The financial burden of physical inactivity

According to the World Health Organization,"physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million (annual)deaths globally.”1 In the Research Highlight of the first issue of this journal,I reviewed the evidence which supports the notion that physical inactivity can cost lives,in terms of longevity and quality of life,especially in the last few years of our lives.2 Here,I would like to review the literature that reveals the financial burden due to physical inactivity.

Relationship between Physical Inactivity and Long-term Outcome in Patients Aged ≥80 Years with Acute Coronary Syndrome

Physical inactivity is very common in octogenarians.However,association between physical inactivity and mortality in octogenarians with acute coronary syndrome(ACS)remains unclear.In this study,we aimed to investigate association between physical inactivity and allcause mortality in octogenarian patients with ACS.In this study,we included a total of 353 hospitalized patients,aged≥80 years,with ACS during the period of 5-year follow-up.The association between physical inactivity and all-cause mortality was analyzed by multivariable Cox aggression.Of the enrolled patients,132(37.4%)were defined as physically inactive,and 221(62.6%)as physically active.Patients with physical inactivity tended to have lower survival rate(21.2%vs.56.5%,P〈0.001)and higher mortality rate(78.8%vs.43.5%,P〈0.001),and had a worse long-term outcome than those with physical activity(chi-square=27.52,and log rank P〈0.001).The physical inactivity was still an independent predictor for long-term allcause mortality independent of confounders including age,prior heart failure,stroke,ejection fraction,beta-blocker,clopidogrel and percutaneous coronary intervention(HR:2.35,95%CI:1.26–4.37,P=0.007).Our study demonstrates that physical inactivity is independently related to increased all-cause mortality in octogenarians with ACS.

COVID-19 risk comorbidities:Time to reappraise our physical inactivity habits(again!)

Infection and mortality rates of coronavirus disease 2019(COVID-19)are astonishing.As of September 7,2020,more than 27 million people around the world have already been infected,with more than 890 thousand deaths.Hypertension,diabetes,and obesity are among the most reported comorbidities associated with mortality by this disease.All these comorbidities are also strongly associated with physical inactivity and sedentary behavior.On the other hand,it is known that aerobic and resistive exercises are excellent tools to prevent and manage these comorbidities.Hence,physically active people may have a better prognosis if infected by COVID-19.Also,science tried to warn about mortality and morbidity associated to physical inactivity more than 80 years ago.However,physical inactivity habits are getting more prevalent around the world.Reasons for that include social,technology,and economic development that led to large industrialization and urbanization.Along with these changes,both professional and domestic activities became less active.Consequently,health care costs related to hypokinesis are estimated to increase exponentially in various regions of the planet.Now,while facing COVID-19 pandemic,it is time to reinforce the physiological,social,and economic relevance of regular physical exercise.Therefore,urgent reappraisal of our physical inactivity habits should be done,again!

How the physical inactivity is affected by social-, economic- and physical-environmental factors: an exploratory study using the machine learning approach

Previous studies have utilized regression models to investigate the impact of environmental factors on physical activity.However,such approaches are inadequate for data-driven analysis seeking to identify robust associations from the intricate and multi-variable interactions between physical activity and environmental factors.With the emergence of the concept of the exposome,which encompasses the totality of exposures,this paper explores machine learning models for predicting the percentage of physical inactivity in U.S.counties,while considering 28 social-,economic-,and physical-environmental factors.The aim of this study is to address the research gap and gain insight into the complex associations between environmental exposures and physical activity.Five machine learning models were tested,and the performances were compared to select the best classifier for further investigation.This study used data from the Behavioral Risk Factor Surveillance System(BRFSS)of the Centers for Disease Control and Prevention.The mean population of all counties was 102,841,and the mean percentage of population below 18 years was 22.3%.The partial dependence plot analysis indicated that only one feature–bachelor’s degree–exhibited a close-to-linear relationship with physical inactivity.Motor-vehicle crash death rate and mean temperature showed nonlinear and non-monotonic relationships with the predicted percentage of physical inactivity.

Physical fitness before and during the COVID-19 pandemic:Results of annual national physical fitness surveillance among 16,647,699 Japanese children and adolescents between 2013 and 2021

Background:Limited nationally representative evidence is available on temporal trends in physical fitness(PF)for children and adolescents during the coronavirus disease 2019(COVID-19)pandemic.The primary aim was to examine the temporal trends in PF for Japanese children and adolescents before and during the COVID-19 pandemic.The secondary aim was to estimate the concurrent trends in body size(measured as body mass and height)and movement behaviors(exercise,screen,and sleep time).Methods:Census PF data for children in Grade 5(aged 10-11 years)and adolescents in Grade 8(aged 13-14 years)were obtained for the years 2013-2021 from the National Survey of Physical Fitness,Athletic Performance,and Exercise Habits in Japan(n=16,647,699).PF and body size were objectively measured,and movement behaviors were self-reported.Using sample-weighted linear regression,temporal trends in mean PF were calculated before the pandemic(2013-2019)and during the pandemic(2019-2021)with adjustments for age,sex,body size,and exercise time.Results:When adjusted for age,sex,body size,and exercise time,there were significant declines in PF during the pandemic,with the largest declines observed in 20-m shuttle run(standardized(Cohen’s)effect size(ES)=-0.109 per annum(p.a.))and sit-ups performance(ES=-0.133p.a.).The magnitude of the declines in 20-m shuttle run and sit-ups performances were 18-and 15-fold larger,respectively,than the improvements seen before the pandemic(2013-2019),after adjusting for age,sex,body size,and exercise time.During the pandemic,both body mass and screen time significantly increased,and exercise time decreased.Conclusion:Declines in 20-m shuttle run and sit-ups performances suggest corresponding declines in population health during the COVID-19pandemic.

Prevalence and determinations of physical inactivity among public hospital employees in Shanghai, China： a cross-sectional study

This study aims to explore the prevalence and determinations of physical inactivity among hospital employees in Shanghai, China. A cross-sectional study of 4612 employees aged 19 to 68years was conducted through stratified cluster sampling from different classes of Shanghai hospitals in 2011. The total physical activity was evaluated using the metabolic equivalent according to the Global Physical Activity Questionnaire. Among the participants, 38.5%, 32.3%, and 64.6% of the employees are inactive at work, commuting, and taking leisure time, respectively. Up to 41.8% of the men and 37.8% of the women （P = 0.012） are physically inactive. When the age and educational level are adjusted, male doctors and medical technicians show a higher percentage of physical inactivity than male workers in logistics （P = 0.001）. Among females, employees who are working in second- and third-class hospitals show a higher proportion of physical inactivity than those who are working in community health care centers. Logistic regression analyses show that the odds ratios （ORs） of leisure-time physical inactivity associated with the intensity of physical activity at work are 2.259, 2.897, and 4.266 for men （P 〈 0.001） and 2.456, 3.259, and 3.587 for women （P 〈 0.001）, respectively. The time during commuting activities is significantly associated with leisure-time physical inactivity in either sex （OR = 2.116 for men and 2.173 for women, P 〈 0.001）. Hospital employees, particularly doctors and medical technicians, show a higher proportion of physical inactivity than other inhabitants in Shanghai. The time and intensity of activity at work and commuting are associated with leisure-time activities.

COVID-19:A pandemic that threatens physical and mental health by promoting physical inactivity

Ever since the outbreak of Coronavirus disease 2019(COVID-19)in late 2019,it has killed millions of people worldwide.Even people not stricken by this disease are not spared from its negative economic,social,and healthrelated drawbacks.This commentary provides insight into the potential mechanisms involved in the development of depression and emotional negativity escalating during the current pandemic.In particular,preventive measures of COVID-19,such as staying at home,are sedentarism measures that decrease physical activity.Physical inactivity alters gut microbiome structure in a fashion that promotes gut dysbiosis and flaring of systemic inflammation,leading to the buildup of body fat.Obesity,which contributes to a trail of health-depleting disorders,furthers gut microbial disintegration while fat tissue stimulates the release of cytokines,promotes metabolic resistance,and alters signaling involved in the production of antioxidants.As a result,the body gets flooded by toxic molecules such pro-inflammatory mediators,free radicals,and advanced glycation end products.These toxic molecules alter cellular function in all body tissues,including those of the brain.Neuroinflammation is associated with progressive declines in cognitive and motor functions along with dysregulation in emotions.Counteracting the sedentarism enforced by the COVID-19 pandemic through the participation in suitable indoors activities and the intake of healthy food is likely to protect against or revert physiological impairments that may affect people retreating to their homes during the current crisis,eventually restoring physical and mental health.

Overweight, obesity, and screen-time viewing among Chinese school-aged children: National prevalence estimates from the 2016 Physical Activity and Fitness in China—The Youth Study

Purpose: This study presents the most recent estimates of prevalence of overweight, obesity, and screen-time viewing among Chinese school-aged children. Demographic differences in these estimates between sexes and resident locales were also examined.Methods: Cross-sectional analyses of 116,615 Chinese school children 9 to 17 years of age who participated in the 2016 Physical Activity and Fitness in China—The Youth Study project. Outcomes were the prevalence of children's overweight(85 th ≤ body mass index(BMI) < 95 th percentile) and obesity(BMI ≥95 th percentile)(defined by the Working Group on Obesity in China) and not meeting screen-time viewing recommendations("not meeting" was defined as more than 2 h per day of viewing activities after school). Analyses were conducted on the whole sample and by school grade cohorts(primary, junior middle, and junior high schools), sex, and residence locales(urban, rural).Results: Overall, 14.4%(95% confidence interval(CI): 13.8%–15.0%) of children and adolescents were overweight, 11.9%(95%CI: 11.0%–13.0%) were obese, and 36.8%(95%CI: 34.7%–38.9%) did not meet screen-time viewing recommendations. Across the 3-grade cohorts, boys were more likely to be obese than girls, and primary and junior middle school children living in urban areas were more likely to be obese than those living in rural areas. Primary and junior middle school boys were less likely to meet screen-time recommendations than girls, and junior high school children living in urban areas were less likely to meet screen-time recommendations than school children of the same grades living in rural areas.Conclusion: In 2016, the prevalence of obesity among Chinese school children was about 12%, and about 37% of them did not meet screen-time viewing recommendations. The prevalence of obesity and sedentary behavior was generally higher among boys than among girls, and it was higher for children living in urban areas than for those living in rural areas.

No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

Background:Regular physical activity(PA)has been postulated to improve,or at least maintain,immunity across the life span.However,the link between physical(in)activity and coronavirus disease 2019(COVID-19)remains to be established.This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19.Methods:Hospitalized patients with COVID-19(mean age:54.9 years)were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo(a quaternary referral teaching hospital)and from Ibirapuera Field Hospital,both located in Sao Paulo,Brazil.PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity.The primary outcome was hospital length of stay.The secondary outcomes were mortality,admission to the intensive care unit(ICU),and mechanical ventilation requirement.Results:The median hospital length of stay was 7.0§4.0 days,median§IQR;3.3%of patients died,13.8%were admitted to the ICU,and 8.6%required mechanical ventilation.Adjusted linear regression models showed that PA indices were not associated with hospital length of stay(work index:b=-0.57(95%confidence interval(95%CI):-1.80 to 0.65),p=0.355;sport index:b=0.43(95%CI:-0.94 to 1.80),p=0.536;leisure-time index:b=1.18(95%CI:-0.22 to 2.59),p=0.099;and total activity index:b=0.20(95%CI:-0.48 to 0.87),p=0.563).None of the PA indices were associated with mortality,admission to the ICU,or mechanical ventilation requirement(all p>0.050).Conclusion:Among hospitalized patients with COVID-19,PA did not independently associate with hospital length of stay or any other clinically relevant outcomes.These findings should be interpreted as meaning that,among already hospitalized patients with more severe forms of COVID-19,being active is a potential protective factor likely outweighed by a cluster of comorbidities(e.g.,type 2 diabetes,hypertension,weight excess)and older age,suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.

Body weight misperception and psychological distress among young South Korean adults:the role of physical activity

Background:Emerging evidence suggests that body weight misperception may be associated with psychological distress among people in developed countries.Participating in physical activity(PA)may negate the association between weight misperception and psychological distress given the well-known benefits of PA on psychological health.This study examined the role of PA in associations between body weight misperception and psychological distress among young South Korean adults.Methods:Data from individuals aged 20 to 39 years who participated in the Fifth Korean National Health and Nutrition Examination Surveys 2010-2012(N=6055)was included in the logistic regressions.Results:The proportions of the respondents under-and over-perceiving their body weight were 66.9%and 0.8%among men and 16.3%and 15.6%among women respectively.A moderating effect of PA participation was observed on the relationship between body weight over-perception and depressed mood(Odds Ratio[OR]=0.55;95%Confidence Intervals[95%CI]=0.34,0.89).Among individuals who did not meet the recommended vigorous-intensity PA(≥20 min/session and≥3 day/week),body weight over-perception was associated with depressed mood(OR=1.71,95%CI=1.19,2.46)compared to the accurate-perception group.However,no association was observed among those who met the recommended vigorous-intensity PA(OR=1.52,95%CI=0.45,5.22).Similar patterns were found among physically active versus inactive individuals(recommended walking not met:OR=2.02,95%CI=1.29,3.15;recommended walking met:OR=1.28,95%CI=0.66,2.49;muscular strengthening exercises for<2 day/week:OR=1.74,95%CI=1.21,2.51;muscular strengthening exercises for≥2 day/week:OR=1.38,95%CI=0.37,5.14).No relationship existed between body weight over-perception and depressed mood after adjusting for PA.Conclusions:Participating in regular PA may buffer a potential negative impact of body weight over-perception on depressive mood.

Cardiovascular Risk Burden in Sub-Saharan Africans with Rheumatoid Arthritis: A Hospital-Based Study in Yaounde, Cameroon

Introduction: Studies on RA (rheumatoid arthritis) and cardiovascular risk in African countries are scarce. Objective: To investigate the relationship between RA and cardiovascular risk in Cameroonian patients. Methodology: In 50 Black RA patients and 51 matched healthy individuals from the general population, we studied cardiovascular risk factors validated by the WHO. Cardiovascular risks estimates were carried out using WHO risk charts for the African region. Epi-info, R and SPPS were used for the statistical analysis. Results: Overall and abdominal adiposity as expressed by increased body mass index and abdominal obesity, were all markedly increased in RA patients compared to non-RA subjects [70% vs. 47%, OR (95% CI) = 2.62 (1.16 - 5.94), p = 0.026;and 54% vs. 33%, OR (95% CI) = 2.34 (1.05 - 5.25), p = 0.045 respectively]. RA patients were more physically inactive than their non-RA counterparts (20% vs. 0, p = 0.001). Whereas RA was associated with a reduced odds of alcoholism [OR (95% CI) = 0.19 (0.06 - 0.62), p = 0.005]. Increased BMI seemed to occur independently of methotrexate (p = 0.76), hydroxychloroquine (p = 0.59), corticosteroids (p = 0.79) treatments, and independently of sex (p = 0.15), age (p = 0.67), and sedentary lifestyle (p = 0.16) in RA patients;but their BMI was weakly correlated with disease duration (r = 0.26;p = 0.074). Meanwhile, male gender was associated with a reduced odds of abdominal obesity [OR (95% CI) = 0.02 (0 - 0.4), p = 0.011]. Cardiovascular risk, comparable by proportions between RA and non-RA subjects, was low in 26 patients (78.8%) and 30 non-RA subjects (83.3%) respectively. Conclusion: Despite the high adiposity burden and a sedentary lifestyle experienced by RA patients compared to their healthy counterparts, RA was not associated with cardiovascular risk as estimated by WHO risk charts.

Body Fluid Changes, Cardiovascular Deconditioning and Metabolic Impairment Are Reversed 24 Hours after a 5-Day Dry Immersion

Dry immersion is an effective and useful model for research in physiology and physiopathology. The focus of this study was to provide integrative insight into renal, endocrine, circulatory, autonomic and metabolic effects of dry immersion. We assessed if the principal changes were restored within 24 h of recovery, and determined which changes were mainly associated with immersion-induced orthostatic intolerance. Five-day dry immersion without countermeasures, and with ad libitum water intake, standardized diet and a permitted short daily rise was performed in a relatively large sample for this experiment type (14 healthy young men). Reduction of total body water derived mostly from extracellular compartment, and stabilized rapidly at the new operating point. Decrease in plasma volume was estimated at 20% - 25%. Five-day immersion was sufficient to impair metabolism with a decrease in glucose tolerance and hypercholesterolemia, but was not associated with pronounced autonomic changes. Five-day immersion induced marked cardiovascular impairment. Immediately after immersion, over half of the subjects were unable to accomplish the 20-min 70° tilt;during tilt, heart rate and total peripheral resistance were increased, and stroke volume was decreased. However, 24 hours of normal physical activity appeared sufficient to reverse orthostatic tolerance and all signs of cardiovascular impairment, and to restitute plasma volume and extracellular fluid volume. Similarly, metabolic impairment was restored. In our study, the major factor responsible for orthostatic intolerance appeared to be hypovolemia. The absence of pronounced autonomic dysfunction might be explained by relatively short duration of dry immersion and daily short-time orthostatic stimulation.

The COVID-19 pandemic and physical activity

The SARS-CoV-2-caused COVID-19 pandemic has resulted in a devastating threat to human society in terms of health,economy,and lifestyle.Although the virus usually first invades and infects the lung and respiratory track tissue,in extreme cases,almost all major organs in the body are now known to be negatively impacted often leading to severe systemic failure in some people.Unfortunately,there is currently no effective treatment for this disease.Pre-existing pathological conditions or comorbidities such as age are a major reason for premature death and increased morbidity and mortality.The immobilization due to hospitalization and bed rest and the physical inactivity due to sustained quarantine and social distancing can downregulate the ability of organs systems to resist to viral infection and increase the risk of damage to the immune,respiratory,cardiovascular,musculoskeletal systems and the brain.The cellular mechanisms and danger of this“second wave”effect of COVID-19 to the human body,along with the effects of aging,proper nutrition,and regular physical activity,are reviewed in this article.

Inflammation,physical activity,and chronic disease:An evolutionary perspective

Low-grade inflammation is emerging as a common feature of contemporary metabolic,psychiatric,and neurodegenerative diseases.Both physical inactivity and abdominal adiposity are associated with persistent systemic low-grade inflammation.Thus,the behavioral,biological,and physiological changes that cause a predisposition to obesity and other co-morbidities could have epigenetic underpinnings in addition to various evolutionary scenarios.A key assumption involves the potential for a mismatch between the human genome molded over generations,and the issue of adapting to the modern high calorie diet and common built environments promoting inactivity.This biological mismatch appears to have dire health consequences.Therefore,the goal of this article is to provide a brief overview on the importance of inflammation as part of human survival and how physical activity(PA)and physical inactivity are critical regulators of systemic inflammation.The review will highlight antiinflammatory effects of PA and exercise training from a metabolic and systemic signaling perspective,which includes skeletal muscle to utilization of fatty acids,TLR4 signaling,and myokine/adipokine effects.The available evidence suggests that PA,regular exercise,and weight loss offer both protection against and treatment for a wide variety of chronic diseases associated with low-grade inflammation through an improved inflammatory profile.

Effects of 60-day bed rest with and without exercise on -ellular and humoral immunological parameters

Exercise at regular intervals is assumed to have a positive effect on immune functions. Conversely, after spaceflight and under simulated weightlessness （e.g., bed rest）, immune functions can be suppressed. We aimed to assess the effects of simulated weightlessness （Second Berlin BedRest Study; BBR2-2） on immunological parameters and to investigate the effect of exercise （resistive exercise with and without vibration） on these changes. Twenty-four physically and mentally healthy male volunteers （20-45 years） performed resistive vibration exercise （n= 7）, resistance exercise without vibration （n=8） or no exercise （n=9） within 60 days of bed rest. Blood samples were taken 2 days before bed rest, on days 19 and 60 of bed rest. Composition of immune cells was analyzed by flow cytometry. Cytokines and neuroendocrine parameters were analyzed by Luminex technology and ELISA/RIA in plasma. General changes over time were identified by paired t-test, and exercise-dependent effects by pairwise repeated measurements （analysis of variance （ANOVA））. With all subjects pooled, the number of granulocytes, natural killer T cells, hematopoietic stem cells and CD45RA and CD25 co-expressing T cells increased and the number of monocytes decreased significantly during the study; the concentration of eotaxin decreased significantly. Different impacts of exercise were seen for lymphocytes, B cells, especially the IgD＋ subpopulation of B cells and the concentrations of IP-IO, RANTES and DHEA-S. We conclude that prolonged bed rest significantly impacts immune cell populations and cytokine concentrations. Exercise was able to specifically influence different immunological parameters. In summary, our data fit the hypothesis of immunoprotection by exercise and may point toward even superior effects by resistive vibration exercise.

Sedentary lifestyle among adults in Jordan,2007

Objective:Sedentary lifestyle is a major risk factor for physical and mental problems,such as cardiovascular,musculoskeletal diseases,and psychological stress.About 60% of the world’s population is not sufficiently physically active in leisure time or during work and social activities.This study aimed to determine the prevalence of inactive Jordanian adults and describe their demo-graphic and behavioral characteristics.Methods:The study used data from the behavioral risk factors surveillance survey conducted in Jordan in 2007.The sample size was 3654.Respondents who were physically inactive for more than 240 min daily(sleep time not included)were considered to have a sedentary lifestyle.Data were analyzed with the program SPSS.Results:The prevalence of a sedentary lifestyle was 82.8%(2965 respondents),with a mean sedentary time of 587 min(95%confidence interval 581-594 min).Among the physically inactive adults,52.6% were men,one third of them aged 35-44 years.Sedentary lifestyle was reported by 30% of those with a secondary level of education or above.Of those with a sedentary lifestyle,37.6% were housewives and 37.5% were employees;66% of them were overweight and obese.Of the physically inactive people,2.5%had a history of heart failure and 1.3%had a history of cer-ebrovascular accidents;57.2% of them tried to engage more in physical activity and almost three quarters of them were interested in improving their dietary habits.Conclusion:Most Jordanian adults have a sedentary lifestyle,which emphasizes that there is a public health problem.Many of them are attempting to lead a healthier lifestyle.Therefore,there is an urgent need to launch an applicable national plan that enables people to practice a healthier lifestyle.

Scavenger Receptor Class B type 1(SR-B1)and the modifiable risk factors of stroke

Stroke is a devastating disease that occurs when a blood vessel in the brain is either blocked or ruptured,consequently leading to deficits in neurological function.Stroke consistently ranked as one of the top causes of mortality,and with the mean age of incidence decreasing,there is renewed interest to seek novel therapeutic treatments.The Scavenger Receptor Class B type 1(SR-B1)is a multifunctional protein found on the surface of a variety of cells.Research has found that that SR-B1 primarily functions in an anti-inflammatory and antiatherosclerotic capacity.In this review,we discuss the characteristics of SR-B1 and focus on its potential correlation with the modifiable risk factors of stroke.SR-B1 likely has an impact on stroke through its interaction with smoking,diabetes mellitus,diet,physical inactivity,obesity,hypercholesterolemia,atherosclerosis,coronary heart disease,hypertension,and sickle cell disease,all of which are critical risk factors in the pathogenesis of stroke.