STUDY DESIGN: A quasi-experimental single-blinded study. PURPOSE: To investigate the effects of ‘graded exercise integrated with education’ on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients. OVERVIEW OF LITERATURE: Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI. METHODS: A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05. RESULTS: The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels. CONCLUSIONS: An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).
Education ; Exercise ; Hand Strength ; Health Education ; Humans ; Motor Activity ; Non-Randomized Controlled Trials as Topic ; Outcome Assessment (Health Care) ; Paraplegia ; Physical Fitness ; Rehabilitation ; Sedentary Lifestyle ; Self Efficacy ; Spinal Cord Injuries ; Spinal Cord ; Spine

BACKGROUND: Metabolic syndrome is a cluster of metabolic disorders, including increased blood pressure, high blood glucose level, abdominal obesity, and abnormal cholesterol or triglyceride levels. When these metabolic disorders occur concurrently, the risk for developing diabetes, cardiovascular disease, and stroke increases. According to Korean National Health and Nutrition Examination Survey V (KNHANES V), about one in four adults have a metabolic syndrome. The prevalence is even higher in the older, female population. Sedentary lifestyle is one of the major risk factors of metabolic syndrome. The World Health Organization (WHO) recommends that adults aged >18 years perform at least 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity aerobic physical activity throughout the week. This study aimed to examine the association between leisure-time physical activity and metabolic syndrome.METHODS: A total of 3,453 Korean women aged >50 years who participated in KNHANES VI and VII were evaluated. By using the WHO recommendations, the leisure time physical activity levels were divided into three groups as follows: none, insufficient, and sufficient. The National Cholesterol Education Program-Adult Treatment Panel III was used to define metabolic syndrome.RESULTS: In this study, leisure-time physical activity level and prevalence of metabolic syndrome were inversely related.CONCLUSION: Leisure time physical activity can be beneficial in reducing the prevalence of metabolic syndrome. More studies on the types and performance duration of physical activities must be conducted to set an appropriate guideline for the middle-aged and elderly female populations.
Adult ; Aged ; Blood Glucose ; Cardiovascular Diseases ; Cholesterol ; Education ; Female ; Humans ; Hypertension ; Leisure Activities ; Motor Activity ; Nutrition Surveys ; Obesity, Abdominal ; Prevalence ; Primary Prevention ; Risk Factors ; Sedentary Lifestyle ; Stroke ; Triglycerides ; World Health Organization

STUDY DESIGN: A prospective cross-sectional study. PURPOSE: To evaluate the risk factors associated with the severity of pain intensity in patients with non-specific low back pain (NSLBP) in Southern China. OVERVIEW OF LITERATURE: Low back pain (LBP) is the leading cause of activity limitation and work absence throughout the world, so a firm understanding of the risk factor associated with NSLBP can provide early and prompt interventions that are aimed at attaining long-term results. METHODS: Participants were recruited from January 2014 to January 2016 and were surveyed using a self-designed questionnaire. Anonymous assessments included Short Form 36-Item Health Survey (SF-36) and Visual Analogue Scale (VAS). The association between the severity of NSLBP and these potential risk factors were evaluated. RESULTS: A total of 1,046 NSLBP patients were enrolled. The patients with primary school education, high body mass index (BMI), those exposed to sustained durations of driving and sitting, smoking, recurrent LBP had increased VAS and Oswestry Disability Index (ODI) scores with lower SF-36 scores (p<0.01). Workers and drivers compared with waiters and patients who lifted >10 kg objects in a quarter of their work time for >10 years had higher VAS and ODI scores with lower SF-36 scores (p<0.01). Multiple logistic regression showed lower levels of education, LBP for 1–7 days, long-lasting LBP in last year, smoking, long duration driving, and higher BMI were associated with more severe VAS score. CONCLUSIONS: The severity of NSLBP is associated with lower levels of education, poor standards of living, heavy physical labor, long duration driving, and sedentary lifestyle. Patients with recurrent NSLBP have more severe pain. Reducing rates of obesity, the duration of heavy physical work, driving or riding, and attenuating the prevalence of sedentary lifestyles and smoking may reduce the prevalence of NSLBP.
Anonyms and Pseudonyms ; Body Mass Index ; China ; Cross-Sectional Studies ; Education ; Health Surveys ; Humans ; Logistic Models ; Low Back Pain ; Obesity ; Prevalence ; Prospective Studies ; Risk Factors ; Sedentary Lifestyle ; Smoke ; Smoking

BACKGROUND: Sedentary behavior has been shown to have deleterious effects on cardiovascular outcomes. This study aimed to examine the association between sedentary time and cardiovascular risk factors in Korean adults. METHODS: A cross-sectional study was performed using data from adults aged 19 years and above in the 2013 Korean National Health and Nutrition Examination Survey. Sedentary time was self-reported and categorized into quintiles. Cardiovascular risk factors, including blood pressure (BP), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein cholesterol, and fasting glucose levels, were categorized into dichotomous variables according to the Adult Treatment Panel III criteria. Multivariate logistic regression was performed with adjustment for various demographic and lifestyle variables, body mass index (BMI), waist circumference (WC), and moderate-to-vigorous physical activity. Complex sampling design was used, and survey weights and sample design variables were applied in analyses. RESULTS: A total of 3,301 individuals were included in the analyses, and mean sedentary time was 6.1 h/d. Prolonged sedentary time was significantly associated with high diastolic BP (top vs. bottom quintile: adjusted odds ratio [OR], 1.71; 95% confidence interval [CI], 1.09–2.68; Ptrend=0.03) and low HDL cholesterol level (top vs. bottom quintile: adjusted OR, 1.42; 95% CI, 1.02–1.98; Ptrend=0.02) after adjustment for BMI, WC, moderate-to-vigorous physical activity, and other variables. No significant associations were found between sedentary time and other cardiovascular risk factors. CONCLUSION: Prolonged sedentary time was significantly associated with high diastolic BP and low HDL cholesterol level in Korean adults. The associations were independent of general and abdominal obesity and moderate-to-vigorous physical activities.
Adult ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Cross-Sectional Studies ; Fasting ; Glucose ; Humans ; Life Style ; Lipoproteins ; Logistic Models ; Motor Activity ; Nutrition Surveys ; Obesity, Abdominal ; Odds Ratio ; Risk Factors ; Sedentary Lifestyle ; Triglycerides ; Waist Circumference ; Weights and Measures

The risk of fracture secondary to low-impact trauma is greater in obese children, suggesting obese children are at risk of skeletal fragility. However, despite this finding, there is a lack of agreement about the impact of excessive adiposity on skeletal development. The combination of poor diet, sedentary lifestyle, greater force generated on impact through falls, and greater propensity to falls may in part explain the increased risk of fracture in obese children. To date, evidence suggests that in early childhood years, obesity confers a structural advantage to the developing skeleton. However, in time, this relationship attenuates and then reverses, such that there is a critical period during skeletal development when obesity has a detrimental effect on skeletal structure and strength. Fat mass may be important to the developing cortical and trabecular bone compartments, provided that gains in fat mass are not excessive. However, when fat accumulation reaches excessive levels, unfavorable metabolic changes may impede skeletal development. Evidence from studies examining bone microstructure suggests skeletal adaption to excessive load fails, and bone strength is relatively diminished in relation to body size in obese children. Mechanisms that may explain these changes include changes in the hormonal environment, particularly in relation to alterations in adipokines and fat distribution. Given the concomitant rise in the prevalence of childhood obesity and fractures, as well as adult osteoporosis, further work is required to understand the relationship between obesity and skeletal development.
Accidental Falls ; Adipokines ; Adiposity ; Adult ; Body Size ; Bone Density ; Child* ; Critical Period (Psychology) ; Diet ; Humans ; Obesity ; Osteoporosis ; Pediatric Obesity ; Prevalence ; Sedentary Lifestyle ; Skeleton

OBJECTIVE: This study aimed to investigate clinical factors contributing to the low physical activity (PA) of patients with chronic schizophrenia. METHODS: PA was measured in 50 outpatients with chronic schizophrenia using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Psychopathology, psychosocial functioning, and extrapyramidal symptoms were assessed using the 18 item-Brief Psychiatric Rating Scale (BPRS-18), Global Assessment of Functioning (GAF), and Drug-Induced Extrapyramidal Symptom Scale (DIEPSS), respectively. We examined differences in these clinical variables between “inactive,”“minimally active,” and “health enhancing physical activity” groups. Linear regression analysis was used to examine the clinical factors explaining low PA levels in patients with schizophrenia. RESULTS: Subjects spent an average of 130.18±238.89 min/wk on moderate/vigorous-intensity PA and only 26% of them met the recommended PA guideline of 150 minutes of at least moderate PA per week. The inactive group showed significantly higher BPRS-18 and DIEPSS scores, and a lower GAF score than the other groups. Linear regression analysis showed that DIEPSS scores independently explained the amount of total PA (p=0.001) and time spent being sedentary (p=0.028). CONCLUSION: This study provides preliminary evidence that extrapyramidal symptoms could be a major impediment to the PA of patients with schizophrenia.
Humans ; Linear Models ; Motor Activity* ; Outpatients ; Psychopathology ; Schizophrenia* ; Sedentary Lifestyle

OBJECTIVES: To identify the most important demographic risk factors for a diagnosis of type 2 diabetes mellitus (T2DM) using a neural network model. METHODS: This study was conducted on a sample of 234 individuals, in whom T2DM was diagnosed using hemoglobin A1c levels. A multilayer perceptron artificial neural network was used to identify demographic risk factors for T2DM and their importance. The DeLong method was used to compare the models by fitting in sequential steps. RESULTS: Variables found to be significant at a level of p < 0.2 in a univariate logistic regression analysis (age, hypertension, waist circumference, body mass index [BMI], sedentary lifestyle, smoking, vegetable consumption, family history of T2DM, stress, walking, fruit consumption, and sex) were entered into the model. After 7 stages of neural network modeling, only waist circumference (100.0%), age (78.5%), BMI (78.2%), hypertension (69.4%), stress (54.2%), smoking (49.3%), and a family history of T2DM (37.2%) were identified as predictors of the diagnosis of T2DM. CONCLUSIONS: In this study, waist circumference and age were the most important predictors of T2DM. Due to the sensitivity, specificity, and accuracy of the final model, it is suggested that these variables should be used for T2DM risk assessment in screening tests.
Body Mass Index ; Diabetes Mellitus, Type 2* ; Diagnosis ; Epidemiology ; Fruit ; Humans ; Hypertension ; Iran ; Logistic Models ; Mass Screening ; Methods ; Models, Statistical ; Neural Networks (Computer)* ; Risk Assessment ; Risk Factors* ; Sedentary Lifestyle ; Sensitivity and Specificity ; Smoke ; Smoking ; Vegetables ; Waist Circumference ; Walking

OBJECTIVES: To identify the most important demographic risk factors for a diagnosis of type 2 diabetes mellitus (T2DM) using a neural network model.METHODS: This study was conducted on a sample of 234 individuals, in whom T2DM was diagnosed using hemoglobin A1c levels. A multilayer perceptron artificial neural network was used to identify demographic risk factors for T2DM and their importance. The DeLong method was used to compare the models by fitting in sequential steps.RESULTS: Variables found to be significant at a level of p < 0.2 in a univariate logistic regression analysis (age, hypertension, waist circumference, body mass index [BMI], sedentary lifestyle, smoking, vegetable consumption, family history of T2DM, stress, walking, fruit consumption, and sex) were entered into the model. After 7 stages of neural network modeling, only waist circumference (100.0%), age (78.5%), BMI (78.2%), hypertension (69.4%), stress (54.2%), smoking (49.3%), and a family history of T2DM (37.2%) were identified as predictors of the diagnosis of T2DM.CONCLUSIONS: In this study, waist circumference and age were the most important predictors of T2DM. Due to the sensitivity, specificity, and accuracy of the final model, it is suggested that these variables should be used for T2DM risk assessment in screening tests.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Diagnosis ; Epidemiology ; Fruit ; Humans ; Hypertension ; Iran ; Logistic Models ; Mass Screening ; Methods ; Models, Statistical ; Neural Networks (Computer) ; Risk Assessment ; Risk Factors ; Sedentary Lifestyle ; Sensitivity and Specificity ; Smoke ; Smoking ; Vegetables ; Waist Circumference ; Walking

PURPOSE: Since pathophysiologic evidence has been raised to suggest that obesity could facilitate an allergic reaction, obesity has been known as an independent risk factor for allergic disease such as asthma. However, the relationship between sedentary behavior and lifestyle which could lead to obesity, and those allergic diseases remains unclear. MATERIALS AND METHODS: We analyzed the relations between physical activity, including sitting time for study, sitting time for leisure and sleep time, and obesity, asthma, allergic rhinitis, and atopic dermatitis using the Korea Youth Risk Behavior Web-based Survey, which was conducted in 2013. Total 53769 adolescent participants (12 through 18 years old) were analyzed using simple and multiple logistic regression analyses with complex sampling. RESULTS: Longer sitting time for study and short sitting time for leisure were associated with allergic rhinitis. High physical activity and short sleep time were associated with asthma, allergic rhinitis, and atopic dermatitis. Underweight was negatively associated with atopic dermatitis, whereas overweight was positively correlated with allergic rhinitis and atopic dermatitis. CONCLUSION: High physical activity, and short sleep time were associated with asthma, allergic rhinitis, and atopic dermatitis.
Adolescent* ; Asthma* ; Dermatitis, Atopic* ; Humans ; Hypersensitivity ; Korea ; Leisure Activities ; Life Style ; Logistic Models ; Motor Activity* ; Obesity* ; Overweight ; Rhinitis, Allergic* ; Risk Factors ; Risk-Taking ; Sedentary Lifestyle ; Thinness

New research into physical activity suggests that it is no longer sufficient just to meet minimum levels recommended by health guidelines in order to reduce cardiovascular risk. Both physical inactivity and sedentary behavior have their own health hazards and need to be addressed separately, in order to explore their different deleterious mechanisms. The aim of this review was to define and to characterize both concepts, and their relationship with major non-communicable chronic diseases. A PubMed database search was undertaken, using the following key words: physical activity, physical inactivity, sedentarism, sedentary behavior, and non-communicable chronic disease. This literature review provides an updated view on physical inactivity and sedentary behavior, and reevaluates their prevalence and association with major non-communicable chronic disease.
Chronic Disease* ; Motor Activity ; Prevalence ; Public Health ; Sedentary Lifestyle