The Development and Validation of An Activity Monitoring System for Use in Measurement of Posture of Childbearing Women During First Stage of Labor

IntroductionThere is limited understanding of the type and extent of maternal postures that midwives should encourage or support during labor. The aims of this study were to identify a set of postures and movements commonly seen during labor, to develop an activity monitoring system for use during labor, and to validate this system design.MethodsVolunteer student midwives simulated maternal activity during labor in a laboratory setting. Participants (N = 15) wore monitors adhered to the left thigh and left shank, and adopted 13 common postures of laboring women for 3 minutes each. Simulated activities were recorded using a video camera. Postures and movements were coded from the video, and statistical analysis conducted of agreement between coded video data and outputs of the activity monitoring system.ResultsExcellent agreement between the 2 raters of the video recordings was found (Cohen's κ = 0.95). Both sensitivity and specificity of the activity monitoring system were greater than 80% for standing, lying, kneeling, and sitting (legs dangling).DiscussionThis validated system can be used to measure elected activity of laboring women and report on effects of postures on length of first stage, pain experience, birth satisfaction, and neonatal condition. This validated maternal posture-monitoring system is available as a reference—and for use by researchers who wish to develop research in this area

Beyond the Clinic: Maximum Free-Living Stepping as a Potential Measure of Physical Performance

Measures of physical performance captured within a clinical setting are commonly used as a surrogate for underlying health or disease risk within an individual. By measuring physical behaviour within a free-living setting, we may be able to better quantify physical performance. In our study, we outline an approach to measure maximum free-living step count using a body-worn sensor as an indicator of physical performance. We then use this approach to characterise the maximum step count over a range of window durations within a population of older adults to identify a preferred duration over which to measure the maximum step count. We found that while almost all individuals (97%) undertook at least one instance of continuous stepping longer than two minutes, a sizeable minority of individuals (31%) had no periods of continuous stepping longer than six minutes. We suggest that the maximum step count measured over a six-minute period may be too sensitive to the adults' lack of opportunity to undertake prolonged periods of stepping, and a two-minute window could provide a more representative measure of physical performance

The Effect of Using Anchored Wake Time to Derive 24‐h Device Measured Circadian Physical Behavior Patterns

Introduction: Tailoring physical activity interventions to individual chronotypes and preferences by time of day could promote more effective and sustainable behavior change; however, our understanding of circadian physical behavior patterns is very limited. Objective: To characterize and compare 24‐h physical behavior patterns expressed relative to clock time (the standard measurement of time‐based on a 24‐h day) versus wake‐up time in a large British cohort age 46. Methods: Data were analyzed from 4979 participants in the age 46 sweep of the 1970 British Cohort Study who had valid activPAL accelerometer data across ≥4 days. Average steps and upright time (time standing plus time stepping) per 30‐min interval were determined for weekdays and weekends, both in clock time and synchronized to individual wake‐up times. Results: The mean weekday steps were 9588, and the mean weekend steps were 9354. The mean weekday upright time was 6.6 h, and the mean weekend upright time was 6.4 h. When synchronized to wake‐up time, steps peaked 1 h after waking on weekdays and 2.5 h after waking on weekends. Upright time peaked immediately, in the first 30‐min window, after waking on both weekdays and weekends. Conclusions: Aligning accelerometer data to wake‐up times revealed distinct peaks in stepping and upright times shortly after waking. Activity built up more gradually across clock time in the mornings, especially on weekends. Synchronizing against wake‐up times highlighted the importance of circadian rhythms and personal schedules in understanding population 24‐h physical behavior patterns, and this may have important implications for promoting more effective and sustainable behavior change

West End Walkers 65+: using programme theory to enhance outcome assessment in a randomised controlled trial

Background: Walking has great potential to engage people in physical activity (PA), and could address health problems associated with sedentary living. Previous research showed increasing walking behaviour in inactive adults aged 18-65 years is feasible 1. However, a systematic review showed that evidence on how to encourage older adults to increase walking is lacking 2. This study aims to test a pedometer-based walking programme in combination with a PA consultation with adults aged 65 years+ in a primary care setting and to design a study protocol that enables shared learning outcomes. Methods: Over 12 months, West End Walkers 65+ will recruit 46 participants, aged 65 years+. Participants will be allocated to: Group 1 PA consultation, individualised walking programme and pedometer; or Group 2 a waiting list control group. Step counts, activity patterns and psychological measures will be assessed pre and post intervention. Focus groups and interviews will be completed with participants and stakeholders post intervention. Programme Theory: Feasibility of the intervention will be assessed using a programme theory. A programme’s theory conceptualises what must be done to bring about desired outcomes. This allows comparison between project planning and design and programme processes3. A triangulation of qualitative and quantitative research measures will inform this assessment. Feasibility will be assessed using goals designed to promote shared and transferrable learning outcomes

Walking Behaviour of Individuals with Intermittent Claudication Compared to Matched Controls in Different Locations: An Exploratory Study

Individuals with intermittent claudication (IC) are less physically active than their peers, but how this varies with location is unclear. Individuals with IC and matched controls [sex, age ±5 years, home < 5 miles] wore an activity monitor (activPAL) and carried a GPS device (AMOD-AGL3080) for 7 days. GPS data categorised walking events as occurring at home (<=50 m from home coordinates) or away from home, and indoors (signal to noise ratio <= 212 dB) or outdoors. Number of walking events, walking duration, steps and cadence were compared between groups and each location pair using mixed model ANOVAs. In addition, the locus of activity (distance from home) at which walking was conducted was compared between groups. Participants (n = 56) were mostly male (64%) and aged 54-89 years. Individuals with IC spent significantly less time walking and took fewer steps than their matched controls at all locations, including at home. Participants spent more time and took more steps away from home than at home, but were similar when walking indoors and outdoors. The locus of activity was significantly smaller for individuals with IC, suggesting that it is not just physical capacity that influences walking behaviour, and other factors (e.g., social isolation) may play a role

Validity, practical utility, and reliability of the activPAL in preschool children

&lt;p&gt;Purpose: With the increasing global prevalence of childhood obesity, it is important to have appropriate measurement tools for investigating factors (e.g. sedentary time) contributing to positive energy balance in early childhood. For pre-school children, single unit monitors such as the activPALTM are promising. However, validation is required as activity patterns differ from adults.&lt;/p&gt; &lt;p&gt;Methods: Thirty pre-school children participated in a validation study. Children were videoed for one hour undertaking usual nursery activity while wearing an activPALTM. Video (criterion method) was analyzed on a second-by-second basis to categorise posture and activity. This was compared with the corresponding activPALTM output. In a subsequent sub-study investigating practical utility and reliability, 20 children wore an activPALTM for seven consecutive 24-hour periods.&lt;/p&gt; &lt;p&gt;Results: A total of 97,750 seconds of direct observation from 30 children were categorized as sit/lie (46%), stand (35%), walk (16%); with 3% of time in nonsit/lie/upright postures (e.g. crawl/crouch/kneel-up). Sensitivity for the overall total time matched seconds detected as activPALTM ‘sit/lie’ was 86.7%, specificity 97.1%, and positive predictive value (PPV) 96.3%. For individual children, the median (interquartile range) sensitivity for activPALTM sit/lie was 92.8% (76.1-97.4), specificity 97.3% (94.9-99.2), PPV 97.0% (91.5-99.1). The activPALTM underestimated total time spent sitting (mean difference -4.4%, p&#60;0.01), and overestimated time standing (mean difference 7.1%, p&#60;0.01). There was no difference in overall % time categorised as ‘walk’ (p=0.2). The monitors were well tolerated by children during a seven day period of free-living activity. In the reliability study, at least five days of monitoring were required to obtain an intraclass correlation coefficient of ≥0.8 for time spent sit/lie according to activPALTM output.&lt;/p&gt; &lt;p&gt;Conclusion: The activPAL had acceptable validity, practical utility, and reliability for the measurement of posture and activity during freeliving activities in pre-school children.&lt;/p&gt

West End Walkers 65+: a randomised controlled trial of a primary care-based walking intervention for older adults:study rationale and design

&lt;p&gt;Background: In Scotland, older adults are a key target group for physical activity intervention due to the large proportion who are inactive. The health benefits of an active lifestyle are well established but more research is required on the most effective interventions to increase activity in older adults. The 'West End Walkers 65+' randomised controlled trial aims to examine the feasibility of delivering a pedometer-based walking intervention to adults aged ≥65 years through a primary care setting and to determine the efficacy of this pilot. The study rationale, protocol and recruitment process are discussed in this paper.&lt;/p&gt; &lt;p&gt;Methods/Design: The intervention consisted of a 12-week pedometer-based graduated walking programme and physical activity consultations. Participants were randomised into an immediate intervention group (immediate group) or a 12-week waiting list control group (delayed group) who then received the intervention. For the pilot element of this study, the primary outcome measure was pedometer step counts. Secondary outcome measures of sedentary time and physical activity (time spent lying/sitting, standing or walking; activPAL™ monitor), mood (Positive and Negative Affect Schedule), functional ability (Perceived Motor-Efficacy Scale for Older Adults), quality of life (Short-Form (36) Health Survey version 2) and loneliness (UCLA Loneliness Scale) were assessed. Focus groups with participants and semi-structured interviews with the research team captured their experiences of the intervention. The feasibility component of this trial examined recruitment via primary care and retention of participants, appropriateness of the intervention for older adults and the delivery of the intervention by a practice nurse.&lt;/p&gt; &lt;p&gt;Discussion: West End Walkers 65+ will determine the feasibility and pilot the efficacy of delivering a pedometer-based walking intervention through primary care to Scottish adults aged ≥65 years. The study will also examine the effect of the intervention on the well-being of participants and gain an insight into both participant and research team member experiences of the intervention.&lt;/p&gt

Participant and workplace champion experiences of an intervention designed to reduce sitting time in desk-based workers : SMART work & life

Background: A cluster randomised controlled trial demonstrated the effectiveness of the SMART Work & Life (SWAL) behaviour change intervention, with and without a height-adjustable desk, for reducing sitting time in desk-based workers. Staff within organisations volunteered to be trained to facilitate delivery of the SWAL intervention and act as workplace champions. This paper presents the experiences of these champions on the training and intervention delivery, and from participants on their intervention participation. Methods: Quantitative and qualitative feedback from workplace champions on their training session was collected. Participants provided quantitative feedback via questionnaires at 3 and 12 month follow-up on the intervention strategies (education, group catch ups, sitting less challenges, self-monitoring and prompts, and the height-adjustable desk [SWAL plus desk group only]). Interviews and focus groups were also conducted at 12 month follow-up with workplace champions and participants respectively to gather more detailed feedback. Transcripts were uploaded to NVivo and the constant comparative approach informed the analysis of the interviews and focus groups. Results: Workplace champions rated the training highly with mean scores ranging from 5.3/6 to 5.7/6 for the eight parts. Most participants felt the education increased their awareness of the health consequences of high levels of sitting (SWAL: 90.7%; SWAL plus desk: 88.2%) and motivated them to change their sitting time (SWAL: 77.5%; SWAL plus desk: 85.77%). A high percentage of participants (70%) reported finding the group catch up session helpful and worthwhile. However, focus groups highlighted mixed responses to the group catch-up sessions, sitting less challenges and self-monitoring intervention components. Participants in the SWAL plus desk group felt that having a height-adjustable desk was key in changing their behaviour, with intrinsic as well as time based factors reported as key influences on the height-adjustable desk usage. In both intervention groups, participants reported a range of benefits from the intervention including more energy, less fatigue, an increase in focus, alertness, productivity and concentration as well as less musculoskeletal problems (SWAL plus desk group only). Work-related, interpersonal, personal attributes, physical office environment and physical barriers were identified as barriers when trying to sit less and move more. Conclusions: Workplace champion and participant feedback on the intervention was largely positive but it is clear that different behaviour change strategies worked for different people indicating that a ‘one size fits all’ approach may not be appropriate for this type of intervention. The SWAL intervention could be tested in a broader range of organisations following a few minor adaptations based on the champion and participant feedback. Trial registration: ISCRCTN registry (ISRCTN11618007)

What do older people do when sitting and why? Implications for decreasing sedentary behaviour

Background and Objectives: Sitting less can reduce older adults’ risk of ill health and disability. Effective sedentary behavior interventions require greater understanding of what older adults do when sitting (and not sitting), and why. This study compares the types, context, and role of sitting activities in the daily lives of older men and women who sit more or less than average. Research Design and Methods: Semistructured interviews with 44 older men and women of different ages, socioeconomic status, and objectively measured sedentary behavior were analyzed using social practice theory to explore the multifactorial, inter-relational influences on their sedentary behavior. Thematic frameworks facilitated between-group comparisons. Results: Older adults described many different leisure time, household, transport, and occupational sitting and non-sitting activities. Leisure-time sitting in the home (e.g., watching TV) was most common, but many non-sitting activities, including “pottering” doing household chores, also took place at home. Other people and access to leisure facilities were associated with lower sedentary behavior. The distinction between being busy/not busy was more important to most participants than sitting/not sitting, and informed their judgments about high-value “purposeful” (social, cognitively active, restorative) sitting and low-value “passive” sitting. Declining physical function contributed to temporal sitting patterns that did not vary much from day-to-day. Discussion and Implications: Sitting is associated with cognitive, social, and/or restorative benefits, embedded within older adults’ daily routines, and therefore difficult to change. Useful strategies include supporting older adults to engage with other people and local facilities outside the home, and break up periods of passive sitting at home

A cross‐cultural translation and adaptation of the Arabic Cardiac Self‐Efficacy Questionnaire for patients with coronary heart disease

Aim: This study aimed to cross-culturally translate and adapt the Cardiac Self-Efficacy Questionnaire into Arabic and subsequently evaluate the psychometric properties of that translation in a population of Arabic patients. Method: The original English version of the Cardiac Self-Efficacy Questionnaire was translated into Arabic following a process recommended by the World Health Organization. A convenience sample consisting of 268 Jordanian patients with coronary heart disease were recruited from a university-affiliated hospital in Amman, Jordan. Data were collected from August, 2018 until January, 2019. The factor structure, face and content validities, and internal consistency of the Arabic Cardiac Self-Efficacy Questionnaire were evaluated. Results: The factor structure analysis supported a three-factor high-order structure of the Arabic Cardiac Self-Efficacy Questionnaire. Face validity showed that the language used, style and format were clear. The content validity demonstrated a very good content validity index. The reliability was good with ranging from 0.89 to 0.93 for all questionnaire subscales. Conclusion: The Arabic Cardiac Self-Efficacy Questionnaire is a valid and reliable instrument to assess the Cardiac Self-Efficacy of Arabic patients diagnosed with coronary heart disease. Further assessment of the psychometric properties of the Arabic version of the questionnaire with different cardiac problems is now recommended