Updating national physical activity guidelines based on the global WHO guidelines: experiences and challenges from Switzerland

Physical activity guidelines are recognized as an important element of a national approach to promote physical activity. This publication summarizes the approach and process taken to update the Swiss Guidelines, presents a summary of the updated guidelines and discusses experiences and identifies challenges. The multistage project involved: 1) to summarize the scientific evidence underpinning the 2020-edition of the WHO guidelines; 2) to systematically analyze the existing Swiss guidelines for different target groups and to develop proposals for updates 3) a participatory process to gain consensus with the main interested groups 4) to finalize the guidelines. Updated guidelines were adopted for infants, pre-school children, children and young people, adults, older adults and pregnant and postpartum women, in most cases following the WHO guidelines. Children, young people and adults living with disability and adults and older adults with chronic conditions are specifically addressed in each of the general guidelines for healthy populations, rather than developing separate guidelines for each of these groups as done by the WHO. The systematic approach in identifying aspects to update, the participatory approach and a scientific consortium and project coordination group with different thematic backgrounds were key strengths in the process. Challenges included the large amount of feedback and finding scientifically sound compromises. The updated versions of the Swiss national guidelines provide an excellent basis to further promote physical activity in Switzerland. A remaining key task is to develop a range of communication tools and materials for different target groups beyond the circle of experts and interested groups, considering available evidence on optimal messaging and best outlet tools and channels. To track population prevalence, inform policy and evaluate physical activity promotion at national and sub-national level in a timely fashion, strengthening existing physical activity monitoring will be important

Associations of Novel and Traditional Vascular Biomarkers of Arterial Stiffness: Results of the SAPALDIA 3 Cohort Study

There is a lack of evidence concerning associations between novel parameters of arterial stiffness as cardiovascular risk markers and traditional structural and functional vascular biomarkers in a population-based Caucasian cohort. We examined these associations in the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3).; Arterial stiffness was measured oscillometrically by pulse wave analysis to derive the cardio-ankle vascular index (CAVI), brachial-ankle (baPWV) and aortic pulse wave velocity (aPWV), and amplitude of the forward and backward wave. Carotid ultrasonography was used to measure carotid intima-media thickness (cIMT) and carotid lumen diameter (LD), and to derive a distensibility coefficient (DC). We used multivariable linear regression models adjusted for several potential confounders for 2,733 people aged 50-81 years.; CAVI, aPWV and the amplitude of the forward and backward wave were significant predictors of cIMT (p < 0.001). All parameters were significantly associated with LD (p < 0.001), with aPWV and the amplitude of the forward wave explaining the highest proportion of variance (2%). Only CAVI and baPWV were significant predictors of DC (p < 0.001), explaining more than 0.3% of the DC variance.; We demonstrated that novel non-invasive oscillometric arterial stiffness parameters are differentially associated with specific established structural and functional local stiffness parameters. Longitudinal studies are needed to follow-up on these cross-sectional findings and to evaluate their relevance for clinical phenotypes

Updating national physical activity guidelines based on the global WHO guidelines: experiences and challenges from Switzerland

Physical activity guidelines are recognized as an important element of a national approach to promote physical activity. This publication summarizes the approach and process taken to update the Swiss Guidelines, presents a summary of the updated guidelines and discusses experiences and identifies challenges. The multistage project involved: 1) to summarize the scientific evidence underpinning the 2020-edition of the WHO guidelines; 2) to systematically analyze the existing Swiss guidelines for different target groups and to develop proposals for updates 3) a participatory process to gain consensus with the main interested groups 4) to finalize the guidelines. Updated guidelines were adopted for infants, pre-school children, children and young people, adults, older adults and pregnant and postpartum women, in most cases following the WHO guidelines. Children, young people and adults living with disability and adults and older adults with chronic conditions are specifically addressed in each of the general guidelines for healthy populations, rather than developing separate guidelines for each of these groups as done by the WHO. The systematic approach in identifying aspects to update, the participatory approach and a scientific consortium and project coordination group with different thematic backgrounds were key strengths in the process. Challenges included the large amount of feedback and finding scientifically sound compromises. The updated versions of the Swiss national guidelines provide an excellent basis to further promote physical activity in Switzerland. A remaining key task is to develop a range of communication tools and materials for different target groups beyond the circle of experts and interested groups, considering available evidence on optimal messaging and best outlet tools and channels. To track population prevalence, inform policy and evaluate physical activity promotion at national and sub-national level in a timely fashion, strengthening existing physical activity monitoring will be important

Physical activity and arterial stiffness in older adults of the SAPALIDA 3 cohort study

Background: This PhD thesis presents the research work of the Swiss National Science Foundation (SNSF) funded project (#147022) entitled “Physical activity as a life style component of aggressive decrease of atherosclerotic modifiers (ADAM) in elderly subjects: the SAPALDIA Cohort Study.” The study has been performed against the background that a physically active lifestyle is linked with decreased risk of cardiovascular disease (CVD) and CVD events, such as myocardial infarction or stroke, at all ages among others through improvements in arterial stiffness reflecting arterial remodeling. Arterial stiffness proved to be an independent predictor of all-cause and cardiovascular mortality. However, arterial stiffness in association with physical activity of different intensities has insufficiently been studied in Caucasian cohorts of older adults and not at all concerning the change of physical activity over time in older Caucasian adults. Aims: The research program realized the following aims: (1) evaluation of the measuring characteristics of the novel cardio-ankle vascular index (CAVI) and the brachial-ankle pulse wave velocity (baPWV) as marker of arterial stiffness for the first time in a Caucasian cohort of older adults and analyses of the (2) cross-sectional and (3) longitudinal association between physical activity as a preventive life style component of aggressive decrease of atherosclerotic modifiers and CVD assessed as arterial stiffness in this ageing Caucasian clientele. Methods: The PhD thesis comprised a large nested study of the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3) including 3026 participants aged 50-81 years. SAPALDIA is a multi-center cohort study in eight distinct areas representative of the environmental diversity of Switzerland geared to the investigation of respiratory and cardiovascular health (including morbidity and mortality) in its ageing cohort. Mixed central and peripheral arterial stiffness was measured oscillometrically and simultaneously by CAVI and baPWV using a non-invasive VaSera VS-1500N vascular screening system (Fukuda Denshi, Tokyo, Japan). The self-reported International Physical Activity Questionnaire (IPAQ) long version was administered to classify the physical activity level in 3072 individuals for the cross-sectional analyses. The IPAQ long form asks for the frequency and duration of moderate and vigorous physical activity in different domains performed during the last seven days (leisure time, domestic and gardening activities, work-related, transport-related). Furthermore, we assessed physical activity in SAPALDIA 2 (2001-2003) and SAPALDIA 3 (2010-2011) using a short questionnaire with a cut-off of at least 150 minutes of moderate-to-vigorous physical activity per week for sufficient activity for the longitudinal analyses. We used multivariable mixed linear and logistic regression models adjusted for several potential confounders to analyze associations between physical activity and arterial stiffness. Results: Measuring characteristics of arterial stiffness indices (CAVI, baPWV) The first aim was to determine the measuring characteristics in terms of the reproducibility of the novel arterial stiffness measure CAVI together with baPWV in a Caucasian clientele within the SAPALDIA cohort. These two arterial stiffness indices are derived from an oscillometric measurement with the VaSera VS-1500N vascular screening system. This work resulted in one publication showing the high reproducibility of these indices (Milestone 1). This could be done for the first time in a Caucasian cohort, since both of these newly emerging arterial stiffness indices reflecting early CVD risk have so far mainly been studied in Asian populations or only in small studies with Caucasians. Valid markers of CVD are essential and highly important for CVD risk stratification on the population level. The analyses of the association of CAVI with blood pressure in comparison with baPWV has been conducted but could not been integrated in a publication so far. The association between CAVI and carotid intima media thickness as a traditional and well established marker of cardiovascular risk is pending. However, we have analyzed associations of CAVI and baPWV with age and sex as the main determinants of arterial stiffness in the SAPALDIA cohort proving the high quality of these indices. Cross-sectional association of physical activity and arterial stiffness In the next step, we have focused on the second aim targeting the analyses of the cross-sectional association between physical activity and arterial stiffness reflecting CVD risk in multilevel models including several confounding factors. Physical activity is regarded as an important health promotion measure with protective impact on the cardiovascular system and, thus, as one component of aggressive decrease of atherosclerotic modifiers. The main focus of the second aim was the question how a physically active lifestyle is cross-sectionally associated with arterial stiffness in the SAPALDIA cohort. Up-to-date this question has been insufficiently studied in older adults in population based studies. Furthermore, there is no comparable cohort in which a measure of arterial stiffness could be analyzed in association with a detailed questionnaire of physical activity like the IPAQ. During the data collection of SAPALDIA 3 the IPAQ has been consulted to classify the subjects’ physical activity level. We hypothesized that a sedentary lifestyle is associated with increased arterial stiffness assessed by CAVI and baPWV. We found that in this general Caucasian population of older adults higher levels especially of vigorous physical activity were associated with lower arterial stiffness reflecting lower cardiovascular risk. These data support the importance of physical activity for improving cardiovascular health in older adults. These results are included in a manuscript published in the European Journal of Epidemiology (Milestone 2). Longitudinal association of physical activity and arterial stiffness To add on this from a longitudinal point of view we have extensively worked on the third aim analyzing the association between change in physical activity between the first and second follow-up of SAPALDIA (SAPALDIA 2 to 3) and CVD risk using CAVI and baPWV as marker in multilevel models including several confounding factors. We hypothesized that an increase in physical activity between SAPALDIA 2 and 3 is associated with lower cardiovascular risk assessed by arterial stiffness. This is the first longitudinal population based cohort study showing that keeping up or adopting a physically active lifestyle was associated with lower arterial stiffness in older adults after a follow-up of almost a decade. Increasing the proportion of older adults adhering to physical activity recommendations incorporating also vigorous physical activity may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general. These findings will strengthen physical activity recommendations within CVD prevention guidelines in older adults with respect to the prevention of manifest CVD and related health outcomes. A manuscript presenting these findings have been published in the journal Age and Ageing (Milestone 3). Conclusions: Consequently, the aims of the PhD research plan could be fulfilled within the proposed timeline, except the pending analyses of the association between CAVI and baPWV with carotid-intima media thickness. We could show that CAVI and baPWV are non-invasive arterial stiffness indices that are easy-to-apply and reproducible for population wide CVD risk stratification in Caucasians. Because arterial stiffness receives growing significance for examinations of asymptomatic subjects in research our cohort study results will lead to improvements of early stage diagnosis and treatment of CVD. Risk stratification is essential for goal-oriented and area-wide primary and secondary care. Early detection of CVD and cardiovascular risk factors is crucial besides promotion of prevention and early treatment for diminishing the increasing health and economic impact of CVD. CAVI and baPWV could be implemented in this epidemiological cohort study to assess the cardiovascular risk related to increased arterial stiffness and associated with insufficient physical activity. Besides, a long-term physically active lifestyle was shown to be beneficially associated with vascular ageing and therefore decreased CVD risk on the population level in the long-term. Since there are few population based studies in Caucasians concerning this topic and the growing acknowledgement of physical activity in population health interventions this study presents highly relevant and unique results in line with current epidemiological, medical and sports science research trends. In conclusion, physical activity may play a major role in long-term healthy cardiovascular ageing at the population level and should be emphasized in CVD management and prevention guidelines. Increasing the proportion of older adults adhering to physical activity recommendations incorporating also vigorous physical activity may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general

Carotid stiffness and physical activity in elderly : a short report of the SAPALDIA 3 cohort study

Regular physical activity has been shown to reduce cardiovascular disease risk in the general population. While smaller studies in specified groups (highly trained versus untrained individuals) indicate a certain dose-dependent effect of physical activity on the reduction of carotid stiffness (an indicator of subclinical vascular disease), it is unclear whether this association is present in a representative sample. Thus, we investigated this question cross-sectionally in participants from the population-based Swiss Cohort Study on Air Pollution And Lung and Heart Diseases In Adults (SAPALDIA).; Self-reported total, moderate and vigorous physical activity and distensibility as a measure of local arterial stiffness among 1636 participants aged 50 to 81 years without clinically manifest diseases were evaluated. Mixed regression models were used to examine associations of physical activity intensity with distensibility.; Vigorous physical activity, but not total nor moderate physical activity, was significantly associated with increased distensibility (= reduced carotid stiffness) in univariate analyses (percent change in the geometric mean and 95% confidence interval per 1 standard deviation increment in vigorous physical activity = 2.54 (0.69; 4.43), p>0.01; in total physical activity = 1.62 (-0.22; 3.50), p = 0.08; in moderate physical activity = 0.70 (-1.12; 2.56), p = 0.45). These associations disappeared when we additionally adjusted for age.; After adjustment for the most important confounders and risk factors, we found no evidence for an association of physical activity with carotid stiffness in the general middle aged to elderly population

Validating device-based physical activity indicators with observation physical activity indicators in Swiss pre-school children

Purpose Accelometry is a very important tool to measure physical activity (PA) in preschoolers, as it can measure 24-hour PA and detect activity which cannot be captured by other methods. However, accelerometer validation for preschoolers is lacking (Altenburg et al. 2022). Specifically, for the ActiGraph wGT3X-BT and Move 4 (ActiGraph LLC; Move4 activity sensor, movisens GmbH) only a few, respectively no preschooler validation studies, were found. Thus, the purpose was to validate these two accelerometers in Swiss preschoolers with the System for Observing Children’s Activity and Relationships during Play (SOCARP; Ridgers et al., 2010). Methods and Design Preschoolers (2-5 years old) from two Swiss Sunday activity programs (MiniMove & Ä Halle wo’s fägt) were randomly selected as part of a larger program evaluation. PA was assessed SOCARP for a duration of 12 minutes per child. During the observation, the children wore both an ActiGraph and a Move4 device taped to their right hip to record steps. Step-counts from the ActiGraph and Move4 were correlated with each other and with moderate-to-vigorous (MV)PA from SOCARP (as SOCARP does not count steps). Results Valid PA data was available for 45/58 (77.6%) children (49% girls) for SOCARP and for 47/58 (81%) children (51% girls) for accelometry. Step count correlations between the accelerometers (Actigraph and Move4) and %MVPA (SOCARP) was medium and positive (r(43) = .34, p = .03 and r(43) = .37, p = .02; respectively). There was a strong step count correlation between the two devices (r(45) = .90, p < .001), although ActiGraph measured significantly more steps than Move4 (m = 557.74, SD = 255.77 versus m = 397.81, SD = 164.10); t(46)=8.47, p < .001). Discussion PA measurement in preschool children can be challenging. However, the correlation between step counts and observed %MVPA indicates criterion validity for both devices. The step-counts of Actigraph and Move4 validate each other, but there is a difference in the absolute number of measured steps. Due to different outcome parameters, calculation algorithms, and inaccessibility to raw acceleration the comparison of the two devices on movement intensity was not possible. Although promising preliminary indications of validity of device-based measurement of PA in Swiss preschool children, further investigations into the methodological approaches of comparing measurements of movement intensity are warranted. References Altenburg, T. M., de Vries, L., op den Buijsch, R., Eyre, E., Dobell, A., Duncan, M., & Chinapaw, M. J. M. (2022). Cross-validation of cut-points in preschool children using different accelerometer placements and data axes. Journal of Sports Sciences, 40(4), 379-385. https://doi.org/10.1080/02640414.2021.1994726 Ridgers, N. D., Stratton, G., & McKenzie, T. L. (2010). Reliability and validity of the system for observing children’s activity and relationships during play (SOCARP). Journal of Physical Activity and Health, 7(1), 17–25. https://doi.org/10.1123/jpah.7.1.1

Aerobic, resistance and combined exercise training on arterial stiffness in normotensive and hypertensive adults: A review

Exercise training has different effects on arterial stiffness according to training modalities. The optimal exercise modality for improvement of arterial function in normotensive and hypertensive individuals has not been well established. In this review, we aim to evaluate the effects of aerobic, resistance and combined aerobic and resistance training on arterial stiffness in individuals with and without hypertension. We systematically searched the Pubmed and Web of Science database from 1985 until December 2013 for relevant randomised controlled trials (RCTs). The data were extracted by one investigator and checked by a second investigator. The training effects on arterial stiffness were estimated using weighted mean differences of the relative changes (%) with 95% confidence intervals (CIs). We finally reviewed the results from 17 RCTs. The available evidence indicates that aerobic exercise tends to have a beneficial effect on arterial stiffness in normotensive and hypertensive patients, but does not affect arterial stiffness in patients with isolated systolic hypertension. Resistance exercise has differing effects on arterial stiffness depending on type and intensity. Vigorous resistance training is associated with an increase in arterial stiffness. There seem to be no unfavourable effects on arterial stiffness if the training is of low intensity, in a slow eccentric manner or with lower limb in healthy individuals. Combined training has neutral or even a beneficial effect on arterial stiffness. In conclusion, our review shows that exercise training has varying effects on arterial stiffness depending on the exercise modalities

Exercise at home program “DomiGym” contributes to the prevention of falls in vulnera-ble elderly people

Background Eighty-eight thousand fall accidents occur each year in Switzerland among people aged 65 and over, which cause a lot of personal suffering and economic costs  Beratungsstelle für Unfallverhütung BFU, 2019). The exercise at home program “DomiGym - Bewegungsangebot zu Hause” (in short: DomiGym) of Pro Senectute Switzerland aims to maintain mobility, counteract the risk of falls and promote social contacts as well as social participation and psychosocial health. Vulnerable, elderly people enjoy with DomiGym an adapted, regular training program focused on strength and balance, in their own homes or in their neighborhoods. Methodology The implementation and effects of the DomiGym offers in the cantons of Zug and Zurich were evaluated using various methodological approaches: tests of strength (Chair-Stand-Test; Mehmet et al., 2019), of balance (Modified Romberg; Agrawa et al., 2011) and of functional mobility (Timed-Up-and-Go-Test; Marks, 2016) as well as written surveys of participants (based on standardized scales used in the Swiss Health Survey). Results On average participants reduced fall risk and improved functional mobility and leg strength (p < 0.05). In a subsample of the canton of Zug, the Timed-Up-and-Go-Test (functional mobility and fall risk) improved by an average of 2.3 seconds (p < 0.005) and the balance test (Romberg) improved by 1.8 seconds (p = 0.005). Over the course of a training series the reduction in fall risk proved clinically relevant in both cantons. Scores on the Timed-Up-and-Go-Test fell on average below the threshold of 13.5 seconds discriminating between fallers and non-fallers. Chair-stand test: Participants improved on average from an initial very high fall risk to an increased fall risk (below 15 seconds). In fact the subsample of canton Zug improved by an average of 3.96 seconds (clinically relevant with regard to the reduction of falls) and the subsample of canton Zurich improved by an average of 2.17 seconds (approximately clinically relevant; threshold value 2.3 seconds; Meretta et al., 2006). DomiGym improved the general health (67%) of most participants and either maintained the original walking level (80%) or even improved it (15%). The majority of DomiGym participants do gymnastic exercises at least weekly outside of DomiGym training. DomiGym participants positively change their movement behavior in everyday life. Conclusions Pro Senectute’s DomiGym reaches older people who cannot or do not want to attend out-of-home physical activity programs. The implementation of DomiGym improves the physical functions of leg strength, functional mobility, and balance, as well as the risk of falls in vulnerable elderly people. It can be assumed that DomiGym reduces the frequency of falls in the long term, contributes to the preservation of mobility and independence in everyday life, including a longer stay in their own homes. References Agrawa, Y., Carey, J. P., Hoffman, H. J., Sklare, D. A., & Schubert, M. C. (2011). The modified Romberg balance test: Normative data in US adults. Otology & Neurotology, 32(8), 1309-1311. https://doi.org/10.1097/MAO.0b013e31822e5bee Beratungsstelle für Unfallverhütung BFU. (2019). Status 2019: Statistik der Nichtberufsunfälle und des Sicherheitsniveaus in der Schweiz. Strassenverkehr, Sport, Haus und Freizeit [Status 2019: Statistics on non-occupational accidents and safety levels in Switzerland. Road traffic, sports, home and leisure]. BFU. https://doi.org/10.13100/bfu.2.360.01 Marks, D. (2016). Aufstehen – Gehen – Umdrehen – Gehen – Hinsetzen – Timed-up-and-go-Test [Stand up – walk – turn around – walk – sit down – timed-up-and-go test]. physiopraxis, 14(07/08), 56-57. https://doi.org/10.1055/s-0042-108951 Mehmet, H., Yang, A. W. H., & Robinson, S. R. (2019). What is the optimal chair stand test protocol for older adults? A systematic review. Disability and Rehabilitation, 42(20), 2828-2835. https://doi.org/10.1080/09638288.2019.1575922 Meretta, B. M., Whitney, S. L., Marchetti, G. F., Sparto, P. J., & Muirhead, R. J. (2006). The five times sit to stand test: Responsiveness to change and concurrent validity in adults undergoing vestibular rehabilitation. Journal of Vestibular Research, 16(4-5). 233-243. https://doi.org/10.3233/VES-2006-164-51

Feasibility of oscillometric aortic pressure and stiffness assessment using the VaSera VS-1500: comparison with a common tonometric method

A number of operator-independent oscillometric devices to measure hemodynamics and arterial stiffness became available recently, but some and in particular VaSera VS-1500 do not provide estimates of aortic pressures and aortic pulse wave velocity (aPWV). The aim of this work was the retrospective application of the ARCSolver algorithm to pulse wave signals acquired with the VaSera VS-1500 device to estimate central systolic blood pressure (cSBP) and aPWV.; ARCSolver estimates of cSBP and aPWV, on the basis of brachial cuff measurements, were compared pair-wise with results from the tonometric SphygmoCor device in 68 individuals (mean age 51±18 years). We used variation estimates, correlation coefficients, age group-related t-tests, and the Bland-Altman method to analyze the reproducibility and agreement of the two methods.; cSBP reproducibility expressed as variability was 14.9% for ARCSolver and 11.6% for SphygmoCor. PWV reproducibility was better for ARCSolver, with a variation estimate of 6.5%, compared with 20.9% using SphygmoCor. The mean cSBP difference was 0.5 mmHg (SD 6.9 mmHg) and 0.32 m/s (SD 1.20 m/s) for PWV, respectively. The age-related differences between ARCSolver and SphygmoCor are in line with previous studies. Bland-Altman plots showed considerable agreement between the two methods without signs of systematic bias.; These results show that the combined application of the ARCSolver method with the VaSera VS-1500 device is feasible and the results are comparable with tonometric determination of cSBP and aPWV. This successful application of the ARCSolver may potentially help to improve cardiovascular risk stratification and prevention at an early stage in a community setting

Long-term physical activity is associated with reduced arterial stiffness in older adults: longitudinal results of the SAPALDIA cohort study

BACKGROUND: longitudinal analyses of physical activity (PA) and arterial stiffness in populations of older adults are scarce. We examined associations between long-term change of PA and arterial stiffness in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). METHODS: we assessed PA in SAPALDIA 2 (2001-03) and SAPALDIA 3 (2010-11) using a short questionnaire with a cut-off of at least 150 min of moderate-to-vigorous PA per week for sufficient activity. Arterial stiffness was measured oscillometrically by means of the brachial-ankle pulse wave velocity (baPWV) in SAPALDIA 3. We used multivariable mixed linear regression models adjusted for several potential confounders in 2,605 persons aged 50-81. RESULTS: adjusted means of baPWV were significantly lower in persons with sufficient moderate-to-vigorous PA (i) in SAPALDIA 2 but not in SAPALDIA 3 (P = 0.048) and (ii) in both surveys (P = 0.001) compared with persons with insufficient activity in both surveys. There was a significant interaction between sex and the level of change in PA concerning baPWV (P = 0.03). The triples of parameter estimates describing the association between level of PA change and baPWV were not significantly different between the two sex-specific models (P = 0.07). CONCLUSIONS: keeping up or adopting a physically active lifestyle was associated with lower arterial stiffness in older adults after a follow-up of almost a decade. Increasing the proportion of older adults adhering to PA recommendations incorporating also vigorous PA may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general