Short Orals: Health outcomes

BACKGROUND: The rates of obesity increase world-wide, including women of child-bearing age, thus, it is critical to develop strategies to prevent the intergenerational cycle of obesity. Data suggests that gestational exercise positively influences pregnancy and birth outcomes. However, it is unknown how exercise metrics influences these outcomes and whether it improves outcomes at the cell and whole-body level.
PURPOSE: To elucidate the influence of exercise metrics (frequency, intensity, time, type, volume) during pregnancy on birth and infant outcomes at the cell and whole body level. We hypothesized that increased exercise volume throughout pregnancy would positively influence birth & infant health at the cell and whole-body level.
METHODS: We measured placentas at delivery. We used mesenchymal stem cells (MSCs) from umbilical cords at birth, and body morphometry at 1-month of age; women did supervised exercise for 24+ weeks of pregnancy; all exercise metrics were recorded.
RESULTS: We demonstrated that increased maternal exercise duration throughout pregnancy as well as weekly and total exercise volume improve placenta health and birth outcomes, even in preterm deliveries. Similarly, we found that increased maternal duration throughout pregnancy as well as weekly and total exercise volume improves infant cellular metabolism and decrease one-month body fat percent.
PRACTICAL IMPLICATIONS: Our data suggests that more maternal exercise is protective and leads to improved pregnancy, placental, and birth outcomes; changes in pregnancy could decrease the propensity to develop poor outcomes as well as obesity and associated metabolic conditions later in life.
Funding: American Heart Association

Background:
Low physical activity (PA) levels are associated with increased mortality. Improved measurement via accelerometery has shown a stronger association between PA and all-cause mortality compared with self-reported survey data, but this has not yet been translated to estimates of the population level disease burden attributable to low PA.

Purpose:
To estimate by how much low physical activity reduces life expectancy, and how much lifetime could be gained by increasing physical activity levels for both populations and individuals.

Methods:
We used device-measured physical activity risk estimates of all-cause mortality and a lifetable model analysis to construct a model of the 2019 American population aged 40+ years. Mortality data were from the National Centre for Health Statistics, 2017.

Results:
If all were as active as the top 25% of the population, Americans over the age 40 could expect to live an extra 5.3 years (95% uncertainty interval 3.7 to 6.8) on average. The greatest average gain in lifetime per single hour of walking was seen for individuals in the lowest activity quartile, where a one-hour walk could add 376.3 minutes (~6.3 hours) to life expectancy (95% uncertainty interval 321.5 to 428.5 minutes), on average.

Conclusions:
Physical activity provides substantially larger health benefits than previously thought.

Practical implications:
Increased investment in physical activity promotion and creating physical activity promoting living environments can yield large health gains.

Funding:
Previous funding from the New South Wales Ministry of Health, Sydney, Australia, is gratefully acknowledged.

Background: Sedentary behavior (SB) is a major risk factor for developing chronic, non-communicable diseases. Interventions to mitigate these risks are needed. Purpose: Investigating the effects of breaking up SB with bouts of Yoga and Tai-Chi on glycemic control, concentration, and well-being in healthy individuals. Methods: A randomized balanced incomplete block study; 15 adults (age=26[2.50], 8 females) completed 2 of 3 protocols: uninterrupted sitting (Control), sitting interrupted with 3-minutes of Yoga every 30-minutes, or with 3-minutes of Tai-Chi every 30-minutes. Protocols lasted 7.5-hour. Glucose was measured with a glucometer. Concentration and well-being were recorded with self-reported questionnaires. Area under the curve (AUC) was calculated for glucose data. Statistical analyses were performed as a hierarchical repeated-measures model. Results: Glucose AUC for Yoga (34.55[3.12] mmol/L) was significantly lower than the Control (38.14[3.18] mmol/L; P< .05). There was a trend toward lower glucose in the Tai-Chi group compared with the Control, but no significant differences were found (AUCTai-Chi = 36.64[3.11] mmol/L; P= .57). Mean concentration in all groups decreased throughout the day, with the largest decrease in the Control. Well-being for the Yoga and Control groups decreased but increased with Tai-Chi. Concentration and well-being responses were not statistically significant between groups. Conclusions: Breaking up SB using 3-minute bouts of Yoga significantly lowers blood glucose in healthy individuals without compromising concentration or well-being. Tai-Chi did not provide the same significant effect on glucose levels but allowed better maintenance of concentration and well-being. Practical implications: This study is the first to demonstrate these effects using short bouts of Yoga/Tai-Chi, adding to the growing body of evidence that certain light-intensity physical activity, in short bouts, can mitigate the deleterious effects of prolonged SB. This contributes to current public health guidelines. Funding: No direct funding was provided for this investigation. Laboratory/room space/equipment was provided from Glasgow Caledonian University.

Background: Optimal levels 24-hour movement behaviors (24h-MB), encompassing sufficient physical activity (PA), limited sedentary behavior (SB) and sufficient sleep duration are crucial for cardiometabolic health. Despite the importance of these 24h-MBs, many adults have difficulties with consistently adopting optimal levels of these behaviors. Understanding factors that underpin adults’ 24h-MB is the fundament for intervention development to optimize these behaviors. Purpose: The aim of this study is to explore associations between 24h-MBs and cardiometabolic health and to identify the correlates explaining adults’ 24h-MBs. Methods: The 24h-MBs were objectively collected by Actigraph GT3X accelerometers. The following cardiometabolic variables were measured: HbA1c, fasting glucose, triglycerides, cholesterol, blood pressure, Body Mass Index (BMI), waist circumference (WC) and fat%. Explanatory variables were collected by an online questionnaire, i.e. attitude, facilitators, barriers, self-efficacy, subjective norm, subjective modelling, and social support. Regression analyses were used to explore associations between cardiometabolic variables or explanatory variables on the one hand and 24h-MB time use estimates on the other hand (Compositional Data Analysis). Results: Data of 191 adults (45 y/o, 68% female) showed associations between the 24h-MB composition with adults’ BMI, WC, and fat% (p<0.001). Different correlates showed significant associations with a more active 24h-MB composition such as male sex (p=0.010), waking up early (p=0.001), being younger (p=0.001), higher self-efficacy regarding PA (p=0.050), less perceived barriers regarding PA (p=0.005), less perceived modelling regarding SB (p=0.040), less perceived barriers regarding interrupting SB (p=0.003), and less perceived facilitators of being sedentary (p=0.008). Conclusions: These preliminary results highlight the association with 24h-MBs and adiposity and will advance the current understanding of correlates of 24h-MB compositions among Flemish adults. Practical implications: Insights in the association between 24h-MBs and cardiometabolic health and the correlates of 24h-MBs provides key points for the development of healthy lifestyle interventions. Funding: Researcher Foundation Flanders (I.W.).

Background: Cardiorespiratory fitness (CRF) in childhood and adolescence is linked with future cardiovascular health. Several sociodemographic and other factors may influence childhood and adolescent CRF. Purpose: To assess factors associated with CRF in Zimbabwean school children and adolescents. Methods: This was a cross-sectional study in which participants were recruited from 20 administrative districts across all 10 provinces in Zimbabwe. Parental consent and child/adolescent assent were obtained before participants completed a self-administered questionnaire which collected socio-demographic and other relevant data. We measured cardiorespiratory fitness (CRF) using the 20-meter shuttle run test and the Leger equation to estimate Vo2max. A multilevel mixed-effects model (SAS PROC MIXED) accounting for clustering at the provincial level was used to determine factors associated with participants’ VO2max. Statistical analyses were performed in SAS 9.4 with the alpha level set at 0.05. Results: The average age (sample n= 1163; 54% female) was 12 ± 0.95 years. Mean estimated VO2max for the whole sample was 46.6 ± 4.8 mL/kg/min. Males had significantly higher Vo2max compared to females (t=9.9; p<.0001). Attending boarding schools (t=-3.0; p=0.003) was associated with lower vo2max compared to day schools. Rural residence was associated with higher Vo2max compared to living in urban areas (t=7.4; p<.0001). The largest proportions of total variance in Vo2max occurred at the individual (95.0%) and provincial (5.0%) levels. Lower BMI, low socioeconomic status, younger age, attending day school, rural residence, active school commute, and male sex, were significantly associated with higher Vo2max. Conclusions: Several factors beyond the individual child or adolescent, including family, community and geographic, were independently associated with CRF, suggesting the need to consider the socioecological model in intervention design. Practical Implications: Childhood and adolescent physical activity programs promoting CRF should specifically target females, boarding schools, and urbanites. Funding: Government of Zimbabwe under the Ministry of Primary and Secondary Education.

Background: Physical inactivity is a global health concern and causes more than five million premature deaths annually. Although heritability estimates suggest a strong genetic influence on physical activity, genome-wide association studies have reported weak associations involving few genetic variants. Partly because physical activity is a complex phenotypic trait that is difficult to accurately capture.

Purpose: To identify genetic variation associated with different aspects of device-measured moderate to vigorous physical activity, such as average minutes of brisk walking or running per day and accumulated bouts of at least 10 or 30 consecutive minutes.

Methods: In HUNT4, 26,159 participants had at least one valid day of device-measured physical activity and genotyping of good quality. Machine-learning was used to classify every five seconds of activity into moderate walking, brisk walking, running, or cycling. This was accumulated into average minutes per day of ‘moderate to vigorous activity’ or ‘brisk walking or running’, and in consecutive bouts of at least 10 or 30 minutes. REGINIE was used to analyze genome-wide association with significance threshold of 5×10^-8. Follow-up analyzes included LD-score regression, ANNOVAR and GTEx to annotate plausible gene and tissue-expressions.

Results: One genetic locus was associated with 10-minute bouts of moderate to vigorous activity, whereas two loci were associated with brisk walking or running in 30-minute bouts. For the latter phenotype, the lead genetic variant rs111388372 on chromosome 4 is located within the GATB gene that are involved in oxidative phosphorylation and is generally expressed across tissues.

Conclusion: Three genetic loci was associated with bouts of continuous moderate to vigorous physical activity, with GATB as a candidate gene.

Practical implications: Genetic variation associated with physical activity provides biological insight into possible mechanisms and may contribute to genetic instruments applicable in Mendelian randomization studies.

Funding: NTNU Health, Norwegian University of Science and Technology (grant no. 81771516)

Background: Movement behaviors (MB) are linked to mortality. However, few studies using device-measured MB were conducted in low-and-middle-income countries (LMICs), and previous investigations did not account for their joint composition. Purpose: Investigate associations of moderate-and-vigorous physical activity (MVPA), light intensity physical activity (LPA), sedentary behavior (SB), and sleep duration with all-cause mortality in Brazilian adults estimating the change in risk by reallocating time between MB. Methods: ELSA-Brasil cohort 3rd wave (2017-2019) participants wore an ActiGraph wGT3X-BT for seven days, filled in a sleep diary, and were followed until July 1st, 2023. We used compositional Cox models adjusted for sociodemographic, behavioral, and health covariates to estimate hazard ratios (HR) associated with reallocating MB. Results Of 12636 participants, 8855 (70%) provided data on exposure and covariates. Mean age was 59.1 years (±8.2), with 55.7% women. We observed 202 deaths (2,3%) during a median follow-up of 4.9 y. Participants showed on average: 47.4 (±25.3) min/day MVPA, 3.44 (±1.14) h/day LPA, 12.25 (±1.7) h/day SB, and 7.52 (±1.27) h/day sleep. The HR associated with reallocating 10 min/day from SB to MVPA was 0.88 (95%CI 0.85-0.92); MVPA to SB 1.17 (95%CI 1.12-1.23); LPA to MVPA 0.89 (95%CI 0.84-0.93); MVPA to LPA 1.17 (95%CI 1.10-1.24); and Sleep to MVPA 0.89 (95%CI 0.85-0.92), MVPA to Sleep 1.17 (95%CI 1.11-1.23). Other reallocations were not significant. Conclusion In Brazilian adults, reallocating any amount of time from other MB to MVPA was consistently associated with lower mortality. This supports the message that “every move counts” and highlights the role of higher-intensity activity in reducing mortality. Practical implications: Enhancing physical activity intensity may be linked to a reduction in mortality. Funding Brazilian Ministry of Health (Department of Science and Technology); Brazilian Ministry of Science, Technology and Innovation (Financiadora de Estudos e Projetos, FINEP; Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq).

Background: Emerging evidence suggests a positive association between physical activity (PA) in adolescence and health status in adulthood. However, the only synthesis of the literature on this relationship is almost two decades old. Purpose: We aimed to update knowledge on this relationship by systematically reviewing the literature on the association between PA in adolescence and health status in early adulthood. Methods: We searched AMED, Medline, CINAHL, APA Psychinfo, and PubMed databases with combinations of five concepts: “PA”, “adolescence”, “health status/quality of life”, “young adulthood”, and “longitudinal”. To be included in this review, articles had to measure PA in adolescence, health status in early adulthood, provide a measure of association between the two and include participants aged 13 to 24 years. Results: A total of 31 articles were retained, including the past literature review and 30 new cohort studies (3 retrospective and 27 prospective). All 14 studies that assessed an association between PA levels over time supported the existence of a low-to-moderate positive association between PA in adolescence and PA in early adulthood. In 13 studies examining PA in adolescence and physical health in early adulthood, 11 found a positive relationship and 2 found no association. The results of 12 studies using mental health outcomes suggest that PA in adolescence is beneficial to mental health in early adulthood. Only 2 studies report the association between PA in adolescence and quality of life in early adulthood and they show mixed results. More PA in adolescence was associated with better overall health in early adulthood in all 5 studies assessing this relationship. Conclusions: This review highlights that PA during adolescence is positively associated with better health outcomes in early adulthood. Practical implications: Promoting PA throughout adolescence is one of the best ways to improve health status in early adulthood.