Cardiorespiratory fitness,white blood cell count,and mortality in men and women

BackgroundWe examined the associations of cardiorespiratory fitness (CRF) and white blood cell count (WBC) with mortality outcomes.MethodsA total of 52,056 apparently healthy adults completed a comprehensive health examination, including a maximal treadmill test and blood chemistry analyses. CRF was categorized as high, moderate, or low by age and sex; WBC was categorized as sex-specific quartiles.ResultsDuring 17.8 ± 9.5 years (mean ± SD) of follow-up, a total of 4088 deaths occurred. When regressed jointly, significantly decreased all-cause mortality across CRF categories was observed within each quartile of WBC in men. Within WBC Quartile 1, all-cause mortality hazard ratios (HRs) with a 95% confidence interval (95%CI) were 1.0 (referent), 1.29 (95%CI: 1.06?1.57), and 2.03 (95%CI: 1.42?2.92) for high, moderate, and low CRF categories, respectively (p for trend < 0.001). Similar trends were observed in the remaining 3 quartiles. With the exception of cardiovascular disease (CVD) mortality within Quartile 1 (p for trend = 0.743), there were also similar trends across CRF categories within WBC quartiles in men for both CVD and cancer mortality (p for trend < 0.01 for all). For women, there were no significant trends across CRF categories for mortality outcomes within Quartiles 1–3. However, we observed significantly decreased all-cause mortality across CRF categories within WBC Quartile 4 (HR = 1.05 (95%CI: 0.76?1.44), HR = 1.63 (95%CI:1.20?2.21), and HR = 1.87 (95%CI:1.29?2.69) for high, moderate, and low CRF, respectively (p for trend = 0.002)). Similar trends in women were observed for CVD and cancer mortality within WBC Quartile 4 only.ConclusionThere are strong joint associations between CRF, WBC, and all-cause, CVD, and cancer mortality in men; these associations are less consistent in women.     

The association of grip strength with cardiovascular diseases and all-cause mortality in people with hypertension: Findings from the Prospective Urban Rural Epidemiology China Study

BackgroundBoth hypertension and grip strength (GS) are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to affect CVD and all-cause mortality is unknown. This study sought to investigate the associations of GS with the risk of major CVD incidence, CVD mortality, and all-cause mortality in patients with hypertension.MethodsGS was measured using a Jamar dynamometer (Sammons Preston, Bolingbrook, IL, USA) in participants aged 35–70 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study. Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.ResultsAmong 39,862 participants included in this study, 15,964 reported having hypertension, and 9095 had high GS at baseline. After a median follow-up of 8.9 years (interquartile range, 6.7–9.9 years), 1822 participants developed major CVD, and 1250 deaths occurred (388 as a result of CVD). Compared with normotensive participants with high GS, hypertensive patients with high GS had a higher risk of major CVD incidence (hazard ratio (HR) = 2.39; 95% confidence interval (95%CI): 1.86–3.06; p < 0.001) or CVD mortality (HR = 3.11; 95%CI: 1.59–6.06; p < 0.001) but did not have a significantly increased risk of all-cause mortality (HR = 1.24; 95%CI: 0.92–1.68; p = 0.159). These risks were further increased if hypertensive participants whose GS level was low (major CVD incidence, HR = 3.31, 95%CI: 2.60–4.22, p < 0.001; CVD mortality, HR = 4.99, 95%CI: 2.64–9.43, p < 0.001; and all-cause mortality, HR = 1.93, 95%CI: 1.47–2.53, p < 0.001).ConclusionThe present study demonstrates that low GS is associated with the highest risk of major CVD incidence, CVD mortality, and all-cause mortality among hypertensive patients. High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.     

Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants

BackgroundThis study examined the joint associations of sleep patterns and physical activity (PA) with all-cause, cardiovascular disease (CVD), and cancer mortality.MethodsA total of 341,248 adults (mean age = 39.7 years; men: 48.3%) were included in the study, with a 15-year follow-up. Participants reported sleep duration and disturbances (difficulty falling asleep, easily awakened, or use of sleeping medication). PA was classified into 4 levels: <7.5, 7.5–14.9, 15.0–29.9, and ≥30.0 metabolic equivalent hours per week (MET-h/week). To understand the joint associations of sleep patterns and PA with mortality, Cox proportional hazard models were conducted, with exposure variables combining sleep duration/disturbances and PA.ResultsCompared with the reference group (sleeping 6–8 h/day), individuals who slept >8 h/day had higher risk for all-cause mortality (hazard ratio (HR) = 1.307, 95% confidence interval (95%CI): 1.248–1.369), CVD mortality (HR = 1.298, 95%CI: 1.165–1.445), and cancer mortality (HR = 1.128, 95%CI: 1.042–1.220). Short sleep duration was not associated with mortality risk. Increased risk of all-cause and CVD mortality was found in participants who had difficulty falling asleep (HR = 1.120, 95%CI: 1.068–1.175; HR = 1.163, 95%CI: 1.038–1.304, respectively), and used sleeping medication (HR = 1.261, 95%CI: 1.159–1.372; HR = 1.335, 95%CI: 1.102–1.618, respectively) compared with those who slept well. Long sleep duration and sleep disturbances were not associated with risk of all-cause and CVD mortality among individuals achieving a PA level of ≥15 MET-h/week, and in particular among those achieving ≥30 MET-h/week.ConclusionLong sleep duration, difficulty falling asleep, and use of sleeping medication were related to a higher risk of death. Being physically active at a moderate intensity for 25–65 min/day eliminated these detrimental associations.     

Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: A prospective cohort study

PurposeThis study aimed to examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults.MethodsThis prospective cohort study involved 768 community-dwelling Spanish older adults (78.8 ± 4.9 years, mean ± SD; 53.9% females) from the Toledo Study for Healthy Aging (2012–2017). The number of steps per day and step cadence (steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline. Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality. Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality.ResultsIncluded participants walked 5835 ± 3445 steps/day with an intensity of 7.3 ± 4.1 steps/min. After adjusting for age, sex, body mass index (BMI), education, income, marital status and comorbidities, higher step count (hazard ratio (HR) = 0.95, 95% confidence interval (95%CI: 0.90–1.00, and HR = 0.87, 95%CI: 0.81–0.95 per additional 1000 steps) and higher step intensity (HR = 0.95, 95%CI: 0.91–0.99, and HR = 0.89, 95%CI: 0.84–0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk, respectively. Compared to the group having low step volume and intensity, individuals in the group having high step volume and intensity had a lower risk of hospitalization (HR = 0.72, 95%CI: 0.52–0.98) and all-cause mortality (HR = 0.60, 95%CI: 0.37–0.98).ConclusionAmong older adults, both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk. Increasing step volume and intensity may benefit older people.     

Adverse associations of sedentary behavior with cancer incidence and all-cause mortality: A prospective cohort study

BackgroundInconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality, and evidence from the Chinese population is scarce. This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity (MVPA) on these relationships.MethodsWe included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire. Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) for cancer and mortality were estimated using Cox proportional hazards regression models.ResultsDuring 559,002 person-years of follow-up, 2388 cancer events, 1571 cancer deaths, and 4562 all-cause deaths were recorded. Sedentary behavior was associated with increased risk of developing cancer and deaths in a dose–response manner. The multivariable-adjusted HRs (95%CIs) were the following: HR = 1.16, 95%CI: 1.01‒1.33; HR = 1.24, 95%CI: 1.04‒1.48; and HR = 1.15, 95%CI: 1.04‒1.28 for cancer incidence, cancer mortality, and all-cause mortality, respectively, for those having ≥10 h/day of sedentary time compared with those having <6 h/day of sedentary time. Sedentary populations (≥10 h/day) developed cancer or died 4.09 years and 2.79 years earlier, respectively, at the index age of 50 years. Failure to achieve the recommended level of MVPA may further aggravate the adverse associations, with the highest cancer and mortality risks being observed among participants with both ≥10 h/day of sedentary time and <150 min/week of MVPA. Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.ConclusionSedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults, especially for those with ≥10 h/day of sedentary time. It is necessary to reduce sedentary time, in addition to increasing MVPA levels, for the prevention of cancer and premature death.     

Replacement of leisure-time sedentary behavior with various physical activities and the risk of dementia incidence and mortality: A prospective cohort study

BackgroundWhether or not there is targeted pharmacotherapy for dementia, an active and healthy lifestyle that includes physical activity (PA) may be a better option than medication for preventing dementia. We examined the association between leisure-time sedentary behavior (SB) and the risk of dementia incidence and mortality. We further quantified the effect on dementia risk of replacing sedentary time with an equal amount of time spent on different physical activities.MethodsIn the UK Biobank, 484,169 participants (mean age = 56.5 years; 45.2% men) free of dementia were followed from baseline (2006–2010) through July 30, 2021. A standard questionnaire measured individual leisure-time SB (watching TV, computer use, and driving) and PA (walking for pleasure, light and heavy do-it-yourself activity, strenuous sports, and other exercise) frequency and duration in the 4 weeks prior to evaluation. Apolipoprotein E (APOE) genotype data were available for a subset of 397,519 (82.1%) individuals. A Cox proportional hazard model and an isotemporal substitution model were used in this study.ResultsDuring a median 12.4 years of follow-up, 6904 all-cause dementia cases and 2115 deaths from dementia were recorded. In comparison to participants with leisure-time SB <5 h/day, the hazard ratio ((HR), 95% confidence interval (95%CI)) of dementia incidence was 1.07 (1.02–1.13) for 5–8 h/day and 1.25 (1.13–1.38) for >8 h/day, and the HR of dementia mortality was 1.35 (1.12–1.61) for >8 h/day. A 1 standard deviation increment of sedentary time (2.33 h/day) was strongly associated with a higher incidence of dementia and mortality (HR = 1.06, 95%CI: 1.03–1.08 and HR = 1.07, 95%CI: 1.03–1.12, respectively). The association between sedentary time and the risk of developing dementia was more profound in subjects <60 years than in those ≥60 years (HR = 1.26, 95%CI: 1.00–1.58 vs. HR = 1.21, 95%CI: 1.08–1.35 in >8 h/day, p for interaction = 0.013). Replacing 30 min/day of leisure sedentary time with an equal time spent in total PA was associated with a 6% decreased risk and 9% decreased mortality from dementia, with exercise (e.g., swimming, cycling, aerobics, bowling) showing the strongest benefit (HR = 0.82, 95%CI: 0.78–0.86 and HR = 0.79, 95%CI: 0.72–0.86). Compared with APOE ε4 noncarriers, APOE ε4 carriers are more likely to see a decrease in Alzheimer's disease incidence and mortality when PA is substituted for SB.ConclusionLeisure-time SB was positively associated with the risk of dementia incidence and mortality. Replacing sedentary time with equal time spent doing PA may be associated with a significant reduction in dementia incidence and mortality risk.     

Cardiorespiratory fitness and cancer in women: A prospective pilot study

PurposeTo assess the association between cardiorespiratory fitness (CRF) and the incidence and mortality from cancer in women, and to evaluate the potential public health implications for cancer prevention.MethodsMaximal exercise testing was performed in a pilot cohort of 184 women (59.3 ± 15.2 years) who were followed for 12.0 ± 6.9 years. Cox hazard models adjusted for established cancer risk factors and accounting for competing events were analyzed for all-type cancer incidence and mortality from cancer. Population-attributable risks and exposure impact number were determined for low CRF (<5 metabolic equivalents (METs)) as a risk factor.ResultsDuring the follow-up, 11.4% of the participants were diagnosed with cancer and 3.2% died from cancer. CRF was inversely and independently associated with cancer outcomes. For every 1-metabolic equivalent increase in CRF, there was a 20% decrease in the risk of cancer incidence (hazard ratio (HR) = 0.80, 95% confidence interval (CI): 0.69–0.92; p = 0.001) and a 26% reduction in risk of cancer mortality (HR = 0.74, 95%CI: 0.61–0.90; p = 0.002). The population-attributable risks of low CRF were 11.6% and 14% for incidence and mortality of cancer, respectively, and the respective exposure impact numbers were 8 and 20.ConclusionGreater CRF was independently associated with a lower risk of incidence and mortality from cancer in women. Screening for low CRF as a cancer risk factor and referring unfit individuals to a supervised exercise program could be a public health strategy for cancer prevention in middle-age women.     

The potential of a year-round school calendar for maintaining children's weight status and fitness: Preliminary outcomes from a natural experiment

PurposeTo evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention compared to a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss via a natural experiment.MethodsHeight, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured in children (5–12 years old) in 3 schools (2 traditional, 1 year-round, n = 990 students, age = 8.6 ± 2.4 years, 53.1% male, 68.9% African American) from 1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- and sex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular Endurance Run laps completed) were assessed for summer 2017 (May–August 2017), school year 2017/2018 (August 2017–May 2018), and summer 2018 (May–August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixed effects regression, with group (traditional vs. year-round calendar), time, and a group-by-time interaction as the independent variables. Secondary regression analyses estimated differences in change within and between groups during each time period, separately.ResultsYear-round students gained less BMI (difference in ∆ = –0.44, 95% confidence interval (CI): –0.67 to –0.03) and less CRF (difference in ∆ = –1.92, 95%CI: –3.56 to –0.28) than students attending a traditional school overall. Compared with traditional students, during both summers, year-round students gained less BMI (summer 2017 difference in ∆ = –0.15, 95%CI: –0.21 to –0.08; summer 2018 difference in ∆ = –0.16, 95%CI: –0.24 to –0.07) and zBMI (summer 2017 difference in ∆ = –0.032, 95%CI: –0.050 to –0.010; summer 2018 difference in ∆ = –0.033, 95%CI: –0.056 to –0.009), and increased CRF (summer 2017 difference in ∆ = 0.40, 95%CI: 0.02–0.85; summer 2018 difference in ∆ = 0.23, 95%CI: –0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI and zBMI and increasing CRF compared with year-round students (difference in BMI ∆ = 0.05, 95%CI: 0.03–0.07; difference in zBMI ∆ = 0.012, 95%CI: 0.005–0.019; difference in Progressive Aerobic Cardiovascular Endurance Run laps ∆ = –0.43, 95%CI: –0.58 to –0.28).ConclusionThe year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit to children's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight and CRF gain/loss were consistent with the structured days hypothesis.     

The association between watching football matches and the risk of cardiovascular events: A meta-analysis

ABSTRACT

To comprehensively shed light on whether viewing football games is associated with a higher risk of cardiovascular disease (CVD). Electronic databases were searched through 17 May 2018. All studies focusing on the association between viewing football matches and the fatal or non-fatal CVD were identified. Viewing football matches was associated with a higher risk of fatal overall CVD (RR: 1.06, 95%CI: 1.01–1.12) in both men (RR: 1.13, 95%CI: 1.004–1.28) and women (RR: 1.08, 95%CI: 1.01–1.15). Subgroup analysis showed that failure of the team has a higher risk of fatal overall CVD (RR: 1.29, 95%CI: 1.15–1.45). However, lower risk of fatal overall CVD from spectators was observed when team obtained a victory (RR: 0.80, 95%CI: 0.66–0.96). For non-fatal CVD, viewing football matches was associated with a higher risk of non-fatal overall CVD (RR: 1.24, 95%CI: 1.09–1.41) in both men (RR: 1.73, 95%CI: 1.12–2.69) and women (RR: 1.25, 95%CI: 1.08–1.45). Subgroup analysis showed that viewing football matches was associated with a higher risk of non-fatal myocardial infarction (RR: 1.20, 95%CI: 1.04–1.38) in both men and women (RR: 1.51, 95%CI: 0.99–2.28; RR: 1.21, 95%CI: 1.08–1.36, respectively). No significant increase was found in fatal or non-fatal stroke. Viewing football matches was associated with a higher risk of the fatal and non-fatal CVD, especially in male spectators. The victory of team could have a lower risk of fatal CVD. Therefore, precautionary measures should be required for the reduction of healthcare burden in football matches.     

Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults

BackgroundDelirium is a neurocognitive disorder characterized by an abrupt decline in attention, awareness, and cognition after surgical/illness-induced stressors on the brain. There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality. One common indicator for cardiovascular health is the heart rate response/recovery (HRR) to exercise, but how this relates to future delirium is unknown.MethodsElectrocardiogram data were examined in 38,740 middle- to older-aged UK Biobank participants (mean age = 58.1 years, range: 40–72 years; 47.3% males) who completed a standardized submaximal exercise stress test (15-s baseline, 6-min exercise, and 1-min recovery) and required hospitalization during follow-up. An HRR index was derived as the product of the heart rate (HR) responses during exercise (peak/resting HRs) and recovery (peak/recovery HRs) and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile, respectively. Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a 2-year landmark analysis to minimize reverse causation. Sociodemographic factors, lifestyle factors/physical activity, cardiovascular risk, comorbidities, cognition, and maximal workload achieved were included as covariates.ResultsDuring a median follow-up period of 11 years, 348 participants (9/1000) newly developed delirium. Compared with the high HRR group (16/1000), the risk for delirium was almost doubled in those with low HRR (hazard ratio = 1.90, 95% confidence interval (95%CI): 1.30–2.79, p = 0.001) and average HRR (hazard ratio = 1.54, 95%CI: 1.07–2.22, p = 0.020)). Low HRR was equivalent to being 6 years older, a current smoker, or ≥3 additional cardiovascular disease risks. Results were robust in sensitivity analysis, but the risk appeared larger in those with better cognition and when only postoperative delirium was considered (n = 147; hazard ratio = 2.66, 95%CI: 1.46–4.85, p = 0.001).ConclusionHRR during submaximal exercise is associated with future risk for delirium. Given that HRR is potentially modifiable, it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.     

Stair climbing,genetic predisposition,and the risk of incident type 2 diabetes: A large population-based prospective cohort study

Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2% females) witho...     

Associations between aerobic and muscle-strengthening physical activity,sleep duration,and risk of all-cause mortality: A prospective cohort study of 282,473 U.S. adults

PurposeTo examine the joint associations between meeting guidelines for physical activity (PA) and sleep duration and all-cause mortality risk among adults.MethodsParticipants were adults (n = 282,473) aged 18–84 years who participated in the 2004–2014 U.S. National Health Interview Survey. Mortality status was ascertained using the National Death Index through December 2015. Self-reported PA (Active: meeting both aerobic (AER) and muscle-strengthening (MSA) guidelines, AER only (AER), MSA only (MSA), or not meeting either AER or MSA (Inactive)) and sleep duration (Short, recommended (Rec), or Long) were classified according to guidelines, and 12 PA–sleep categories were derived. Adjusted hazard ratios and 95% confidence intervals (95%CIs) for all-cause mortality risk were estimated using Cox proportional hazards regression models.ResultsA total of 282,473 participants (55% females) were included; 18,793 deaths (6.7%) occurred over an average follow-up of 5.4 years. Relative to the Active-Rec group, all other PA-sleep groups were associated with increased mortality risk except for the Active-Short group (hazard ratio = 1.08; 95%CI: 0.92–1.26). The combination of long sleep with either MSA or Inactive appeared to be synergistic. For a given sleep duration, mortality risk progressively increased among participants classified as AER, MSA, and Inactive. Within each activity level, the mortality risk was greatest among adults with long sleep.ConclusionRelative to adults meeting guidelines for both PA and sleep duration, adults who failed to meet guidelines for both AER and muscle strengthening PA and who also failed to meet sleep duration guidelines had elevated all-cause mortality risks. These results support interventions targeting both PA and sleep duration to reduce mortality risk.     

Mortality in relation to changes in physical activity in middle-aged to older Chinese: An 8-year follow-up of the Guangzhou Biobank Cohort Study

BackgroundPhysical activity (PA) is generally encouraged. Studies from developed countries in the West have shown that maintenance of adequate PA or increasing PA are associated with lower mortality risk. It is unclear whether these associations apply to an older Chinese population. Hence, we examined the changes in PA prospectively among a middle-aged and older Chinese population over an average of 4 years and explored their subsequent mortality risks.MethodsMetabolic equivalent scores of PA among participants in the Guangzhou Biobank Cohort Study were calculated. Participants were divided into 3 groups related to PA level, and changes in PA were classified into 9 categories. Information on vital status and causes of death from March 2008 to December 2012 (the first repeated examination) until December 31, 2017, was obtained via record linkage with the Death Registry.ResultsOf 18,104 participants aged 61.21 ± 6.85 years (mean ± SD), 1461 deaths occurred within 141,417 person-years. Compared to participants who maintained moderate PA, those who decreased PA from moderate or high levels to a low level had increased risks for all-cause mortality (hazard ratio (HR) = 1.47, 95% confidence interval (95%CI): 1.11–1.96). Participants who maintained a high level of PA (HR = 0.83, 95%CI: 0.70–0.98) or increased PA from low to high levels (HR = 0.71, 95%CI: 0.52–0.97) showed lower all-cause mortality risks. Those who maintained low PA levels showed a higher all-cause mortality risk, whereas those who increased their PA levels showed a non-significantly lower risk. Similar results were found for cardiovascular disease risk.ConclusionEven at an older age, maintaining a high PA level or increasing PA from low to high levels results in lower mortality risks, suggesting that substantial health benefits might be achieved by maintaining or increasing engagement in adequate levels of PA. The increased risk of maintaining a low PA level or decreasing PA to a low level warrants the attention of public health officials and clinicians.     

No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

BackgroundRegular physical activity (PA) has been postulated to improve, or at least maintain, immunity across the life span. However, the link between physical (in)activity and coronavirus disease 2019 (COVID-19) remains to be established. This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19.MethodsHospitalized patients with COVID-19 (mean age: 54.9 years) were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital) and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.ResultsThe median hospital length of stay was 7.0 ± 4.0 days, median ± IQR; 3.3% of patients died, 13.8% were admitted to the ICU, and 8.6% required mechanical ventilation. Adjusted linear regression models showed that PA indices were not associated with hospital length of stay (work index: β = –0.57 (95% confidence interval (95%CI): –1.80 to 0.65), p = 0.355; sport index: β = 0.43 (95%CI: –0.94 to 1.80), p = 0.536; leisure-time index: β = 1.18 (95%CI: –0.22 to 2.59), p = 0.099; and total activity index: β = 0.20 (95%CI: –0.48 to 0.87), p = 0.563). None of the PA indices were associated with mortality, admission to the ICU, or mechanical ventilation requirement (all p > 0.050).ConclusionAmong hospitalized patients with COVID-19, PA did not independently associate with hospital length of stay or any other clinically relevant outcomes. These findings should be interpreted as meaning that, among already hospitalized patients with more severe forms of COVID-19, being active is a potential protective factor likely outweighed by a cluster of comorbidities (e.g., type 2 diabetes, hypertension, weight excess) and older age, suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.     

The relationships between step count and all-cause mortality and cardiovascular events: A dose–response meta-analysis

BackgroundA goal of 10,000 steps per day is widely advocated, but there is little evidence to support that goal. Our purpose was to examine the dose–response relationships between step count and all-cause mortality and cardiovascular disease risk.MethodsCochrane Central Register of Controlled Trials, EMBASE, OVID, PubMed, Scopus, and Web of Science databases were systematically searched for studies published before July 9, 2021, that evaluated the association between daily steps and at least 1 outcome.ResultsSixteen publications (12 related to all-cause mortality, 5 related to cardiovascular disease; and 1 article contained 2 outcomes: both all-cause death and cardiovascular events) were eligible for inclusion in the meta-analysis. There was evidence of a nonlinear dose–response relationship between step count and risk of all-cause mortality or cardiovascular disease (p = 0.002 and p = 0.014 for nonlinearity, respectively). When we restricted the analyses to accelerometer-based studies, the third quartile had a 40.36% lower risk of all-cause mortality and a 35.05% lower risk of cardiovascular event than the first quartile (all-cause mortality: Q1 = 4183 steps/day, Q3 = 8959 steps/day; cardiovascular event: Q1 = 3500 steps/day, Q3 = 9500 steps/day; respectively).ConclusionOur meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults, with nonlinear dose–response patterns.     

The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison

PurposeThis study aimed to examine the effects of plyometric jump training (PJT) on lower-limb stiffness.MethodsSystematic searches were conducted in PubMed, Web of Science, and Scopus. Study participants included healthy males and females who undertook a PJT programme isolated from any other training type.ResultsThere was a small effect size (ES) of PJT on lower-limb stiffness (ES = 0.33, 95% confidence interval (95%CI): 0.07–0.60, z = 2.47, p = 0.01). Untrained individuals exhibited a larger ES (ES = 0.46, 95%CI: 0.08–0.84, p = 0.02) than trained individuals (ES = 0.15, 95%CI: ‒0.23 to 0.53, p = 0.45). Interventions lasting a greater number of weeks (>7 weeks) had a larger ES (ES = 0.47, 95%CI: 0.06–0.88, p = 0.03) than those lasting fewer weeks (ES = 0.22, 95%CI: ‒0.12 to 0.55, p = 0.20). Programmes with ≤2 sessions per week exhibited a larger ES (ES = 0.39, 95%CI: 0.01–0.77, p = 0.04) than programmes that incorporated >2 sessions per week (ES = 0.20, 95%CI: –0.10 to 0.50, p = 0.18). Programmes with <250 jumps per week (ES = 0.50, 95%CI: 0.02–0.97, p = 0.04) showed a larger effect than programmes with 250–500 jumps per week (ES = 0.36, 95%CI: 0.00–0.72, p = 0.05). Programmes with >500 jumps per week had negative effects (ES = –0.22, 95%CI: –1.10 to 0.67, p = 0.63). Programmes with >7.5 jumps per set showed larger effect sizes (ES = 0.55, 95%CI: 0.02–1.08, p = 0.04) than those with <7.5 jumps per set (ES = 0.32, 95%CI: 0.01–0.62, p = 0.04).ConclusionPJT enhances lower-body stiffness, which can be optimised with lower volumes (<250 jumps per week) over a relatively long period of time (>7 weeks).     

Twenty-four-hour movement guidelines during middle adolescence and their association with glucose outcomes and type 2 diabetes mellitus in adulthood

Purpose:The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes(glycated hemoglobin and fasting glucose) and type 2 diabetes mellitus(T2DM) in adulthood,14 and 22 years later.Methods:We analyzed data from apparently healthy adolescents aged 12-18 years who participated in Waves Ⅰ and Ⅱ(1994-1996,n=14,738),Wave Ⅳ(2008-2009,n=8913),and Wave V(2016-2018,n=3457) of the National Longitudinal Study o...     

Movement behaviors and their association with depressive symptoms in Brazilian adolescents: A cross-sectional study

Background:Physical activity,sleep,and sedentary behaviors compose 24-h movement behaviors and have been independently associated with depressive symptoms.However,it is not clear whether it is the movement behavior itself or other contextual factors that are related to depressive symptoms.The objective of the present study was to examine the associations between self-reported and accelerometer-measured movement behaviors and depressive symptoms in adolescents.Methods:Cross-sectional data from 610 adolescents(14-18 years old)were used.Adolescents answered questions from the Center for Epidemiological Studies Depression scale and reported time spent watching videos,playing videogames,using social media,time spent in various physical activities,and daytime sleepiness.Wrist-worn accelerometers were used to measure sleep duration,sleep efficiency,sedentary time,and physical activity.Mixed-effects logistic regressions were used.Results:Almost half of the adolescents(48%)were classified as being at high risk for depression(score≥20).No significant associations were found between depressive symptoms and accelerometer-measured movement behaviors,self-reported non-sport physical activity,watching videos,and playing videogames.However,higher levels of self-reported total physical activity(odd ratio(OR)=0.92,95%confidence interval(95%CI):0.86-0.98)and volume of sports(OR=0.88,95%CI:0.79-0.97),in minutes,were associated with a lower risk of depression,while using social media for either 2.0-3.9 h/day(OR=1.77,95%CI:1.58-2.70)or>3.9 h/day(OR=1.67,95%CI:1.10-2.54),as well as higher levels of daytime sleepiness(OR=1.17,95%CI:1.12-1.22),were associated with a higher risk of depression.Conclusion:What adolescents do when they are active or sedentary may be more important than the time spent in the movement behaviors because it relates to depressive symptoms.Targeting daytime sleepiness,promoting sports,and limiting social media use may benefit adolescents.     

The association of major patterns of physical activity,sedentary behavior and sleeping with mortality in older adults

Objective: To identify major patterns of physical activity (PA), sedentary behavior (SB) and sleeping (all self-reported), and their association with long-term mortality.

Methods: Cohort of 2,851 individuals aged ≥ 60 from Spain. Mortality was ascertain from 2003 up to July 2013. Patterns of PA, SB and sleeping were identified by factor analysis.

Results: During follow-up, 1,145 deaths occurred. The first pattern, named “sedentary and non-active pattern”, was characterized by long sleeping or lying time, and not doing even light PA (household chores or walking). The second pattern was named “active and non-sedentary pattern”, and was characterized long time devoted to vigorous activities, long walking time, and short seating time. Compared to those in the first quartile of the “sedentary and non-active pattern”, those in the highest quartile showed a 71% higher mortality (HR: 1.71; 95%CI: 1.42–2.07; p-trend:<0.001); it corresponds to being 6-year older. By contrast, being in the highest versus the lowest quartile of the “active and non-sedentary pattern” was associated with a 32% lower mortality (HR: 0.68: 0.57–0.82; p-trend:<0.001); it corresponds to being 4-year younger.

Conclusion: The “sedentary and non-active” pattern had a large impact on mortality. The “active and non-sedentary” pattern showed an opposite and slightly lower association.     

Immediate effect of high-intensity exercise on brain-derived neurotrophic factor in healthy young adults: A systematic review and meta-analysis

BackgroundAlthough brain-derived neurotrophic factor (BDNF) has been identified as a molecular biomarker of the neurophysiological effects induced by exercise, the acute effects of high-intensity exercise (HIE) on BDNF levels are inconclusive. This study aims to estimate the immediate effects of HIE on BDNF levels in healthy young adults.MethodsA systematic search was conducted in the MEDLINE, Scopus, Cochrane CENTRAL, and SPORTDiscuss databases up to December 2020. Randomized controlled trials (RCTs) and non-RCTs reporting pre–post changes in serum or plasma BDNF after an acute intervention of HIE compared to a control condition were included. Pooled effect sizes (p-ESs) and 95% confidence intervals (95%CIs) were calculated for RCTs using a random effects model with Stata/SE (Version 15.0; StataCorp., College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PROPERO registration number: CRD42020221047.ResultsA total of 22 studies with 552 individuals (age range: 20–31 years; 59.1% male) were included. The meta-analysis included 10 RCTs that reported valid outcome data. Higher BDNF levels were observed when HIE interventions were compared with non-exercise (p-ES = 0.55, 95%CI: 0.12–0.98; I² = 25.7%; n = 4 studies) and light-intensity exercise (p-ES = 0.78, 95%CI: 0.15–1.40; I² = 52.4%; n = 3 studies) but not moderate-intensity exercise (p-ES = 0.93, 95%CI: –0.16 to 2.02; I² = 88.5%; n = 4 studies) conditions.ConclusionIn comparison to non-exercise or light-intensity exercises, an immediate increase in BDNF levels may occur when young adults perform HIE. Given the benefits obtained maximizing circulating BDNF when performing HIE and its potential effects on brain health, our findings suggest that HIE could be recommended by clinicians as a useful exercise strategy to healthy adults.