Introdução: Embora muitos estudos tenham demonstrado diferentes efeitos da prática de Atividade Física por idosos, o relato de melhora das condições psíquicas e emocionais e da capacidade funcional para as atividades cotidianas ainda carece de maiores comprovações. Objetivo: analisar o valor de um programa de atividade física no enfrentamento do estresse em idosos. Métodos: Estudo de intervenção em um grupo de 18 idosos encaminhados do ambulatório do Serviço de Geriatria do HC-FMUSP, aderentes a um programa de atividade física supervisionado e avaliados pelo Perfil da Atividade Humana (PAH) e pelo Questionário de Coping. Resultados: nas escalas de avaliação de coping e de desempenho funcional, foi verificado um incremento da capacidade de enfrentamento do estresse e melhora nas atividades cotidianas após a prática do programa de atividade física . Conclusões: A pratica de atividade física regular e orientada, mesclando trabalho aeróbio, de resistência, de alongamento e respiratórios produz efeitos positivos na capacidade de coping e na de realização das suas atividades cotidianas / Introduction: there are many studies which have demonstrate different effects of the physical activities program on the elderly people fitness, but the effects on the psychological and emotional profile and the daily live activities have been done. Objective: To analyze the value of a physical activity program on the elderly stress coping. Methods: Intervention study in a group of 18 elderly coming from the Geriatric Service of the Medical College Hospital, University of São Paulo (HCFMUSP), which were adherent to a physical activity program that were supervised and evaluated by the Human Activity Profile (PAH) and the Coping Questionnaire. Results: An increment in the stress coping capacity and an improving of the daily activities were verified after the physical activity program practicing. Conclusions: The practice of supervised and regular physical activity intercalating aerobic with resistance, stretching, and respiratory exercises yield positive effects in the coping capacity and in the accomplishment of the daily activities

Introdução: Estudos mostram a importância de quantificar a atividade física e sua associação no processo saúde-doença. Esta tarefa não é simples, principalmente em crianças, por constituir um construto multidimensional que envolve atividades realizadas no lazer, em ambientes educacionais, vinculadas à ocupação e ao transporte. O acelerômetro está em destaque nos estudos epidemiológicos com adultos e crianças nos quais existe interesse na aferição de atividade física. Objetivo: Explorar aspectos metodológicos na aferição de atividade física por meio de acelerômetro em crianças de 7 a 10 anos. Metodologia: Estudo de revisão sistemática de trabalhos selecionados segundo passos pré-definidos: critérios de inclusão dos estudos; estratégia de busca; critérios para avaliação de qualidade dos estudos identificados; informações a serem extraídas. Entre as características de interesse estão as relacionadas à tecnologia do equipamento, à utilização, à população e às medidas de aferição. Resultados: Foram localizados 872 trabalhos nas 4 bases de dados (Pubmed, Embase, SPORTDiscus, Lilacs). Foram incluídos na revisão 68 estudos com qualidade metodológica. Foi constatada a predominância de utilização de acelerômetros uniaxiais da marca Actigraph® (Modelos: GT1M; 7164), com sua maior utilização na região do quadril direito, por sete dias da semana, com epochs de duração de 60 segundos, considerando como válida a informação de 3 ou mais dias de coleta e a presença de grande variedade de pontos de corte para diferentes níveis de intensidade e desfechos da atividade física. Conclusão: O acelerômetro é bastante utilizado em pesquisas epidemiológicas na aferição de atividade física por meio de counts, uma medida que não apresenta fácil entendimento. São aspectos metodológicos que limitam a comparação entre os estudos: diferentes marcas e modelos, diferentes número de dias de observação, grande variabilidade nas faixas etárias, diferentes durações do epoch e de pontos de corte. Identifica-se a necessidade de mais estudos metodológicos para elucidar a aplicabilidade do acelerômetro como instrumento de aferição da atividade física em crianças de 7 a 10 anos / Background: Studies have shown the importance of quantifying physical activity and its association in health-disease process. This task is not easy, especially in children, because it represents a multidimensional construct that involves leisure activities, educational settings, linked to occupation and transportation. The accelerometer is frequently used in epidemiological studies with adults and children where there is interest in assessing physical activity. Objective: To explore methodological aspects in physical activity assessment using accelerometer among children aged 7 to 10 years. Methodology: Systematic literature review of studies selected according to pre-defined steps: inclusion criteria studies; search strategy, quality assessment criteria of studies identified; information to be extracted. Among the interest features, may be mentioned those related to the technology of the accelerometer, group of age and outcome measures. Results: It was found 872 papers in four databases (PubMed, Embase, SPORTDiscus, Lilacs). Were included in the review, 68 studies showed methodological quality. It was found the predominant equipament was the uniaxial accelerometers Actigraph® (Models: GT1M, 7164), frequently fixated on the right hip, seven days a week, with epochs lasting 60 seconds, for valid the information it was observed 3 or more days of collection and the presence of a large variety of cutoff points for intensity levels and physical activity outcomes. Conclusion: The accelerometer is used in epidemiological research on the assessment of physical activity considering counts as measure but it has no easy understanding. The results depend on methodological aspects that limitate the use of this equipament such as differents brands and models, fixation sites, as well as different number of days of observation, very large group of age, different epoch duration and cutoff points for outcame definition. We identified the need for more methodological studies to elucidate the applicability of the accelerometer in children aged 7 to 10 years

INTRODUÇÃO: A atividade física (AF) é reconhecida como uma boa alternativa de prevenção de doenças e promoção do bem-estar físico, mental e social das populações. Não obstante esse consenso, os programas de AF para idosos têm dificuldades para encontrar métodos que sejam capazes de proporcionar, simultaneamente, eficácia nos efeitos desejados e permanência dos participantes. OBJETIVO: comparar a aquisição, a retenção e a permanência dos efeitos biopsicossociais de dois modelos de intervenção de AF para idosas em Moçambique. MÉTODO: um grupo de 69 mulheres idosas com idade igual ou superior a 60 anos participaram do estudo, tendo sido criteriosamente selecionadas e aleatoriamente distribuídas para dois grupos: Formal (prática de atividades físicas formais) e Lúdico (prática de atividades lúdicas). A intervenção foi realizada em duas fases e as aulas tiveram frequência de 3 vezes por semana em dias alternados (segundas, quartas e sextas feiras), sessões diárias de uma hora de duração e orientadas por monitores credenciados. Na primeira fase (Fase 1) que durou 12 semanas, o Grupo Formal (n=35) realizou sessões de 20 minutos de trabalho aeróbio em cicloergômetro com intensidade de esforço controlada de 65 à 85% da frequência cardíaca máxima (FCmáx.), mais 8 exercícios de resistência muscular com 15 repetições máximas (RM) enquanto o Grupo Lúdico (n=34) realizou atividades físicas de caráter lúdico compostas por jogos, atividades recreativas ativas incluindo danças tradicionais. Na segunda fase (Fase 2) que durou 8 semanas, cada grupo foi subdividido em dois subgrupos que combinados resultaram na formação de 4 subgrupos: Formal (n=18/14); Lúdico (n=17/15); Formal + Lúdico (ForLuD; n=17/14) e Lúdico + Formal (LudFor; n=17/16). Um dos subgrupos continuou a realizar o mesmo tipo de atividade da fase 1 (retenção), enquanto o outro realizou AF que antes não tinha realizado (permanência). Antes do início da intervenção e no final de cada fase as participantes foram submetidas aos mesmos testes (pré; pós1 e pós2) que incluía: (1) antropometria (peso, altura, perímetro da cintura e porcentagem da gordura por bioimpedância); (2) fatores de risco de doença cardiovascular (pressão arterial sistólica e diastólica; glicemia; colesterol, lipoproteína de alta densidade e triglicerídeos); (3) teste de aptidão física de Rikli e Jones (1999) (sentar e levantar; rosca; sentar e alcançar; agilidade e caminhada); (4) nível da atividade física habitual (acelerômetro por 7 dias) e (5) variáveis psicossociais (autoeficácia; autopercepção do desempenho; autoestima, autoimagem e motivação intrínseca). Os dados foram analisados no SPSS.20 com 95% de intervalo de confiança e obedeceu aos pressupostos da normalidade de dados (ANOVA mista) e não normalidade (Mann-Whitney, Wilcoxon e Qui quadrado). RESULTADOS: As participantes apresentaram elevada prevalência de risco de saúde no início do estudo, quadro que permaneceu até o final da intervenção. Na fase de aquisição ambos os grupos melhoraram a capacidade cardiorrespiratória e aumentaram o nível de confiança em continuar a participar do programa. Na retenção e na permanência todos os subgrupos diminuíram a porcentagem de gordura corporal e melhoraram a agilidade. Não houve diferença estatisticamente significante na comparação intergrupos (na aquisição) e intersubgrupos (na retenção e na permanência). CONCLUSÃO: Os dois modelos de intervenção foram similares nos efeitos biopsicossociais da AF, o que permite sugerir que o modelo lúdico é uma alternativa real e viável de programa de intervenção para idosas moçambicanas, consideradas as condições culturais, sociais e econômicas do país / INTRODUCTION: Physical activity (PA) is recognized as a good alternative to prevent disease and to promote populations physical, mental and social well being. Beside this agreement, PA programs for the elderly have faced difficulties to find methods that can congregate the efficacy of the effects and the permanence of people on the program. OBJECTIVE: the aim of this study was to compare the acquisition, retention and permanence of biopsychosocial effects of two types of PA program for Mozambican older women. METHOD: 69 older women (>=60 years old) were randomlly distributed to two groups: FAG (formal activity group) and LAG (ludic activity group). The intervention program was carried out in two phases with 3 practice sessions (one hour of duration) per week (Mondays, Wednesdays and Fridays), and were oriented by credited trainers. The first phase of the study lasted 12 weeks and the participants of FAG (n=35) practiced 20 min of aerobic work on the treadmill with standard intensity control procedure (65 to 85% HR max) followed by 8 muscular endurance exercises with 15 maxim repetitions (RM). On the other hand participants of LAG (n=34) practiced games, dance and recreational activities. On the second phase, the study had 8 weeks of practice, and both groups were further divided into 2 sub-groups whose combination resulted in 4 sub-groups: Formal activity (FFAG; n=18/14); Ludic activity (LLAG; n=17/15); Formal+Ludic activity (FLAG; n=17/14) and Ludic+Formal activity (LFAG; n=17/16). Two of the sub-groups continued to practice the same activity of the first phase and another two sub-groups changed to the activities practiced by the other group in the first phase. The participants were submitted to the anthropometry test batteries (weight, height, west and body fat) and risk factor of cardiovascular disease test (systolic blood press and diastolic blood press; glycemic; cholesterol; high-density lipoprotein and triglycerides). Additionally they were submitted to fitness test (chair stand; arm curl; chair sit-and-reach; 8-foot up-and-go and 6-minute walk), physical activity level test (by accelerometer for seven consecutive days) and psychosocial factors test (self-efficacy; self-perception skill, self-esteem; self-image and intrinsic motivation). The data were analyzed by SPSS.20 with 95% of confidence interval. When normality criterion was achieved parametric test was used (mixed ANOVA) and nonparametric tests (Mann-Whitney, Wilcoxon and X square tests) were used when normality criterion was not achieved. RESULTS: the participants showed high level of health risk factor from the beginning to the end of the intervention. In the acquisition all groups improved the cardiorespiratory fitness and the level of the confidence to continue on the PA program. In the retention and permanence, all sub-groups reduced the level of body fat and improved agility. Inter-group comparisons reveled no statistical difference between groups (acquisition) and sub-groups (retention and permanence). CONCLUSION: The two types of PA program were similar in acquisition, retention and permanence of the biopsychosocial effects. Thus, it can be suggested that the ludic model of PA program is a real and viable alternative program for Mozambican older women, especially taking into account the cultural, social and economic conditions of the country

RESUMO Introdução: Estudos internacionais mostram que o ambiente está associado com a prática de atividades físicas em adultos e idosos. Todavia, não existem estudos que tenham avaliado essa associação na população idosa do Brasil. Objetivo: Estudar a associação entre as atividades físicas praticadas no lazer e como forma de locomoção com variáveis ambientais em idosos residentes no distrito de Ermelino Matarazzo da Zona Leste do município de São Paulo. Metodologia: 380 idosos (60 anos e mais) participaram do estudo transversal de base domiciliar. Para a avaliação das atividades físicas no lazer e como forma de locomoção foi utilizado o questionário IPAQ (Questionário internacional de atividades físicas) versão longa e para a avaliação das atividades físicas domésticas e no trabalho foi utilizado o questionário do VIGITEL (Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico), além de outras questões inclusas especificamente para o estudo. A avaliação do ambiente foi realizada através de uma escala de percepção adaptada da escala NEWS (Neighborhood Environmental Walkability Scale). Para a análise estatística, seis modelos de análise de regressão logística múltipla foram criados para verificar a associação dos diferentes domínios de atividades físicas (variáveis dependentes: atividades físicas no lazer; atividades físicas de locomoção; caminhada no lazer ou na locomoção) com as variáveis de percepção do ambiente (variáveis independentes), controladas por sexo, idade, estado civil, tabagismo, escolaridade, trabalho e presença de dores. Três modelos adotaram como variável dependente o critério de 150 minutos de atividade física semanal, enquanto os outros três modelos adotaram como variável dependente a realização de pelo menos dez minutos de atividade física semanal. Resultados: A proporção de idosos fisicamente ativos foi de 35,4%, 14,7% e 43,2% para atividade física de locomoção, atividade física de lazer e caminhada no lazer ou como forma de locomoção, respectivamente. A presença de parques, o recebimento de convite de parentes para praticar atividades físicas e o trânsito não sendo considerado como uma barreira para praticar atividades físicas foram associadas com a prática de 150 minutos por semana de atividades físicas de locomoção. A presença de igrejas ou templos religiosos nas proximidades das casas, a presença de farmácias a até 10 minutos de caminhada das casas e a presença de boa iluminação pública nas ruas foram associadas com alguma prática (de 10 a 149 minutos por semana) de atividades físicas de locomoção. A presença de calçadas foi associada com alguma prática (de 10 a 149 minutos por semana) de atividades físicas no lazer. A presença de farmácias, presença de boa iluminação pública nas ruas e a presença de pontos de ônibus a até 10 minutos de caminhada das casas foram associadas com alguma prática (de 10 a 149 minutos por semana) de caminhada como forma de locomoção ou de lazer. Conclusão: Programas de promoção de atividades físicas para a população idosa devem considerar as variáveis relacionadas ao ambiente construído (presença de calçadas), ao ambiente natural (parques e áreas verdes), à segurança, trânsito de veículos, à iluminação pública e a pontos de comércio, de serviços e de convívio social e ao suporte social de parentes. / ABSTRACT Introduction: International studies show that the environment is associated with the levels of physical activity in adults and elder people. However, there are no studies that have evaluated this association in the elder population of Brazil. Objective: To study the association between leisure and transportation physical activity and the environment variables in elder residents of Ermelino Matarazzo district in the east side of São Paulo city. Methods: 380 elderly (60 years and over) participated on the cross-sectional study of domiciliary base. The evaluation of the level of the leisure and the transportation physical activities were used the IPAQ (International physical activity questionnaire) long version and for evaluation of the household and work physical activities was used the VIGITEL questionnaire (Surveillance of risk factors for chronic diseases through telephone interviews), and other questions included specifically for this study. The evaluation of the perceived environment was made through a suitable perception scale adapted from the NEWS scale (Neighborhood Environmental Walkability Scale). For the statistical analyses, six models of analysis of multiple logistic regression were created to study the association of the different physical activity models (dependent variables: leisure physical activity; transportation physical activity; walk in the leisure or transportation) with the perception of the environment variable (independent variables), controlled by sex, age, marital status, smoking, education, work and the presence of pain. Results: The proportion of physically active elderly was of 35.4%, 14.7% and 43.2% for physical activity in transportation, physical activity in leisure and walking for leisure or for transportation, respectively. The presence of nearby parks, receiving invitation from relatives to practice physical activities and the traffic not being barrier for the practicing of physical activities was associated with the 150 minutes per week of the transportation physical activity. The presence of churches, a walk up to 10 minutes to the drugstore and the presence of good public illumination in the streets were associated with some practice (from 10 to 149 minutes per week) of the transportation physical activity. The presence of the sidewalks was associated with the some practice (from 10 to 149 minutes per week) of the leisure physical activity. The presence of the drugstore, the presence of good public illumination in the streets and a walk of up to 10 minutes to the bus stop were associated with some practice (from 10 to 149 minutes per week) of the walk in the transportation or leisure. Conclusion: Programs for physical activity promotion for the elderly population must consider the variables related to the constructed environment (presence of a sidewalk), the natural environment (green parks and green areas), the security, the traffic, the public illumination and the presence of services, points of social conviviality and social support of the family.

Long-term excessive positive energy balance results in overweight and obesity, which is caused by adipose tissue deposition. This increases the occurrence of cardiovascular diseases and type 2 diabetes. Adipose tissue plays an active role in the development of these diseases and so it is important to understand how this tissue responds to relevant stimuli such as feeding, fasting and physical activity. The study in Chapter 4 examined the impact of fasting and feeding, on adipose tissue responsiveness to prolonged moderate intensity exercise. Ten healthy overweight men aged 26 ± 5 years (mean ± SD) with a waist circumference of 105 ± 10 cm walked at 60% of maximum oxygen uptake under either fasted (12 h overnight fasting) or fed (70% carbohydrate breakfast) conditions in a randomised, counterbalanced design. Feeding comprised 648 ± 115 kcal 2 h before exercise. The expression of several metabolism-related adipose tissue genes was acutely regulated whilst participants undertook fasted exercise, including up-regulation of lipolytic lipase and transporter (adipose triglyceride lipase, hormone sensitive lipase & fatty acid translocase/CD36), glycolytic inhibitor (pyruvate dehydrogenase 4), insulin singling molecules (glucose transporter type 4 & insulin receptor substrate 2) as well as adipose insulin receptor substrate 2 protein contents (all p ≤ 0.05), compared to exercise in the fed state. The results indicate that adipose tissue responsiveness to prolonged exercise is affected by the dietary conditions. The study in Chapter 5 examined whether adipose tissue would be influenced by more modest changes in accumulated physical activity. Eleven overweight participants (7 men and 4 post-menopausal women) aged 50 ± 5 years (means ± SD) completed two identical mixed meal (~1,700 ± 360 kcal in total) feeding trials (prolonged sitting versus breaking sitting) in a randomised, counterbalanced design. The breaking sitting intervention comprised walking for 2 min every 20 min over 5 h. The results demonstrated that postprandial insulin and glucose concentrations were attenuated (all p ≤ 0.05) while participating in regular small bouts of walking but this did not affect adipose tissue metabolic- and insulin-associated pathways in adipose tissue. The study in Chapter 6 examined the responsiveness to aforementioned different forms of physical activity (a single bout of prolonged exercise versus accumulation of small bout of physical activity) on a challenge imposed by 50% overfeeding. Twenty-four lean, active and healthy men aged 21 ± 3 years were recruited. Participants were randomised to either an overfeeding with restricted physical activity (≤ 4,000 steps per day) group (OVER, n = 8), overfeeding with restricted physical activity (≤ 4,000 steps per day) plus daily 45 min endurance moderate intensity walking group (50% V̇O2max) (OVER + EN, n = 8) or overfeeding with restricted physical activity (≤ 4,000 steps per day) plus intermittent breaking sitting group (OVER + BREAKS, n = 8). All groups achieved the same overfeeding (50% of overfeeding based on their habitual diet). Notably, despite the impairment of insulin sensitivity as a result of the energy surplus, the accumulation of small bouts of physical activity blunted overfeeding induced up-regulation of adipose lipogenetic activity (i.e. the down-regulation of sterol regulatory element binding protein 1c and fatty acid synthase) and circulating inflammation (i.e. no change of white blood cell count) compared to energy surplus with sedentary lifestyle and/or overfeeding plus a single bout of moderate intensity exercise. This could mean that the form of physical activity undertaken could play a key role in lipogenesis activation. Based on the results from this thesis, it appears that energy consumption and physical activity are both capable of acutely and chronically influencing adipose tissue metabolic signalling and regulation.

The purpose of this thesis was to examine the interaction between cardiovascular risk factors (particularly novel inflammatory measures) and short-term changes in physical activity. This is important as it is necessary to establish whether the changes that occur to these markers over the longer-term might be a consequence of short-term changes in physical activity. Chapter 4 investigated the challenges in handling the large volume of minute-by-minute data obtained from the use of a novel device for estimating physical activity energy expenditure from synchronous heart rate and accelerometer data. This chapter describes the development of specific software to enable efficient data-processing and evaluated the advantages and disadvantages of this new method of physical activity measurement. Chapter 5 sought to understand the reproducibility of various measures that were central to progress in this field in order to justify their inclusion in future intervention-based studies. This work showed that the inflammatory markers C-Reactive Protein and interleukin-6 and the lipid markers total cholesterol, high-density lipoprotein, low-density lipoprotein and triglycerides were all reproducible measures. The measurement of physical activity energy expenditure, when demarked into common categories, was also mostly reproducible. The circulating marker oxidised-low-density lipoprotein, an in-house adhesion assay and in-house mononuclear cell cytokine secretion assay were determined to be not reproducible and were not used further in this thesis. In Chapter 6 a group of highly active middle-aged men undertook one week of detraining where all structured exercise was removed but activities of daily living were allowed. It was shown that this short-term period of detraining did not elicit any changes in any of the inflammatory, lipid or glucose/insulin markers measured including a commercial, externally-validated whole-blood cytokine secretion assay. In Chapter 7 a sedentary group of middle-aged men performed daily brisk walking for 30 minutes over one week. This period of training did not elicit any change in any of the inflammatory, lipid or glucose/insulin markers measured; including no changes in glucose measures with an oral glucose tolerance test either one day after the last training session or three days later. The differences between the highly-active (Chapter 6) and sedentary (Chapter 7) participants in inflammatory markers were large with substantially higher concentrations for C-Reactive Protein and interleukin-6 in the sedentary middle-aged men. Because these do not change in response to relatively short-term detraining (Chapter 6) or training (Chapter 7) it appears that these differences represent long-term changes and adaptations. Therefore, in addition to being reproducible, fasting inflammatory and lipid markers are very stable with no changes after positive or negative short-term alterations in physical activity level. One immediate implication of this stability is improved ease of follow-up measures after interventions (e.g., training studies) since differences appear to reflect chronic changes in response to the regular training/detraining undertaken and not to recent exercise per se. In the future it will be important to establish better demarcations of acceptable physical activity behaviour. It will also be important to establish whether recently-trained individuals also exhibit stability in their inflammatory markers after a short-period of detraining and whether sedentary individuals are ever capable of achieving the blood profiles of their highly-active counterparts.

Background: Gameful design has been shown to have the potential to increase motivation for and engagement with physical activity (PA). However, at present, there is a significant lack of well-designed frameworks identifying effective pathways to increase PA behaviour. Purpose: To design a rigorous, methodologically sound, theory-grounded framework for developing gamefully designed PA interventions. Methods: Intervention Mapping (IM) was used to develop the study protocol, consisting of three studies. Study 1 encompassed the design of a novel theoretical framework leading to the selection of a gamefully designed PA intervention application. Study 2 entailed the intervention implementation. Participants (n = 83; mean age = 33.56; females = 48) were randomised to a six-week intervention. Data collection over a six-month period included biometric data, objective measurement of moderate-to-vigorous PA (MVPA) and a detailed PA motivation inventory. Study 3 presented a process evaluation focused on usefulness, effectiveness and feasibility via a systematic mixed-methods approach. Results: Study 1 led to the creation of a new Taxonomy of Situated Motivational Affordances (SMAs) for Gameful Design, the establishment of selection criteria for gamefully designed PA applications and the selection of a commercial application (Fitocracy) for the example case pilot intervention. Study 2 showed no statistically significant change observations in relation to MVPA; however, at six weeks the intervention group showed significant increased levels of identified regulation (internalised motivation) for PA. A significant correlation (p=0.031) between intrinsic regulation and MVPA was verified. Study 3 determined the usefulness of a systematic methodological study design, a low adoption rate of the intervention application and the appreciation of the complex nature of human motivation in relation to PA. Conclusions: Gamefully designed applications grounded in theories such as SDT, BCTs and the newly developed Taxonomy of SMAs for Gameful Design have the potential to be effective in impacting motivation for PA and PA levels.

Cross-sectional evidence associates breakfast omission with negative health outcomes. The present work aimed to examine if these cross-sectional associations have a causal component, by conducting randomised control trials in healthy humans. It was established using lean individuals that there are divergent hormonal responses to morning feeding and fasting, although increased energy intake at lunch following fasting incompletely compensated for breakfast intake. Hormonal and subjective appetite responses in the afternoon did not consistently provide evidence for increased hunger following fasting. In the same participants assigned to a 6-week free-living intervention of either 700 kcal pre 11:00 or fasting until 12:00 daily, it was found that energy intake was greater in those assigned breakfast consumption, but that physical activity was also greater than those fasting. Cardiovascular risk factors and measures of metabolic control were largely unaffected by either intervention. There was no adaptation of acute metabolic/hormonal responses to feeding following either intervention. In obese individuals, similar patterns of results were obtained for the hormonal and metabolic responses to acute feeding and fasting, but with no compensation for breakfast intake at lunch. Results from the free-living intervention demonstrated no difference in energy intake between groups or physical activity over the entire day, but greater energy expenditure during the morning in those consuming breakfast. Markers of cardiovascular health and metabolic control were generally not differently affected by either intervention. Neither intervention caused adaptation of the acute hormonal and metabolic responses to feeding. In summary, acute morning fasting does not cause complete compensation for breakfast intake at lunch, or result in greater hunger throughout the afternoon. Daily morning fasting does not affect acute responses to feeding or cause increased energy intake or weight gain relative to self-selected breakfast consumption, but seems to limit physical activity in lean, and to a lesser extent, in obese individuals.

The FITNESSGRAM® is regularly used to assess physical fitness (PF) of adolescents. In addition to the PF assessment, the FITNESSGRAM also includes self-report physical activity (PA) items. The purpose of this study was to examine whether the self-report aerobic, muscular strengthening, and flexibility PA behavior items indicated adolescents’ cardiorespiratory, muscular strength, and flexibility fitness and their body composition. Logistic regression analysis was used to examine the relation between the amount of PA and PF status. Adolescents not meeting the recommended PA amount had significantly higher odds of not achieving a healthy fitness status. Meeting the recommended PA amount was associated with achieving healthy PF status. Thus, adolescents’ amounts of aerobic, muscular strengthening, and flexibility PA were an indication of their corresponding health-related PF standard.

Background: Fatigue is common and distressing after stroke. Many stroke survivors say it is their worst or one of their worst symptoms. The frequency of clinically significant fatigue, whether fatigue is likely to be more or less problematic over time, and its aetiology are unknown. There are currently no known treatments. One hypothesis is that fatigue after stroke is triggered by physical deconditioning which sets up a self-perpetuating cycle of fatigue, avoidance of physical activity, further deconditioning and more fatigue. Another theory is that low mood may contribute to fatigue. Aims: This thesis therefore aims to investigate the frequency and natural history of fatigue after stroke and to explore its associations with mood, physical activity and/or fitness. Method: These aims were addressed by carrying out: 1) a systematic review of all longitudinal observational studies which have assessed fatigue on at least two separate time points and reported its frequency, 2) a systematic review of all observational studies which have measured both fatigue poststroke and one or more measures of physical activity and/or fitness at the same time point and 3) a longitudinal cohort study which assessed clinically significant fatigue, mood and physical activity and fitness at one, six and 12 months after stroke. Results: Frequency of fatigue ranged from 30% to 92% at first time point and frequency of fatigue decreased over time in seven of the ten studies identified in the systematic review of longitudinal studies. The second systematic review found that only two of the eight studies identified found a significant direct relationship between fatigue and physical activity and/or fitness poststroke. In the longtidudinal cohort study, clinically significant fatigue was identified in 32.6% of 132 participants at one month and was still present in a fifth of 91 participants at 12 months, two-thirds of participants who had clinically significant fatigue at one month did not have it by six months and that most (60.4%) individuals either reported fatigue at all three time points or that they did not have fatigue at any time point. There were significant associations between daily step count and fatigue at each time point (p= < 0.0001, 0.011, 0.006). Physical activity (p=0.002, 0.006) and anxiety (p= < 0.0001, 0.001) at one month were independent significant predictors of fatigue severity at six and 12 months after stroke. Age, gender, fatigue before stroke, step count and anxiety at one month accounted for 22% and 27% of the variance in fatigue severity at six and 12 months respectively. No significant associations were found between fatigue and measures of physical fitness. Discussion and conclusion: The findings suggest that although fatigue is common and persistent after stroke, it is more likely to become less problematic over time. They also suggest that the de-conditioning hypothesis of the aetiology of fatigue may be too simplistic and that other factors are involved in the development and perpetuation of fatigue after stroke. Implications are that patients should be assessed for fatigue early after stroke and that the development of an intervention which increases activity and/or reduces anxiety may be beneficial.