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Background Evidence for the positive effects of physiotherapy for persons with Parkinson's disease (PwPD) is rapidly increasing. However, little is known about the provision of physiotherapy for PwPD in everyday practice. The objective of this study was to gain insight into the nature of physiotherapeutic care for PwPD in hospitals, primary care units, and community services in Sweden. Methods A web-based survey was sent out to 2956 members of the Swedish Association of Physiotherapists, including questions about treatment, measurement tools, multi-professional collaborations, adherence to physiotherapy guidelines, professional expertise, and needs for gaining expertise regarding PwPD. Results Of the 1189 physiotherapists who completed the survey, 705 were treating 1 or more PwPD per month in hospitals (21%), in primary care units (37%), and in the community (42%). Physiotherapy frequently targeted a wide range of musculoskeletal and mobility impairments; however, freezing of gait and pain were less frequently treated. Measurement tools recommended for PwPD were infrequently used, and there was a preference for single-item questions/tools compared with multi-item instruments. Collaboration with other health care professionals for the rehabilitation of PwPD was rare and was more evident in hospitals than in primary care units and the community. Adherence to physiotherapy guidelines was poor, and most respondents reported that they treated too few PwPD to retain their expertise and they perceived a need to increase their knowledge and skills about physiotherapy for PwPD. Conclusion The current findings emphasize the need to strengthen expertise regarding the assessment and treatment of PwPD among physiotherapists in Sweden and to apply strategies endorsing multi-professional collaboration for PD rehabilitation.

Objectives To investigate the associations of objectively assessed sedentary time, light intensity physical activity (PA), moderate to vigorous intensity PA (MVPA), and total PA with all-cause mortality and mortality from cardiovascular disease (CVD) or cancer in a Swedish population-based cohort with 15 years follow-up time. Design Longitudinal prospective cohort study. Methods Data from 851 persons (56% women) ≥35 years at baseline were included. Primary exposure variables were time (min/day) spent sedentary, in light intensity PA and in MVPA, and total counts from an Actigraph 7164 accelerometer. Data on all-cause mortality and mortality from CVD or cancer were obtained from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of mortality with 95% confidence intervals (CI). Results Compared with the least sedentary participants, those in the most sedentary tertile had an increased risk of all-cause mortality, HR: 2.7 (1.4, 5.3), CVD mortality, HR: 5.5 (1.4, 21.2) and cancer mortality, HR: 4.3 (1.2, 16.0). For all-cause mortality, those in the highest light intensity PA tertile had a HR 0.34 (0.17, 0.67) compared with the lowest tertile. A similar pattern was found for CVD and cancer mortality. More time spent in MVPA was associated with the largest risk reduction for CVD mortality, with an almost 90% lower risk in the tertile with the most time in MVPA. Conclusions This study confirms a strong inverse relationship between MVPA and mortality, and adds new insight for the understanding of the associations between sedentary time and light intensity PA and mortality.

Aim: The aim of this study was to investigate the potential associations of reallocating 30 minutes sedentary time in long bouts (>60 min) to sedentary time in non-bouts, light intensity physical activity (LPA) and moderate-to vigorous physical activity (MVPA) with cardiometabolic risk factors in a population diagnosed with prediabetes or type 2 diabetes. Methods: Participants diagnosed with prediabetes and type 2 diabetes (n = 124, 50% men, mean [SD] age = 63.8 [7.5] years) were recruited to the physical activity intervention Sophia Step Study. For this study baseline data was used with a cross-sectional design. Time spent in sedentary behaviors in bouts (>60 min) and non-bouts (accrued in

This study compared common free-living physical activity (PA) outcomes, assessed with the Actigraph GT3X+ accelerometer and processed with two different filter settings, in a sample of elderly individuals with Parkinson´s disease (PD). Sixty-six individuals (73.1 ± 5.8 years) with mild to moderate idiopathic PD carried an accelerometer for 7 d. Data were processed with the default filter setting and a low frequency extension filter (LFE). Significantly larger values were obtained with the LFE for mean counts and steps per day, and for minutes per day in low intensity- and lifestyle activities at moderate intensity, but not for moderate-to vigorous intensity ambulatory activities. The largest difference was observed for mean ± SD steps per day (default = 4730 ± 3210; LFE = 11 117 ± 4553). Intraclass correlation confidence intervals and limits of agreement were generally wide, indicating poor agreement. A sub-study, in which 15 individuals with PD performed a self-paced 3 min walk, demonstrated that neither filter setting differed from video-recorded steps (p ≥ 0.05). This suggests that the LFE might overestimate PA-outcomes in free-living conditions. Until new evidence supporting an extension of the lower filter-band is presented, it is recommended that the default filter setting be used when assessing PA in elderly individuals with PD.

Aim:To compare self-reported pedometer steps with accelerometer steps under free-living conditions in individuals with Parkinson’s disease (PD) or osteoporosis (OP).Methods:Seventy-three individuals with PD and 71 individuals with OP wore a pedometer (Yamax LS2000) and an accelerometer (ActiGraph GT1M/GT3X+) simultaneously for one week.Results:Fifty-one individuals with PD (72.6 ± 5.3 years) and 61 with OP (75.6 ± 5.3 years) provided simultaneously recorded data for 3–7 consecutive days. Pedometer steps were significantly lower than accelerometer steps in the PD group (p = .002) but not in the OP group (p = .956). Bland-Altman plots demonstrated wide limits of agreement between the instruments in both PD (range = 6,911 steps) and OP (range = 6,794 steps).Conclusion:These results suggest that the ActiGraph GT1M/GT3X+ should be preferred over the Yamax LS2000 for the assessment of steps in both research and clinical evaluations, particularly in individuals with PD or altered gait.

To explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12 months, adjusting for known early-life risk factors for subsequent childhood obesity.Baseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n = 144/53) and parental education (n = 57/139). Observational data on infant growth between 0 and 12 months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12 months and rapid weight gain 0-6 months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking.Relative weight at 3, 6 and 12 months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education.Low parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year.

Summary Objective To calibrate the Actigraph GT3X+ accelerometer for wrist-worn placement in young preschoolers by developing intensity thresholds for sedentary, low- and high-intensity physical activity. Furthermore, to cross-validate the developed thresholds in young preschoolers. Methods Actigraph GT3X+ was used to measure physical activity during structured activities and free play in 38 children (15–36 months). Activity was video recorded and scored into sedentary, low- and high-intensity physical activity based on Children's Activity Rating Scale (CARS) and combined with accelerometer data using a 5 s epoch. Receiver operating characteristic analysis was used to develop intensity thresholds in 26 randomly selected children. The remaining 12 children were used for cross-validation. Results Intensity thresholds for sedentary were ≤89 vertical counts (Y) and ≤221 vector magnitude (VM) counts per 5 s and ≥440 Y counts and ≥730 VM counts per 5 s for high-intensity physical activity. Sensitivity and specificity were 60–100% for the developed intensity thresholds. Strong correlations (Spearman rank correlation 0.69–0.91) were found in the cross-validation sample between the developed thresholds for the accelerometer and CARS scoring time in all intensity categories. Conclusion The developed intensity thresholds appear valid to categorize sedentary behaviour and physical activity intensity categories in children 2 years of age.

ObjectiveTo examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.DesignSystematic review and harmonised meta-analysis.Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.Eligibility criteriaProspective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.Data extraction and analysisGuidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.Main outcome measureAll cause mortality.Results39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).ConclusionHigher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.Systematic review registrationPROSPERO CRD42018091808.

The aim of the present study was to evaluate and compare objective and subjective outcome in patients 2 and 5 years after anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or hamstring grafts. The second aim was to report the prevalence of re- and contralateral ACL ruptures.Sixty-eight patients (BPTB, n = 34 and hamstring graft, n = 34) were evaluated preoperatively, 2 and 5 years after ACL reconstruction. Anterior knee laxity and rotational knee joint stability, muscle torque, hop length, anterior knee pain, activity level and self-reported knee function and quality of life were evaluated within and between groups. The prevalence of re- and contralateral ACL ruptures was also recorded.No significant difference in anterior knee laxity, rotational knee joint stability, hop length anterior knee pain or knee function and quality of life were noted at the 5-year follow-up. No significant differences in concentric or eccentric quadriceps torque at 90°/s and 230°/s were found at any of the follow-ups between and within grafts. A significant group difference in hamstring torque 1.05 (0.02) for BPTB and 0.89 (0.02) for hamstring grafts, and in hop length (leg symmetry index) follow-up 0.94 (0.07) for BPTB compared to 0.99 (0.07) for hamstring grafts (P = 0.002) was found at the 2 year follow-up in favour of the BPTB graft, but not at the 5 year follow-up. A significant improvement over time, irrespective of graft, was found in the KOOS's subscales Sport/Rec and quality of life (P0.001). None of the patients, irrespective of group, returned to their pre-injury level of sport (P0.05). Over the five postoperative years, one man and eight women (13 %) (hamstring graft, n = 5 and BPTB graft, n = 4), sustained a total of 11 (16.2 %) new ACL ruptures: seven (10.2 %) re-ruptures and four (5.9 %) ruptures of the contralateral ACL.At the 5-year follow-up, there were no significant differences in terms of anterior knee laxity, rotational knee joint stability, muscle torque, anterior knee pain, hop performance, quality of life or activity level between patients who had undergone reconstruction with BPTB or hamstring grafts. None of the patients, irrespective of group, had returned to their pre-injury level of activity. Eight out of the nine patients who had sustained a second ACL rupture were women.

Seasonal and regional variation may influence physical activity (PA) patterns. These associations are in need of further investigation. The objective of the current study was to examine the association of season and region on objectively measured PA. The study was designed as a cross-sectional study with 1172 participants living in Sweden. Data on PA were collected throughout a calendar year using accelerometry. Regions were categorised as south (Götaland), central (Svealand) and north (Norrland). Outcome variables included accelerometer-measured mean counts per minute, sedentary time and time in low intensity and moderate-intensity physical activity (MVPA) or greater. ANCOVA was used to determine the associations of season and region with PA, adjusting for sex, age, body mass index (BMI) and education. The results showed that during the Spring season more time was spent in MVPA than during the Autumn. For participants living in the south of Sweden, a significant trend for season was found for MVPA, with Spring having the highest MVPA (P = 0.025). Season had a borderline significant association with MVPA or higher intensity activities (P = 0.051). No significant effects of region or season on total PA, low-intensity PA and sedentary periods of time were observed. The results indicate that studies conducted in a population living in high latitudes, may not be significantly affected by seasonality or region when assessing PA.

Background:The 2016 Swedish Report Card on Physical Activity (PA) for Children and Youth is a unique compilation of the existing physical and health related data in Sweden. The aim of this article is to summarize the procedure and results from the report card.Methods:Nationally representative surveys and individual studies published between 2005–2015 were included. Eleven PA and health indicators were graded using the Active Healthy Kids Canada grading system. Grades were assigned based on the percentage of children/youth meeting a defined benchmark (A: 81% to 100%, B: 61% to 80%, C: 41% to 60%, D: 21% to 40%, F: 0% to 20%, or incomplete (INC).Results:The assigned grades were Overall Physical Activity, D; Organized Sport Participation, B+; Active Play, INC; Active Transportation, C+; Sedentary Behaviors, C; Family and Peers, INC; School, C+; Community and the Built Environment, B; Government Strategies and Investments, B; Diet, C-; and Obesity, D.Conclusions:The included data provides some support that overall PA is too low and sedentary behavior is too high for almost all age groups in Sweden, even with the many national policies as well as an environment that is favorable to the promotion of PA.

BACKGROUND The desirable effects of physical activity in individuals with Parkinson's disease are well-known, although according to results from previous studies factors associated with objectively assessed physical activity are not fully investigated. OBJECTIVE To investigate demographic, disease-related and mobility-related factors that associate with objectively measured physical activity, in a sample of older adults with mild to moderate Parkinson's disease. METHODS Demographic, disease-related and mobility-related factors were gathered by interview from a total of 91 older adults with Parkinson's disease, followed by an evaluation of balance control using the Mini-BESTest. After initial testing, participants wore a tri-axial accelerometer during a week of free-living. Correlation analysis and multiple linear regression was used to investigate factors associated with total PA, represented by total activity counts, and time in brisk walking. RESULTS Motor impairment, physical function, body mass index and dyskinesia contributed to the variance of total physical activity, explaining 34 % of the variance, while physical function and balance control were significant factors associated with brisk walking, explaining 22 %. CONCLUSIONS This study identified factors that have not been shown to associate with objectively measured physical activity previously, such as dyskinesia, balance control and self-rated physical function. The findings also demonstrated that associated factors differ, depending on the activity behavior being investigated. However, other factors than those included in this study may also be of importance.

Introduction To determine time spent at different physical activity intensities, accelerometers need calibration. The aim of this study was to develop and cross-validate intensity thresholds for the Actigraph GT3X+ accelerometer for wrist and hip placement in four-year-old children. Methods In total 30 children (49 months, SD 3.7) were recruited from five preschools in Stockholm. Equipped with an accelerometer on the wrist and another on the hip, children performed three indoor activities and one free-play session while being video recorded. Subsequently, physical activity intensity levels were coded every 5th second according to the Children’s Activity Rating Scale. Receiver Operating Characteristic (ROC) curves was used to develop wrist and hip intensity thresholds, the upper threshold for sedentary, and lower threshold for moderate-to-vigorous physical activity (MVPA), for the vertical axis (VA) and for the vector magnitude (VM). A leave-one-out method was used to cross-validate the thresholds. Results Intensity thresholds for wrist placement were ≤ 178 (VA) and ≤ 328 (VM) for sedentary and ≥ 871 (VA) and ≥ 1393 (VM) counts/5 seconds for MVPA. The corresponding thresholds for hip placement were ≤ 43 (VA) and ≤ 105 (VM) for sedentary and ≥ 290 (VA) and ≥ 512 (VM) for MVPA. The quadratic weighted Kappa was 0.92 (95% CI 0.91–0.93) (VA) and 0.95 (95% CI 0.94–0.96) (VM) for the wrist-worn accelerometer and 0.76 (98% CI 0.74–0.77) and 0.86 (95% CI 0.85–0.87) for the hip-worn. Conclusion Using wrist placement and the VM when measuring physical activity with accelerometry in 4-year-old children is recommended.

Understanding about socio-cultural differences in physical activity in children with high and low risk for obesity can help tailor intervention programs in different settings. This study aimed to compare objectively measured physical activity in two-year-olds and their parents, living in Stockholm, Sweden, and Wuhan, China. Data from Early STOPP was used. Children and parents wore an accelerometer in connection with the child’s second birthday. Weekly and hourly patterns were examined. Correlation between child and parental physical activity was assessed. Data on 146 Swedish and 79 Chinese children and their parents was available. Children, mothers and fathers in Stockholm were significantly more active than their counterparts in Wuhan (children; 2989 (SD 702) vs. 1997 (SD 899) counts per minute (CPM), mothers 2625 (SD 752) vs. 2042 (SD 821) CPM; fathers 2233 (SD 749) vs. 1588 (SD 754) CPM). Activity levels were similar over a week for children and parents within both countries. No parental-child correlations, except for a paternal-son correlation in Stockholm, were found. Children, mothers and fathers in Stockholm are more active compared with their counterparts in Wuhan. Interventions to increase physical activity needs to take cultural aspects into account, also when targeting very young children.

Background and purpose Transient ischemic attack (TIA) is a strong predictor of stroke, and physical inactivity is one risk factor for TIA/stroke. "Physical activity on Prescription" (PaP) can increase physical activity, but the effect of PaP after TIA has not been described. Our goal was to objectively measure the effect of PaP on physical activity and physical capacity, as well as self-rated health at 3 and 6 months after TIA. Methods The primary outcome was moderate to vigorous intensities of physical activity objectively assessed by accelerometry. Secondary outcomes were steps per day assessed by accelerometry, physical capacity assessed by the 6-minute walk test, and self-rated health assessed by EQ-5D VAS. Results Eighty-eight individuals with TIA were randomized to an intervention group (n = 44) that received conventional treatment and PaP or to a control group (n = 44) that received conventional treatment alone. There was a 30% dropout among the participants at 6 months. No significant differences between groups were found in physical activity at 3 and 6 months. At 6 months, participants in the intervention group were significantly more likely to have improved their physical capacity than the control group. There was no significant difference between groups in self-rated health. Discussion and conclusions PaP did not increase physical activity after TIA; however, there was an increase in physical capacity. The nonsignificant results for physical activity may be the result of a relatively high baseline physical activity level. The results may also indicate that prior studies suggesting that PaP increases physical activity overestimated effects because of the self-reported nature of the previous outcomes.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A134).

Background There is growing evidence for the positive effects of exercise training programs on balance control in Parkinson disease (PD). To be effective, balance training needs to be specific, progressive, and highly challenging. Little evidence exists, however, for how people with PD-related balance impairments perceive highly challenging and progressive balance training programs with dual-task components. Objective The purpose of this study was to explore and describe perceptions of a highly challenging balance training program among people with mild to moderate PD. Design This study was qualitative in nature. In-depth interviews were conducted with 13 individuals with mild to moderate PD who had participated in a highly challenging balance training program. Interview transcripts were analyzed using qualitative content analysis, with an inductive approach. Results The analysis revealed 3 subthemes concerning participants' perceptions of highly challenging and progressive balance training: (1) movement to counter the disease, (2) dual-task training in contrast to everyday strategies, and (3) the struggle to maintain positive effects. The first subtheme reflects how physical activity was used as a short-term and long-term strategy for counteracting PD symptoms and their progression. The second subtheme incorporates the described experiences of being maximally challenged in a secure and supportive group environment, circumstances that stood in contrast to participants' everyday lives. The third subtheme describes participants' long-term struggle to maintain program effects on cognitive and physical function in the face of disease progression. Interpretation of the underlying patterns of these subthemes resulted in one overarching theme: training at the limits of balance capacity causes a rethinking motor and cognitive resources. Limitations The findings of this study cannot be considered to reflect the beliefs of those with weaker or negative beliefs concerning physical activity or be transferred to those at more severe stages of the disease. Conclusions Findings from this study suggest that being pushed to the limits of balance capacity provoked people with mild to moderate PD to rethink their individual motor and cognitive resources, a process that was further enabled by the PD-specific group setting.

Purpose Dynamic chairs have the potential to facilitate movements that could counteract health problems associated with sedentary office work. This study aimed to evaluate whether a dynamic chair can increase movements during desk-based office work. Methods Fifteen healthy subjects performed desk-based office work using a dynamic office chair and compared to three other conditions in a movement laboratory. In a field study, the dynamic office chair was studied during three working days using accelerometry. Results Equivocal results showed that the dynamic chair increased upper body and chair movements as compared to the conventional chair, but lesser movements were found compared to standing. No differences were found between the conditions in the field study. Conclusions A dynamic chair may facilitate movements in static desk-based office tasks, but the results were not consistent for all outcome measures. Validation of measuring protocols for assessing movements during desk-based office work is warranted.

The aim of the paper is to describe the introduction of a portfolio method of teaching and learning, and to describe students’ perceptions of the method as well as a peer-review system in a course, in the physiotherapy programme, at the Karolinska Institutet. A further aim was to describe the level of grades over time. A modified form of a showcase portfolio method together with a three-graded assessment criteria was introduced into the course. Students, over five semesters, were included in the project (n = 287) of which 91% answered questions and statements regarding their perception of the assessment method and the peer-review system. All portfolios were graded in a scale of three: fail, pass and pass with distinction. The majority of students were satisfied and reported positive learning effects with the assessment method and review system. However, the students asked for more guidance in how to give feedback. During these five semesters, the percentage of students that passed with distinction increas...

To cite this article: Int J Dent Hygiene 10, 2012; 270–276 DOI: 10.1111/j.1601-5037.2011.00539.x Johannsen A, Bolander-Laksov K, Bjurshammar N, Nordgren B, Friden C, Hagstromer M. Enhancing meaningful learning and self-efficacy through collaboration between dental hygienist and physiotherapist students – a scholarship project. Abstract: Introduction: Within the field of Dental Hygiene (DH) and Physiotherapy (PT), students are taught to use an evidence-based approach. Educators need to consider the nature of evidence-based practice from the perspective of content knowledge and learning strategies. Such effort to seek best available evidence and to apply a systematic and scholarly approach to teaching and learning is called scholarship of teaching and learning. Objectives: To evaluate the application of the scholarship model including an evidence-based approach to enhance meaningful learning and self-efficacy among DH and PT students. Methods: Based on the research on student learning, three central theories were identified (constructivism, meaningful learning and self-efficacy). These were applied in our context to support learner engagement and the application of prior knowledge in a new situation. The DH students performed an oral health examination on the PT students, and the PT students performed an individual health test on the DH students; both groups used motivational interviewing. Documentation of student’s learning experience was carried out through seminars and questionnaires. Results: The students were overall satisfied with the learning experience. Most appreciated are that it reflected a ‘real’ professional situation and that it also reinforced important learning from their seminars. Conclusion: The scholarship model made the teachers aware of the importance of evidence-based teaching. Furthermore, the indicators for meaningful learning and increased self-efficacy were high, and the students became more engaged by practising in a real situation, more aware of other health professions and reflected about tacit knowledge.

The use of physical activity monitors in population-based research has increased dramatically in the past decade. In this report, we review the major purpose for using physical activity monitors in different types of population-based studies (i.e., surveillance, intervention, association studies) and discuss the strengths and weaknesses for the various behavioral outcomes derived from monitors for each study type. We also update and extend previous recommendations for use of these instruments in large-scale studies, particularly with respect to selecting monitor systems in the context of technological advances that have occurred in recent years. The current state of the science with respect to optimal measurement schedules for use of physical activity monitors is also discussed. A checklist and flowchart are provided so that investigators have more guidance when reporting key elements of monitor use in their studies.

To develop a self-administered questionnaire for the evaluation of donor-site-related functional problems after anterior cruciate ligament (ACL) reconstruction with autograft harvested from the hamstring tendon or patellar tendon and to determine the content validity, reliability and preliminary factor structure of this new instrument. Seven physiotherapists with long clinical experience of rehabilitation after ACL reconstruction and 60 patients from the target population participated as experts in the developmental stages of the questionnaire. Content validity was determined and quantified with the content validity index (CVI). Test–retest reliability, internal consistency and factor structure were evaluated in another 64 patients reconstructed with an autograft. The final questionnaire included 16 items on symptoms and function during activities of daily living and exercise. Excellent content validity on both item level (I-CVI ≥ 0.83, range 0.83–1.00) and scale level (S-CVI = 0.93) was found. The test–retest reliability was good, ICC = 0.94. Internal consistency was high, and Cronbach’s α was 0.92 and 0.94 at each test occasion. The principal components analysis yielded a four-component structure. The questionnaire “Donor-site-Related Functional Problems following Anterior Cruciate Ligament (ACL) Reconstruction” is a patient-reported questionnaire with high content validity and reliability for the evaluation of donor-site-related functional problems after ACL reconstruction, with autograft harvested from the hamstring tendon or patellar tendon. The results of this study support the use of this questionnaire as a standardized outcome measure for both research purposes and in clinical settings.

Background Recent epidemiologic evidence points to the health risks of prolonged sitting, that are independent of physical activity, but few papers have reported the descriptive epidemiology of sitting in population studies with adults. Purpose This paper reports the prevalence of "high sitting time" and its correlates in an international study in 20 countries. Methods Representative population samples from 20 countries were collected 2002–2004, and a question was asked on usual weekday hours spent sitting. This question was part of the International Prevalence Study, using the International Physical Activity Questionnaire (IPAQ). The sitting measure has acceptable reliability and validity. Daily sitting time was compared among countries, and by age group, gender, educational attainment, and physical activity. Results Data were available for 49,493 adults aged 18–65 years from 20 countries. The median reported sitting time was 300 minutes/day, with an interquartile range of 180–480 minutes. Countries reporting the lowest amount of sitting included Portugal, Brazil, and Colombia (medians ≤180 min/day), whereas adults in Taiwan, Norway, Hong Kong, Saudi Arabia, and Japan reported the highest sitting times (medians ≥360 min/day). In adjusted analyses, adults aged 40–65 years were significantly less likely to be in the highest quintile for sitting than adults aged 18–39 years (AOR=0.796), and those with postschool education had higher sitting times compared with those with high school or less education (OR=1.349). Physical activity showed an inverse relationship, with those reporting low activity on the IPAQ three times more likely to be in the highest-sitting quintile compared to those reporting high physical activity. Conclusions Median sitting time varied widely across countries. Assessing sitting time is an important new area for preventive medicine, in addition to assessing physical activity and sedentary behaviors. Population surveys that monitor lifestyle behaviors should add measures of sitting time to physical activity surveillance. Moreover, the use of objective measures to capture the spectrum of sedentary (sitting) and physical activity behaviors is encouraged, particularly in low- and middle-income countries commencing new surveillance activities.

Background Dietary assessment is a challenge in general, and specifically in individuals with intellectual disabilities (ID). This study aimed to evaluate personal digital photography as a method of assessing different aspects of dietary quality in this target group. Method Eighteen adults with ID were recruited from community residences and activity centres in Stockholm County. Participants were instructed to photograph all foods and beverages consumed during 1 day, while observed. Photographs were coded by two raters. Observations and photographs of meal frequency, intake occasions of four specific food and beverage items, meal quality and dietary diversity were compared. Evaluation of inter-rater reliability and validity of the method was performed by intra-class correlation analysis. Results With reminders from staff, 85% of all observed eating or drinking occasions were photographed. The inter-rater reliability was excellent for all assessed variables (ICC ≥ 0.88), except for meal quality where ICC was 0.66. The correlations between items assessed in photos and observations were strong to almost perfect with ICC values ranging from 0.71 to 0.92 and all were statistically significant. Conclusion Personal digital photography appears to be a feasible, reliable and valid method for assessing dietary quality in people with mild to moderate ID, who have daily staff support.

Sedentary Behavior (SB) is among the most frequent human behaviors and is associated with a plethora of serious chronic lifestyle diseases as well as premature death. Office workers in particular are at an increased risk due to their extensive amounts of occupational SB. However, we still lack an objective method to measure SB consistent with its definition. We have therefore developed a new measurement system based on muscular activity and accelerometry. The primary aim of the present study was to calibrate the new-developed 8-CH-EMG+ for measuring occupational SB against an indirect calorimeter during typical desk-based office work activities. In total, 25 volunteers performed nine office tasks at three typical workplaces. Minute-by-minute posture and activity classification was performed using subsequent decision trees developed with artificial intelligence data processing techniques. The 8-CH-EMG+ successfully identified all sitting episodes (AUC = 1.0). Furthermore, depending on the number of electromyography channels included, the device has a sensitivity of 83&ndash, 98% and 74&ndash, 98% to detect SB and active sitting (AUC = 0.85&ndash, 0.91). The 8-CH-EMG+ advances the field of objective SB measurements by combining accelerometry with muscular activity. Future field studies should consider the use of EMG sensors to record SB in line with its definition.

Although questionnaires are useful for evaluating patterns of physical activity in populations, they need to be validated. The objective of this study was to determine the validity and reliability of the long version of the International Physical Activity Questionnaire (IPAQ) in a Spanish population. The participants wore a uniaxial MTI Actigraph (Computer Science and Application, Inc.) accelerometer for 7 days and self-completed the IPAQ questionnaire twice, to assess its reliability. Criterion validity was assessed by comparing data from the IPAQ and data from the MTI. The final sample included 54 adults for the validity analysis and 66 adults for the reliability analysis. The correlations (r) between the IPAQ and the accelerometer were 0.29 (P

Background:The aim of this study was to compare physical activity components in the long, self-administrated version of IPAQ with an accelerometer in a population sample.Methods:In total 980 subjects (18-65 years) wore an accelerometer (Actigraph) for 7 consecutive days and thereafter filled in the IPAQ. Measures of total physical activity, time spent in moderate and in vigorous activity as well as time spent sitting as assessed by the IPAQ and the Actigraph were compared.Results:The results showed significant low to moderate correlations (Rs = 0.07−0.36) between the 2 instruments and significantly (P < .001) higher values for sitting and vigorous intensity physical activity from the IPAQ compared with the Actigraph. The higher the values reported by the IPAQ the bigger differences were seen between the instruments. Comparison between the tertiles of total physical activity by the 2 instruments showed significant overall association with consistent agreement in the low and the high tertiles.Conclusion:The long form of IPAQ is a valid measure of physical activity in population research. However, the IPAQ likely overestimates actual physical activity as shown by its limited ability to classify adults into low and high categories of physical activity based on accelerometer data.

This study compares levels and patterns of objectively assessed physical activity in Sweden and the United States by using identical accelerometer metrics. Data of adult respondents withor =4 days withor =10 hours per day of accelerometer wear from Sweden (2001-2002, n = 1,172) and the United States (2003-2004, n = 2,925) were compared. Outcomes reported by age and body mass index within sex include accelerometer counts per minute and amounts and bouts of activity at different intensities, that is, sedentary, low, lifestyle, and moderate or higher intensity physical activity. The mean counts per minute were 375 (95% confidence interval (CI): 360, 390) and 377 (95% CI: 363, 391) for Swedish and US males, respectively, and 363 (95% CI: 347, 379) and 298 (95% CI: 289, 307) for Swedish and US females. Older respondents and those with higher body mass index had lower activity levels. Swedish and US males spent 36 (95% CI: 34, 38) and 33 (95% CI: 31, 36) minutes per day, and Swedish and US females spent 32 (95% CI: 29, 34) and 19 (95% CI: 17, 21) minutes per day in moderate or higher intensity physical activity. Older Swedes were more active in moderate or higher intensity activities than were older US respondents. However, younger Swedish males had more sedentary behavior time than did younger US males. These results provide a framework for international comparisons of physical activity levels and patterns, and they represent strong evidence for the importance of investment in objective measurement of physical activity.

ObjectiveTo modify the self-administered, short version of the International Physical Activity Questionnaire (IPAQ) for adults to be used in the elderly (aged 65 years and above), and to validate this modified IPAQ for the elderly (IPAQ-E).DesignA direct validity study using accelerometer-measured physical activity (PA) as the criterion measure, and an indirect criterion validity study using high-sensitivity C-reactive protein (hs-CRP) as a biological marker of activity.SettingOrganisations for retired persons in Sweden.SubjectsThe direct validity study consisted of fifty-four participants and the indirect criterion validity study consisted of 359 participants. All participants were retired persons (66–91 years) living independently.ResultsAll self-reported activity domains (sitting, walking, moderate and vigorous) were positively correlated with the corresponding variable objectively assessed by an accelerometer (ρ= 0·277–0·471), but a systematic error was observed. The specificity of IPAQ-E to identify low-active participants was 85 %, and the sensitivity to identify the more active participants was 81 %. A main effect of IPAQ-E category (Low, Moderate or High) was observed for hs-CRP (P= 0·041).ConclusionsWe found this modified version of IPAQ, the IPAQ-E, to be well accepted by our sample of socially active elderly. It provided acceptable estimates of PA, well in line with other questionnaires, even though it had a systematic error. The IPAQ-E was able to identify an expected response of a biomarker (hs-CRP) to PA. We recommend the use of the IPAQ-E to classify participants aged 65 years and above into PA categories, to rank individuals or to identify individuals meeting certain PA criteria.

To examine the reliability of a set of health-related physical fitness tests used in the European Union-funded Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study on lifestyle and nutrition among adolescents.A set of physical fitness tests was performed twice in a study sample, 2 weeks apart, by the same researchers.A total of 123 adolescents (69 males and 54 females, aged 13.6+/-0.8 years) from 10 European cities participated in the study.Flexibility, muscular fitness, speed/agility and aerobic capacity were tested using the back-saver sit and reach, handgrip, standing broad jump, Bosco jumps (squat jump, counter movement jump and Abalakov jump), bent arm hang, 4 x 10 m shuttle run, and 20-m shuttle run tests.The ANOVA analysis showed that neither systematic bias nor sex differences were found for any of the studied tests, except for the back-saver sit and reach test, in which a borderline significant sex difference was observed (P=0.044). The Bland-Altman plots graphically showed the reliability patterns, in terms of systematic errors (bias) and random error (95% limits of agreement), of the physical fitness tests studied. The observed systematic error for all the fitness assessment tests was nearly 0.Neither a learning nor a fatigue effect was found for any of the physical fitness tests when repeated. The results also suggest that reliability did not differ between male and female adolescents. Collectively, it can be stated that the reliability of the set of physical fitness tests examined in this study is acceptable. The data provided contribute to a better understanding of physical fitness assessment in young people.

Adolescents are an interesting but neglected target group in obesity prevention. We assessed the feasibility of using a diet optimization approach for computer-tailored nutrition interventions for adolescents.Development of an optimization model based on the public health approach to diet optimization. On the basis of food frequency questionnaires (FFQ) of 48 adolescents (14-17 years) optimized diets were calculated.The optimization calculations for all cases resulted in individual advice. On a total of 137 items included in the FFQ, the individualized advice included changes in a minimum of 36 and a maximum of 88 items (mean: 61 items), recommendations for changes in the food items ranged from less than 1 g day(-1) up to 1660 g day(-1). In almost all cases a higher intake of fruit and vegetables was recommended; some unexpected advice was also generated (for example, to decrease the consumption of brown bread and to increase the consumption of pizza). The strengths and weaknesses of the optimized diets are discussed.Using the optimization approach is a step forward in nutrition tailoring interventions but the model used in the present feasibility study still needs to be refined.

Strong evidence suggests a link between physical inactivity and chronic disease prevalence in the adult population. To target the right groups for interventions in a population, accurate assessment of physical activity is important. The objective of this study was to assess the levels and pattern of physical activity and inactivity in an adult population sample using an objective method.In total, 1114 adults (56% women, 45+/-15 yr), randomly recruited from the Swedish population across a year, used an accelerometer (Actigraph MTI) for seven consecutive days. Inactivity was defined as100 counts per minute, and cutoff values for moderate and vigorous activity were 1952-5724 and5724 counts per minute, respectively. Average intensity was measured as counts per minute.The adults were active in at least moderate-intensity activity for a median (intraquartile range) of 31 (18-47) min.d(-1). Fifty-two percent accumulated 30 min.d(-1) of at least moderate-intensity physical activity. Only 1% achieved those 30 min from three or more bouts of at least 10 min. Average intensity, moderate and vigorous physical activity was lower with higher age or body mass index (BMI). Men spent more time than women in moderate and vigorous physical activity, but there was no gender difference in average intensity. The variation in inactivity could not be explained by gender, age, or BMI.Objectively obtained estimates of physical activity yielded lower values and a different activity pattern compared with those obtained by commonly used self-reports. This highlights the need to better understand the nature and measurement issues of health-enhancing physical activity of adults.

The aim of this study was to assess profiles of physical activity (PA) behavior using accelerometers among middle-aged and elderly women in free-living conditions. A subset of 133 women aged 56–75 years from the population-based Swedish Mammography Cohort with valid accelerometer data was included in the analysis. The proportion of women who met the PA recommendation of accumulating 30 min of moderate-to-vigorous physical activity (MVPA), in either one continuous bout or several shorter bouts lasting 8–10 min, on five or more days/week was 31%. The precision of mean daily estimates of MVPA and of inactivity based on 7 days monitoring was 0.80 and 0.86, respectively. On average, participants spent 103 min/day on MVPA, but only about a third of that time was accumulated in the recommended pattern of bouts lasting at least 8–10 min. Obese women had, on average, one bout of MVPA less than normal-weight women (mean 3.6 bouts/day). The mean MVPA decreased 10 min/day with every 5-year increase in age. A low proportion of women accumulated MVPA in the pattern recommended for health benefits. The proportion would increase considerably if women maintained their current amount of MVPA but increased the duration of each bout of MVPA.

To make individualized counseling possible, valid and reliable measures of physical activity are necessary. In health care, quality must be continuously secured and developed. Follow-up of life-style habits such as physical activity does not differ from monitoring of other treatment in the health care setting. After counseling and appropriate period of time, evaluation should be done to assess if there has been any change in the physical activity level. For assessment and evaluation of physical activity in routine clinical practice the National Board for Health and Social Welfare indicator questions regarding physical activity are recommended. For a more detailed assessment and evaluation of physical activity and sedentary behavior comprehensive validated instruments/diaries should be used. For precise and objective assessment and evaluation of both physical activity and sedentary behavior, movement sensors are recommended.

Recommendations for physical activity have been prepared by Professional Associations for Physical Activity and approved by the Swedish Society of Medicine in 2011. All adults are recommended regular aerobic and muscle strengthening physical activity. Lowest recommended dose (intensity x time) of aerobic physical activity is 150 minutes at moderate or 75 minutes at high intensity per week. More health benefits are achieved if the dose is higher than the lowest recommended dose. Longer periods of sedentary behavior should be avoided. Elderly are also recommended balance training. The benefits of physical activity outweigh the risks. The Swedish National Board of Health and Welfare recommends that the healthcare system offer counselling with the adjunct of exercise on prescription or a pedometer to persons with insufficient physical activity, i.e. less than the lowest recommended dose in the current recommendations for physical activity.

BACKGROUND: Physical activity prevents or delays progression of impaired glucose tolerance in high-risk individuals. Physical activity promotion should serve as a basis in diabetes care. It is necessary to develop and evaluate health-promoting methods that are feasible as well as cost-effective within diabetes care. The aim of Sophia Step Study is to evaluate the impact of a multi-component and a single component physical activity intervention aiming at improving HbA1c (primary outcome) and other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes. METHODS/DESIGN: Sophia Step Study is a randomized controlled trial and participants are randomly assigned to either a multi-component intervention group (A), a pedometer group (B) or a control group (C). In total, 310 patients will be included and followed for 24 months. Group A participants are offered pedometers and a website to register steps, physical activity on prescription with yearly follow-ups, motivational interviewing (10 occasions) and group consultations (including walks, 12 occasions). Group B participants are offered pedometers and a website to register steps. Group C are offered usual care. The theoretical framework underpinning the interventions is the Health Belief Model, the Stages of Change Model, and the Social Cognitive Theory. Both the multi-component intervention (group A) and the pedometer intervention (group B) are using several techniques for behavior change such as self-monitoring, goal setting, feedback and relapse prevention. Measurements are made at week 0, 8, 12, 16, month 6, 9, 12, 18 and 24, including metabolic and cardiovascular biomarkers (HbA1c as primary health outcome), accelerometry and daily steps. Furthermore, questionnaires were used to evaluate dietary intake, physical activity, perceived ability to perform physical activity, perceived support for being active, quality of life, anxiety, depression, well-being, perceived treatment, perceived stress and diabetes self- efficacy. DISCUSSION: This study will show if a multi-component intervention using pedometers with group- and individual consultations is more effective than a single- component intervention using pedometers alone, in increasing physical activity and improving HbA1c, other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02374788 . Registered 28 January 2015.

© 2015 Elsevier Ireland Ltd. All rights reserved. Background/objective Increased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors. Methods A sample of 769 adolescents (12.5-17.5 years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included. Results Concerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between >PA ≥ 60 min/d; SB ≥ 2 h> and the ratio TC/HDL-c (β = 0.27; 95%CI 0.01 to 0.52; p < 0.05), and a negative association between >MVPA ≥ 60 min/d; SB < 2 h> with the 4Skinfolds (β = - 0.32; 95%CI - 0.61 to - 0.02; p < 0.05). Moreover, >SB ≥ 2 h/d> was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p < 0.05), while >PA ≥ 60 min/d; SB < 2 h> had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p < 0.05). After adjustment for potential confounders, a positive association between SB and 4Skinfolds was shown (β = 0.28; 95%CI 0.04 to 0.53; p < 0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p = 0.042), and there was a protective effect of >VPA ≥ 30 min/d; SB < 2 h> against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p < 0.05). Conclusion The current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk.

Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.

IntroductionThe International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. The short version of the IPAQ has been tested extensively and is now used in many international studies. The present study aimed to explore the validity characteristics of the long-version IPAQ.Subjects and methodsForty-six voluntary healthy male and female subjects (age, mean±standard deviation: 40.7±10.3 years) participated in the study. PA indicators derived from the long, self-administered IPAQ were compared with data from an activity monitor and a PA log book for concurrent validity, and with aerobic fitness, body mass index (BMI) and percentage body fat for construct validity.ResultsStrong positive relationships were observed between the activity monitor data and the IPAQ data for total PA (ρ = 0.55, P < 0.001) and vigorous PA (ρ = 0.71, P < 0.001), but a weaker relationship for moderate PA (ρ = 0.21, P = 0.051). Calculated MET-h day−1 from the PA log book was significantly correlated with MET-h day−1 from the IPAQ (ρ = 0.67, P < 0.001). A weak correlation was observed between IPAQ data for total PA and both aerobic fitness (ρ = 0.21, P = 0.051) and BMI (ρ = 0.25, P = 0.009). No significant correlation was observed between percentage body fat and IPAQ variables. Bland–Altman analysis suggested that the inability of activity monitors to detect certain types of activities might introduce a source of error in criterion validation studies.ConclusionsThe long, self-administered IPAQ questionnaire has acceptable validity when assessing levels and patterns of PA in healthy adults.

The European Youth Heart Study (EYHS) addresses cardiovascular disease risk factors and their determinants in European children and adolescents. The Swedish part of the study began with cross-sectional data collection in 9- and 15-year-old schoolchildren in 1998–1999 (EYHS-I). Repeated observations of the key indicators were performed in 2004–2005 (EYHS-II). The purpose of this study was to assess potential dropout effects in EYHS-II. Participants in both EYHS-I and EYHS-II (n=459) were compared with dropouts who participated only in the EYHS-I (n=678) in relation to baseline physical activity, cardiorespiratory fitness and socioeconomic and anthropometric characteristics. Bivariate comparisons were performed using chi-square tests and gamma tests for nominal and ordinal data, respectively. Continuous data were compared by t tests and Mann−Whitney tests depending on the distribution. The Bonferroni correction was used to control for multiple hypothesis testing. Multiple logistic regression with backward elimination of variables was applied to study independent effects of variables on the probability of becoming a dropout. Analyses were performed separately for the younger and older age groups. The dropout proportion in EYHS-II was 60%. Subjects from the older age group were less likely to participate in the follow-up study (32% vs. 50%, p

The World Health Organisation (WHO) recommends the development of comparable national physical activity surveillance systems to assess trends within and amongst countries as the Global Strategy for Diet and Physical Activity is implemented. To date, the lack of well-standardised measurement instruments has impeded such efforts, but new methodologies are being developed for this purpose. This paper describes the usefulness of the International Physical Activity Questionnaire (IPAQ) in population samples. The Special Eurobarometer Wave 58.2 2002 covered physical activity and provided a good vehicle for assessment of health-enhancing physical activity (HEPA) in the European Union. Data from around 1,000 individuals in each of the 15 member states were collected after careful translation of the questionnaire. IPAQ scoring protocol version 2 was used for definition of activity categories. Data on the prevalence of sufficient total activity, sedentariness, frequent walking and sitting, in total and by gender across European Union (EU) countries showed consistent patterns. The prevalence of sufficient physical activity for health across the member countries was 29%. It ranged from 44% in the Netherlands to 23% in Sweden. The prevalence of sedentariness across countries was in general the mirror image. Regular walking was most prevalent in Spain. Gender was related to physical activity in that men were 1.6 times more likely than women to be sufficiently active, less likely to be sedentary and slightly more likely to sit for at least 6 hours daily. The findings suggest that two thirds of the adult populations of the European countries are insufficiently active for optimal health benefits. As the IPAQ measurement provides information about the patterns of total physical activity and inactivity, the findings indicate possibilities for targeted health promotion efforts.

Public health needs a better understanding of how much, and in what way, populations are physically active. This paper presents subjectively assessed measures of health-enhancing physical activity (HEPA), among males and females, and their relation to social and demographic factors in a representative sample of the Swedish population. In total 2,500 adults aged 18–74 years were randomly selected from the official population register, 1,470 of whom responded [59%, mean age: 46 years, body mass index (BMI): 25.5]. The short version of the International Physical Activity Questionnaire (IPAQ) and the IPAQ scoring protocol, version 2.0 ( http://www.ipaq.ki ) was used. For total HEPA the subjects reported a median of 1,699 (693–3,600) metabolic equivalents (MET) min·week−1. Men reported more total HEPA than women (p

The physical environment has emerged as a potential correlate to physical activity, and altering the environment could be one way to increase physical activity on a population level. The aim of the present study was to assess the test–retest reliability of the Swedish version of an environmental instrument developed for population-based studies. The study population was recruited from a larger study performed at the same time. A random sample of Swedish adults, age 18–74, was invited to participate in the reliability testing of 17 questions regarding the local physical environment. The questions addressed variables such as presence of sidewalks, bike paths and recreational facilities as well as questions regarding aesthetic, social and safety attributes. A total of 98 subjects completed the test and retest questionnaires. Overall percent agreement ranged from 55.1–92.9%. Intraclass correlation (ICC) for the total sample ranged from 0.36–0.98. The questions regarding motorized vehicles produced the highest total reliability score (ICC=0.98) and the question regarding safety from crime during the day produced the lowest (ICC=0.36). Small differences were seen between men and women for a few variables, but no apparent pattern was identified. The test–retest of the Swedish version of the environmental module resulted in substantial agreement for most variables. The instrument showed an acceptable reliability and can therefore be used in future studies regarding local environmental attributes and physical activity in Sweden.

A low level of physical activity is a risk factor for several chronic diseases, and evidence suggests that physical activity levels are in decline. Reversing this trend will involve a change in behaviour for most people. However, the associations between many psychosocial determinants and physical activity are not well understood. This study aims to examine the relationship between self-reported physical activity and perceived self-efficacy and stages of change. Students attending a third-level college in Dublin, Ireland, were recruited to participate in the study (n=201, mean age 20.7 years). Physical activity was assessed with the use of the long format, self-administered International Physical Activity Questionnaire (IPAQ), and subjects were assigned to tertiles of activity. Self-efficacy and stages of change (in relation to increasing physical activity) were assessed by means of a questionnaire. Males reported more physical activity, had higher self-efficacy and were more likely to be in the action or maintenance stages of change. The stages of change were positively correlated with tertiles of reported activity (P

To evaluate the validity of the Previous Day Physical Activity Recall (PDPAR) as a physical activity diary in adolescents using two accelerometer intensity classifications.One hundred eighth graders (47 boys, 53 girls) used the PDPAR as a daily diary and wore MTI accelerometers for four consecutive days. Measured time spent in moderate (or = 3 METs) and vigorous (or = 6 METs) activity was based on two published MTI cut-point limits (that of Freedson et al./Trost et al. and that of Puyau et al.). Spearman rank order correlations and Bland-Altman plots were used to examine agreement between MTI and PDPAR diary estimates of activity.MTI estimates of mean minutes per day of total moderate to vigorous physical activity (MVPA) were 65.2 (+/-43.2) using the Freedson et al./Trost et al. cutoffs and 17.5 (+/-18.5) using those of Puyau et al., while students self-reported 105.1 (+/-80.1) min.d(-1). Significant relationships were observed between the diary and MTI for total MVPA using either the Freedson et al./Trost et al. (r = 0.42) or Puyau et al. (r = 0.41) cutoff as well as raw counts (r = 0.44). Plots showed reasonable agreement between the diary and Freedson et al./Trost et al. MTI estimates of MVPA for daily totals ofor = 60 min, but the Puyau et al. estimates were consistently lower. Diaries overestimated activity as time increased when compared to either MTI cut point, especially on vigorous activity.Time estimates of MVPA differed by assessment tool, but diary estimates showed adequate association with the MTI. Diaries reflected intensity-specific activity, corresponding most closely with the Freedson et al./Trost et al. classification of moderate, but substantially overestimated vigorous activity regardless of cut-point method. This is likely due to the measurement characteristics of the PDPAR, which classifies activities in 30-min blocks, as well as the nature of common activities in which high levels of intensity are not sustained.

Background: Successful public health programs in the area of physical activity demand a clear understanding of how, and to what extent, people are physically active. Physical activity is, however, difficult to measure accurately.Objective: We conducted tests using various methods, including an accelerometer and the International Physical Activity Questionnaire (IPAQ).Design: The results were applied on a feasibility sample, aged 41910 years (N¾49) and on random samples of a community in the Stockholm area (N¾200) and of the Swedish population (N¾196), aged 47914 years and 45913 years respectively.Results: A majority of individuals in all samples reached the current recommendation of at least thirty minutes in total per day or more of moderate physical activity. However, based on accelerometer data this was achieved mainly through sporadic bouts of less than one minute. Few, if any, appeared to reach thirty minutes of continuous moderately intense activity or even continuous bouts of at least ten m...