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INTRODUCCIÓN: El manejo de los diabéticos es complejo debido a múltiples factores de riesgo asociados y complicaciones que disminuyen su calidad de vida. OBJETIVOS: Determinar si la prevalencia de actividad física y tiempo sentado viendo TV difieren según el estado de glicemia en población entre 30 a 69 años residentes de Tumbes. METODOLOGIA: Análisis de datos secundarios de un estudio de base poblacional. Dos fueron las variables de respuesta, nivel de actividad física y tiempo sentado viendo TV. La exposición fue estado de glicemia categorizada en euglicémico, disglicémico y diabético tipo 2, dividida en diabético no consciente y consciente de su enfermedad. Se reportó el análisis con razones de prevalencia e intervalos de confianza al 95% utilizando modelos de regresión de Poisson. RESULTADOS: Los datos de 1607 participantes se analizaron, 809 (50.3%) fueron mujeres, la edad media fue 48.2 años (DE 10.6). La prevalencia de diabetes total fue 11.0% (IC95% 9.5% - 12.6%) y disglicemia 16.9% (IC95% 15.1% - 18.8%). Un total de 605 (37.6%; IC95% 35.2% -39.9%) reportaron bajos niveles de actividad física y 1019 (63.3%; IC95% 60.9% - 65.7%) pasar ≥2 horas al día sentados viendo TV. En modelo multivariado, no se encontró asociación significativa entre estado de glicemia y niveles de actividad física (RP= 1.14; IC95% 0.95-1.36); igualmente entre estado de glicemia y tiempo sentado viendo TV. Sin embargo, los diabéticos conscientes fueron más probables de tener bajos niveles de actividad física comparados con los euglicémicos (RP= 1.31; IC 95% 1.06-1.61). CONCLUSIONES: No se encontró asociación significativa entre estado de glicemia, nivel de actividad física y tiempo sentado viendo TV, hallándose niveles similares de actividad física entre euglicémicos, disglicémicos y diabéticos. Los diabéticos conscientes tienen 30% más probabilidad de presentar actividad física baja respecto a euglicémicos. Se recomienda aumentar los niveles de actividad física para prevenir complicaciones de DM2. / INTRODUCTION: The management of diabetics is complex due to multiple associated risk factors and complications that decrease their quality of life. OBJECTIVES: To assess whether the prevalence of physical activity levels and sitting time watching TV differ depending on glycemia status in population between 30 and 69 years old living in Tumbes. METHODS: A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels and sitting time watching TV. The exposure was glycemia status categorized into euglycemia, dysglycemia and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models. RESULTS: Data of 1607 individuals, mean age 48.2 (SD:10.6) years, 809 (50.3%) females, were analyzed. Dysglicemia and T2DM was present in 16.9% (95% CI: 15.1% 18.8%) and 11.0% (95% CI: 9.5%-12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%-39.9%) had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%-65.7%) spent ≥2 hours per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR =1.14; 95% CI: 0.95- 1.36). Similarly between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR=1.31; 95% CI: 1.06-1.61) compared to the euglycemics. CONCLUSIONS: We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical activity among those with euglycemia, dysglicemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemics. There is a need to increase physical activity levels among T2DM individuals to prevent DM2 complications. / Tesis

Developmental disabilities (DEVDIS) such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), developmental delay (DD), and learning disabilities, affect 14% of US youth, who also experience higher rates of obesity, approximately 19%, than youth without these conditions. Screen time is a risk factor for obesity, though it is not well-studied among youth with developmental disabilities. Youth with developmental disabilities experience challenges with learning, have underdeveloped social skills, and problematic behaviors. These predispositions can often result in peer rejection. The resulting social isolation may make these youth particularly vulnerable to engaging in solitary activities such as screen time. The objectives of this dissertation were to compare screen time rates among youth with developmental disabilities to typically developing youth and to examine the associations between social and family engagement with screen time among youth with developmental disabilities. Data from the 2007 National Survey of Children’s Health (NSCH), a national cross-sectional study that assesses the physical and emotional health of US children (N = 91,642), were used. Youth 6-17 years, with ADHD (n = 7,024), ASD (n = 1,200), DD (n = 3,276), LD (n = 7,482), and without special health care needs (n = 44,461) were studied. Unadjusted analyses found that children with DEVDIS engage in higher rates of screen time than youth without special health care needs. For youth with DEVDIS who were medicated for their ADHD, these associations attenuated. Thus ADHD symptoms, a common comorbidity across developmental disabilities, drove associations between the other developmental disabilities and screen time. Across all developmental disability groups, television in the bedroom was a significant screen time risk factor in both children and adolescents. Among children with ADHD, additional screen time risk factors included lack of caregiver knowledge of the child’s friends and any social engagement outside of the household. Among adolescents with ADHD, additional screen time risk factors included lower frequency that caregiver attends adolescent’s events and sport social engagement. Findings of this dissertation elucidate modifiable screen time risk factors that could potentially be adapted to decrease screen time among youth with developmental disabilities.

Background. Emerging evidence suggests that youth with attention deficit/hyperactivity disorder (ADHD) may engage in sub-optimal health behaviors including high levels of screen time, low physical activity participation, and consumption of poor diets. These are independent risk factors for adverse health outcomes, and health-related behavior patterns established in childhood can track into adulthood. Thus, identifying and addressing dietary and physical activity habits in sub-populations of youth have important implications for health over the lifespan. The specific aims of this dissertation were to: (1) compare screen time between youth with and without ADHD and to assess its relationship to ADHD symptomatology; (2) compare participation in physical activity (PA) between adolescents with and without ADHD and to assess the relationship of PA participation to ADHD symptomatology; and (3) evaluate the association of diet quality and dietary patterns to ADHD symptomatology among youth ages 8-15 years. Methods. The aforementioned outcomes of interest were analyzed using data from the continuous National Health and Nutrition Examination Survey (NHANES) 2001-2004. These waves of NHANES included a structured DSM-IV-based interview administered to parents that identified youth with ADHD and also yielded symptom counts for hyperactivity/impulsivity and inattention. Screen time and physical activity data were obtained from questionnaires that queried the amount of time spent watching television, playing videos, or using the computer outside of school time, and also surveyed the types, frequency, and duration of PA in which youth participated. Diet quality and dietary patterns, which included consumption of sugar-sweetened beverages (SSBs), total calorie intake, and eating frequency, were obtained by a 24-hour dietary recall using the Automated Multiple Pass Method of interviewing. Linear and logistic regression models adjusted for sociodemographic factors and anxiety/depression were employed to address the specific aims. Results. The findings suggest that youth with ADHD are at the same, if not higher, risk for engaging in suboptimal health behaviors. Overall, youth participating in NHANES engaged in excessive amounts of screen time, failed to acquire sufficient physical activity, and consumed diets of poor quality. However, our findings suggest that ADHD symptomatology places youth at higher risk for sedentary behavior and poor diet quality. Relative to screen time, youth with ADHD showed a trend toward increased screen time, as did youth who took medication. ADHD symptoms were also associated with over two hours of daily TV viewing and overall increased screen time, and this was particularly true for children ages 8-11 years. Relative to physical activity, the outcomes did not differ between youth with and without ADHD, but the majority of youth did not meet the recommended guidelines of 60 minutes or more of moderate-to-vigorous PA each day. Diet quality was poor across the population of youth who participated in NHANES, and hyperactive/impulsive symptoms were associated with an even greater decrease in diet quality in both children and adolescents. In males, the presence of hyperactive/impulsive symptoms was associated with a decrease in diet quality, whereas in females, inattentive symptoms accounted for a decrease in diet quality. No differences in the other dietary patterns (i.e., SSB consumption, total energy intake, and eating frequency) were observed. Conclusions. The diagnosis of ADHD and/or its symptoms are associated with less-than-recommended levels of screen time and poor diet quality, though youth in general were found to be engaging in suboptimal sedentary, physical activity, and dietary behaviors. The mechanisms for why youth with ADHD may have increased vulnerability to poorer health behaviors are not yet well understood. The findings from this dissertation support the need for ongoing efforts to address lifestyle factors among the nation’s youth generally, but may also stimulate new hypotheses about the needs of youth with ADHD from both public health and clinical perspectives, and encourage research on the implications of ADHD symptomatology on health-related behaviors and lifestyle factors.

Objectif : La Covid-19 a conduit à de nombreuses complications. Parmi celles-ci, on compte le syndrome post-Covid-19, qui inclut fréquemment le malaise post-effort (MPE), observé dans environ 90% des cas. Après une analyse du profil sociodémographique des personnes atteintes de MPE, le présent mémoire a visé à comprendre ce phénomène en évaluant les différentes variables du MPE en fonction du niveau d'activité physique (AP) des personnes touchées. Méthodes : La collecte des données a été faite à l'aide d'un questionnaire mis en ligne sur Lime Survey et distribué via Facebook. Le questionnaire visait à évaluer le niveau d'AP (loisirs, travail et transport) avant et après l'infection par la Covid-19. La population ciblée pour cette étude était constituée de personnes ayant présenté le syndrome post-Covid-19, soit le MPE. Résultats : Globalement, les résultats indiquent que les individus avec MPE (n=154) sont moins actifs et plus sédentaires après avoir contracté la Covid-19 qu’avant. Toutefois, les analyses d’interactions ont permis de faire ressortir des éléments importants. Les personnes atteintes de MPE ont vu un maintien ou une diminution significative de l'AP au travail et totale (intensité moyenne et élevée) après avoir contracté la Covid-19. De façon plus spécifique, ce sont particulièrement les femmes et les personnes dont la dernière infection remonte à plus d'un an qui ont été touchées par cette baisse. Alors que des déplacements à pieds ont diminué chez les femmes, ils ont augmentés chez les hommes. Par ailleurs, les déplacements à vélo ont diminués après la Covid-19 et ce, plus particulièrement pour les hommes, indiquant un potentiel déplacements du vélo vers la marche pour le transport. Répondre positivement aux 5 questions sur le MPE était aussi associé à une plus grande réduction de l’AP d’intensité moyenne ainsi que moyenne et élevée au travail mais à une augmentation moins marquée de la sédentarité. Avoir une récupération plus lente était associée à une réduction plus importante de l’AP d’intensité moyenne à élevée au travail. Et alors que les individus non effrayés par la peur de faire un malaise post-effort augmentaient leur niveau d’AP (intensité moyenne et moyenne/élevée) au travail, ceux effrayés le réduisait à la suite de la Covid. Finalement, ni l’âge, ni le nombre de contaminations qu’ils ont subi et ni le lieu de naissance des répondants avec le MPE n’ont pas eu d’effet sur les changements du mode de vie. Conclusions : Cette étude révèle que les personnes atteintes du syndrome post-Covid-19 à risque de MPE sont non seulement plus sédentaires mais qu’elles rapportent une baisse de l'AP qui touche surtout le travail et ce, de façon plus prononcée chez les personnes gravement atteintes de MPE et chez les femmes. Ces résultats sont importants à considérer dans un contexte de la reprise d'AP au travail post-Covid-19 de ces patients qui peuvent avoir des niveaux de déconditionnement physique plus importants. / Objective: Covid-19 has led to numerous complications. Among these, we count the post-Covid-19 syndrome, which frequently includes post-exertional malaise (PEM), i.e., in about 90% of cases. After analyzing the sociodemographic profile of people with PEM, the current thesis aims to understand this phenomenon by evaluating the different variables of PEM according to the level of physical activity (PA). Methods: We collected data using an online questionnaire hosted on Lime Survey and distributed via Facebook. The questionnaire aimed to assess the level of PA (leisure, work, and transport) before and after Covid-19 infection. The target population for this study consisted of individuals who exhibited post-Covid-19 syndrome, also known as PEM. Results: Overall, the results indicate that individuals with PEM (n=154) are less active and more sedentary after contracting Covid-19 than before. However, interaction analyses have brought out some important elements. People suffering from MPE experienced either a maintenance or a significant decrease in PA at work and overall (medium and high intensity) after contracting Covid-19. More specifically, it was particularly women and people whose last infection was more than a year ago who were affected by this decrease. While walking decreased among women, it increased among men. Moreover, cycling decreased after Covid-19, especially among men, indicating a potential shift from cycling to walking for transportation. Responding positively to the 5 PEM questions was also associated with a greater reduction in medium-intensity PA and medium to high-intensity work, but with a less pronounced increase in sedentary behavior. Having a slower recovery was associated with a greater reduction in medium to high intensity PA at work. And while individuals not scared of PEM increased their level of PA (medium intensity and medium/high) at work, those scared reduced it following Covid. Finally, neither age, nor the number of infections they suffered, nor the birthplace of respondents with ME/CFS had an effect on lifestyle changes. Conclusions: This study reveals that individuals with post-Covid-19 syndrome at risk of PEM are not only more sedentary, but they also report a decrease in PA, primarily impacting work, and this is especially pronounced in those severely affected by PEM and in women. These findings are important to consider in the context of resuming PA at work post-Covid-19 for these patients who may have higher levels of physical deconditioning.

INTRODUÇÃO: Pacientes com doença pulmonar obstrutiva crônica (DPOC) tem atividade física reduzida. Barreiras que limitam a atividade física e a medida objetiva da limitação ainda são pouco estudadas nesta população. Conhece-las permite um planejamento adequado para incremento da atividade de vida diária (AVD). OBJETIVO: Comparar a AVD de portadores de DPOC e controles com um sensor de movimento, identificar barreiras que impedem a AVD e correlaciona-los à gravidade da dispneia, ao teste de caminhada de 6 minutos (TC6) e um escore de limitação da AVD. MÉTODOS: O número de passos, a distância percorrida em quilômetros e o tempo de caminhada foram registrados por um acelerômetro de bolso e um pedômetro durante 7 dias consecutivos. Um questionário de barreiras percebidas e a escala AVD (LCADL) foram utilizados para qualificar fatores que impedem a AVD. A dispneia foi medida por duas escalas distintas e a capacidade física submáxima pelo TC6. RESULTADOS: Foram avaliados 40 sujeitos com DPOC e 40 controles saudáveis. Os pacientes com DPOC realizaram tempo menor de caminhada (68,5 ± 25,8 minutos/dia vs. 105,2 ± 49,4; p < 0,001), menor distância (3,9 ± 1,9 km/dia vs. 6,4 ± 3,2; p < 0,001) e menor número de passos/dia. A falta de estrutura, influência social e falta de vontade foram as principais barreiras referidas para realização de AVD. O TC6 correlacionou-se com os resultados do acelerômetro, mas o LCADL não. CONCLUSÃO: Portadores de DPOC são menos ativos quando comparados a adultos saudáveis. Sedentarismo e as barreiras para atividade física tem implicação imediata na prática clínica indicando medidas de intervenção precoce / INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) have reduced physical activity. Barriers that limit physical activity and objective measures of limitation are poorly studied in this population. The knowledge of them allows a proper planning for increased physical activity. OBJECTIVES: To compare ADLs in COPD patients and controls using a motion sensor, identify perceived barriers that prevent AVD and correlate them to the severity of dyspnea, to the 6-minute walk test (6MWT) and a score of AVD limitation. METHODS: An pocket accelerometer and a pedometer recorded the number of steps, distance in Km and walking time for seven consecutive days. A survey of perceived barriers and the ADL scale (LCADL) were used to describe factors that prevent AVD. Dyspnea was measured by two different scales and submaximal exercise capacity by 6MWT. RESULTS: 40 subjects with COPD and 40 healthy controls were evaluated. Patients with COPD performed less time walking (68.5 ± 25.8 minutes / day vs. 105.2 ± 49.4; p < 0.001), shorter distance (3.9 ± 1.9 km / day vs. 6.4 ± 3.2; p < 0.001) and a smaller number of steps/day. The lack of infrastructure, social influences and unwillingness were the main barriers to performing ADLs. The 6MWT correlated with the results of the accelerometer, but not LCADL. CONCLUSION: Patients with COPD are less active compared to healthy adults. Sedentary and barriers to physical activity has immediate implications in clinical practice indicating early intervention measures

INTRODUÇÃO: Pacientes com doença pulmonar obstrutiva crônica (DPOC) tem atividade física reduzida. Barreiras que limitam a atividade física e a medida objetiva da limitação ainda são pouco estudadas nesta população. Conhece-las permite um planejamento adequado para incremento da atividade de vida diária (AVD). OBJETIVO: Comparar a AVD de portadores de DPOC e controles com um sensor de movimento, identificar barreiras que impedem a AVD e correlaciona-los à gravidade da dispneia, ao teste de caminhada de 6 minutos (TC6) e um escore de limitação da AVD. MÉTODOS: O número de passos, a distância percorrida em quilômetros e o tempo de caminhada foram registrados por um acelerômetro de bolso e um pedômetro durante 7 dias consecutivos. Um questionário de barreiras percebidas e a escala AVD (LCADL) foram utilizados para qualificar fatores que impedem a AVD. A dispneia foi medida por duas escalas distintas e a capacidade física submáxima pelo TC6. RESULTADOS: Foram avaliados 40 sujeitos com DPOC e 40 controles saudáveis. Os pacientes com DPOC realizaram tempo menor de caminhada (68,5 ± 25,8 minutos/dia vs. 105,2 ± 49,4; p < 0,001), menor distância (3,9 ± 1,9 km/dia vs. 6,4 ± 3,2; p < 0,001) e menor número de passos/dia. A falta de estrutura, influência social e falta de vontade foram as principais barreiras referidas para realização de AVD. O TC6 correlacionou-se com os resultados do acelerômetro, mas o LCADL não. CONCLUSÃO: Portadores de DPOC são menos ativos quando comparados a adultos saudáveis. Sedentarismo e as barreiras para atividade física tem implicação imediata na prática clínica indicando medidas de intervenção precoce / INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) have reduced physical activity. Barriers that limit physical activity and objective measures of limitation are poorly studied in this population. The knowledge of them allows a proper planning for increased physical activity. OBJECTIVES: To compare ADLs in COPD patients and controls using a motion sensor, identify perceived barriers that prevent AVD and correlate them to the severity of dyspnea, to the 6-minute walk test (6MWT) and a score of AVD limitation. METHODS: An pocket accelerometer and a pedometer recorded the number of steps, distance in Km and walking time for seven consecutive days. A survey of perceived barriers and the ADL scale (LCADL) were used to describe factors that prevent AVD. Dyspnea was measured by two different scales and submaximal exercise capacity by 6MWT. RESULTS: 40 subjects with COPD and 40 healthy controls were evaluated. Patients with COPD performed less time walking (68.5 ± 25.8 minutes / day vs. 105.2 ± 49.4; p < 0.001), shorter distance (3.9 ± 1.9 km / day vs. 6.4 ± 3.2; p < 0.001) and a smaller number of steps/day. The lack of infrastructure, social influences and unwillingness were the main barriers to performing ADLs. The 6MWT correlated with the results of the accelerometer, but not LCADL. CONCLUSION: Patients with COPD are less active compared to healthy adults. Sedentary and barriers to physical activity has immediate implications in clinical practice indicating early intervention measures