Die vorliegende Dissertation untersucht den Zusammenhang zwischen der Ausprägung physischer Aktivität und der Prävalenz kardiovaskulärer Risikofaktoren und Komorbiditäten bei Patienten mit milder bis moderater chronischer Niereninsuffizienz (CKD). Ziel ist die Identifikation kardiovaskulärer Risikofaktoren und Komorbiditäten, die durch physische Aktivität bei diesem Patientenkollektiv positiv beeinflusst werden können. Grundlagen: Es besteht eine deutlich gesteigerte kardiovaskuläre Morbidität und Mortalität für Patienten mit CKD. Diese versterben häufig bereits aufgrund kardiovaskulärer Ereignisse bevor sie das Stadium des ESRD erreichen. Besonders den "traditionellen" kardiovaskulären Risikofaktoren, deren Prävalenz bei CKD deutlich gesteigert ist, kommt im Zusammenhang zwischen CKD und CVD eine bedeutende Rolle zu. Im Rahmen dieser Studie wurden unter den "traditionellen" Risikofaktoren diejenigen zusammengefasst, deren Gesamtheit das metabolische Syndrom definiert. Es gilt als belegt, dass physische Aktivität bei gesunden Personen einen präventiven Einfluss auf diese "traditionellen" Risikofaktoren einer CVD besitzt. In wieweit dies auf CKD Patienten mit ihrer vielfältigen weiteren kardiovaskulären Risikofaktoren übertragen werden darf und welchen Einfluss physische Aktivität hier haben kann, ist ungewiss. Es besteht allerdings Evidenz für eine deutliche Reduktion der physischen Aktivität bei Vorliegen einer milden bis moderaten CKD. Methodik: Die prospektive klinisch-experimentelle Pedometerstudie stellt die erste objektiv erhobene Datensammlungen physischer Aktivität dieser Größe von Patienten mit CKD im Stadium 3 dar. Die 1153 eingeschlossenen Probanden wurden bundesweit aus der multizentrischen GCKD-Studie rekrutiert. Die Schrittzahlerfassung wurde über einen Zeitraum von 13 konsekutiven Tagen durchgeführt. Unter Berücksichtigung standardisiert erhobener Laborwerte und Fragebögen wurde die Assoziation physischer Aktivität mit kardiovaskulären Risikofaktoren und Komorbiditäten ermittelt. Ergebnisse: Die physische Aktivität der chronisch nierenerkrankten Studienpopulation erweist sich objektiv gemessen als deutlich eingeschränkt. Mit sinkendem Aktivitätsniveau geht eine gesteigerte kardiovaskuläre Morbidität einher. Für die Faktoren HbA1c, Alter und WHR ist eine inverse Korrelation zur Schrittzahl gegeben. Es konnte gezeigt werden, dass die mittlere Schrittzahl von Probanden, die an den kardiovaskulären Komorbiditäten pAVK, KHK, Herzinsuffizienz und Schlaganfall leiden oder die Risikofaktoren Diabetes mellitus und Adipositas aufweisen, hochsignifikant geringer ist als diejenige Schrittzahl von Probanden, die diese Faktoren nicht aufweisen. Darüber hinaus zeigt die durchgeführte Regressionsanalyse, dass auch nach Adjustierung für Alter, Geschlecht, Bildungsstatus und Anstellung mit einer höheren Schrittzahl ein signifikant gemindertes Risiko bezüglich des Vorliegens der Variablen pAVK, KHK, Herzinsuffizienz, Diabetes mellitus, Adipositas und Rauchen gegeben ist als in einer weniger aktiven Vergleichsgruppe mit der gleichen Nierenfunktionseinschränkung. Bezüglich der kardiovaskulären Risikofaktoren ist somit festzustellen, dass vor allem die Risikofaktoren Adipositas und Diabetes mellitus eine Beeinflussbarkeit aufgrund des Faktors physische Aktivität zeigen. Fazit: Eine reduzierte physische Aktivität ist auch bei Patienten mit CKD mit einem höheren kardiovaskulären Risiko verbunden. Bei Patienten mit CKD können durch physische Aktivität vor allem die kardiovaskulären Risikofaktoren Adipositas und Diabetes mellitus positiv beeinflusst werden. Die krankheitsbedingt deutlich beeinflussten Risikofaktoren arterielle Hypertonie und Dyslipidämie unterliegen bei dieser Studienpopulation hingegen keinem messbaren positiven Effekt physischer Aktivität. Daher sollte insbesondere Patienten mit chronischem Nierenleiden, die zudem an einer Adipositas und oder einem Diabetes mellitus leiden, zu physischer Aktivität geraten werden. / This Study explores the effects of physical activity on the prevalence of cardiovascular risk factors as well as cardiovascular comorbidities in patients with mild to moderate kidney disease. Aim is to identify risk factors and comorbidities which underlay a positive impact of physical activity in these patients. Background: Patients with CKD suffer from a higher burden of cardiovascular disease which results in an increased cardiovascular mortality. In most instances these patients die from cardiovascular events before they reach ESRD. Especially "traditional" cardiovascular risk factors, which are indeed more common in patients with CKD, seem to have influence on the association of CKD und CVD. This study summarizes the entirety of the metabolic syndrome as "traditional" cardiovascular risk factors. It has already been shown that physical activity has a positive and preventive influence on these "traditional" risk factors in the general population. Weather those findings can be assigned to patients with CKD which underlay various different cardiovascular risk factors is uncertain. But there is already evidence that physical activity is dramatically reduced in mild to moderate CKD. Methods: 1153 individuals with CKD stage 3 were recruited from the national multicenter GCKD-Study to participate in the prospective clinical experimental Pedometer-Study. Thereby this study generates the first objective data of physical activity of this size in patients with mild to moderate CKD stage 3. Stepcount measurement took place for 13 consecutive days. Highly standardized questionnaires as well as laboratory data made it possible to investigate the association of physical activity and cardiovascular risk factors and comorbidities. Results: We found a significantly decreased objectively measured physical activity for mild to moderate CKD population. The decrease of activity goes along with an increased cardiovascular morbidity. We found an inverse correlation of stepcount and HbA1c, age und WHR. It was to show a significant reduction of stepcount in study subjects that suffer from cardiovascular comorbidities as well as diabetes mellitus or obesity in comparison to study subjects missing these factors. After adjustment of age, sex, educational status and employment status, regression analysis show a significantly reduced risk for PAD, AMI, CHF, diabetes mellitus, obesity and smoking going along with higher stepcount compared with less active individuals with the same kidney failure. In conclusion we observed that the cardiovascular risk factors diabetes mellitus and obesity can be positively influenced by physical activity in CKD population. Conclusion: Reduced physical activity in CKD population goes along with higher cardiovascular risk. Especially the cardiovascular risk factors diabetes mellitus and obesity can be positively influenced by physical activity in CKD population. The distinctly CKD influenced cardiovascular risk factors hypertension and dyslipidaemia do not show positive interference going along with physical activity as they do in general population. However in particular CKD patients who in addition suffer from obesity and or diabetes mellitus should be advised to increase physical activity.

Introduction: Pedometers are increasingly used as a self-monitoring aid for achieving and increasing daily physical activity. Older pedometers had varied levels of accuracy ranging from 0 to 45% difference and were needed to be positioned in a certain way (on the waist). Newer models can be placed anywhere on the body but its accuracy is unknown when they are placed at different bodily sites. Purpose: We determined the accuracy of various newer pedometers under controlled laboratory and free walking conditions. Method: A total of 40 subjects (20 male and 20 female) varying widely in age (18-61 years) and BMI (18-38 kg/m²) were studied. The pedometers, including Omron HJ-320, Omron HJ-324U, Lifesource XI-25, Fitbit Ultra, and Virgin Health Miles, were placed at waist, at chest, in a pocket, and on an armband. The number of steps recorded with the pedometers was compared against those counted with a hand tally counter while the subjects walked on the treadmill at 54, 80, 107, 134, and 161 m/min and on paved ground outside at a self-selected pace. Results: With the exception of one, all the pedometers were accurate (within ±5% of the criterion measure) at moderate walking speeds (80 and 107 m/min). The results were similar no matter where the pedometers were placed on the body and where the walking was performed. There were general tendencies for the accuracy to decrease at slower and faster walking speeds in most pedometers. The mean difference scores increased particularly when the pedometers were placed in the pockets or in the purse. Conclusions: Most of the pedometers examined were accurate when they were placed at waist, chest, and armband no matter what walking speed or what terrain they exercised. But some pedometers did not register accuracy when they were put in the pocket or in the purse particularly at a slow and fast walking speed. / text

Sammanfattning Syfte Att påverka aktivitetsgraden under en lektion i Idrott och Hälsa med hjälp av intag av banan innan lektionstillfället. Frågställning Kan intaget av en banan öka antalet steg som tas under en lektion i Idrott och Hälsa? Är det någon skillnad i steg mellan att inta en banan före eller efter en lektion i Idrott och Hälsa, samt gentemot kontrollgruppen? Metod Under en period på tio veckor, utrustades tjugotvå elever med stegräknare av modellen LS200 (Tudor-Locke, et al, 2004). Monterade enligt tillverkarens anvisningar, det vill säga, i kontakt med höftbenet. Lektionerna var innan lunch på tisdagar och torsdagar. Lektionsplaneringen var uppdelad i moment om två lektioner. Under alla lektioner togs stor hänsyn till att eleverna gavs möjlighet att själva styra över sin aktivitetsgrad. Men det menas att någon lektion med en bestämd sträcka, eller en dans med ett bestämt antal steg inte genomfördes. Inom alla moment var eleverna fria innanför ramarna för aktiviteten. Tio av tjugotvå elever serverades banan innan eller efter varje lektion. Tolv av tjugotvå var kontrollgrupp och fick ingen banan alls. Vilken lektion, av varje veckas två, som skulle servera banan innan respektive efter lektionstillfället, avgjordes av en tärning. Vid ojämna siffror, serverades bananen före lektion på tisdag. Jämna siffror, bananen serverades innan lektion torsdag. Efter varje lektion samlades stegräknarna in och antal steg registrerades av författaren i Excel. Resultat Att äta en banan innan en lektion i idrott och hälsa gav ingen statistisk säkerställd påverkan av den fysiska aktiviteten. Mellan banangruppens (åt banan) steg, banan före och banan efter, skiljde det sex steg, 2603 (SD 313) steg mot 2597 (SD 238) steg. Mellan kontrollgruppens (som inte åt banan) steg, banan före och banan efter, skiljde det 76 steg, 2621 (SD 283) steg mot 2535 (SD 314) steg. Slutsats Ett statistiskt säkerställd samband mellan att äta en banan innan en lektion i idrott och hälsa, och aktivitetsgraden under samma lektion i Idrott och Hälsa, återfanns ej.

Improving physical activity (PA) participation is a public health priority in developed and developing countries to curb the substantial and growing prevalence of lifestyle-related diseases. Early childhood may be an especially important time to encourage PA; however, there is a paucity of research in this area. The aim of this research was to contribute to the limited body of work in PA in early childhood by investigating PA measurement approaches in young children and applying this knowledge to determine socio-environmental associations of preschool PA. An initial literature review provided the background for the thesis and determined the approaches taken in the ensuing chapters. A second literature review provided a detailed critique of research specific to PA measurement in early childhood to further inform the empirical studies. Information for the empirical chapters was drawn from three research projects: two studies were completed that assessed tools for objectively measuring PA in young children (pedometers and accelerometers), and these studies informed a final project to quantify associates of PA in a sample of preschool-aged children. Novel and important findings from the preliminary studies were that pedometer accuracy for measuring free-living PA and walking in children aged 3-5 years was poor, especially for pedometers worn at the back of the child, or during slow walking. Furthermore, when investigating the utility of accelerometers (more complex and frequently adopted tools) to quantify PA intensity in preschoolers, their application and use of commonly employed thresholds resulted in systematic underestimation of PA intensity and poor agreement (=0.09) when compared with a direct observation criterion measure. Application of existing accelerometer thresholds to classify PA intensity in preschoolers was therefore likely to yield biased estimates. Given the dearth of robust alternatives, a novel approach was developed to calculate individual activity rates from the raw accelerometer data. To account for over-dispersion in accelerometer counts, daily average activity rates per second were derived for each participant using negative binomial generalised estimating equation (GEE) models with a first-order autoregressive (AR1) correlation structure. These rates were assumed to be exchangeable between days and normally distributed. Potential socio-environmental associates of children’s activity rates and body size were thus assessed using normal GEE models with exchangeable correlation structures. Parental PA and child age were independently and significantly associated with child activity rates (P≤0.04). No relationships between child body size and PA or television (TV) exposure were found. Common approaches to PA measurement and data consideration were challenged in this research and novel robust methods devised utilising contemporary statistical methods. Accelerometer data can be successfully reduced to individual activity rates to mitigate current issues related to objective PA quantification with preschoolers. Parental involvement in preschool PA interventions is worthy of further investigation, and younger children may stand to benefit more from increased activity. Further exploration of the complex interactions between PA, exposure to media, and health outcomes in preschool-aged children is warranted.

The purpose of this study was to determine the effect of a child-focused, school-delivered physical activity program on daily steps of children and their paternal parent, and to evaluate the acceptability to teachers of the 'Walk your Dad' program. A pre-test, post-test experimental/control groups design was used. The sample, recruited from Eltham College of Education, consisted of 60 children aged 10- to 13-years and 48 paternal parents aged 35- to 64-years. Physical activity levels were assessed over a 6-day period using New Lifestyles pedometers, 1-week prior to and 1-week after the intervention. The 12-week intervention consisted of two cross curriculum homework activities per week delivered to children by their classroom teacher, focusing on increasing physical activity behaviours of children and their paternal parent. Following cleaning and imputation, data were analysed using descriptive statistics and repeated measures ANOVA. Teachers (n=2) of intervention group participants independently completed a survey on the acceptability of the program in the week following its completion. Mean weekend steps for children in the intervention group increased from 15,436 +/- 7,680 at pre-test to 19,575 +/- 10,537 at post-test, while among control group children steps decreased from 17,981 +/- 6,552 to 17,278 +/- 6,769. On weekdays (4-days), mean steps for children in the intervention group increased from 46,090 +/- 16,001 to 48,760 +/- 13,648, while among control group children, steps decreased from 46,907 +/- 9,912 to 43,717 +/- 10,255. Mean weekend steps for paternal parents in the intervention group increased from 15,116 +/- 5,640 to 17,473 +/- 6,836, while among control group paternal parents steps decreased from 18,239 +/- 8,345 to 17,836 +/- 6,855. On weekdays (four days) mean steps for paternal parents in the intervention group increased from 31,141 +/- 13,246 to 31,507 +/- 13,132 while among control group paternal parents steps decreased from 34,942 +/- 11,109 to 32,502 +/- 12,602. Repeated measures ANOVA analyses revealed that on weekends for children there were significant differenc es between pre- and post-test (p less than.000), between pre- and post-test for boys and girls (p less than.000), and between boys, girls, intervention and control class (p =.01) at post-test. On weekdays for children there was a significant difference between intervention and control class at post-test (p =.01). Results for paternal parents indicated that there was a significant difference on weekends between pre- and post-test (p less than.000) and on weekdays there was a significant difference between intervention and control class at post-test (p =.05). Both intervention class teachers had consistent views about the program. The findings suggest that during the period of research and among this group, the intervention had a positive effect on weekend step behaviour of girls and weekday step behaviour of girls, boys and their paternal parents. The process evaluation revealed some aspects of the program may require modification.

No description available.

Improving physical activity (PA) participation is a public health priority in developed and developing countries to curb the substantial and growing prevalence of lifestyle-related diseases. Early childhood may be an especially important time to encourage PA; however, there is a paucity of research in this area. The aim of this research was to contribute to the limited body of work in PA in early childhood by investigating PA measurement approaches in young children and applying this knowledge to determine socio-environmental associations of preschool PA. An initial literature review provided the background for the thesis and determined the approaches taken in the ensuing chapters. A second literature review provided a detailed critique of research specific to PA measurement in early childhood to further inform the empirical studies. Information for the empirical chapters was drawn from three research projects: two studies were completed that assessed tools for objectively measuring PA in young children (pedometers and accelerometers), and these studies informed a final project to quantify associates of PA in a sample of preschool-aged children. Novel and important findings from the preliminary studies were that pedometer accuracy for measuring free-living PA and walking in children aged 3-5 years was poor, especially for pedometers worn at the back of the child, or during slow walking. Furthermore, when investigating the utility of accelerometers (more complex and frequently adopted tools) to quantify PA intensity in preschoolers, their application and use of commonly employed thresholds resulted in systematic underestimation of PA intensity and poor agreement (=0.09) when compared with a direct observation criterion measure. Application of existing accelerometer thresholds to classify PA intensity in preschoolers was therefore likely to yield biased estimates. Given the dearth of robust alternatives, a novel approach was developed to calculate individual activity rates from the raw accelerometer data. To account for over-dispersion in accelerometer counts, daily average activity rates per second were derived for each participant using negative binomial generalised estimating equation (GEE) models with a first-order autoregressive (AR1) correlation structure. These rates were assumed to be exchangeable between days and normally distributed. Potential socio-environmental associates of children’s activity rates and body size were thus assessed using normal GEE models with exchangeable correlation structures. Parental PA and child age were independently and significantly associated with child activity rates (P≤0.04). No relationships between child body size and PA or television (TV) exposure were found. Common approaches to PA measurement and data consideration were challenged in this research and novel robust methods devised utilising contemporary statistical methods. Accelerometer data can be successfully reduced to individual activity rates to mitigate current issues related to objective PA quantification with preschoolers. Parental involvement in preschool PA interventions is worthy of further investigation, and younger children may stand to benefit more from increased activity. Further exploration of the complex interactions between PA, exposure to media, and health outcomes in preschool-aged children is warranted.

The purpose of this study was to determine the effect of leisure-based screen time on physical activity. Ninety-four families participated in this six-week study. Each family was randomly assigned to one of three screen time groups: (1) control group (2) 2-hour-limit group or (3) one-hour-limit group. Family members wore a Walk4Life LS 2505® pedometer to measure steps. Daily screen time logs were filled out each night and leisure-based screen time and steps were recorded. Analysis of variance (steps x group) was used to determine differences among the groups. Univariate tests showed there were no significant differences among any of the adult groups (F (2,101) = 1.02, p =.361). Similar to the adults, univariate tests in the 13 to 18-year-olds indicated there were no significant differences among any of the groups (F (2 ,62) = 368, p =.694). In the 5 to 12-year-olds, univariate tests determined significant group differences (F (2,164) = 3.35, p =.037). Estimated marginal mean differences indicated a significant difference between the control and 2-hour-limit groups (p =.011). In looking at all the children, males averaged more steps per day than females, and all groups in the 5 to 12-year-olds averaged more steps compared to the 13 to 18-year-olds (10,828 vs. 9,875 steps each day). The 5 to 12-year-olds in the 2-hour-limit and control groups viewed 72 minutes and 114 minutes of screen time each day, respectively. In conclusion, engaging in about 42 minutes less of screen time each day may increase physical activity by ~1,300 more steps each day.

Bakgrund: Fysisk aktivitet har flera hälsofördelar, men trots detta är en stod del av Europas befolkning inte fysiskt aktiva. Fysioterapeuter kan främja hälsa genom ökad fysisk aktivitet och ett verktyg för det är självmonitorering, vilket har framgått i systematiska litteraturöversikter. Däremot framgår inte hur självmonitoreringen har utformats, vilket begränsar dess kliniska tillämpning. Syfte: Syftet med denna studie är att sammanställa befintlig forskning för att beskriva utformningen av självmonitorering i studier som har som mål att öka fysisk aktivitet och bedöma inkluderade studiers kvalitet. Metod: En systematisk litteraturöversikt genomfördes och sju RCT-studier inkluderades efter litteratursökningar i Pubmed, Cinahl och Psycinfo. Studierna granskades utifrån examensarbetets syfte och frågeställningar samt med granskningsmall för kvalitet och preliminär evidensstyrka från SBU. Resultat: I samtliga studier kombinerades självmonitorering av fysisk aktivitet med andra beteendeförändringstekniker. Metoder var pedometer, accelerometer och självskattning som mättes med olika mått. Duration och frekvens varierade. Utvärderingsinstrumentet accelerometer och självskattning användes med flera utfallsmått. Fysiska aktivitetsnivån ökade statistiskt signifikant i fyra av studierna. Sammanvägda studiekvalitéten bedömdes som medelhög och preliminär evidensstyrka som måttligt stark. Slutsatser: Självmonitorering som intervention ökade fysisk aktivitet vid användning av pedometer med mått antal steg, i kombination med feedback och målsättning. Däremot är det osäkert att uttala sig om övrig utformning.

In 2000, the U.S. Census Bureau reported that Latinos represented 12.6% of the total population in the United States. It is projected that by 2010 Latinos will account for 15.5% of the population (1,2). Latinos account for 32% of the population in Texas, and specifically in Corpus Christi, Latinos represent 54% of the population (3). The purpose of this study was to compare reported versus actual physical activity among limited resource Latina mothers. This study also aimed to explore the validity of the existing Behavioral Risk Factor Surveillance System (BRFSS) and Seven-Day Physical Activity Recall (PAR) physical activity assessment tools. Fifty-five Latina mothers from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Corpus Christi, Texas were recruited to participate in this study. Data were collected through a combined (BRFSS and PAR) physical activity questionnaire as well as through step counts using pedometers. BRFSS and PAR reported significantly different levels of moderate physical activity (p=0.0312) using Chi Square tests when appropriate. The response rate in PAR for all levels of activity intensity was higher than BRFSS. There were significant trends between the number of steps reported and BRFSS and PAR moderate physical activity. Further, the majority of subjects who averaged greater than 5,000 steps per day did not perceive themselves to be moderately active in either BRFSS or PAR. These findings question the validity of these physical activity assessment tools with this population. / Master of Science