Geoffrey P. Whitfield

Updating ACSM's Recommendations for Exercise Preparticipation Health Screening.

The purpose of the American College of Sports Medicines (ACSM) exercise preparticipation health screening process is to identify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. Recent studies have suggested that using the current ACSM exercise preparticipation health screening guidelines can result in excessive physician referrals, possibly creating a barrier to exercise participation. In addition, there is considerable evidence that exercise is safe for most people and has many associated health and fitness benefits; exercise-related cardiovascular events are often preceded by warning signs/symptoms; and the cardiovascular risks associated with exercise lessen as individuals become more physically active/fit. Consequently, a scientific roundtable was convened by the ACSM in June 2014 to evaluate the current exercise preparticipation health screening recommendations. The roundtable proposed a new evidence-informed model for exercise preparticipation health screening on the basis of three factors: 1) the individuals current level of physical activity, 2) presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease, and 3) desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events. Identifying cardiovascular disease risk factors remains an important objective of overall disease prevention and management, but risk factor profiling is no longer included in the exercise preparticipation health screening process. The new ACSM exercise preparticipation health screening recommendations reduce possible unnecessary barriers to adopting and maintaining a regular exercise program, a lifestyle of habitual physical activity, or both, and thereby emphasize the important public health message that regular physical activity is important for all individuals.

Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a nationally representative sample of US adults aged >=40 years from the National Health and Nutrition Examination Survey 2001 to 2004.

Background— Although the American Heart Association/American College of Sports Medicine’s Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ≥40 years. Methods and Results— Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calculated the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004 who would receive a recommendation for physician consultation based on AAPQ referral criteria. Additionally, we compared recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample. AAPQ referral proportions were higher with older age. Across all age groups ≥40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the 2 screening tools produced similar results for 72.4% of respondents. Conclusions— These results suggest that >90% of US adults aged ≥40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption and stress the healthcare infrastructure.

Patterns of accelerometer-derived estimates of inactivity in middle-age women

PURPOSE The studys purpose was to characterize accelerometer-derived estimates of physical inactivity collected during five consecutive weeks in middle-age women. METHODS Data were obtained from 63 participants (95.5%) enrolled in the Evaluation of Physical Activity Measures in Middle-Age Women Study. Inactive time (min · d(-1)) was estimated as the sum of activity counts <100, and inactive-to-active transitions were defined as an interruption in which a period of inactivity was immediately followed by a minute or more above 100 counts. A repeated-measures ANOVA using PROC MIXED (SAS/STAT software, v. 9.2) was used to describe hourly, daily, and weekly variation in estimates of physical inactivity. RESULTS Participants were 52.7 ± 5.5 yr, 85.7% non-Hispanic white, and 63.5% postmenopausal, with a body mass index of 26.7 ± 5.1 kg · m(-2). Inactive time gradually increased as the day continued, particularly on weekend days. When compared with weekdays, average inactive time was lower on Saturday and Sunday (all P < 0.01 except for Saturday vs Monday, P < 0.10); Saturdays were not significantly different from Sundays. Breaks in inactive time were significantly lower on Sunday when compared with weekdays and Saturday (all P < 0.05), and fewer breaks were noted on Saturday when compared with Wednesday and Friday (both P < 0.01). After adjustment for total wear time or inactive time, most day-to-day differences were attenuated. Week-by-week differences in physical inactivity estimates were also not statistically significant. CONCLUSIONS The results of this study suggest that inactive time increases as the day continues and that daily physical inactivity estimates are more stable after 1) adjustment for wear time or 2) when averaged over the week. Researchers should carefully consider the intended application of physical inactivity estimates before data collection and processing, analysis, and final data reporting.

Sedentary and active: self-reported sitting time among marathon and half-marathon participants.

BACKGROUND Emerging evidence suggests that combined physical activity (PA) and inactivity may be more important for chronic disease risk than PA alone. A highly active yet highly sedentary population is needed to study this interaction. The present purpose is to describe the sitting habits of a group of recreational runners and determine if sitting varies with reported training duration or anticipated running velocity. METHODS Marathon and half-marathon participants completed the Multicontext Sitting Time Questionnaire and reported peak training duration, anticipated finishing time, and demographic information. Sitting time was described across 5 contexts for workdays and nonworkdays. Total sitting time was analyzed by tertiles of training duration and anticipated event running velocity. RESULTS 218 participants took part in this study. Median reported training time was 6.5 hours per week. Median total sitting time was higher on workdays than nonworkdays (645 and 480 minutes, respectively, P < .0001). Total sitting time was not associated with training duration or anticipated event running velocity. CONCLUSIONS These results suggest that recreational distance runners are simultaneously highly sedentary and highly active, supporting independence of sedentary behaviors and moderate- to vigorous-intensity PA. This population may provide the characteristics needed to study the joint effects of active and sedentary behaviors on health outcomes.

Assessing sitting across contexts: development of the multicontext sitting time questionnaire.

Purpose: To describe the development and preliminary evaluation of the Multicontext Sitting Time Questionnaire (MSTQ). Method: During development of the MSTQ, contexts and domains of sitting behavior were utilized as recall cues to improve the accuracy of sitting assessment. The terms “workday” and “nonworkday” were used to disambiguate occupational and discretionary sitting. An expert panel evaluated content validity. Among 25 participants, test–retest reliability of the MSTQ items was assessed with intraclass correlation coefficients (ICCs). Convergent validity was assessed versus relative and absolute accelerometer-estimated sedentary time and activity log using Pearson (r) or Spearman (ρ) correlation coefficients where appropriate. Results: Pilot testing revealed Web-based MSTQ administration was rapid, scalable, and inexpensive. Most items in the MSTQ demonstrated acceptable reliability (ICCs>.70). Compared with accelerometer-estimated sedentary time relative to total wear time, the MSTQ exhibited a low correlation on workdays (r = .34) and a moderately high correlation on nonworkdays (r = .61). Conclusions: The systematic development of the MSTQ resulted in several improvements over previous tools and may serve as a model for purpose-driven questionnaire design. Additional validation is needed to conclusively determine the utility of the MSTQ.

All health is local: state and local planning for physical activity promotion.

CONTEXT Physical activity is a leading cause of death in the world. Although state and local public health planning is a useful strategy to address noncommunicable disease health concerns such as heart disease, diabetes, cancer, and obesity, physical activity frequently is subsumed in such disease-centric planning efforts. This strategy could dilute broader efforts to promote physical activity, create administrative silos that may be trying to accomplish similar goals, and weaken efforts to more collectively address a variety of noncommunicable diseases. Currently, few stand-alone state plans directed specifically at physical activity exist. The reasons and barriers for this situation are not understood. OBJECTIVE In 2011, we surveyed public health care practitioners to describe state and local efforts for physical activity planning. DESIGN Cross-sectional study. SETTING Survey of physical activity practitioners in the United States. PARTICIPANTS A total of 227 former or current members of the US National Society of Physical Activity Practitioners in Public Health who completed a survey. RESULTS Overall, 48.0% of respondents indicated that they were aware of public health plans for physical activity promotion in their state, whereas 36.6% indicated that they did not know. Respondents at the state level more frequently reported awareness of a plan (62.1%) than those with local-level (52.4%) or other job responsibilities (36.0%). A greater proportion of respondents reported that stand-alone physical activity plans existed in their state than actually did exist in the respective states. Integration with the National Physical Activity Plan was least often identified as a moderately or extremely relevant aspect of a state-level physical activity plan, although it was chosen at a high percentage (75.7%). Respondents identified financial support (88.0%) and political will and support (54.6%) most frequently as very or somewhat difficult barriers to moving forward with state-level physical activity plans. CONCLUSIONS These data suggest that despite efforts to increase development and use of stand-alone physical activity plans, most practitioners rely on existing chronic disease- or obesity-related plans to guide their efforts. Barriers to developing stand-alone physical activity plans must be addressed to develop such plans.

Bone mineral density across a range of physical activity volumes: NHANES 2007-2010

INTRODUCTION The association between aerobic physical activity volume and bone mineral density (BMD) is not completely understood. The purpose of this study was to clarify the association between BMD and aerobic activity across a broad range of activity volumes, particularly volumes between those recommended in the 2008 Physical Activity Guidelines for Americans and those of trained endurance athletes. METHODS Data from the 2007-2010 National Health and Nutrition Examination Survey were used to quantify the association between reported physical activity and BMD at the lumbar spine and proximal femur across the entire range of activity volumes reported by US adults. Participants were categorized into multiples of the minimum guideline-recommended volume based on reported moderate- and vigorous-intensity leisure activity. Lumbar and proximal femur BMD were assessed with dual-energy x-ray absorptiometry. RESULTS Among women, multivariable-adjusted linear regression analyses revealed no significant differences in lumbar BMD across activity categories, whereas proximal femur BMD was significantly higher among those who exceeded the guidelines by 2-4 times than those who reported no activity. Among men, multivariable-adjusted BMD at both sites neared its highest values among those who exceeded the guidelines by at least 4 times and was not progressively higher with additional activity. Logistic regression estimating the odds of low BMD generally echoed the linear regression results. CONCLUSIONS The association between physical activity volume and BMD is complex. Among women, exceeding guidelines by 2-4 times may be important for maximizing BMD at the proximal femur, whereas among men, exceeding guidelines by ≥4 times may be beneficial for lumbar and proximal femur BMD.

Walking for Transportation or Leisure Among U.S. Women and Men — National Health Interview Survey, 2005–2015

Physical activity confers considerable health benefits, but only half of U.S. adults report participating in levels of aerobic physical activity consistent with guidelines (1,2). Step It Up! The Surgeon Generals Call to Action to Promote Walking and Walkable Communities identified walking as an important public health strategy to increase physical activity levels (3). A previous report showed that the self-reported prevalence of walking for transportation or leisure increased by 6 percentage points from 2005 to 2010 (4), but it is unknown whether this increase has been sustained. CDC analyzed National Health Interview Survey (NHIS) data from 2005 (26,551 respondents), 2010 (23,313), and 2015 (28,877) to evaluate trends in the age-adjusted prevalence of self-reported walking among adults aged ≥18 years. The prevalence of walking increased steadily among women, from 57.3% in 2005, to 62.5% in 2010, and to 65.1% in 2015 (significant linear trend). Among men, a significant linear increase in reported walking was observed, from 54.3% in 2005, to 61.8% in 2010, and to 62.8% in 2015, although the increase stalled between 2010 and 2015 (significant linear and quadratic trends). Community design policies and practices that encourage pedestrian activity and programs tailored to the needs of specific population subgroups remain important strategies for promoting walking (3).

Applying the Acsm Preparticipation Screening Algorithm to U.s. Adults: National Health and Nutrition Examination Survey 2001–2004

Purpose For most people, the benefits of physical activity far outweigh the risks. Research has suggested that exercise preparticipation questionnaires might refer an unwarranted number of adults for medical evaluation before exercise initiation, creating a potential barrier to adoption. The new American College of Sports Medicine (ACSM) prescreening algorithm relies on current exercise participation; history and symptoms of cardiovascular, metabolic, or renal disease; and desired exercise intensity to determine referral status. Our purpose was to compare the referral proportion of the ACSM algorithm to that of previous screening tools using a representative sample of U.S. adults. Methods On the basis of responses to health questionnaires from the 2001–2004 National Health and Nutrition Examination Survey, we calculated the proportion of adults 40 yr or older who would be referred for medical clearance before exercise participation based on the ACSM algorithm. Results were stratified by age and sex and compared with previous results for the ACSM/American Heart Association Preparticipation Questionnaire and the Physical Activity Readiness Questionnaire. Results On the basis of the ACSM algorithm, 2.6% of adults would be referred only before beginning vigorous exercise and 54.2% of respondents would be referred before beginning any exercise. Men were more frequently referred before vigorous exercise, and women were more frequently referred before any exercise. Referral was more common with increasing age. The ACSM algorithm referred a smaller proportion of adults for preparticipation medical clearance than the previously examined questionnaires. Conclusions Although additional validation is needed to determine whether the algorithm correctly identifies those at risk for cardiovascular complications, the revised ACSM algorithm referred fewer respondents than other screening tools. A lower referral proportion may mitigate an important barrier of medical clearance from exercise participation.

Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey – 2015

Barriers to safe walking may prevent people from being physically active, and previous reports have identified differences in barriers to safe walking across racial and ethnic groups. The purpose of this research was to determine the role demographic characteristics play on racial/ethnic differences in perceived barriers to safe walking and determine if racial/ethnic differences vary by urban/rural residence and Census region. Participants in the 2015 National Health Interview Survey Cancer Control Supplement (n = 31,433 adults ≥18 years) reported perceived barriers to safe walking (traffic, crime, and animals) and demographic characteristics. Urban/rural residence and Census region were based on home addresses. We calculated adjusted prevalence of barriers by race/ethnicity using logistic regression; geographic differences in barriers across racial/ethnic groups were examined via interaction terms. After adjustment for demographic characteristics, non-Hispanic blacks (blacks) and Hispanics reported crime and animals as barriers more frequently than non-Hispanic whites (whites) (crime: blacks, 22.2%; Hispanics, 16.7%; whites, 9.0%; animals: blacks, 18.0%; Hispanics, 12.4%; whites, 8.5%). Racial/ethnic differences in perceived crime as a barrier were more pronounced in the Northeast and Midwest than in the South and West. Urban-dwelling blacks (all regions) and Hispanics (Midwest and South) reported animals as barriers more frequently than whites. Racial/ethnic differences in perceived barriers to safe walking remained after adjusting for demographic characteristics and varied by geographic location. Addressing perceived crime and animals as barriers to walking could help reduce racial/ethnic differences in physical activity, and several barriers may need to be assessed to account for geographic variation.