Objective: To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults. Design: Pragmatic, cluster randomised community intervention trial. Setting: 12 general practices in Sheffield; four randomly selected as intervention populations, and eight as control populations. Participants: All those aged 65 and over in the least active four fifths of the population responding to a baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control practices. Intervention: Eligible subjects were invited to free locally held exercise classes, made available for two years. Main outcome measures: All cause and exercise related cause specific mortality and hospital service use at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility analysis was also undertaken. Results: Twenty six per cent of the eligible intervention practice population attended one or more exercise sessions. There were no significant differences in mortality rates, survival times, or admissions. After adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status, although this reached significance only for the energy dimension and two composite scores (p,0.05). The incremental average QALY gain of 0.011 per person in the intervention population resulted in an incremental cost per QALY ratio of J17 174 (95% CI = J8300 to J87 120). Conclusions: Despite a low level of adherence to the exercise programme, there were significant gains in health related quality of life. The programme was more cost effective than many existing medical interventions, and would be practical for primary care commissioning agencies to implement.

BackgroundData on longitudinal monitoring of daily physical activity (PA) patterns in youth over successive years is scarce but may provide valuable information for intervention strategies aiming to promote PA.MethodsParticipants were 853 children (starting age ~8 years) recruited from 29 Australian elementary schools. Pedometers were worn for a 7-day period each year over 5 consecutive years to assess PA volume (steps per day) and accelerometers were worn concurrently in the final 2 years to assess PA volume (accelerometer counts (AC) per day), moderate and vigorous PA (MVPA), light PA (LPA) and sedentary time (SED). A general linear mixed model was used to examine daily and yearly patterns.ResultsA consistent daily pattern of pedometer step counts, AC, MVPA and LPA emerged during each year, characterised by increases on school days from Monday to Friday followed by a decrease on the weekend. Friday was the most active and Sunday the least active day. The percentage of girls and boys meeting international recommendations of 11,000 and 13,000 steps/day respectively on a Monday, Friday and Sunday were 36%, 50%, 21% for boys and 35%, 45%, 18% for girls. The equivalent percentages meeting the recommended MVPA of >60 min/day on these days were 29%, 39%, 16% for boys and 15%, 21%, 10% for girls. Over the 5 years, boys were more active than girls (mean steps/day of 10,506 vs 8,750; p<0.001) and spent more time in MVPA (mean of 42.8 vs 31.1 min/day; p<0.001). Although there was little evidence of any upward or downward trend in steps/day from age 8 to 12 years, there was a trend toward lower MVPA, LPA and a corresponding increase in SED from age 11 to 12 years.ConclusionA weekly pattern of PA occurred in children as young as age 8 on a day by day basis; these patterns persisting through to age 12. In addition to supporting previous evidence of insufficient PA in children, our data, in identifying the level and incidence of insufficiency on each day of the week, may assist in the development of more specific strategies to increase PA in community based children.

These elite volleyball players had a lower range of motion (internal rotation) and relative muscle imbalance in the dominant compared with the non-dominant shoulder.

Purpose Understanding factors that influence accurate assessment of physical activity (PA) and sedentary behavior (SB) is important to measurement development, epidemiologic studies, and interventions. This study examined agreement between self-reported (International Physical Activity Questionnaire – Long Form, IPAQ-LF) and accelerometry-based estimates of PA and SB across six countries, and identified correlates of between-method agreement. Methods Self-report and objective (accelerometry-based) PA and SB data were collected in 2002-2011 from 3,865 adult participants in eight cities from six countries (Belgium, Czech Republic, Denmark, Spain, UK, and USA). Between-method relative agreement (correlation) and absolute disagreement (mean difference between conceptually- and intensity-matched IPAQ-LF and accelerometry-based PA and SB variables) were estimated. Also, socio-demographic characteristics and PA patterns were examined as correlates of between-method agreement. Results Observed relative agreement (relationships of IPAQ-LF with accelerometry-based PA and SB variables) was small to moderate (r=0.05-0.37) and was moderated by socio-demographic (age, sex, weight status, education) and behavioral (PA-types) factors. The absolute disagreement was large, with participants self-reporting higher PA intensity and total time in moderate-to-vigorous PA than accelerometry. Also, self-reported sitting time was lower than accelerometry-based sedentary behavior. After adjusting for socio-demographic and behavioral factors, the absolute disagreement between pairs of IPAQ-LF and accelerometry-based PA variables remained significantly different across cities/countries. Conclusions Present findings suggest systematic cultural and/or linguistic and socio-demographic differences in absolute agreement between the IPAQ-LF and accelerometry-based PA and SB variables. These results have implications for the interpretation of international PA and SB data and correlates/determinants studies. They call for further efforts to improve such measures.

This study reports the results of a battery of physical function tests used to assess physical function of older patients with clinical knee and/or hip osteoarthritis (OA), and the correlation to the WOMAC Index (disease-specific questionnaire). A total of 106 sedentary subjects, aged >60 years (mean 69.4, S.D. 5.9) with hip and/or knee OA (mean 12.2 yrs, S.D. 11.0) participated in the study. Mobility, joint flexibility and muscle strength were evaluated by recording time to: walk a distance of 8', ascend/descend 4 stairs, rise from/sit down from a chair (5 times). Hip/knee flexion and isometric quadriceps strength were also measured. Categories of performance were formed by dividing data into quartiles for each test (1=highest, 4=lowest score, 5=unable to complete) and, by summing the category scores, a total summary score (TSS) was obtained. The battery of physical function tests showed an acceptable test-retest reliability (ICC of all tasks > or =0.80) and internal consistency (Cronbach's alpha > or =0.80). Performance scores on walking, stair climb, chair-rise and ROM of affected OA joints were significantly correlated with each other, and with the WOMAC Index (P<0.05, Spearman's correlation). Lower scores on the TSS were associated with lower scores on all the WOMAC Index items (P<0.001). This study shows that a simple battery of physical function tests in combination with the WOMAC Index are reliable and may be useful outcome measures in the evaluation of therapeutic interventions and geriatric rehabilitation.

Sport participants were more active, fitter and had less body fat (girls only) than non-sports participants. However, the associated benefits of sport with PA diminished during adolescence and the majority of sports participants did not meet recommended levels of PA. Strategies aiming to maximise the benefits of sports participation may be enhanced by providing special attention to the early adolescent period particularly among girls.

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ObjectiveTo assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population.MethodsA retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m2); normal weight (19–24 kg/m2); overweight (25–29 kg/m2); obese class I (30–34 kg/m2); obese class II (35–39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined.ResultsWithin this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862).ConclusionsWomen who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.