Elaine M. Murtagh

Accumulated versus Continuous Exercise for Health Benefit : A Review of Empirical Studies

Current physical activity guidelines endorse the notion that the recommended amount of daily physical activity can be accumulated in short bouts performed over the course of a day. Although intuitively appealing, the evidence for the efficacy of accumulated exercise is not plentiful. The purpose of this review was to compare the effects of similar amounts of exercise performed in either one continuous or two or more accumulated bouts on a range of health outcomes.Sixteen studies met the selection criteria for inclusion in the review, in which at least one outcome known to affect health was measured before and after continuous and accumulated exercise training interventions. Where improvements in cardiovascular fitness were noted, most studies reported no difference in the alterations between accumulated and continuous patterns of exercise. In the few studies where a normalization of blood pressure was observed from baseline to post-intervention, there appear to be no differences between accumulated and continuous exercise in the magnitude of this effect. For other health outcomes such as adiposity, blood lipids and psychological well-being, there is insufficient evidence to determine whether accumulated exercise is as effective as the more traditional continuous approach.Seven short-term studies in which at least one health-related outcome was measured during the 0- to 48-hour period after a single continuous bout of exercise and a number of short bouts of equivalent total duration were included in the review. Many of the studies of such short-term effects considered the plasma triglyceride response to a meal following either accumulated short or continuous bouts of exercise. Collectively, these studies suggest that accumulated exercise may be as effective at reducing postprandial lipaemia. Further research is required to determine if even shorter bouts of accumulated exercise (<10 minutes) confer a health benefit and whether an accumulated approach to physical activity increases adherence among the sedentary population at whom this pattern of exercise is targeted.

The effect of a worksite based walking programme on cardiovascular risk in previously sedentary civil servants [NCT00284479].

BackgroundA significant proportion of Europeans do not meet the recommendations for 30 mins of physical activity 5 times per week. Whether lower frequency, moderate intensity exercise alters cardiovascular disease (CVD) risk has received little attention. This study examined the effects of 45 minutes self-paced walking, 2 d· wk-1 on aerobic fitness, blood pressure (BP), body composition, lipids and C-Reactive Protein (CRP) in previously sedentary civil servants.Methods37 subjects (24 women) aged 41.5 ± 9.3 years were randomly assigned to either two 45 minute walks per week (walking group) or no training (control group). Aerobic fitness, body composition, blood pressure (BP), CRP and lipoprotein variables were measured at baseline and following 8 weeks. Steps counts were measured at baseline and during weeks 4 and 8 of the intervention.ResultsCompared to the control group, the walking group showed a significant reduction in systolic BP and maintained body fat levels (P < 0.05). There were no changes other risk factors. Subjects took significantly more steps on the days when prescribed walking was performed (9303 ± 2665) compared to rest days (5803 ± 2749; P < 0.001).ConclusionThese findings suggest that walking twice per week for 45 minutes at ~ 62% HRmax, improves activity levels, reduces systolic BP and prevents an increase in body fat in previously sedentary adults. This walking prescription, however, failed to induce significant improvements in other markers of cardiovascular disease risk following eight weeks of training.

Walking: the first steps in cardiovascular disease prevention

Purpose of review Health professionals are presented with the challenge of prescribing physical activity that is likely to be sustained by the sedentary majority. Walking is eminently suited to physical activity prescription for inactive individuals as it is accessible to men and women of all ages and social groups and poses little risk of injury. This paper reviews recent evidence of the health benefits of walking and promotion of walking behavior. Recent findings Large observational studies consistently show associations between walking and cardiovascular disease endpoints over long periods of follow-up. Intervention studies further support the health benefits of walking, showing improvements in clinical biomarkers and measures after shorter periods of follow-up. Walking appears to have cardiovascular disease-related health benefits in younger, middle-aged, and older men and women, in both healthy and patient populations. Pedometer-based, mobile phone-based, and computer-based programs are effective in increasing walking levels. Neighborhood and workplace amenities and programs may be important supports for walking behaviors. Summary Walking has the potential to play a key role in the primary and secondary prevention of cardiovascular disease. Clinicians can prescribe walking to assist patients meet physical activity recommendations and help identify supports available to the patient.

The effect of walking on risk factors for cardiovascular disease: An updated systematic review and meta-analysis of randomised control trials

OBJECTIVE To conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease. METHODS Four electronic databases and reference lists were searched (Jan 1971-June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model. RESULTS 32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (-3.58 mm Hg, 95% CI -5.19 to -1.97) and diastolic (-1.54 mm Hg, 95% CI -2.83 to -0.26) blood pressure, waist circumference (-1.51 cm, 95% CI -2.34 to -0.68), weight (-1.37 kg, 95% CI -1.75 to -1.00), percentage body fat (-1.22%, 95% CI -1.70 to -0.73) and body mass index (-0.53 kg/m(2), 95% CI -0.72 to -0.35) but failed to alter blood lipids. CONCLUSIONS Walking interventions improve many risk factors for cardiovascular disease. This underscores the central role of walking in physical activity for health promotion.

Session 1: Public health nutrition: Physical activity prescription for public health.

The increased prevalence of CVD deaths in the past 60 years is a result in considerable part of the influence of environmental and lifestyle changes, including decreased daily energy expenditure through physical exertion. Physical activity prescription has therefore become an important public health issue. Exercise guidelines have evolved considerably since their first publication by the American College of Sports Medicine (ACSM) in 1978. Guidelines initially focused on moderate- to vigorous-intensity exercise to develop and maintain cardiorespiratory fitness. However, in the face of escalating physical inactivity, public health agencies sought to develop an exercise prescription more palatable to the sedentary majority and in 1995 recommended the accumulation of 30 min moderate-intensity exercise on most days of the week. The unexpected result of this message was that some individuals believed that vigorous exercise was not necessary, whilst others believed that low levels of physical activity were sufficient. In 2008 the ACSM and the American Heart Association sought to clarify this position and published an updated recommendation in which: the beneficial role of vigorous-intensity exercise is explicitly stated; adults are encouraged to combine moderate- and vigorous-intensity exercise to meet the minimum recommendation of moderate-intensity physical activity for a 30 min on 5 d/week or vigorous-intensity aerobic activity for 20 min on 3 d/week; the dose-response relationship between physical activity and health is reinforced. The immense challenge for public health professionals now lies in encouraging the sedentary population to adopt a more active lifestyle.

Prevalence and correlates of physical inactivity in community-dwelling older adults in Ireland

The public health challenges associated with rapid population ageing are likely to be exacerbated by poor physical activity levels. The purpose of this study was to identify correlates of physical inactivity in a population-representative sample of older adults in Ireland. This paper reports a secondary analysis of data from 4892 adults aged 60+ from the Irish Longitudinal Study on Ageing (TILDA). TILDA includes an assessment of the mental and physical health, and social and financial circumstances of participants assessed in a home interview and self-completion questionnaire. Chi squared statistics and forced entry logistic regression were used to identify factors associated with physical inactivity. Females were over twice as likely to be inactive as their male counterparts (Odds Ratio 2.2). Increasing old age was associated with inactivity among males and females. Those who reported above secondary level education, no reported falls in the last year and no fear of falling were less likely to be physically inactive. While older adults who noted poor/fair self-reported health, that they did not look after grandchildren, did not own a car or did not attend a course were also more likely to be inactive than those who reported positively for these items. Gender displayed a strong but often contrasting influence on factors that affect physical activity among older adults. Among females, living alone or in a rural area, retirement, fair/poor emotional health and activity being limited by illness were all significantly associated with inactivity. While cohabiting, being employed and residing in an urban area were related to low levels of activity in males. Our findings identify specific groups of the older Irish population who may be at particular risk of physical inactivity and thereby the associated physiological and psychological hazards. These results can support the development of tailored interventions to promote healthy ageing.

Seasonal and Annual Variation in Young Children's Physical Activity

INTRODUCTION It is well established that regular physical activity (PA) contributes to lower levels of morbidity and mortality. However, little is known about the stability of very young childrens PA habits across seasons and years. The aims of this study were to 1) examine the influence of season and increasing age on objectively assessed PA in preschool children and 2) examine the stability of young childrens PA rankings during 1 yr. METHODS The PA levels of preschool (3- and 4-yr-old) children were measured, using 6-d pedometer step counts, during winter and spring (n = 85, 52 boys). PA levels were measured again 1 yr after the spring data collection when the children had entered primary school (n = 37, 22 boys). Parents completed questionnaires to assess attitudes toward PA, PA habits, and demographic information in the winter of the first year and the spring of the second year. RESULTS Young children take approximately 2000 (20%) fewer steps per day in winter than in spring with a rank order stability between the two measures of r = 0.04 (P < 0.01). A modest degree of the observed intrachild or seasonal variation was related to the amount of time fathers played with their children (P < 0.05) and the availability of a safe place for children to play (P < 0.05). Children took approximately 2300 (20%) more steps per day at age 5 compared with age 4 (P < 0.01). The rank order stability of young childrens PA during this period was low with correlations ranging from 0.01 to 0.15. CONCLUSIONS Results suggest that a one-off assessment of PA is unlikely to be representative of a young childs activity during 1 yr and that PA tracks poorly from age 4 to 5.

Effect of Active Lessons on Physical Activity, Academic, and Health Outcomes: A Systematic Review

ABSTRACT Purpose: The purpose of this study was to conduct a systematic review of classroom-based physical activity interventions that integrate academic content and assess the effectiveness of the interventions on physical activity, learning, facilitators of learning, and health outcomes. Method: Six electronic databases (ERIC, PubMed, Google Scholar, Science Direct, Cochrane Library, and EMBASE) and reference lists were searched for English-language articles, published January 1990 through March 2015, reporting classroom-based interventions that deliberately taught academic content using physically active teaching methods for at least 1 week duration, with physical activity, health, learning, or facilitators-of-learning outcomes. Two authors reviewed full-text articles. Data were extracted onto an Excel spreadsheet, and authors were contacted to confirm accuracy of the information presented. Results: Fifteen studies met the inclusion criteria. Six studies reporting on physical activity levels were found to have medium-to-large effect sizes. All 4 studies reporting learning outcomes showed positive effects of intervention lessons. Teachers and students were pleased with the programs, and enhanced on-task behavior was identified (n = 3). Positive effects were also reported on students’ body mass index levels (n = 3). Conclusions: Physically active academic lessons increase physical activity levels and may benefit learning and health outcomes. Both students and teachers positively received and enjoyed these teaching methods. These findings emphasize the need for such interventions to contribute toward public health policy.

Results From Ireland's 2014 Report Card on Physical Activity in Children and Youth

BACKGROUND Physical activity (PA) levels are a key performance indicator for policy documents in Ireland. The first Ireland Report Card on Physical Activity in Children and Youth aims to set a robust baseline for future surveillance of indicators related to PA in children and youth. METHODS Data collected between 2003-2010 on more than 35,000 7- to 18-year-old children and youth were used and graded using a standardized grading system for 10 indicators. RESULTS Grades assigned for the indicators were as follows: overall physical activity levels, D-; sedentary behavior (TV viewing), C-; organized sport participation, C-: physical education, D-; active play, inconclusive (INC); active transportation, D; school, C-, community and the built environment, B; family, INC; and government, INC. CONCLUSIONS PA recommendations exist in Ireland but this Report Card has shown that participation is still low. A number of promising policies, programs and services are in place but these require thorough evaluation and adequate resourcing. Agreement and implementation of a common framework for the systematic surveillance of indictors related to PA of children and youth is necessary to monitor change over time and ensure the impact of promising work is captured.

Flying the ‘Active School Flag’: physical activity promotion through self-evaluation in primary schools in Ireland

Primary schools are key sites where children can be active, advance their knowledge and understanding of how to participate in physical activity (PA) and develop an appreciation of its importance in their lives. This study explored the role of schools in promoting PA asking: how do primary schools approach the promotion of whole-school PA? Data submitted by 21 schools as part of a self-evaluation PA initiative were included in a secondary analysis using an inductive thematic approach. Schools’ approaches to PA promotion were more structured and inclusive, illustrating what schools valued and what they viewed as feasible within their contexts and resources. Self-evaluation and self-improvement processes can contribute to the promotion of whole-school PA in primary schools. While changes to school practices that better reflect educational policy on PA promotion are encouraging, the long-term impact of the self-evaluation process merits further investigation.