How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review

BackgroundCadence (steps/min) may be a reasonable proxy-indicator of ambulatory intensity. A summary of current evidence is needed for cadence-based metrics supporting benchmark (standard or point of reference) and threshold (minimums associated with desired outcomes) values that are informed by a systematic process.ObjectiveTo review how fast, in terms of cadence, is enough, with reference to crafting public health recommendations in adults.MethodsA comprehensive search strategy was conducted to identify relevant studies focused on walking cadence and intensity for adults. Identified studies (n=38) included controlled (n=11), free-living observational (n=18) and intervention (n=9) designs.ResultsThere was a strong relationship between cadence (as measured by direct observation and objective assessments) and intensity (indirect calorimetry). Despite acknowledged interindividual variability, ≥100 steps/min is a consistent heuristic (e.g, evidence-based, rounded) value associated with absolutely defined moderate intensity (3 metabolic equivalents (METs)). Epidemiological studies report notably low mean daily cadences (ie, 7.7 steps/min), shaped primarily by the very large proportion of time (13.5 hours/day) spent between zero and purposeful cadences (<60 steps/min) at the population level. Published values for peak 1-min and 30-min cadences in healthy free-living adults are >100 and >70 steps/min, respectively. Peak cadence indicators are negatively associated with increased age and body mass index. Identified intervention studies used cadence to either prescribe and/or quantify ambulatory intensity but the evidence is best described as preliminary.ConclusionsA cadence value of ≥100 steps/min in adults appears to be a consistent and reasonable heuristic answer to ’How fast is fast enough?' during sustained and rhythmic ambulatory behaviour.Trial registration numberNCT02650258

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Is metformin use associated with a reduced risk of oesophageal cancer? A systematic review and meta-analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-140432 ◽

2021 ◽

pp. postgradmedj-2021-140432

Author(s):

Yue Chen ◽

Xingyu Cheng ◽

Chenyu Sun ◽

Na Hyun Kim ◽

Sujatha Kailas ◽

...

Keyword(s):

Sensitivity Analysis ◽

Oesophageal Cancer ◽

Search Strategy ◽

Meta Analysis ◽

Random Effect ◽

Registration Number ◽

Comprehensive Search ◽

Meta Regression ◽

Comprehensive Search Strategy ◽

Reduced Risk

ObjectivesStudies on the association between metformin use and the risk of oesophageal cancer (OC) have generated controversial findings. This updated meta-analysis was conducted to reassess the effects of metformin on OC.MethodsA comprehensive search strategy was conducted to select relevant studies from origination to February 2021. Heterogeneity was evaluated through the Q test and I2 statistics. HRs and 95% CIs were pooled through either random-effect or fixed-effect models. Meta-regression, subgroup analyses, sensitivity analysis and publication bias diagnosis were also performed.ResultsSeven studies with 5 426 343 subjects were included. Metformin use was associated with reduced risk of OC (HR=0.69, 95% CI 0.54 to 0.87, p<0.001). Sensitivity analysis suggested that the results were relatively stable.ConclusionMetformin is associated with a reduced risk of OC. More well-designed studies are still needed to further elaborate on these associations.PROSPERO registration numberCRD42021237127.

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Obesity management in primary care: systematic review exploring the influence of therapeutic alliance

Family Practice ◽

10.1093/fampra/cmab026 ◽

2021 ◽

Author(s):

Elizabeth A Sturgiss ◽

Kathleen O’Brien ◽

Nicholas Elmitt ◽

Jason Agostino ◽

Stephen Ardouin ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Therapeutic Alliance ◽

Meta Analysis ◽

Direct Care ◽

Statistical Heterogeneity ◽

Registration Number ◽

Obesity Interventions ◽

Comprehensive Search ◽

Comprehensive Search Strategy

Abstract Purpose To identify the influence of the therapeutic alliance on the effectiveness of obesity interventions delivered in primary care. Method Systematic review of randomized controlled trials of primary care interventions for adult patients living with obesity. Comprehensive search strategy using the terms ‘obesity’, ‘primary care’ and ‘intervention’ of seven databases from 1 January 1998 to March 2018. Primary outcome was difference in weight loss in interventions where a therapeutic alliance was present. Results From 10 636 studies, 11 (3955 patients) were eligible. Only one study had interventions that reported all aspects of therapeutic alliance, including bond, goals and tasks. Meta-analysis was not included due to high statistical heterogeneity and low numbers of trials; as per our protocol, we proceeded to narrative synthesis. Some interventions included the regular primary care practitioner in management; very few included collaborative goal setting and most used prescriptive protocols to direct care. Conclusions We were surprised that so few trials reported the inclusion of elements of the therapeutic alliance when relational aspects of primary care are critical for effectiveness. Interventions could be developed to maximize therapeutic relationships and research reports should describe interventions comprehensively. Systematic review registration number CRD42018091338 in PROSPERO (International prospective register of systematic reviews).

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Physiological demands of singing for lung health compared with treadmill walking

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2021-000959 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000959

Author(s):

Keir EJ Philip ◽

Adam Lewis ◽

Sara C Buttery ◽

Colm McCabe ◽

Bishman Manivannan ◽

...

Keyword(s):

Minute Ventilation ◽

Well Being ◽

Treadmill Walking ◽

Moderate Intensity ◽

Psychological Benefits ◽

Metabolic Equivalents ◽

Training Modality ◽

Registration Number ◽

Physiological Demands ◽

Lung Health

IntroductionParticipating in singing is considered to have a range of social and psychological benefits. However, the physiological demands of singing and its intensity as a physical activity are not well understood.MethodsWe compared cardiorespiratory parameters while completing components of Singing for Lung Health sessions, with treadmill walking at differing speeds (2, 4 and 6 km/hour).ResultsEight healthy adults were included, none of whom reported regular participation in formal singing activities. Singing induced acute physiological responses that were consistent with moderate intensity activity (metabolic equivalents: median 4.12, IQR 2.72–4.78), with oxygen consumption, heart rate and volume per breath above those seen walking at 4 km/hour. Minute ventilation was higher during singing (median 22.42 L/min, IQR 16.83–30.54) than at rest (11 L/min, 9–13), lower than 6 km/hour walking (30.35 L/min, 26.94–41.11), but not statistically different from 2 km/hour (18.77 L/min, 16.89–21.35) or 4 km/hour (23.27 L/min, 20.09–26.37) walking.ConclusionsOur findings suggest the acute metabolic demands of singing are comparable with walking at a moderately brisk pace, hence, physical effects may contribute to the health and well-being benefits attributed to singing participation. However, if physical training benefits result remains uncertain. Further research including different singing styles, singers and physical performance impacts when used as a training modality is encouraged.Trial registration numberClinicalTrials.gov registry (NCT04121351).

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What is the Minimum Step Rate Required to Achieve Moderate-Intensity Walking Overground in Adolescent Girls?

Pediatric Exercise Science ◽

10.1123/pes.2019-0138 ◽

2020 ◽

Vol 32 (4) ◽

pp. 197-203

Author(s):

Mhairi J. MacDonald ◽

Samantha G. Fawkner ◽

Ailsa G. Niven

Keyword(s):

Adolescent Girls ◽

Mixed Model ◽

Small Sample Size ◽

Resting Metabolic Rate ◽

Population Level ◽

Small Sample ◽

Moderate Intensity ◽

Anthropometric Measures ◽

Step Rate ◽

Metabolic Equivalents

Background: In order to promote walking, researchers have sought to identify the required step rate to maintain a health-enhancing walking intensity However, there is limited evidence regarding the stepping rate required to promote moderate-intensity walking in adolescent girls. Purpose: To identify the step rate equivalent to moderate-intensity physical activity (MPA) in adolescent girls and to explore the influence that different anthropometric measures may have on the step rate equating to MPA in this population. Methods: A total of 56 adolescent girls (mean age = 13.8[0.7] y) were recruited to the study. Anthropometric variables and resting metabolic rate were assessed, followed by 3 overground walking trials on a flat surface at approximately 2, 3, and 4 mph, each lasting a minimum of 4 minutes. Oxygen uptake was assessed using a portable gas analyzer and subsequently converted into metabolic equivalents (METs). Step count was assessed by real-time direct observation hand tally. Results: Employing the linear regression between step rate and METs (r2 = .20, standard error of estimates = 0.003) suggests that 120 steps per minute was representative of an MPA (3 METs) equating to 7200 steps in 60 minutes. Multiple regression and mixed-model regression confirmed weight-related variables and maturity were significant predictors of METs (P < .01). Conclusion: The results suggest that, at population level, a step rate of 120 steps per minute may be advocated to achieve MPA in adolescent girls; although, due to the small sample size used, caution should be applied. At an individual level, other factors, such as age and weight, should be considered.

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Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes

Sports Medicine ◽

10.1007/s40279-020-01379-5 ◽

2020 ◽

Author(s):

Adam Runacres ◽

Kelly A. Mackintosh ◽

Melitta A. McNarry

Keyword(s):

General Population ◽

Cancer Mortality ◽

English Language ◽

Meta Analysis ◽

Premature Mortality ◽

Epidemiological Studies ◽

Registration Number ◽

Mortality Ratio ◽

Former Elite Athletes

Abstract Introduction Exercise is widely accepted to improve health, reducing the risk of premature mortality, cardiovascular disease (CVD) and cancer. However, several epidemiological studies suggest that the exercise-longevity relationship may be ‘J’ shaped; with elite athlete’s likely training above these intensity and volume thresholds. Therefore, the aim of this meta-analysis was to examine this relationship in former elite athletes. Methods 38,047 English language articles were retrieved from Web of Science, PubMed and SportDiscus databases published after 1970, of which 44 and 24 were included in the systematic review and meta-analysis, respectively. Athletes were split into three groups depending on primary sport: Endurance (END), Mixed/Team, or power (POW). Standard mortality ratio’s (SMR) and standard proportionate mortality ratio (SPMR) were obtained, or calculated, and combined for the meta-analysis. Results Athletes lived significantly longer than the general population (male SMR 0.69 [95% CI 0.61–0.78]; female SMR 0.51 [95% CI 0.40–0.65]; both p < 0.01). There was no survival benefit for male POW athletes compared to the general population (SMR 1.04 [95% CI 0.91–1.12]). Although male athlete’s CVD (SMR 0.73 [95% CI 0.62–0.85]) and cancer mortality (SMR 0.75 [95% CI 0.63–0.89]), were significantly reduced compared to the general population, there was no risk-reduction for POW athletes CVD mortality (SMR 1.10 [0.86–1.40]) or END athletes cancer mortality (SMR 0.73 [0.50–1.07]). There was insufficient data to calculate female sport-specific SMR’s. Discussion Overall, athletes live longer and have a reduced incidence of both CVD and cancer mortality compared to the general population, refuting the ‘J’ shape hypothesis. However, different health risks may be apparent according to sports classification, and between sexes, warranting further investigation. Trial registration PROSPERO (registration number: CRD42019130688).

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Walking Cadence during Moderate-Intensity Physical Activity in Pregnant Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126593 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6593

Author(s):

Mallory Marshall ◽

Beth Birchfield ◽

Rebecca Rogers ◽

Joyeuse Senga ◽

McKenna Persch ◽

...

Keyword(s):

Oxygen Consumption ◽

Pregnant Women ◽

Pearson Correlation ◽

Current Data ◽

Moderate Intensity ◽

Metabolic Alterations ◽

Moderate Intensity Physical Activity ◽

Metabolic Equivalents ◽

Significant Difference ◽

Three Stages

Evidence has established that a cadence of 100 steps/min is indicative of the moderate intensity threshold of 3 metabolic equivalents (METs), but this has only been described in non-pregnant individuals. As metabolic alterations are well established during pregnancy, the purpose of this study was to determine if the walking cadence equivalent to 3 METs in pregnant women is similar to non-pregnant populations. Pregnant females (n = 29; age = 30.3 ± 3.2 years, gestational age = 23.9 ± 6.6 weeks) in their second or third trimester (>12 weeks gestation) completed three stages of treadmill walking for 5 min at different standardized walking speeds: 2.5, 3.0, and 3.5 miles per hour (mph). Oxygen consumption (VO2) and heart rate (HR) were measured each minute and METs were calculated for each stage. Real-time continuous monitoring of walking cadence was evaluated by an OptoGait gait analysis system. Following the three standardized speed stages, participants completed an additional stage walking at a speed that elicited 100 steps/min; VO2 and HR were also collected. A one-sample t-test was used to compare MET values at each stage to the heuristic 3 MET cutoff, and Pearson correlation coefficient was calculated to evaluate the relationship between cadence and METs. Mean cadence increased linearly across the three stages (2.5 mph = 103.7 ± 4.5, 3.0 mph = 112.5 ± 5.3, and 3.5 mph = 120.4 ± 6.2 steps/min), as did METs (2.5 mph = 2.7 ± 1.7, 3.0 mph = 3.2 ± 0.8, and 3.5 mph = 4.3 ± 1.8 METs) regardless of trimester. The average treadmill speed at which women walked at 100 steps/min was 2.4 ± 0.4 mph which elicited an oxygen consumption of 9.5 mL•kg−1•min−1, or 2.7 ± 0.7 METs. There was no significant difference between METs at 3.0 mph and the conventional 3 MET cut point for moderate-intensity PA (p < 0.05). There was a moderate and significant relationship between METs and cadence (2nd trimester: r = 0.51; 3rd trimester: r = 0.42). Current data indicate for the first time that the traditionally used 3 MET cutoff for moderate-intensity activity is appropriate for pregnant women despite metabolic alterations associated with pregnancy. This may have important implications for exercise prescription in pregnant populations.

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Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

Brain Plasticity ◽

10.3233/bpl-200111 ◽

2020 ◽

pp. 1-15

Author(s):

Daniel Joseph Lamport ◽

Claire Michelle Williams

Keyword(s):

Systematic Reviews ◽

Evidence Base ◽

Epidemiological Studies ◽

Cognitive Outcome ◽

Current Evidence ◽

Duration Of Treatment ◽

Current Evidence Base ◽

Cognitive Benefits ◽

Meta Analyses ◽

The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

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Effects of Polyphenol Intake on Metabolic Syndrome: Current Evidences from Human Trials

Oxidative Medicine and Cellular Longevity ◽

10.1155/2017/5812401 ◽

2017 ◽

Vol 2017 ◽

pp. 1-18 ◽

Cited By ~ 64

Author(s):

Gemma Chiva-Blanch ◽

Lina Badimon

Keyword(s):

Metabolic Syndrome ◽

Type Ii Diabetes ◽

Randomized Trials ◽

Virgin Olive Oil ◽

Epidemiological Studies ◽

Current Evidence ◽

Aromatic Plants ◽

Polyphenol Intake ◽

Public Health Strategies

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors which severely increases the risk of type II diabetes and cardiovascular disease. Several epidemiological studies have observed a negative association between polyphenol intake and MetS rates. Nevertheless, there are relatively small numbers of interventional studies evidencing this association. This review is focused on human interventional trials with polyphenols as polyphenol-rich foods and dietary patterns rich in polyphenols in patients with MetS. Current evidence suggests that polyphenol intake has the potential to alleviate MetS components by decreasing body weight, blood pressure, and blood glucose and by improving lipid metabolism. Therefore, high intake of polyphenol-rich foods such as nuts, fruits, vegetables, seasoning with aromatic plants, spices, and virgin olive oil may be the cornerstone of a healthy diet preventing the development and progression of MetS, although there is no polyphenol or polyphenol-rich food able to influence all MetS features. However, inconsistent results have been found in different trials, and more long-term randomized trials are warranted to develop public health strategies to decrease MetS rates.

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Use of geographical information systems in multiple sclerosis research: A systematic scoping review

10.21203/rs.3.rs-236908/v1 ◽

2021 ◽

Author(s):

Soheil Hashtarkhani ◽

Hossein Tabatabaei-Jafari ◽

Behzad Kiani ◽

MaryAnne Furst ◽

Luis Salvador-Carulla ◽

...

Keyword(s):

Multiple Sclerosis ◽

Scoping Review ◽

Geographical Information Systems ◽

Geographical Information ◽

Complex Nature ◽

Gis Applications ◽

Thematic Mapping ◽

Health Related ◽

Comprehensive Search ◽

Comprehensive Search Strategy

Abstract Introduction: Geographical Information System (GIS) and spatial analysis have an emerging role in the understanding and management of health-related outcomes. However, there is a knowledge gap about the extent to which GIS has supported Multiple Sclerosis (MS) research. Therefore, this review aimed to explore the types of GIS applications and the complexity of their visualisation in MS research. Methods: A systematic scoping review was conducted based on York’s five-stage framework. PubMed, Scopus and Web of Science were searched for relevant studies published between 2000 and 2020 using a comprehensive search strategy based on the main concepts related to GIS and MS. Grounded, inductive analysis was conducted to organize studies into meaningful application areas. Further, we developed a tool to assess the visualisation complexity of the selected papers.Results: Of 3,723 identified unique citations, 42 papers met our inclusion criteria for the final review. One or more of the following types of GIS applications were reported by these studies: (a) thematic mapping (37 papers); (b) spatial cluster detection (16 papers); (c) risk factors detection (16 papers); and (d) health access and planning (two papers). In the majority of studies (88%), the score of visualisation complexity was relatively low: three or less from the range of zero to six. Conclusions: Although the number of studies using GIS techniques has dramatically increased in the last decade, the use of GIS in the areas of MS access and planning is still under-researched. Additionally, the capacity of GIS in visualising complex nature of MS care system is not yet fully investigated.

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Modeling of Metabolic Equivalents (METs) during Moderate Resistance Training Exercises

Applied Sciences ◽

10.3390/app11188773 ◽

2021 ◽

Vol 11 (18) ◽

pp. 8773

Author(s):

Muhammad Adeel ◽

Chien-Hung Lai ◽

Chun-Wei Wu ◽

Jiunn-Horng Kang ◽

Jian-Chiun Liou ◽

...

Keyword(s):

Blood Pressure ◽

Resistance Training ◽

Perceived Exertion ◽

Training Group ◽

Repeated Measure ◽

Moderate Intensity ◽

Measure Data ◽

Training Experience ◽

Metabolic Equivalents ◽

Resting Period

Energy expenditure through metabolic equivalent (MET) prediction during resistance exercises in humans can be modeled by using cardiorespiratory parameters. In this study, we aimed to predict MET during six moderate-intensity resistance training sessions consisting of three different exercises. Eleven participants were recruited into two groups; an untrained (n = 5; with no resistance training experience) and a trained group (n = 6; with 2 months resistance training experience). Each participant completed six training sessions separated with a rest interval of 1–2 days. While wearing a mask for indirect calorimetric measurements using Cortex Metalyzer 3B, each participant performed training sessions consisting of three types of dumbbell exercises: shoulder press, deadlift, and squat. The metabolic equivalents (METs), respiratory exchange ratio (RER), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood lactate (BL), and Borg rate of perceived exertion (RPE) were measured. The MET was predicted using generalized estimating equations (GEE) for repeated measure data collected during exercise and rest periods. It was observed that during exercise period, RER, HR, SBP, and BL for the training group (QIC = 187, 95% CI = −0.012~0.915, p = 0.000*~0.033*) while RER, HR, SBP, DBP, and RPE (QIC = 48, 95% CI = −0.024~0.422, p = 0.000*~0.002*) during resting period for untrained group significantly predicted MET for moderate-intensity interval resistance training. It is concluded that the cardiorespiratory variables are significantly related to MET. During exercise, RER and HR significantly predicted MET for both groups along with additional parameters of SBP and BL for the training group. While during the resting period, RER, HR, SBP, DBP, and RPE related significantly for untrained and BL for training group respectively.

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