prevalence of students meeting the TAKS standard was significantly higher in the highest fitness category for BMI and CVF compared to all other categories, regardless of sex or grade category (p < .05). Linear modeling suggested a 5% increase in the prevalence of students meeting healthy BMI and CVF standards would result in a 2.25% and 0.65% increase in the prevalence of students meeting the TAKS standard (both p < .05)., Conclusion: Findings suggest a healthy BMI and CVF are associated with higher academic achievement, and the need for additional research examining the role of potential confounders and/or effect modifiers longitudinally., (© 2014, American School Health Association.)

Objective: To examine the association between sedentary behavior and cardiometabolic risk, while taking into account cardiorespiratory fitness (fitness) and physical activity., Participants and Methods: We examined the association of sedentary behavior, physical activity, and fitness (exposure variables) to cardiometabolic biomarkers and metabolic syndrome (outcome measures) among a historic cohort (January 2, 1981, through October 16, 2012) of men. First, we estimated the association (cross-sectionally and longitudinally) of sedentary behavior along with physical activity and fitness to lipids and lipoproteins, glucose, blood pressure, and markers of adiposity, including body mass index, waist circumference, and body fat percentage. We then prospectively examined the effects of baseline sedentary time on the incidence of metabolic syndrome, while adjusting for physical activity, fitness, and other covariates in multivariate models., Results: Multivariate analysis of baseline data revealed that in comparison with the reference group (≤9 h/wk of sedentary time), more sedentary behavior was significantly associated with a higher triglyceride level, a higher triglycerides-high-density lipoprotein cholesterol ratio, and a higher body mass index, waist circumference, and body fat percentage (P<.05 for trend), after adjusting for physical activity and covariates. When adjusting for fitness and covariates, prolonged sedentary time was only associated with a higher triglyceride-high-density lipoprotein cholesterol ratio (P=.02 for trend). Sedentary time was not associated with the incidence of metabolic syndrome in multivariate models. Longitudinal analyses revealed that a 1-metabolic equivalent increase in fitness was significantly (P<.05) associated with almost all biomarkers when adjusting for sedentary behavior, with little moderation observed., Conclusion: The association between prolonged sedentary time and cardiometabolic biomarkers is markedly less pronounced when taking fitness into account. Further exploration of the effects of sedentary behavior on cardiometabolic risk is warranted in cohorts with available fitness data. Furthermore, our findings underscore the need to encourage achieving higher fitness levels through meeting physical activity guidelines to decrease disease risk factors., (Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Purpose: The objective of this study is to determine whether summary estimates of a self-report physical activity questionnaire that does not specifically assess frequency or duration (the Coronary Artery Risk Development in Young Adults (CARDIA) physical activity history (PAH)) differs from the summary estimates of one that does (CARDIA Supplemental Questionnaire)., Methods: After the year 25 examination (2010-2011), 203 CARDIA black and white men and women (age 50.3 ± 3.6 yr) at the Oakland, CA, site participated in this comparison study. The between-questionnaire association and agreement were determined for continuous and categorical estimates on the basis of 1) quartiles and 2) meeting 2008 physical activity guidelines. Differences in participant characteristics by concordance/discordance status were also examined. Finally, receiver operating characteristic curves were computed to determine the accuracy of the PAH compared with the supplemental questionnaire., Results: Reported physical activity levels were high and varied significantly by race and sex (all P < 0.01). Between-questionnaire estimates were significantly correlated (rho = 0.75 to 0.90, all P < 0.001) and had high agreement (κ = 0.51 to 0.80) across all race/sex groups. A higher proportion of women than men were classified as concordant by quartile of vigorous intensity (P = 0.001), but no other participant characteristics were associated with concordant/discordant quartile ranking. Participants classified as concordant on the basis of physical activity guidelines had lower body mass index than those classified as discordant (both P < 0.05). The area under the curve was 0.95, suggesting that the PAH has high accuracy for classifying individuals as meeting physical activity guidelines., Conclusions: Although it is inconvenient that the PAH is not expressed in more standard units, these findings support the practice of not directly assessing frequency and duration, which are frequent sources of reporting error.

Purpose: The objective of this study is to examine the temporal and bidirectional relationships between accelerometer-derived physical activity estimates and actigraphy-assessed sleep characteristics among older women., Methods: A subgroup of participants (N = 143, mean age = 73 yr) enrolled in the Healthy Women Study wore an ActiGraph accelerometer on their waist and an Actiwatch sleep monitor on their wrist concurrently for seven consecutive days. Multilevel models examined whether ActiGraph-assessed daily activity counts (ct·min⁻¹·d⁻¹) and moderate- to vigorous-intensity physical activity (MVPA; min·d⁻¹) predicted Actiwatch-assessed sleep onset latency, total sleep time, sleep efficiency, and sleep fragmentation. Similar models were used to determine whether nighttime sleep characteristics predicted physical activity the following day., Results: In unadjusted models, greater daily activity counts (B = -0.05, P = 0.005) and more minutes of MVPA (B = -0.03, P = 0.01) were temporally associated with less total sleep time across the week. Greater sleep efficiency was associated with greater daily activity counts (B = 0.37, P = 0.01) and more minutes of MVPA (B = 0.64, P = 0.009) the following day. Less sleep fragmentation was also associated with greater daily activity counts and more MVPA the following day. Findings were similar after adjustment for age, education, body mass index, depressive symptoms, arthritis, and accelerometer wear time., Conclusions: Few studies have used objective measures to examine the temporal relationships between physical activity and sleep. Notably, these findings suggest that nightly variations in sleep efficiency influence physical activity the following day. Thus, improving overall sleep quality in addition to reducing nightly fluctuations in sleep may be important for encouraging a physically active lifestyle in older women.

We aimed to assess whether a family history of coronary heart disease, diabetes, or cancer is linked to meeting public health guidelines for health-promoting physical activity. To achieve this objective, we analyzed data on 29,513 adults who came to the Cooper Clinic (Dallas, Texas) between January 1, 1990, and December 31, 2010, for a preventive medicine visit. Patients completed a comprehensive medical survey including information on family medical history, physical activity, and other lifestyle behaviors. Bivariate and multivariate logistic regression were used to examine the relationship between having a family history of chronic disease and meeting physical activity guidelines. The results indicated that individuals with a family history of disease had reduced odds for meeting or exceeding physical activity guidelines. For example, participants with a family history of 3 diseases were 36% less likely to meet or exceed physical activity guidelines than their counterparts without a family history of disease (odds ratio, 0.64; 95% CI, 0.58-0.72), while controlling for covariates. Among this large sample of adults, those with a family history of chronic disease were less inclined to regularly engage in physical activity. Thus, targeted programs encouraging adoption and maintenance of health-promoting physical activity might be warranted, specifically targeting individuals with familial history of disease., (Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the association between TV viewing and obesity by race/ethnicity and socio-economic status., Design: Cross-sectional analysis of 5,087 respondents to the Health Information National Trends Survey (HINTS), a nationally representative sample of US adults. Multivariate regression models were computed to assess the association between quartiles of TV viewing and BMI, stratified by race/ethnicity, educational attainment, employment and health insurance status., Results: Findings indicate that increased TV viewing was associated with higher odds for being overweight/obese in the entire sample, while adjusting for physical activity and other confounders. After stratification by race/ethnicity, increased odds for overweight/obesity in the 3(rd) and 4(th) quartiles of TV viewing (e.g., 3(rd) quartile-cumulative OR = 1.43, 95%CI 1.07-1.92) was observed in non-Hispanic whites, with statistical significance. In non-Hispanic blacks and Hispanics, the odds were similar to whites, but did not reach statistical significance. Significant relations between greater TV viewing and increased BMI were observed in college graduates and non-graduates, those with health insurance and the employed., Conclusions: This study extends previous research by examining potential inconsistencies in this association between various racial/ethnic groups and some socio-economic variables, which primarily were not found.

A low ankle-brachial index (ABI) is associated with increased risk for cardiovascular events and mortality. Physical inactivity in individuals with a low ABI may further increase their risk for cardiovascular events. The purpose of this paper is to examine the relationship between the intensity of free-living physical activity and cardiovascular disease (CVD) risk by ABI status. During 2003-2004, the National Health and Nutrition Examination Survey included an accelerometer module and collected ABI data. Individuals were classified as having a normal (1-1.4) or low (< 1) ABI. The Framingham risk score (FRS) was used to determine CVD risk. Multiple linear regression was used to determine the association of total accelerometer counts and time spent at various physical activity intensity levels with FRS by ABI groups. Individuals with a low ABI spent less time engaging in moderate-to-vigorous intensity physical activity (MVPA) (9.1 min/day vs 13.2 min/day; p = 0.06) when compared to those with a normal ABI. There were no differences in light intensity physical activity (LPA) or sedentary behavior between ABI groups. Total accelerometer counts were inversely related to FRS. MVPA, but not LPA, was inversely related to FRS in both normal and low ABI groups (p < 0.001 and p = 0.001, respectively). In conclusion, these findings suggest that even modestly higher levels of physical activity may be beneficial for secondary risk prevention in this high-risk group.

Accumulating data suggest that depression is associated with risk factors for cardiovascular disease, but few studies have investigated potential behavioral mediators of such associations, particularly among women. In this study of healthy young adult women (n = 225), we examined associations among depressive symptoms, health behaviors, and serum lipid levels. Depressive symptoms were assessed with the 20-item Center for Epidemiologic Studies-Depression scale, and a fasting blood sample was obtained for serum lipid levels, including total cholesterol, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C). Diet was measured using 24-h recalls, and other health behaviors (physical activity, smoking) were assessed via self-report questionnaire. Results indicated a modest negative association between depressive symptoms and LDL-C levels. Higher levels of depressive symptoms were also associated with lower total and insoluble dietary fiber intake, both of which were associated with HDL-C and LDL-C. Mediational analyses indicated a significant indirect effect of depressive symptoms on LDL-C via total and insoluble dietary fiber in unadjusted analyses, but not in adjusted analyses. The present findings suggest that depressive symptoms are inversely associated with serum LDL-C levels in young adult women, but that these associations are not likely mediated by adverse lifestyle behaviors.

Many studies examining genetic influences on physical activity (PA) have evaluated the impact of single nucleotide polymorphisms (SNPs) related to the development of lifestyle-related chronic diseases, under the hypothesis that they would be associated with PA. However, PA is a multidetermined behavior and associated with a multitude of health consequences. Thus, examining a broader range of candidate genes associated with a broader range of PA correlates may provide new insights into the genetic underpinnings of PA. In this study, we focus on one such correlate - sensation-seeking behavior. Participants (N = 1130 Mexican origin youth) provided a saliva sample and data on PA and sensation-seeking tendencies in 2008-2009. Participants were genotyped for 630 functional and tagging variants in the dopamine, serotonin and cannabinoid pathways. Overall 30% of participants (males - 37.6% and females - 22.0%) reported ≥60 min of PA on 5 of 7 days. After adjusting for gender, age and population stratification, and applying the Bayesian False Discovery Probability approach for assessing noteworthiness, four gene variants were significantly associated with PA. In a multivariable model, being male, having higher sensation-seeking tendencies and at least one copy of the minor allele for SNPs in angiotensin I-converting enzyme gene [ACE; rs8066276 odds ratio (OR) = 1.44; P = 0.012] and tryptophan hydroxylase 2 gene (TPH2; rs11615016 OR = 1.73; P = 0.021) were associated with increased likelihood of meeting PA recommendations. Participants with at least one copy of the minor allele for SNPs in synaptosomal-associated protein 25 gene (SNAP25; rs363035 OR = 0.53; P = 0.005) and cannabinoid receptor 1 gene (CNR1; rs6454672 OR = 0.62; P = 0.022) have decreased likelihood of meeting PA recommendations. Our findings extend current knowledge of the complex relationship between PA and possible genetic underpinnings., (© 2012 The Authors. Genes, Brain and Behavior © 2012 Blackwell Publishing Ltd and International Behavioural and Neural Genetics Society.)

Objective: Despite the well-supported biological link between physical activity (PA) and atherosclerosis, most previous studies have reported a null association between PA and coronary artery calcification (CAC). The aim of this study was to examine the relationship between PA and CAC progression in 148 Healthy Women Study (HWS) participants over 28 years of observation., Methods: The HWS was designed to examine cardiovascular risk factor changes from premenopause to postmenopause. Based on CAC scores collected on two follow-up visits (electron beam tomography [EBT] 1 and EBT4) scheduled 12 years apart, participants were classified into one of three groups: (1) no-detectable CAC group (n = 37; 0 CAC on both visits); (2) incident CAC group (n = 46; 0 CAC on the first visit and >0 CAC on the last visit); or (3) prevalent CAC group (n = 65; >0 CAC on both visits). PA data were collected regularly throughout the study using self-report questionnaires and accelerometers on EBT4., Results: The percentage of HWS participants with no detectable CAC decreased from 56.1% on EBT1 to 25.0% on EBT4. Times spent per day in accumulated moderate- to vigorous-intensity PA (MVPA) and bouts of MVPA were each significantly higher in the no-detectable CAC group when compared with the prevalent CAC group (both P ≤ 0.01). After covariate adjustment, these differences remained statistically significant (both P < 0.05). Although self-reported summary estimates collected throughout the study were significantly associated with accelerometer data on EBT4, there were no significant differences in self-reported PA levels by CAC group after covariate adjustment., Conclusions: Study findings suggest that low levels of accelerometer-derived MVPA may be indicative of subclinical disease in older women.

Purpose: The objective of this study is to prospectively examine the independent and joint effects of alcohol consumption and cardiorespiratory fitness on the incidence of metabolic syndrome (MetS) in a cohort of men., Methods: A prospective examination was done of 3411 apparently healthy men at baseline, who came to the Cooper Clinic (Dallas, TX) for at least two preventive visits (1979-2010). Primary exposure variables were cardiorespiratory fitness and alcohol intake; the outcome measure was MetS and the components thereof. Cox proportional hazards models were computed to assess the relation between the exposure variables and the incidence of MetS while adjusting for confounders., Results: For a mean follow-up period of 9 yr (SD = 7.8), 276 men developed MetS. In multivariable analysis, a dose-response relationship was observed between increased levels of fitness and reduced MetS risk (moderate fitness: HR = 0.60; 95% confidence interval (CI), 0.43-0.82; high fitness: HR = 0.49, 95% CI, 0.35-0.69). When examining the independent effects of alcohol, light drinking increased the risk for MetS by 66% (HR = 1.66, 95% CI, 1.11-2.48). No statistically significant interaction effect was observed between alcohol and fitness in relation to MetS (P = 0.32). When assessing the relation between each exposure and the components of MetS, higher fitness consistently reduced the risk of all components, whereas lower alcohol intake reduced the risk of elevated glucose and blood pressure and increased the risk for low HDL cholesterol., Conclusions: Among this cohort of men, higher fitness levels reduced the risk for MetS and its components. The relation between alcohol intake levels and metabolic risk was more complex and not reflected when examining MetS as a whole.

Background: Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation., Methods: In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson's χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student's t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation., Results: Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active., Conclusions: Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.

Background: Media use is associated with an increased risk of chronic disease and reduced quality of life among children. This study examined the relationship between media use during discretionary hours after school and psychological and physical assets among preadolescent girls., Methods: A cross-sectional analysis was conducted using data from a larger quasi-experimental evaluation of a positive youth development program through sport for third- to fifth-grade girls. Indicators of media use were the number of hours per school day spent watching television and videos and using computers. Psychological assets included global self-esteem, body size satisfaction, and commitment to physical activity; physical assets included physical activity. Nested random effects analysis of variance (ANOVA) models were used to examine the relationship between media use and psychological and physical assets controlling for relevant confounding factors., Results: The analytic sample included 1027 participants; most were ≥10 years old, non-White; 27% self-reported ≥4 hours of media use on school days. In adjusted results, media use was inversely associated with self-esteem (p = .008) and commitment to physical activity (p < .001). Time spent using media was not associated with body size satisfaction or physical activity in this age group., Conclusions: Media use was negatively associated with self-esteem and commitment to physical activity. It may be useful for school professionals to encourage after-school programs that offer opportunities for girls to reduce sedentary pursuits and improve important psychological and physical assets., (© 2011, American School Health Association.)

Introduction: Weight loss has been associated with higher physical activity (PA) levels and frequent dietary self-monitoring. Less is known about how PA self-monitoring affects adherence to PA goals, PA levels, and weight change., Methods: The SMART Trial is a clinical weight loss trial in which 210 overweight adults were randomized equally to one of three arms: 1) paper record (PR), 2) personal digital assistant with self-monitoring software (PDA), and 3) PDA with daily tailored feedback message (PDA + FB). PA self-monitoring and adherence to PA goals were based on entries in weekly submitted diaries. PA levels were measured via self-report by the past 6-month Modifiable Activity Questionnaire at baseline and 6 months., Results: Data are presented on 189 participants with complete 6-month PA data (84% female, 77% white, mean age = 47.3 ± 8.8 yr, mean body mass index = 34.1 ± 4.5 kg·m(-2)). Median PA level was 7.96 MET·h·wk(-1) at baseline and 13.4 MET·h·wk(-1) at 6 months, with significant PA increases in all three arms. PDA + FB arm had a higher mean number of weekly self-monitoring entries than the PR arm (3.4 vs 2.4, P = 0.003) and were more likely to maintain high (i.e., 100%) adherence to PA goals over time than the PDA (P = 0.02) or PR arms (P = 0.0003). Both PA self-monitoring and adherence to PA goals were related to higher PA levels at 6 months. A higher mean rate of PA self-monitoring was associated with a greater percentage of weight decrease (ρ = -0.49, P < 0.0001) at 6 months., Conclusions: PA self-monitoring and adherence to PA goals were more likely in participants in the PDA + FB arm and in turn predicted higher PA levels and weight loss.

Background: The determination of factors affecting curve flexibility is important in idiopathic scoliosis patients with regard to the Risser sign. The objective of this retrospective study was to identify factors affecting curve flexibility in patients with skeletally immature and mature idiopathic scoliosis., Methods: The records of all patients with idiopathic scoliosis who received surgical treatment from July 2001 to August 2008 at our hospital were screened. The Risser sign was used to separate the patients into a skeletally mature group (Risser grade = 5) and skeletally immature group (Risser grade < 5). Data recorded and compared were flexibility (%), bending angle (°), apical vertebral rotation (°), Cobb angle (°), curve location, prior use of brace treatment, and number of vertebrae in the curve., Results: The study cohort consisted of 217 patients (34 males, 183 females) in the Risser grade < 5 group and 124 (21 males, 103 females) in the Risser grade = 5 group. Multiple linear regression analysis revealed that the Cobb angle and the curve location significantly affected curve flexibility in the Risser grade < 5 group, whereas in the Risser grade = 5 group, Cobb angle and age significantly affected flexibility., Conclusions: Cobb angle and curve location influence main curve flexibility in skeletally immature adolescent idiopathic scoliosis, and Cobb angle and age influence curve flexibility in skeletally mature adult scoliosis. Measurement of these values may aid in the evaluation of treatment options and preoperative planning.

Cardiorespiratory fitness is an independent predictor of cardiovascular events in women; however, maximal oxygen consumption (VO(2max)) protocols are not always feasible. The Evaluation of Physical Activity Measures in Middle-Aged Women Study was a 6-week study designed to evaluate six physical activity (PA) measures in women, aged 45-65 years. We investigated the Ebbeling submaximal treadmill (EbbTM) protocol's ability to reflect an active lifestyle in 66 women [median (IQR) age, 51.0 (48.0, 56.5) years]. Participants were screened using ACSM and AHA guidelines and classified as moderate or low cardiovascular risk. VO(2max) was estimated using the EbbTM in all participants (TEST1). Moderate risk women repeated the EbbTM (TEST2) while low risk completed a maximal treadmill test. Intraclass correlation coefficients (ICC) and minimal detectable change (MDC(90)) score were calculated to examine reliability. Spearman rank order or Pearson product-moment correlation coefficients were used to determine the association between estimated VO(2max) and physical fitness and activity measures. Estimated VO(2max) from the EbbTM protocol had excellent reproducibility [ICC = 0.95 (95% CI: 0.89, 0.98) and MDC(90) was 1.62 mL kg(-1) min(-1). The EbbTM protocol was associated with measured VO(2max) (ρ = 0.48; p = 0.01) and was positively correlated with moderate- (ρ = 0.32; p = 0.02), vigorous- (ρ = 0.47; p = 0.0005) and moderate-to-vigorous-intensity PA (ρ = 0.36; p = 0.009), pedometer steps (ρ = 0.41; p = 0.002) and inversely correlated with waist circumference (ρ = -0.58; p < 0.0001), body fat (ρ = -0.55; p < 0.0001), and right leg endurance (ρ = -0.41; p = 0.003). The EbbTM protocol was shown to be reliable and associated with objective measures of fitness and PA in healthy, middle-aged women.

Background: Spine surgery using computer-assisted navigation (CAN) has been proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing versus the conventional intraoperative image intensifier (CIII). However, as we know, few previous studies have described the learning curve of CAN in spine surgery., Methods: We performed two consecutive case cohort studies on pedicel screw accuracy and operative time of two spine surgeons with different experience backgrounds, A and B, in one institution during the same period. Lumbar pedicel screw cortical perforation rate and operative time of the same kind of operation using CAN were analyzed and compared using CIII for the two surgeons at initial, 6 months and 12 months of CAN usage., Results: CAN spine surgery had an overall lower cortical perforation rate and less mean operative time compared with CIII for both surgeon A and B cohorts when total cases of four years were included. It missed being statistically significant, with 3.3% versus 4.7% (P = 0.191) and 125.7 versus 132.3 minutes (P = 0.428) for surgeon A and 3.6% versus 6.4% (P = 0.058), and 183.2 versus 213.2 minutes (P = 0.070) for surgeon B. In an attempt to demonstrate the learning curve, the cases after 6 months of the CAN system in each surgeon's cohort were compared. The perforation rate decreased by 2.4% (P = 0.039) and 4.3% (P = 0.003) and the operative time was reduced by 31.8 minutes (P = 0.002) and 14.4 minutes (P = 0.026) for the CAN groups of surgeons A and B, respectively. When only the cases performed after 12 months using the CAN system were considered, the perforation rate decreased by 3.9% (P = 0.006) and 5.6% (P < 0.001) and the operative time was reduced by 20.9 minutes (P < 0.001) and 40.3 minutes (P < 0.001) for the CAN groups of surgeon A and B, respectively., Conclusions: In the long run, CAN spine surgery decreased the lumbar screw cortical perforation rate and operative time. The learning curve showed a sharp drop after 6 months of using CAN that plateaued after 12 months; which was demonstrated by both perforation rate and operative time data. Careful analysis of the data showed CAN is especially useful for less experienced surgeon to reduce perforation rate and intraoperative time, although further comparative studies are anticipated.

Background: Current accelerometer technology allows for data collection using brief time sampling intervals (i.e., epochs). The study aims were to examine the role of epoch length on physical activity estimates and subsequent relationships with clinically-meaningful health outcomes in post-menopausal women., Methods: Data was obtained from the Woman On the Move through Activity and Nutrition Study (n = 102). Differences in activity estimates presented as 60s and 10s epochs were evaluated using paired t-tests. Relationships with health outcomes were examined using correlational and regression analyses to evaluate differences by epoch length., Results: Inactivity, moderate- and vigorous-intensity activity (MVPA) were significantly higher and light-intensity activity was significantly lower (all P < 0.001) when presented as 10s epochs. The correlation between inactivity and self-reported physical activity was stronger with 10s estimates (P < 0.03); however, the regression slopes were not significantly different. Conversely, relationships between MVPA and body weight, BMI, whole body and trunk lean and fat mass, and femoral neck bone mineral density was stronger with 60s estimates (all P < 0.05); however, regression slopes were similar., Conclusion: These findings suggest that although the use of a shorter time sampling interval may suggestively reduce misclassification error of physical activity estimates, associations with health outcomes did not yield strikingly different results. Additional studies are needed to further our understanding of the ways in which epoch length contributes to the ascertainment of physical activity in research studies., Trial Registration: Clinical Trials Identifier: NCT00023543.