Atrial fibrillation (AF) causes a third of all strokes, but often goes undetected before stroke. Identification of unknown AF in the community and subsequent anti-thrombotic treatment could reduce stroke burden. We investigated community screening for unknown AF using an iPhone electrocardiogram (iECG) in pharmacies, and determined the cost-effectiveness of this strategy.Pharmacists performedpulse palpation and iECG recordings, with cardiologist iECG over-reading. General practitioner review/12-lead ECG was facilitated for suspected new AF. An automated AF algorithm was retrospectively applied to collected iECGs. Cost-effectiveness analysis incorporated costs of iECG screening, and treatment/outcome data from a United Kingdom cohort of 5,555 patients with incidentally detected asymptomatic AF. A total of 1,000 pharmacy customers aged ≥65 years (mean 76 ± 7 years; 44% male) were screened. Newly identified AF was found in 1.5% (95% CI, 0.8-2.5%); mean age 79 ± 6 years; all had CHA2DS2-VASc score ≥2. AF prevalence was 6.7% (67/1,000). The automated iECG algorithm showed 98.5% (CI, 92-100%) sensitivity for AF detection and 91.4% (CI, 89-93%) specificity. The incremental cost-effectiveness ratio of extending iECG screening into the community, based on 55% warfarin prescription adherence, would be $AUD5,988 (€3,142; $USD4,066) per Quality Adjusted Life Year gained and $AUD30,481 (€15,993; $USD20,695) for preventing one stroke. Sensitivity analysis indicated cost-effectiveness improved with increased treatment adherence.Screening with iECG in pharmacies with an automated algorithm is both feasible and cost-effective. The high and largely preventable stroke/thromboembolism risk of those with newly identified AF highlights the likely benefits of community AF screening. Guideline recommendation of community iECG AF screening should be considered.

Objective-To assess the test-retest reliability and validity of the physical activity questions in the World Health Organisation health behaviour in schoolchildren (WHO HBSC) survey. Methods-In the validity study, the Multistage Fitness Test was administered to a random sample of year 8 (mean age 13.1 years; n = 1072) and year 10 (mean age 15.1 years; n = 954) high school students from New South Wales (Australia) during February/March 1997. The students completed the self report instruments on the same day. An independent sample of year 8 (n = 121) and year 10 (n = 105) students was used in the reliability study. The questionnaire was administered to the same students on two occasions, two weeks apart, and test-retest reliability was assessed. Students were classified as either active or inadequately active on their combined responses to the questionnaire items. Kappa and percentage agreement were assessed for the questionnaire items and for a two category summary measure. Results-All groups of students (boys and girls in year 8 and year 10) classified as active (regardless of the measure) had significantly higher aerobic fitness than students classified as inadequately active. As a result of highly skewed binomial distributions, values of kappa were much lower than percentage agreement for testretest reliability of the summary measure. For year 8 boys and girls, percentage agreement was 67% and 70% respectively, and for year 10 boys and girls percentage agreement was 85% and 70% respectively. Conclusions-These brief self report questions on participation in vigorous intensity physical activity appear to have acceptable reliability and validity. These instruments need to be tested in other cultures to ensure that the findings are not specific to Australian students. Further refinement of the measures should be considered. (Br J Sports Med 2001;35:263-267)

Background: Frailty and sarcopenia are common age-related conditions associated with adverse outcomes. Physical activity has been identified as a potential preventive strategy for both frailty and sarcopenia. The authors aimed to investigate the association between physical activity and prevention of frailty and sarcopenia in people aged 65 years and older. Methods: The authors searched for systematic reviews (January 2008 to November 2019) and individual studies (January 2010 to March 2020) in PubMed. Eligible studies were randomized controlled trials and longitudinal studies that investigated the effect of physical activity on frailty and/or sarcopenia in people aged 65 years and older. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate certainty of evidence. Results: Meta-analysis showed that physical activity probably prevents frailty (4 studies; frailty score pooled standardized mean difference, 0.24; 95% confidence interval, 0.04–0.43; P = .017, I2 = 57%, moderate certainty evidence). Only one trial investigated physical activity for sarcopenia prevention and did not provide conclusive evidence (risk ratio 1.08; 95% confidence interval, 0.10–12.19). Five observational studies showed positive associations between physical activity and frailty or sarcopenia prevention. Conclusions: Physical activity probably prevents frailty among people aged 65 years and older. The impact of physical activity on the prevention of sarcopenia remains unknown, but observational studies indicate the preventive role of physical activity.

There is well established scientific evidence on the role of regular physical activity in promoting health and preventing non communicable disease (NCD) and this provides a solid platform for stronger commitment and national programs aimed at increasing levels of participation in most countries. Globally, NCD"s account for 60% of all deaths worldwide and 80% of these occur in low and middle income countries (LMIC). The need to scale up NCD prevention efforts, particularly in LMIC is well recognised, however evidence a lone has yet to translate into increased action and investment in prevention strategies. Using an "active living" approach, national strategies should promote and support physical activity in different settings, including at home, in "active transport" (e.g. walking and cycling to get from place to place), and in leisure time (e.g. sports, recreation, exercise and play). However, what is missing in most countries is sufficient political commitment and the necessary long term investment. For this reason, there is a need for greater advocacy work to promote the importance of physical activity, its central role in NCD prevention along side tobacco control and healthy diets, and the co benefits for other related agenda"s such as environmental sustainability. The development of the Toronto Charter for Physical Activity: A global call for action was undertaken to address these gaps and provide the field with a powerful advocacy tool. Guided by an expert writing group the development used a stepped approach including an open, global web-based consultation phase allowing a wide range of stakeholder, institutions, governments and individuals to comment on the content and structure. The Charter took about 2 years to develop and received over 2000 individual comments from over 450 individuals or organisations from across 55 countries and all regions of the world. Overall, there was strong endorsement on the need for a Charter to articulate "the case" for physical activity and provide an international consensus on a set of common actions that should be implemented to promote physical activity. The Toronto Charter provides a short, clear internationally agreed consensus highlighting all benefits of physical activity, beyond just health. It outlines specific examples of actions and these address all relevant sectors including: education, transport, sports and recreation and urban planning. The Charter was launched during the closing plenary session of the 3 rd International Congress on Physical Activity and Public Health in Toronto, May 2010. Since then, the Charter has been translated into 11 languages and has received over 500 individual and 135 organisational indications of support with representation from around the world. Given the forthcoming United Nation"s High Level Meeting of the General Assembly on chronic non-communicable disease (Sept 2011) it is timely to have the Toronto Charter, and the recently released supporting document "NCD Prevention: Investments that work for physical activity", to present ...

Promoting walking and various forms of moderate-intensity physical activities to young adult males, and encouraging young adult females to adopt other forms of moderate-intensity activity to complement walking may help to ameliorate decreases in physical activity over the adult lifespan.