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This study aims to investigate the dynamic changes in daily step counts under different housing systems and further explore the effects of housing system on the body conformation, carcass traits, meat quality, and serum biochemical parameters of a Chinese indigenous chicken breed. At 60 d of age, 300 Jiuyuan Black male chickens with similar body weights in each housing system were further raised until the age of 150 d. At 90, 120, and 150 d of age, in both cage-reared and free-range systems, the top 20 chickens with the highest step counts measured using pedometers and the bottom 20 chickens with the lowest step counts were designated as the cage high-steps group (CHS), the cage low-steps group (CLS), the free-range high-steps group (FHS), and the free-range low-steps group (FLS), respectively. The results show that, at any age stage, the average daily steps (ADS) and total steps (TS) of the FHS group are significantly higher than the other three groups (p < 0.05). The TS of almost all groups showed an overall downward trend as the age increased. Increased exercise volume results in reduced shank length (90 d), breast width (90 d), and keel length (150 d) (p < 0.05). Only birds at 90 d of age from the FHS and FLS groups exhibited lower live body weight, carcass weight, half-eviscerated weight, eviscerated weight, breast muscle weight, leg muscle weight, and percentage of eviscerated weight than the CLS group (p < 0.05). Birds from the FHS group showed the highest heart weight values but the lowest abdominal fat weight values among these four groups (p < 0.05). Both the breast and leg muscle samples from the FHS group displayed higher dry matter and shear force than those from the CHS and CLS groups (p < 0.05). The FHS group displayed the lowest intramuscular fat among the four groups (p < 0.05). The creatine kinase (CK) and lactate dehydrogenase (LDH) levels in chickens of all age stages were almost observed to rise with increased physical activity. In conclusion, free-range chickens with more exercise volume exhibited an elevated heart weight and reduced abdominal fat but showed negative effects on some body measurements and carcass traits. These results can provide a theoretical basis for the selection of different housing systems for Chinese indigenous chickens.

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BACKGROUND: Step counting is comparable among many research-grade and consumer-grade accelerometers in laboratory settings. OBJECTIVE: The purpose of this study was to compare the agreement between Actical and Apple Watch step-counting in a community setting. METHODS: Among Third Generation Framingham Heart Study participants (N=3486), we examined the agreement of step-counting between those who wore a consumer-grade accelerometer (Apple Watch Series 0) and a research-grade accelerometer (Actical) on the same days. Secondarily, we examined the agreement during each hour when both devices were worn to account for differences in wear time between devices. RESULTS: We studied 523 participants (n=3223 person-days, mean age 51.7, SD 8.9 years; women: n=298, 57.0%). Between devices, we observed modest correlation (intraclass correlation [ICC] 0.56, 95% CI 0.54-0.59), poor continuous agreement (29.7%, n=957 of days having steps counts with ≤15% difference), a mean difference of 499 steps per day higher count by Actical, and wide limits of agreement, roughly ±9000 steps per day. However, devices showed stronger agreement in identifying who meets various steps per day thresholds (eg, at 8000 steps per day, kappa coefficient=0.49), for which devices were concordant for 74.8% (n=391) of participants. In secondary analyses, in the hours during which both devices were worn (n=456 participants, n=18,760 person-hours), the correlation was much stronger (ICC 0.86, 95% CI 0.85-0.86), but continuous agreement remained poor (27.3%, n=5115 of hours having step counts with ≤15% difference) between devices and was slightly worse for those with mobility limitations or obesity. CONCLUSIONS: Our investigation suggests poor overall agreement between steps counted by the Actical device and those counted by the Apple Watch device, with stronger agreement in discriminating who meets certain step thresholds. The impact of these challenges may be minimized if accelerometers are used by individuals to determine whether they are meeting physical activity guidelines or tracking step counts. It is also possible that some of the limitations of these older accelerometers may be improved in newer devices.

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The purpose of this study was to examine the validity of two wearable smartwatches (the Apple Watch 6 (AW) and the Galaxy Watch 4 (GW)) and smartphone applications (Apple Health for iPhone mobiles and Samsung Health for Android mobiles) for estimating step counts in daily life. A total of 104 healthy adults (36 AW, 25 GW, and 43 smartphone application users) were engaged in daily activities for 24 h while wearing an ActivPAL accelerometer on the thigh and a smartwatch on the wrist. The validities of the smartwatch and smartphone estimates of step counts were evaluated relative to criterion values obtained from an ActivPAL accelerometer. The strongest relationship between the ActivPAL accelerometer and the devices was found for the AW (r = 0.99, p < 0.001), followed by the GW (r = 0.82, p < 0.001), and the smartphone applications (r = 0.93, p < 0.001). For overall group comparisons, the MAPE (Mean Absolute Percentage Error) values (computed as the average absolute value of the group-level errors) were 6.4%, 10.5%, and 29.6% for the AW, GW, and smartphone applications, respectively. The results of the present study indicate that the AW and GW showed strong validity in measuring steps, while the smartphone applications did not provide reliable step counts in free-living conditions.

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BACKGROUND: Patients with advanced cancer undergoing chemotherapy experience significant symptoms and declines in functional status, which are associated with poor outcomes. Remote monitoring of patient-reported outcomes (PROs; symptoms) and step counts (functional status) may proactively identify patients at risk of hospitalization or death. OBJECTIVE: The aim of this study is to evaluate the association of (1) longitudinal PROs with step counts and (2) PROs and step counts with hospitalization or death. METHODS: The PROStep randomized trial enrolled 108 patients with advanced gastrointestinal or lung cancers undergoing cytotoxic chemotherapy at a large academic cancer center. Patients were randomized to weekly text-based monitoring of 8 PROs plus continuous step count monitoring via Fitbit (Google) versus usual care. This preplanned secondary analysis included 57 of 75 patients randomized to the intervention who had PRO and step count data. We analyzed the associations between PROs and mean daily step counts and the associations of PROs and step counts with the composite outcome of hospitalization or death using bootstrapped generalized linear models to account for longitudinal data. RESULTS: Among 57 patients, the mean age was 57 (SD 10.9) years, 24 (42%) were female, 43 (75%) had advanced gastrointestinal cancer, 14 (25%) had advanced lung cancer, and 25 (44%) were hospitalized or died during follow-up. A 1-point weekly increase (on a 32-point scale) in aggregate PRO score was associated with 247 fewer mean daily steps (95% CI -277 to -213; P<.001). PROs most strongly associated with step count decline were patient-reported activity (daily step change -892), nausea score (-677), and constipation score (524). A 1-point weekly increase in aggregate PRO score was associated with 20% greater odds of hospitalization or death (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4; P=.01). PROs most strongly associated with hospitalization or death were pain (aOR 3.2, 95% CI 1.6-6.5; P<.001), decreased activity (aOR 3.2, 95% CI 1.4-7.1; P=.01), dyspnea (aOR 2.6, 95% CI 1.2-5.5; P=.02), and sadness (aOR 2.1, 95% CI 1.1-4.3; P=.03). A decrease in 1000 steps was associated with 16% greater odds of hospitalization or death (aOR 1.2, 95% CI 1.0-1.3; P=.03). Compared with baseline, mean daily step count decreased 7% (n=274 steps), 9% (n=351 steps), and 16% (n=667 steps) in the 3, 2, and 1 weeks before hospitalization or death, respectively. CONCLUSIONS: In this secondary analysis of a randomized trial among patients with advanced cancer, higher symptom burden and decreased step count were independently associated with and predictably worsened close to hospitalization or death. Future interventions should leverage longitudinal PRO and step count data to target interventions toward patients at risk for poor outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04616768; https://clinicaltrials.gov/study/NCT04616768. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-054675.

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BACKGROUND: The purpose of this study was to evaluate the impact of direct anterior approach (DAA) or posterior approach (PA) on step and stair counts after total hip arthroplasty using a remotely monitored mobile application with a smartwatch while controlling for baseline characteristics. METHODS: This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year. Step and stair counts were available for 1,501 and 847 patients, respectively. Longitudinal regression models were created to control for baseline characteristics. RESULTS: Patients in the DAA group had significantly lower body mass index (P = .049) and comorbidities (P = .028), but there were no significant differences in age (P = .225) or sex (P = .315). The DAA patients had a higher average and improvement from baseline in step count at 2 and 3 weeks postoperatively after controlling for patient characteristics (P = .028 and P = .044, respectively). The average stair counts were higher for DAA patients at one month postoperatively (P = .035), but this difference was not significant after controlling for patient demographics. Average stair ascending speeds and changes from baseline were not different between DAA and PA patients. Descending stair speed was higher at 2 weeks postoperatively for DAA patients, but was no longer higher after controlling for baseline demographics. CONCLUSIONS: After controlling for baseline characteristics, DAA patients demonstrate earlier improvement in step count than PA patients after total hip arthroplasty. However, patient selection and surgeon training may continue to influence outcomes through a surgical approach.

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The purposes were to examine the criterion-related validity of the steps estimated by consumer-wearable activity trackers (wrist-worn activity trackers: Fitbit Ace 2, Garmin Vivofit Jr, and Xiomi Mi Band 5; smartphone applications: Pedometer, Pedometer Pacer Health, and Google Fit/Apple Health) and their comparability in primary schoolchildren under controlled conditions. An initial sample of 66 primary schoolchildren (final sample = 56; 46.4% females), aged 9-12 years old (mean = 10.4 ± 1.0 years), wore three wrist-worn activity trackers (Fitbit Ace 2, Garmin Vivofit Jr 2, and Xiaomi Mi Band 5) on their non-dominant wrist and had three applications in two smartphones (Pedometer, Pedometer Pacer Health, and Google Fit/Apple Health for Android/iOS installed in Samsung Galaxy S20+/iPhone 11 Pro Max) in simulated front trouser pockets. Primary schoolchildren's steps estimated by the consumer-wearable activity trackers and the video-based counting independently by two researchers (gold standard) were recorded while they performed a 200-meter course in slow, normal and brisk pace walking, and running conditions. Results showed that the criterion-related validity of the step scores estimated by the three Samsung applications and the Garmin Vivofit Jr 2 were good-excellent in the four walking/running conditions (e.g., MAPE = 0.6-2.3%; lower 95% CI of the ICC = 0.81-0.99), as well as being comparable. However, the Apple applications, Fitbit Ace 2, and Xiaomi Mi Band 5 showed poor criterion-related validity and comparability on some walking/running conditions (e.g., lower 95% CI of the ICC < 0.70). Although, as in real life primary schoolchildren also place their smartphones in other parts (e.g., schoolbags, hands or even somewhere away from the body), the criterion-related validity of the Garmin Vivofit Jr 2 potentially would be considerably higher than that of the Samsung applications. The findings of the present study highlight the potential of the Garmin Vivofit Jr 2 for monitoring primary schoolchildren's steps under controlled conditions.

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BACKGROUND: Geriatric depression and anxiety have been identified as mood disorders commonly associated with the onset of dementia. Currently, the diagnosis of geriatric depression and anxiety relies on self-reported assessments for primary screening purposes, which is uncomfortable for older adults and can be prone to misreporting. When a more precise diagnosis is needed, additional methods such as in-depth interviews or functional magnetic resonance imaging are used. However, these methods can not only be time-consuming and costly but also require systematic and cost-effective approaches. OBJECTIVE: The main objective of this study was to investigate the feasibility of training an end-to-end deep learning (DL) model by directly inputting time-series activity tracking and sleep data obtained from consumer-grade wrist-worn activity trackers to identify comorbid depression and anxiety. METHODS: To enhance accuracy, the input of the DL model consisted of step counts and sleep stages as time series data, along with minimal depression and anxiety assessment scores as non-time-series data. The basic structure of the DL model was designed to process mixed-input data and perform multi-label-based classification for depression and anxiety. Various DL models, including the convolutional neural network (CNN) and long short-term memory (LSTM), were applied to process the time-series data, and model selection was conducted by comparing the performances of the hyperparameters. RESULTS: This study achieved significant results in the multi-label classification of depression and anxiety, with a Hamming loss score of 0.0946 in the Residual Network (ResNet), by applying a mixed-input DL model based on activity tracking data. The comparison of hyper-parameter performance and the development of various DL models, such as CNN, LSTM, and ResNet contributed to the optimization of time series data processing and achievement of meaningful results. CONCLUSIONS: This study can be considered as the first to develop a mixed-input DL model based on activity tracking data for the multi-label identification of late-life depression and anxiety. The findings of the study demonstrate the feasibility and potential of using consumer-grade wrist-worn activity trackers in conjunction with DL models to improve the identification of comorbid mental health conditions in older adults. The study also established a multi-label classification framework for identifying the complex symptoms of depression and anxiety.

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Background: Increasing physical activity may prevent cognitive decline. Previous studies primarily focused on older adults and used self-reported questionnaires to assess physical activity. We examined the relationship between step count, an objective measure of physical activity, and cognitive function in community-based middle-aged and older Japanese men. Methods: The Shiga Epidemiological Study of Subclinical Atherosclerosis randomly recruited community-dwelling healthy men aged 40-79 years from Shiga, Japan, and measured their step counts over 7 consecutive days using a pedometer at baseline (2006-2008). Among men who returned for follow-up (2009-2014), we assessed their cognitive function using the Cognitive Abilities Screening Instrument (CASI) score. We restricted our analyses to those with valid 7-day average step counts at baseline and those who remained free of stroke at follow-up (n = 676). Using analysis of covariance, we calculated the adjusted means of the CASI score according to the quartiles of the average step counts. Results: The mean (standard deviation) of age and unadjusted CASI score were 63.8 (9.1) years and 90.8 (5.8), respectively. The CASI score was elevated in higher quartiles of step counts (90.2, 90.4, 90.6, and 91.8 from the lowest to the highest quartile, respectively, [p for trend = 0.004]) in a model adjusted for age and education. Further adjustment for smoking, drinking, and other cardiovascular risk factors resulted in a similar pattern of association (p for trend = 0.005). Conclusion: In apparently healthy middle-aged and older Japanese men, a greater 7-day average step count at baseline was associated with significantly higher cognitive function score.

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BACKGROUND: There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking. OBJECTIVE: This study explores the relationship between age and women's self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women. METHODS: A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women's perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments. RESULTS: Significant barriers to daily walking were observed in the 21-49-year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49-year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75-year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women's walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart. CONCLUSIONS: Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women's ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages.

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OBJECTIVES: Investigate the impact of daily occupational walking steps on the progression of papillary thyroid cancer (PTC), a topic hitherto underresearched. MATERIAL AND METHODS: The authors analyzed the data from 800 individuals with PTC across stages 0-IV. Participants were evenly divided into 2 distinct occupational groups: office workers and construction workers (N = 400 each). Data included comprehensive records of daily walking steps, demographic information, and clinical indicators. Pearson's correlation coefficients or analysis of variance (ANOVA) were employed to assess the linkage between daily walking steps and PTC risk and stage, as well as associated biochemical markers. RESULTS: The analysis revealed a significant inverse relationship between daily walking steps and PTC risk. A higher frequency of daily steps was associated with reduced chances of PTC onset and a lower diagnostic stage of the disease. This protective effect of physical activity was particularly pronounced in the construc- tion worker cohort. Subsequent evaluations showed that construction workers who consistently logged higher daily steps had markedly lower levels of thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, thyroid peroxidase antibody, thyroglobulin antibody, and thy- roglobulin (Tg). Notably, daily walking steps exhibited a strong inverse correlation with body mass index (BMI), age, PTC volumes, and levels of TSH and Tg across both occupational groups (ρ < -0.37). The increase in daily steps was associated with the reduction in PTC stages (p < 0.001). CONCLUSIONS: The research underscores the potential benefits of increased daily walking steps, suggesting that they may play a protective role in reducing PTC risk and moderating its progression. Int J Occup Med Environ Health. 2024;37(1):58-71.

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BACKGROUND: Physical activity (PA) is an important contributor to one's physical and mental health both acutely and across the lifespan. Much research has done on the ambient environment's impact on PA; however, these studies have used absolute values of atmospheric measures such as temperature and humidity, which vary spatiotemporally and make comparisons between studies which differ in location or time of year difficult to square with one another. METHODS: Here, we employ the Global Weather Type Classification, Version 2, to determine the combined impact of temperature and humidity on PA in a sample of insufficiently active young adults. We conducted secondary analyses of data from a single-group behavioral intervention trial that varied the number of digital messages sent daily. Young adults (n = 81) wore Fitbit Versa smartwatches for a 6-month period sometime between April 2019 and July 2020, and location was tracked using a custom smartphone application. RESULTS: Mixed linear models indicated that, across 8179 person-days, PA was significantly lower on days with humid conditions and significantly higher on warm dry days, though the latter relationship was no longer significant when controlling for timing in relation to the COVID-19 pandemic declaration. Demographic factors did not affect the relationship between weather and PA. CONCLUSIONS: Results are a first step in providing additional guidance for encouraging PA in insufficiently active individuals given forecasted daily weather conditions. Future work should examine seasonal variability in the weather type-PA relationship without the influence of a world-altering event influencing results.

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PURPOSE: To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders. METHODS: Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale. RESULTS: Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life. CONCLUSIONS: Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.

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@#Objective     To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods     From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. Results    Totally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P<0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1± 2 542.0 steps, P<0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion     The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.

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OBJECTIVE: Coronary heart disease has several risk factors that require a multifactorial community intervention approach in prevention efforts. Prevalence of coronary heart disease and its risk factors have been disproportionately high among American Indians. The objective of this study is to evaluate the impact of ambulatory activity levels on the development of coronary heart disease in this population. METHODS: Using pedometer data and other lifestyle and clinical factors from 2492 participants in the Strong Heart Family Study, we examined the associations of average daily step counts with incident coronary heart disease during an 18 to 20 year follow-up. RESULTS: After adjusting for potential confounders, participants with daily step counts in the 4th quartile (>7282 steps per day) had significantly lower odds of developing coronary heart disease compared to those in the 1st quartile (<3010 steps per day) (p = 0.035). CONCLUSIONS: Higher daily step count (over 7282 steps per day) is significantly associated with lower incidence of coronary heart disease among American Indian participants of the Strong Heart Family Study in a 20-year follow-up period.

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What is already known about this topic?: Current literature underscores the significance of appropriate physical activity in managing diabetes, primarily utilizing self-reported data. Yet, the impact of objectively measured physical activity in older diabetic populations remains unclear. What is added by this report?: Our research on elderly diabetic patients indicated a correlation between an increased number of daily steps and improved metabolic profiles, as well as a decrease in the incidence of cardiovascular complications. What are the implications for public health practice?: Elevated daily step counts may confer significant benefits to elderly individuals with diabetes. The use of devices to monitor these steps could serve as a potent cardiovascular marker, and hold great potential as a screening or intervention tool in community-oriented settings.

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OBJECTIVES: Physically active lifestyles are associated with several health benefits. Physical activity (PA) levels are low in post-industrial populations, but generally high throughout life in subsistence populations. The Hadza are a subsistence-oriented foraging population in Tanzania known for being physically active, but it is unknown how recent increases in market integration may have altered their PA patterns. In this study, we examine PA patterns for Hadza women and men who engage in different amounts of traditional foraging. MATERIALS AND METHODS: One hundred and seventy seven Hadza participants (51% female, 19-87 years) wore an Axivity accelerometer (dominant wrist) for ~6 days during dry season months. We evaluated the effects of age, sex, and lifestyle measures on four PA measures that capture different aspects of the PA profile. RESULTS: Participants engaged in high levels of both moderate-intensity PA and inactivity. Although PA levels were negatively associated with age, older participants were still highly active. We found no differences in PA between participants living in more traditional "bush" camps and those living in more settled "village" camps. Mobility was positively associated with step counts for female participants, and schooling was positively associated with inactive time for male participants. CONCLUSIONS: The similarity in PA patterns between Hadza participants in different camp types suggests that high PA levels characterize subsistence lifestyles generally. The sex-based difference in the effects of mobility and schooling on PA could be a reflection of the Hadza's gender-based division of labor, or indicate that changes to subsistence-oriented lifestyles impact women and men in different ways.

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Background: There is a tendency for older adults to become more physically inactive, especially older women. Physical inactivity has been exacerbated since the COVID-19 pandemic. Lockdowns and information-based preventive measures for COVID-19 increased the number of short-form video app users and short-form video exposure, including content exposure and the duration of exposure, which has demonstrated important effects on youths' health and health-related behaviors. Despite more older adults viewing short-form videos, less is known about the status of their short-form video exposure or the impacts of the exposure on their physical activity. Objective: This study aims to describe physical activity-related content exposure among older adults and to quantify its impacts along with the duration of short-form video exposure on step counts, low-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Methods: We analyzed a subsample (N=476) of older women who used smartphones and installed short-form video apps, using the baseline data collected from an ongoing cohort study named the Physical Activity and Health in Older Women Study (PAHIOWS) launched from March to June 2021 in Yantai, Shandong Province, China. The information on short-form video exposure was collected by unstructured questions; physical activity-related content exposure was finalized by professionals using the Q-methodology, and the duration of exposure was transformed into hours per day. Step counts, LPA, and MVPA were assessed with ActiGraph wGT3X-BT accelerometers. Multiple subjective and objective covariates were assessed. Linear regression models were used to test the effects of short-form video exposure on step counts, LPA, and MVPA. MVPA was dichotomized into less than 150 minutes per week and 150 minutes or more per week, and the binary logistic regression model was run to test the effects of short-form video exposure on the achievement of spending 150 minutes or more on MVPA. Results: Of 476 older women (mean age 64.63, SD 2.90 years), 23.7% (113/476) were exposed to physical activity-related short-form videos, and their daily exposure to short-form videos was 1.5 hours. Physical activity-related content exposure increased the minutes spent on MVPA by older women (B=4.14, 95% CI 0.13-8.15); the longer duration of short-form video exposure was associated with a reduced step count (B=-322.58, 95% CI -500.24 to -144.92) and minutes engaged in LPA (B=-6.95, 95% CI -12.19 to -1.71) and MVPA (B=-1.56, 95% CI -2.82 to -0.29). Neither content exposure nor the duration of exposure significantly increased or decreased the odds of older women engaging in MVPA for 150 minutes or more per week. Conclusions: Short-form video exposure has both positive and negative impacts on the physical activity of older adults. Efforts are needed to develop strategies to leverage the benefits while avoiding the harms of short-form videos.

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BACKGROUND: Hospitalized older patients spend most of the waking hours in bed, even if they can walk independently. Excessive bedrest contributes to the development of frailty and worse hospital outcomes. We describe the study protocol for the Breaking Bad Rest Study, a randomized clinical trial aimed to promoting more movement in acute care using a novel device-based approach that could mitigate the impact of too much bedrest on frailty. METHODS: Fifty patients in a geriatric unit will be randomized into an intervention or usual care control group. Both groups will be equipped with an activPAL (a measure of posture) and StepWatch (a measure of step counts) to wear throughout their entire hospital stay to capture their physical activity levels and posture. Frailty will be assessed via a multi-item questionnaire assessing health deficits at admission, weekly for the first month, then monthly thereafter, and at 1-month post-discharge. Secondary measures including geriatric assessments, cognitive function, falls, and hospital re-admissions will be assessed. Mixed models for repeated measures will determine whether daily activity differed between groups, changed over the course of their hospital stay, and impacted frailty levels. DISCUSSION: This randomized clinical trial will add to the evidence base on addressing frailty in older adults in acute care settings through a devices-based movement intervention. The findings of this trial may inform guidelines for limiting time spent sedentary or in bed during a patient's stay in geriatric units, with the intention of scaling up this study model to other acute care sites if successful. TRIAL REGISTRATION: The protocol has been registered at clinicaltrials.gov (identifier: NCT03682523).

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AIMS: There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality. METHODS AND RESULTS: We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81-0.91; P < 0.001], while a 500-step increment was associated with a 7% decrease in CV mortality (HR 0.93; 95% CI 0.91-0.95; P < 0.001). Compared with the reference quartile with median steps/day 3867 (2500-6675), the Quartile 1 (Q1, median steps: 5537), Quartile 2 (Q2, median steps 7370), and Quartile 3 (Q3, median steps 11 529) were associated with lower risk for all-cause mortality (48, 55, and 67%, respectively; P < 0.05, for all). Similarly, compared with the lowest quartile of steps/day used as reference [median steps 2337, interquartile range 1596-4000), higher quartiles of steps/day (Q1 = 3982, Q2 = 6661, and Q3 = 10 413) were linearly associated with a reduced risk of CV mortality (16, 49, and 77%; P < 0.05, for all). Using a restricted cubic splines model, we observed a nonlinear dose-response association between step count and all-cause and CV mortality (Pnonlineraly < 0.001, for both) with a progressively lower risk of mortality with an increased step count. CONCLUSION: This meta-analysis demonstrates a significant inverse association between daily step count and all-cause mortality and CV mortality with more the better over the cut-off point of 3867 steps/day for all-cause mortality and only 2337 steps for CV mortality.

There is strong evidence showing that sedentary life may significantly increase the risk of cardiovascular (CV) disease and shorten the lifespan. However, the optimal number of steps, both the cut-off points over which we can see health benefits, and the upper limit (if any), and their role in health are still unclear. In this meta-analysis of 17 studies with almost 227 000 participants that assessed the health effects of physical activity expressed by walking measured in the number of steps, we showed that a 1000-step increment correlated with a significant reduction of all-cause mortality of 15%, and similarly, a 500-step increment correlated with a reduced risk of CV mortality of 7%. In addition, using the dose­response model, we observed a strong inverse nonlinear association between step count and all-cause mortality with significant differences between younger and older groups. It is the first analysis that not only looked at age and sex but also regional differences based on the weather zones, and for the first time, it assesses the effect of up to 20 000 steps/day on outcomes (confirming the more the better), which was missed in previous analyses. The analysis also revealed that depending on the outcomes, we do not need so many steps to have health benefits starting with even 2500/4000 steps/day, which, in fact, undermines the hitherto definition of a sedentary life.

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BACKGROUND: There is a lack of understanding of how daily step counts differentially affect the risk of all-cause mortality in adult with congestive heart failure (CHF) by sex in the United States (US). OBJECTIVES: To explore the relationship between daily step counts and all-cause mortality in patients with CHF by sex. METHODS: This is a cohort analysis from the National Health and Nutrition Examination Survey from 2005 to 2006. Multiple Cox hazard regression was performed to explore the association of step counts and all-cause mortality in patients with CHF by sex. RESULTS: In this study, 363 unweighted samples were enrolled from NHANES 2005-2006, representing about 8.4 million of the US population. Further, 46.28% were women, and the average age was 46 years. Patients with CHF in the more than 5581 steps/day group (HR, 0.31 [95% CI, 0.16-0.58]) had a significantly reduced risk of all-cause mortality compared with the patients in the less 5581 steps/day group after accounting for all covariates. In men, after accounting for all the covariates, there was a significant difference in more than 5581 steps/day group (HR, 0.33 [95% CI, 0.14-0.76]) on all-cause mortality in men with CHF compared with men in the less than 5581 steps/day group. CONCLUSIONS: Step count is associated with all-cause mortality in patients with CHF. Taking 5581 daily steps was associated with a decreased risk of all-cause mortality in patients with CHF.

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