A Preliminary Investigation into the Effect of Continuous Vigorous Exercise and Lifestyle-embedded Physical Activity upon Acute Glycaemic Regulation

Background and Purpose Continuous glucose monitoring (CGM) has recently emerged as a new tool for patients with diabetes mellitus to monitor glucose levels and aid maintainenance of euglycaemia. CGM provides information on ambulatory, postprandial and nocturnal glucose excursions. Extant research has thus far focused upon charting glucose excursions in diabetic patients, with limited normoglycaemic comparative data available. Additionally little is known upon how physical activity affects acute blood glucose regulation. The purpose of this study was to investigate the effect of continuous exercise and lifestyle-embedded physical activity upon glucose regulation, and assess the feasibility of prolonged CGM data collection in a normoglycaemic individual. Method One physically active non-diabetic male [age: 22 y; mass: 71.5 kg; height: 181 cm] underwent 7 days CGM, performing 3 trial conditions: a sedentary control (< 2500 steps, pedometer controlled), a continuous exercise condition (2 x 30 min treadmill running at 70% HRmax), and a lifestyle-embedded physical activity condition (100 min fractionalized moderate activity). Diet was standardised and physical activity levels were monitored via accelerometry throughout. Results Descriptive results displayed lower whole day mean blood glucose levels in both the continuous (Mean ± SD: 5.2 ± 0.3 mmol.L-1) and lifestyle conditions (5.3 ± 1.1 mmol.L-1), compared to sedentary control (5.6 ± 0.5 mmol.L-1). A post exercise decrease in glucose levels (2 h pre-6 h post (5.3 – 5.1 mmol.L-1)) with a carryover effect for the following day (reduced mean glucose 24 h pre-post (5.5 ± 0.5 - 5.2 ± 0.3 mmol.L-1)) was identified in the continuous exercise condition. In addition a significant correlation (R= 0.75, P = 0.02) was found between physical activity counts and CGM glucose values (mmol.L-1) during the continuous bout of vigorous exercise. Discussion and Conclusions It was concluded that day to day glucose homeostasis may be optimised through bouts of continuous vigorous exercise. The utilisation of CGM in exercise protocols and prolonged data collection is deemed a feasible proposition; however larger scale studies may pose logistical problems. This study was limited by its single subject design and specificity to normoglycaemic populations, future studies should look to include a greater sample size and characterise glycaemic regulation in pre-diabetic and diabetic populations

Comparability of measured acceleration from accelerometry-based activity monitors

Accelerometers that provide triaxial measured acceleration data are now available. However, equivalence of output between brands cannot be assumed and testing is necessary to determine whether features of the acceleration signal are interchangeable.National Osteoporosis Societ

Choice of activity-intensity classification thresholds impacts upon accelerometer-assessed physical activity-health relationships in children

It is unknown whether using different published thresholds (PTs) for classifying physical activity (PA) impacts upon activity-health relationships. This study explored whether relationships between PA (sedentary [SED], light PA [LPA], moderate PA [MPA], moderate-to-vigorous PA, vigorous PA [VPA]) and health markers differed in children when classified using three different PTs

Associations between cardiorespiratory fitness, physical activity and clustered cardiometabolic risk in children and adolescents: the HAPPY study

Clustering of cardiometabolic risk factors can occur during childhood and predisposes individuals to cardiometabolic disease. This study calculated clustered cardiometabolic risk in 100 children and adolescents aged 10-14 years (59 girls) and explored differences according to cardiorespiratory fitness (CRF) levels and time spent at different physical activity (PA) intensities. CRF was determined using a maximal cycle ergometer test, and PA was assessed using accelerometry. A cardiometabolic risk score was computed as the sum of the standardised scores for waist circumference, blood pressure, total cholesterol/high-density lipoprotein ratio, triglycerides and glucose. Differences in clustered cardiometabolic risk between fit and unfit participants, according to previously proposed health-related threshold values, and between tertiles for PA subcomponents were assessed using ANCOVA. Clustered risk was significantly lower (p < 0.001) in the fit group (mean 1.21 ± 3.42) compared to the unfit group (mean -0.74 ± 2.22), while no differences existed between tertiles for any subcomponent of PA. Conclusion These findings suggest that CRF may have an important cardioprotective role in children and adolescents and highlights the importance of promoting CRF in youth

Cardiorespiratory fitness is associated with hard and light intensity physical activity but not time spent sedentary in 10–14 year old schoolchildren: the HAPPY study

Sedentary behaviour is a major risk factor for developing chronic diseases and is associated with low cardiorespiratory fitness in adults. It remains unclear how sedentary behaviour and different physical activity subcomponents are related to cardiorespiratory fitness in children. The purpose of this study was to assess how sedentary behaviour and different physical activity subcomponents are associated with 10–14 year-old schoolchildren's cardiorespiratory fitness

Average acceleration and intensity gradient of primary school children and associations with indicators of health and wellbeing

Average acceleration (AvAcc) and intensity gradient (IG) have been proposed as standardised metrics describing physical activity (PA) volume and intensity, respectively. We examined hypothesised between-group PA differences in AvAcc and IG, and their associations with health and wellbeing indicators in children. ActiGraph GT9X wrist accelerometers were worn for 24-h·d−1 over seven days by 145 children aged 9-10. Raw accelerations were averaged per 5-s epoch to represent AvAcc over 24-h. IG represented the relationship between log values for intensity and time. Moderate-to-vigorous PA (MVPA) was estimated using youth cutpoints. BMI z-scores, waist-to-height ratio (WHtR), peak oxygen uptake (VO2peak), Metabolic Syndrome risk (MetS score), and wellbeing were assessed cross-sectionally, and 8-weeks later. Hypothesised between-group differences were consistently observed for IG only (p<.001). AvAcc was strongly correlated with MVPA (r=0.96), while moderate correlations were observed between IG and MVPA (r=0.50) and AvAcc (r=0.54). IG was significantly associated with health indicators, independent of AvAcc (p<.001). AvAcc was associated with wellbeing, independent of IG (p<.05). IG was significantly associated with WHtR (p<.01) and MetS score (p<.05) at 8-weeks follow-up. IG is sensitive as a gauge of PA intensity that is independent of total PA volume, and which relates to important health indicators in children

Seasonal variation in objectively measured physical activity, sedentary time, cardio-respiratory fitness and sleep duration among 8–11 year-old Danish children: a repeated-measures study

Abstract Background Understanding fluctuations in lifestyle indicators is important to identify relevant time periods to intervene in order to promote a healthy lifestyle; however, objective assessment of multiple lifestyle indicators has never been done using a repeated-measures design. The primary aim was, therefore, to examine between-season and within-week variation in physical activity, sedentary behaviour, cardio-respiratory fitness and sleep duration among 8–11 year-old children. Methods A total of 1021 children from nine Danish schools were invited to participate and 834 accepted. Due to missing data, 730 children were included in the current analytical sample. An accelerometer was worn for 7 days and 8 nights during autumn, winter and spring, from which physical activity, sedentary time and sleep duration were measured. Cardio-respiratory fitness was assessed using a 10-min intermittent running test. Results The children had 5% more sedentary time, 23% less time in moderate-to-vigorous physical activity and 2% longer sleep duration during winter compared to spring and cardio-respiratory fitness was 4% higher during spring compared to autumn (P < 0.001). Sedentary time was higher and total physical activity, moderate-to-vigorous physical activity and sleep duration (boys only) were lower during weekends at all seasons (P ≤ 0.01). Intraclass correlation coefficients between seasons ranged from 0.47-0.74, leaving 45-78% to seasonal variation. Conclusions Overall, sedentary time was higher and physical activity lower during winter and during weekends. The most accurate and unbiased estimates of physical activity came from autumn; however, the considerable intra-individual variation suggests that a single measurement may not adequately characterise children’s habitual sleep and activity

The backwards comparability of wrist worn GENEActiv and waist worn ActiGraph accelerometer estimates of sedentary time in children

Objectives: To examine the backward comparability of a range of wrist-worn accelerometer estimates of sedentary time (ST) with ActiGraph 100 count∙min-1 waist ST estimates. Design: Cross-sectional, secondary data analysis Method: One hundred and eight 10-11-year-old children (65 girls) wore an ActiGraph GT3X+ accelerometer (AG) on their waist and a GENEActiv accelerometer (GA) on their non-dominant wrist for seven days. GA ST data were classified using a range of thresholds from 23-56 mg. ST estimates were compared to AG ST 100 count∙min-1 data. Agreement between the AG and GA thresholds was examined using Cronbach’s alpha, intraclass correlation coefficients (ICC), limits of agreement (LOA), Kappa values, percent agreement, mean absolute percent error (MAPE) and equivalency analysis. Results: Mean AG total ST was 492.4 minutes over the measurement period. Kappa values ranged from 0.31-0.39. Percent agreement ranged from 68-69.9%. Cronbach’s alpha values ranged from 0.88-0.93. ICCs ranged from 0.59-0.86. LOA were wide for all comparisons. Only the 34 mg threshold produced estimates that were equivalent at the group level to the AG ST 100 count∙min-1 data though sensitivity and specificity values of ~64% and ~74% respectively were observed. Conclusions: Wrist-based estimates of ST generated using the 34 mg threshold are comparable with those derived from the AG waist mounted 100 count∙min-1 threshold at the group level. The 34 mg threshold could be applied to allow group-level comparisons of ST with evidence generated using the ActiGraph 100 count∙min-1 method though it is important to consider the observed sensitivity and specificity results when interpreting findings

A Systematic Literature Review with Meta-Analyses of Within- and Between-Day Differences in Objectively Measured Physical Activity in School-Aged Children

Background: Targeting specific time periods of the day or week may enhance physical activity (PA) interventions in youth. The most prudent time segments to target are currently unclear.  Objectives: To systematically review the literature describing differences in young people’s objectively measured PA on weekdays vs. weekends, in school vs. out of school, weekends vs. out of school and lesson time vs. break time.  Methods: Electronic databases were searched for English-language, cross-sectional studies of school-aged children (4–18 years) reporting time-segment-specific accelerometer-measured PA from 01/1990 to 01/2013. We meta-analysed standardised mean differences (SMD) between time segments for mean accelerometer counts per minute (TPA) and minutes in moderate-to-vigorous PA (MVPA). SMD is reported in units of standard deviation; 0.2, 0.5 and 0.8 represent small, moderate and large effects. Heterogeneity was explored using meta-regression (potential effect modifiers: age, sex and study setting).  Results: Of the 54 included studies, 37 were eligible for meta-analyses. Children were more active on weekdays than weekends [pooled SMD (95 % CI) TPA 0.14 (0.08; 0.20), MVPA 0.42 (0.35; 0.49)]. On school days, TPA was lower in school than out of school; however, marginally more MVPA was accumulated in school [TPA −0.24 (−0.40; −0.08), MVPA 0.17 (−0.03; 0.38)]. TPA was slightly lower on weekends than out of school on school days, but a greater absolute volume of MVPA was performed on weekends [TPA −0.10 (−0.19; −0.01), MVPA 1.02 (0.82; 1.23)]. Heterogeneity between studies was high (I2 73.3–96.3 %), with 20.3–53.1 % of variance between studies attributable to potential moderating factors.  Conclusions: School-aged children are more active on weekdays than weekend days. The outcome measure influences the conclusions for other comparisons. Findings support the tailoring of intervention strategies to specific time periods

Cut-point-free accelerometer metrics to assess children's physical activity: an example using the school day

The aims were to (i) investigate associations between a novel accelerometer metric: the minimum acceleration value above which the most active 30-minutes were accumulated during the school day (M30ACC), and health indicators, and (ii) demonstrate that applying an equivalent cut-point to the M30ACC metric gives comparable prevalence results as a moderate-to-vigorous physical activity (MVPA) cut-point approach. Two-hundred-and-ninety-six children (age 9-10-years) wore wrist-mounted accelerometers for 7-days. School day MVPA and M30ACC were calculated. Body mass index (BMI), waist-to-height ratio (WHtR), and cardiorespiratory fitness (CRF) were also measured. Mixed linear models investigated associations between M30ACC and health indicators. Agreement between ranked MVPA and M30ACC values was assessed using percent agreement, kappa, sensitivity, and specificity statistics. M30ACC thresholds associated with health indicators were 213 mg (BMI), 206 mg (WHtR), and 269 mg (CRF) for girls. The equivalent values for boys were 234mg (BMI), 230 mg (WHtR), and 327 mg (CRF). Less than half of girls and 75% of boys accumulated 30 minutes of school day MVPA. Just less than 50% of girls and >80% of boys had M30ACC values ≥200 mg, which is equivalent to brisk walking. Agreement between MVPA and M30ACC tertiles was high, reflected by the sensitivity and specificity values of > 90%. Results demonstrate the utility of M30ACC as a PA metric that is not heavily influenced by researcher decisions. M30ACC has potential as an accelerometer-specific metric for generating PA guidelines related to health indicators, and easily understood forms of activity such as brisk walking