Non-alcoholic fatty liver modifies associations of body mass index and waist circumference with cardiometabolic risk: The CARDIA study.

Background: Non-alcoholic fatty liver disease (NAFLD) is recognized as a prevalent determinant of cardiometabolic diseases. The association between NAFLD and obesity warrants further research on how NAFLD modifies associations between body mass index (BMI) and Waist circumference (WC) with cardiometabolic risk (CMR). Objective: This study assessed whether NAFLD modifies associations between BMI and WC with 5-year changes in CMR in 2366 CARDIA study participants. Methods: Non-contrast CT was used to quantify liver attenuation, with ≤51 Hounsfield Units (HU) used to define NAFLD in the absence of secondary causes of excess liver fat. The dependent variable was the average Z score of fasting glucose, insulin, triglycerides [log], (-) high-density lipoprotein cholesterol (HDL-C), and systolic blood pressure(SBP). Multivariable linear regression was used to estimate the associations between BMI and WC with CMR. Effect modification by NAFLD was assessed by an interaction term between NAFLD and BMI or WC. Results: The final sample had 539 (23%) NAFLD cases. NAFLD modified the association of BMI and WC with CMR (interaction p < 0.0001 for both). BMI and WC were associated with CMR in participants without NAFLD (p < 0.001), but not among those with NAFLD. Participants with NAFLD and normal BMI and WC had CMR estimates that were higher than those without NAFLD in the obese categories. Among those without NAFLD the 5 years CMR change estimate was 0.09 (95% CI: 0.062, 0.125) for BMI ≥30 kg/m2 compared to -0.06 (-0.092, -0.018) for BMI < 25 kg/m2, and among those with NAFLD, these estimates were 0.15 (0.108, 0.193) and 0.16 (-0.035, 0.363). Conclusions: NAFLD modifies associations of BMI and WC with CMR. Compared with BMI and WC, NAFLD was more strongly associated with CMR. In the presence of NAFLD, BMI and WC were not associated with CMR. These findings have implications for clinical screening guidelines.

Aerobic and Muscle-Strengthening Physical Activity, Television Viewing, and Nonalcoholic Fatty Liver Disease: The CARDIA Study.

BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) in U.S. adults is over 30%, yet the role of lifestyle factors in the etiology of NAFLD remains understudied. We examined the associations of physical activity, by intensity and type, and television viewing with prevalent NAFLD. METHODS: Cross-sectional analysis of a population-based sample of 2726 Black (49%) and White (51%) adults (Mean (SD) age, 50 (3.6) years; 57.3% female) from the CARDIA study. Exposures were aerobic activity by intensity (moderate, vigorous; hours/week); activity type (aerobic, muscle-strengthening; hours/week); and television viewing (hours/week), examined concurrently in all models and assessed by validated questionnaires. Our outcome was NAFLD (liver attenuation < 51 Hounsfield Units), measured by non-contrast computed tomography, after exclusions for other causes of liver fat. Covariates were sex, age, race, study center, education, diet quality, smoking status, alcohol consumption, and body mass index or waist circumference. RESULTS: 648 participants had NAFLD. In the fully adjusted modified Poisson regression model, the risk ratios per interquartile range of each exposure were moderate-intensity aerobic activity, 1.10 (95% CI, 0.97-1.26); vigorous-intensity aerobic activity, 0.72 (0.63-0.82); muscle-strengthening activity, 0.89 (0.80-1.01); and television viewing, 1.20 (1.10-1.32). Relative to less active participants with higher levels of television viewing, those who participated in ≥2 h/week of both vigorous-intensity aerobic and muscle-strengthening activity and <7 h/week of television viewing had 65% lower risk of NAFLD (risk ratio = 0.35, 95% CI = 0.23-0.51). CONCLUSION: Adults who follow public health recommendations for vigorous-aerobic and muscle-strengthening activity, as well as minimize television viewing, are considerably less likely to have NAFLD than those who do not follow the recommendations and who have relatively high levels of television viewing.

Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 pandemic: a 1-Year longitudinal survey.

BACKGROUND: Efforts to limit the spread of COVID-19 have included public space closures, mask usage, and quarantining. Studies regarding the impact of these measures on the psychosocial and behavioral health outcomes of the workforce have focused frequently on healthcare employees. To expand the literature base, we deployed a one-year longitudinal survey among mostly non-healthcare employees assessing changes in select psychosocial outcomes, health behaviors, and COVID-19-related transmission prevention behaviors and perceptions. METHODS: We deployed the CAPTURE baseline survey across eight companies from November 20, 2020-February 8, 2021. The baseline survey included questions on psychosocial outcomes, health behaviors, and COVID-19 transmission prevention behaviors, with several questions containing a retrospective component to cover the time period prior to the pandemic. Additional questions on vaccination status and social support were subsequently added, and the updated survey deployed to the same baseline participants at three, six, and 12 months after baseline survey deployment. We analyzed data descriptively and performed Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare data within and between time points. RESULTS: A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees completing all four time points. Employees reported higher stress, anxiety, fatigue, and feelings of being unsafe across all time points compared to pre-pandemic. Time spent sleeping increased initially but returned to pre-pandemic levels at follow-up. Lower rates of physical activity and higher rates of non-work screen time and alcohol consumption relative to pre-pandemic were also reported. Over 90% of employees perceived wearing a mask, physical distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very important' in preventing the spread of COVID-19 across all time points. CONCLUSIONS: Relative to pre-pandemic, poorer psychosocial outcomes and worsened health behaviors were observed across all time points, with values worse at the baseline and 12-month time points when COVID-19 surges were highest. While COVID-19 prevention behaviors were consistently deemed to be important by employees, the psychosocial outcome and health behavior data suggest the potential for harmful long-term effects of the pandemic on the well-being of non-healthcare employees.

Inactivation of replication-competent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on common surfaces by disinfectants.

This experimental laboratory-based study evaluated two disinfectants' efficacy against replication-competent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on three surfaces. Disinfectants were effictive at eliminating the presence, viability, and subsequent replication of SARS-CoV-2 on all surfaces. Although SARS-CoV-2 likely spreads primarily via airborne transmission, layered mitigation should include high-touch surface disinfection.

Dose-response association of aerobic and muscle-strengthening physical activity with mortality: a national cohort study of 416 420 US adults.

OBJECTIVES: To investigate the dose-response association of aerobic physical activity (PA) and muscle-strengthening exercise (MSE) with all-cause mortality. METHODS: National Health Interview Survey data (1997-2014) were linked to the National Death Index through 2015, which produced a cohort of 416 420 US adults. Cox proportional-hazard models were used to estimate HRs and 95% CIs for the associations of moderate aerobic PA (MPA), vigorous aerobic PA (VPA) and MSE with mortality risk. Models controlled for age, sex, race-ethnicity, income, education, marital status, survey year, smoking status, body mass index and chronic conditions. RESULTS: Relative to those who engaged in no aerobic PA, substantial mortality risk reduction was associated with 1 hour/week of aerobic PA (HR: 0.85, 95% CI: 0.83 to 0.86) and levelled off at 3 hours/week of aerobic PA (0.73, 0.71 to 0.75). Similar results were observed for men and women and for individuals younger and older than 60 years. MSE conferred additional mortality risk reduction at 1 time/week (0.89, 0.81 to 0.97) and appeared no longer beneficial at 7 times/week (0.99, 0.94 to 1.04). CONCLUSION: The minimum effective dose of aerobic PA for significant mortality risk reduction was 1 hour/week of MPA or VPA, with additional mortality risk reduction observed up to 3 hours/week. For older adults, only small decreases in mortality risk were observed beyond this duration. Completing MSE in combination with aerobic PA conferred additional mortality risk reduction, with a minimum effective dose of 1-2 times/week.

Localized and Whole-Room Effects of Portable Air Filtration Units on Aerosol Particle Deposition and Concentration in a Classroom Environment.

In indoor environments with limited ventilation, recirculating portable air filtration (PAF) units may reduce COVID-19 infection risk via not only the direct aerosol route (i.e., inhalation) but also via an indirect aerosol route (i.e., contact with the surface where aerosol particles deposited). We systematically investigated the impact of PAF units in a mock classroom, as a supplement to background ventilation, on localized and whole-room surface deposition and particle concentration. Fluorescently tagged particles with a volumetric mean diameter near 2 µm were continuously introduced into the classroom environment via a breathing simulator with a prescribed inhalation-exhalation waveform. Deposition velocities were inferred on >50 horizontal and vertical surfaces throughout the classroom, while aerosol concentrations were spatially monitored via optical particle spectrometry. Results revealed a particle decay rate consistent with expectations based upon the reported clean air delivery rates of the PAF units. Additionally, the PAF units reduced peak concentrations by a factor of around 2.5 compared to the highest concentrations observed and led to a statistically significant reduction in deposition velocities for horizontal surfaces >2.5 m from the aerosol source. Our results not only confirm that PAF units can reduce particle concentrations but also demonstrate that they may lead to reduced particle deposition throughout an indoor environment when properly positioned with respect to the location of the particle source(s) within the room (e.g., where the largest group of students sit) and the predominant air distribution profile of the room.

Feasibility of smartphone application- and social media-based intervention on college students' health outcomes: A pilot randomized trial.

Objective We evaluated the feasibility of a 10-week program combining a smartphone application and theoretically-based, social media-delivered health education intervention to improve college students' health behaviors and outcomes. Participants: Forty-four college students (32 female; X̅age=21.6 years) in 2015-2016. Methods: Participants were randomized into one of two groups: (1) experimental: used MapMyFitness smartphone application to log and track physical activity (PA) and participated in a Social Cognitive Theory-based, Facebook-delivered health education intervention; (2) comparison: only included in a separate, but content-identical, Facebook intervention. Our primary outcomes pertained to intervention feasibility while our secondary outcomes reflected health behaviors and outcomes. Results: Intervention interest was high, with retention 95.5%. Experimental participants used MapMyFitness 1.71x/week, with both groups implementing the Facebook-delivered health education tips 1-3x/week. We observed a modest sedentary behavior reduction in the experimental group (-29.2-minutes/day). Additionally, both groups demonstrated slight reductions in weight (experimental:-1.2 kg/comparison:-0.6 kg) and body fat percentage (both groups:-0.8%-decrease). Increased PA-related social support and decreased barriers were observed. Conclusions: A low-burden and well-integrated social media-based intervention is feasible and of interest to college students, possibly improving select health behaviors and outcomes. PA-oriented smartphone application offered limited additional benefit.

Acute Effects of Virtual Reality Exercise Biking on College Students' Physical Responses.

Purpose: Current evidence regarding the use of commercially available immersive virtual reality (VR) headsets and compatible VR exercise apparatus in the promotion of individuals' physical activity (PA) is lacking. This exploratory study investigated the acute effects of a VirZoom VR exercise bike (vBike) on college students' physical responses compared to an exergaming bike (eBike) and a traditional stationary exercise bike (tBike). Method: Forty-eight college students (34 females, Xage = 23.58 ± 3.39; XBMI = 23.81 ± 3.57) completed three separate 20-minute cycling sessions on the vBike, eBike, and tBike in a counterbalanced order. Outcomes included rating of perceived exertion (RPE), assessed at 4-minute intervals throughout each cycling session, and overall PA, operationalized as pedal revolution counts (PRC) during each session. Results: Linear models indicated significant group differences between exercise modalities for RPE (F (2,138) = 14.76-27.30, all p < .001, η2 = 0.17-0.27) and PRC (F (2,138) = 74.862, p < .001, η2 = 0.48). Pairwise comparisons revealed that RPE was reported significantly higher at each time point (i.e., 4th minute, 8th minute, 12th minute, 16th minute, and 20th minute) during the tBike session vs. the vBike and eBike sessions (p < .001) and that participants had higher PRC during the vBike session vs. the eBike and tBike sessions (p < .001). Conclusion: A commercially available VR exercise bike would trigger greater overall PA as compared to exergaming and traditional cycling while being perceived less intense. Future intervention studies conducted in real-world settings to determine cause and effect relationship are warranted.

Psychosocial and Behavioral Outcomes and Transmission Prevention Behaviors: Working During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: To investigate the impact of coronavirus disease 2019 (COVID-19) on psychosocial and behavioral responses of the non-health care workforce and to evaluate transmission prevention behavior implementation in the workplace. PARTICIPANTS AND METHODS: We deployed the baseline questionnaire of a prospective online survey from November 20, 2020, through February 8, 2021 to US-based employees. The survey included questions on psychosocial and behavioral responses in addition to transmission prevention behaviors (e.g., mask wearing). Select questions asked employees to report perceptions and behaviors before and during the COVID-19 pandemic. Data were analyzed descriptively and stratified by work from home (WFH) percentage. RESULTS: In total, 3607 employees from 8 companies completed the survey. Most participants (70.0%) averaged 90% or more of their time WFH during the pandemic. Employees reported increases in stress (54.0%), anxiety (57.4%), fatigue (51.6%), feeling unsafe (50.4%), lack of companionship (60.5%), and feeling isolated from others (69.3%) from before to during the pandemic. Productivity was perceived to decrease for 42.9% of employees and non-work-related screen time and alcohol consumption to increase for 50.7% and 25.1% of employees, respectively, from before to during the pandemic. Adverse changes were worse among those with lower WFH percentages. Most employees reported wearing a mask (98.2%), washing hands regularly (95.7%), and physically distancing (93.6%) in the workplace. CONCLUSION: These results suggest worsened psychosocial and behavioral outcomes from before to during the COVID-19 pandemic and higher transmission prevention behavior implementation among non-health care employees. These observations provide novel insight into how the COVID-19 pandemic has impacted non-health care employees.

Inactivation of Replication-Competent Vesicular Stomatitis Virus as SARS-CoV-2 Surrogate on Common Surfaces by Disinfectants.

Surface disinfection is part of a larger mitigation strategy to prevent the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus causing coronavirus disease-2019 (COVID-19). Research evaluating the time, nature, and extent of surface disinfection of replication-competent viruses is needed. We evaluated the efficacy of two disinfectants against a replication-competent SARS-CoV-2 surrogate on three common public surfaces. Vesicular stomatitis virus expressing green fluorescent protein (VSV-GFP) was our replication-competent SARS-CoV-2 surrogate. Disinfection occurred using Super Sani-Cloth Germicidal Disposable Wipes and Oxivir Tb spray per manufacturer instructions to test the efficacy at reducing the presence, viability, and later replication of VSV-GFP on stainless steel, laminate wood, and porcelain surfaces using standardized methods after recovery and toxicity testing. During the main trials, we placed 100 µL spots of VSV-GFP at viral titers of 108, 107, and 106 PFU/mL on each surface prior to disinfection. Trials were completed in triplicate and post-disinfection measurements on each surface were compared to the measurements of non-disinfected surfaces. Disinfectants were considered efficacious when ≥3-log10 reduction in the number of infectious VSV-GFP virus units was observed on a given surface during all trials. Both disinfectants produced a ≥3.23-log10 reduction in infectious VSV-GFP virus unit numbers, with all trials showing no viable, replication-competent VSV-GFP present on any tested surface. The two disinfectants eliminated the presence, viability, and later replication of VSV-GFP, our SARS-CoV-2 surrogate, on all surfaces. This information suggests that, if following manufacturer instructions, overcleaning surfaces with multiple disinfectant solutions may be unnecessary.

Effect of Children's Weight Status on Physical Activity and Sedentary Behavior during Physical Education, Recess, and After School.

Children's body mass index may affect physical activity (PA) participation. Therefore, this study examined the effect of children's weight status on underserved elementary school children's PA and sedentary behavior (SB) throughout the segmented day. Participants were 138 children (X¯age = 8.14 years). Children's height and weight were measured with subsequent classification of children as healthy weight or overweight/obese. Durations of moderate-to-vigorous PA (MVPA), light PA (LPA), and SB during physical education (PE), morning recess, lunch recess, after school, and overall were assessed via accelerometry over three days. Independent t-tests evaluated differences in children's MVPA, LPA, and SB during each daily segment by weight status. Significantly higher MVPA was observed for children of healthy weight status versus children with overweight/obesity during morning recess, t(136) = 2.15, p = 0.03, after school, t(136) = 2.68, p < 0.01, and overall, t(136) = 2.65, p < 0.01. Interestingly, comparisons of children of healthy weight status and children with overweight/obesity's LPA and SB during the after-school segment revealed a trend wherein children with overweight/obesity participated in slightly greater LPA/less SB than children of healthy weight status. Higher MVPA was observed among children of healthy weight versus children with overweight/obesity during most daily segments. Concerted efforts should focus on increasing MVPA among children with overweight/obesity.

Comparison of College Students' Blood Pressure, Perceived Exertion, and Psychosocial Outcomes During Virtual Reality, Exergaming, and Traditional Exercise: An Exploratory Study.

Objective: Integrating novel technologies, such as virtual reality (VR), into traditional exercise apparatuses (e.g., stationary bikes) may assist in promoting physical activity (PA) participation among young adults. Therefore, this study's purpose was to examine young adults' systolic and diastolic blood pressure (BP) change (BPpost - BPpre), rating of perceived exertion (RPE), enjoyment, and self-efficacy during VR, exergaming, and traditional stationary cycling sessions. Materials and Methods: Forty-nine college students (34 females; Mage = 23.6 ± 3.4 years; MBMI = 23.8 ± 3.1 kg/m2) participated in three separate 20-minute stationary cycling sessions: (1) PlayStation 4 VR; (2) Xbox 360 exergaming; and (3) traditional stationary cycling. Participants' systolic and diastolic BP change was measured by using an Omron HEM-705CP digital BP cuff. Further, RPE was assessed by using the modified Borg RPE Scale and enjoyment and self-efficacy were evaluated by using validated questionnaires. Results: A multivariate analysis of variance indicated significant differences for systolic BP change, RPE, enjoyment, and self-efficacy between the three cycling sessions (F(2, 144) = 3.3-32.4, P < 0.05, [Formula: see text] = 0.04-0.3). Specifically, participants had significantly higher enjoyment and self-efficacy and lower RPE during VR cycling compared with the other two cycling sessions despite similar or higher change systolic BP during the VR cycling session. There was no statistically significant change in diastolic BP between the three cycling sessions (P > 0.05). Conclusion: Incorporating VR equipment with traditional stationary cycle ergometers may be favorable when seeking to promote enjoyable PA in college students. To further support VR exercise's efficacy, future studies with more rigorous research designs are warranted.

Association between Objective Activity Intensity and Heart Rate Variability: Cardiovascular Disease Risk Factor Mediation (CARDIA).

PURPOSE: We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease risk factors. METHODS: Data were from 1668 participants (X[Combining Overline]age = 45.9 ± 3.5 yr, 58.0% female, 39.9% black) who participated in year 20 (2005-2006) of the Coronary Artery Risk Development in Young Adults Fitness Study. The ActiGraph 7164 estimated participants' mean minutes per day of vigorous-intensity PA (VPA), moderate-intensity PA (MPA), and light-intensity PA (LPA) over 7 d. Three sequential 10-s 12-lead ECG strips were used to derive standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Mediators representing glycemic control indices included fasting glucose, fasting insulin, and 2-h oral glucose tolerance, with other mediators being traditional cardiovascular disease risk factors. Multiple linear regression assessed independent associations of PA intensity with HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV association attributable to physiological mediators. RESULTS: Participants averaged 2.7 ± 6.2 min·d, 33.0 ± 22.0 min·d, and 360.2 ± 83.8 min·d of VPA, MPA, and LPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. After adjustment for demographic and lifestyle behaviors, VPA was associated with both HRV metrics (SDNN: std beta = 0.06 [0.03, 0.10]; rMSSD: std beta = 0.08 [0.05, 0.12]) and LPA with rMSSD only (std beta = 0.05 [0.01, 0.08]). Fasting insulin and glucose mediated 11.6% to 20.7% of the association of VPA and LPA with HRV, with triglycerides also potentially mediating these associations (range, 9.6%-13.4%). CONCLUSIONS: Accelerometer-estimated VPA was associated with higher (i.e., improved) HRV. Light-intensity PA also demonstrated a positive association. Mediation analyses suggested these associations may be most attributable to glucose-insulin dynamics.

The effect of green walking on heart rate variability: A pilot crossover study.

We investigated the effects of regular walking in green and suburban environments on heart rate variability (HRV) and blood pressure (BP) in middle-aged adults. Twenty-three adults participated in a non-randomized crossover experiment comprised of once-weekly 50-min moderate-intensity walking sessions. Separated by a two-week washout period, participants walked for three weeks in each of two treatment conditions (green and suburban) in a local arboretum and suburban sidewalks of Chaska, MN. Eleven participants completed green walking first and 12 suburban walking first. Walks were split into 15-min intra-walk phases, with phases representing each walk's beginning, middle, and final 15-min. Repeated measures linear mixed models evaluated (1) HRV phase differences between treatments and HRV change within treatments, and (2) pre- and post-walk BP differences between treatments and pre-to post-walk BP changes. Intra-walk phase analyses revealed higher HRV during green walking vs. suburban walking during phase 2 (p < 0.0001) and phase 3 (p = 0.02). Less HRV reduction was seen between intra-walk phases 1 and 2 during green vs. suburban walking (p = 0.02). Pre-to post-walk changes revealed decreased mean systolic BP for both green (p = 0.0002) and suburban (p = 0.003) walking conditions, but not for diastolic BP. Post-walk BP results were similar after both green walking and suburban walking. In summary, walking sessions in a green environment elicited greater beneficial HRV responses compared to a suburban environment. Additionally, walking in either environment, green or suburban, promoted reductions in systolic BP.

Resting heart rate and incidence of venous thromboembolism.

BACKGROUND/OBJECTIVES: Higher resting heart rate is a risk factor for arterial cardiovascular diseases. We assessed whether higher heart rate is a risk factor for venous thromboembolism (VTE). METHODS: In a prospective epidemiologic cohort, the Atherosclerosis Risk in Communities (ARIC) Study, we associated resting heart rate by electrocardiogram with physician-validated incident hospitalized VTE through 2015. We also examined whether lower heart rate variability (HRV), a marker of cardiac autonomic imbalance, might be a risk factor for VTE. RESULTS: Resting heart rate at Visit 1 (1987-1989), when participants were 45 to 64 years old (mean, 54 years), was not associated with incidence of VTE (n = 882 cases). However, heart rate at Visit 4 (1996-1998; mean age, 63 years) was associated positively with VTE (n = 557 cases). The adjusted hazard ratios (95% confidence intervals) of VTE across Visit 4 heart rate categories of <60, 60 to 69, 70 to 79, and ≥80 bpm were 1 (reference), 1.22 (1.01-1.49), 1.39 (1.09-1.78), and 1.44 (1.01-2.06), respectively, and when evaluated continuously 1.11 (1.02-1.21) per 10 bpm greater heart rate. For the most part, HRV indices were not associated with VTE or associations were explained by inverse correlations of HRV indices with heart rate. CONCLUSION: We found a significant positive and independent association of resting heart rate at ARIC Visit 4 with incidence of VTE. The reason why high heart rate is a risk marker for VTE warrants further exploration.

Acute Effects of Immersive Virtual Reality Exercise on Young Adults' Situational Motivation.

The development of innovative technology, such as virtual reality (VR), has provided opportunities for promoting physical activity (PA) in a fun and engaging manner. The purpose of this study was to examine differences in young adults' situational motivation (SM) among immersive VR, non-immersive VR, and traditional stationary cycling sessions. In all, 49 healthy college students (35 females; Mage = 23.6 years, SD = 3.4; M%BF = 24.0%, SD = 7.5) completed three separate 20 min cycling sessions: (1) immersive VR cycling; (2) non-immersive VR cycling; and (3) traditional cycling. Participants' SM was assessed via the situational motivation scale, which included four subconstructs: intrinsic motivation, identified regulation, external regulation, and amotivation. Repeated measures ANOVAs indicated significant differences for situational motivation between cycling sessions (F (2, 96) = 4.74-53.04, p < 0.01, ηp2 = 0.090-0.525). Specifically, participants elicited the highest level of intrinsic motivation in immersive VR cycling compared to the other two sessions. Moreover, participants in both immersive VR and traditional cycling showed greater identified regulation than the non-immersive VR session. Furthermore, participants showed greater external regulation compared to the immersive VR session. In addition, greater amotivation was observed in non-immersive VR compared to the immersive VR session. Findings suggested that immersive VR exercise has the potential to be an attractive exercise alternative, possibly promoting greater PA participation and adherence among young adults.

Walking Green: Developing an Evidence Base for Nature Prescriptions.

Although the health benefits of exercise and exposure to nature are well established, most evidence of their interaction comes from acute observations of single sessions of activity. However, documenting improved health outcomes requires ongoing interventions, measurement of multiple outcomes, and longitudinal analyses. We conducted a pilot study to guide the development of a protocol for future longitudinal studies that would assess multiple physiological and psychological outcomes. Herein, we report psychological outcomes measured from thirty-eight participants before and after three conditions: a 50 min walk on a forest path, a 50 min walk along a busy road, and a period of activities of daily living. Changes in positive and negative affect, anxiety, perceived stress, and working memory are reported. We benchmark these results to existing studies that used similar protocols and also identify elements of the protocol that might impair recruitment or retention of subjects in longer-term studies. Linear mixed-models regression revealed that walking improved psychological state when compared to activities of daily living, regardless of walk environment (p < 0.05). Comparison of mean differences showed that forest walks yielded the largest and most consistent improvements in psychological state. Thus, despite a protocol that required a 3.5 h time commitment per laboratory visit, the beneficial effects of walking and exposure to a forested environment were observed.

Home-Based Exergaming on Preschoolers' Energy Expenditure, Cardiovascular Fitness, Body Mass Index and Cognitive Flexibility: A Randomized Controlled Trial.

PURPOSE: The effects of exergaming-based physical activity (PA) interventions on preschoolers' health outcomes and cognition remain largely unexplored. Therefore, we conducted a randomized controlled trial to discern the effectiveness of a home-based educational exergaming intervention on preschoolers' energy expenditure, fitness, body mass index, and cognition. METHODS: Participants were 32 preschoolers (16 girls; 59.4% Asian; Mage = 4.72, SD = ±0.73) recruited from the Twin Cities area in Minnesota. During baseline testing, we measured preschooler's daily energy expenditure (EE), cardiovascular fitness, body mass index, and cognitive flexibility using validated instruments. Participants were then randomly assigned to one of two conditions: (1) the exergaming intervention condition; or (2) control condition. The intervention program requested children participate in home-based educational exergaming using the LeapTV gaming console for at least 30 min/session 5 times/week. The control condition asked children to maintain regular PA patterns without any exergaming gameplay. Each condition lasted 12 weeks. We conducted identical outcome assessments for all children at baseline and post-intervention. RESULTS: Analysis of covariance with repeated measures yielded significant time x group interaction effects for cognitive flexibility, Wilks' Lambda = 0.81, F(1, 29) = 6.98, p = 0.01, η2 = 0.19, suggesting children in the exergaming group demonstrated significantly greater increases in cognitive flexibility as compared to those in the control group over time. There were no significant differences for time x group changes between the two groups for EE, Wilks' Lambda = 0.92, F(1, 29) = 2.29, p = 0.14, η2 = 0.08; cardiovascular fitness, Wilks' Lambda = 0.96, F(1, 29) = 1.07, p = 0.31, η2 = 0.04; and BMI, Wilks' Lambda = 0.99, F(1, 29) = 0.05, p = 0.82, η2 = 0.01. However, our data did suggest a marginal effect of time for EE, Wilks' Lambda = 0.89, F(1, 29) = 3.26, p = 0.08, η2 = 0.08, indicating that children's daily EE increased from baseline to post-intervention. CONCLUSIONS: Home-based educational exergaming may positively impact cognitive flexibility in preschoolers. Studies with larger sample sizes in multiple geographic locations are needed, with our study suggesting a longer intervention period might also be warranted.

Effects of School-Based Exergaming on Urban Children's Physical Activity and Cardiorespiratory Fitness: A Quasi-Experimental Study.

BACKGROUND: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program's effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children's objectively-measured PA and cardiorespiratory fitness (CRF). MATERIALS AND METHODS: Eighty-one fourth grade students (X̅age = 9.23 ± 0.62; 39 girls; 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014-2015. The intervention school's children participated in a once-weekly 50-minute exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children's in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. RESULTS: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, η2 = 0.09, p < 0.01, and MVPA, F(1, 79) = 4.58, η2 = 0.06, p < 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: -7.63 minutes; control: -17.59 minutes), but demonstrated lower CRF over time (intervention: +46.73 seconds; control: +61.60 seconds). CONCLUSIONS: Observations suggested that school-based exergaming implementation may be effective in increasing children's MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

Retired Elite Athletes' Physical Activity, Physiological, and Psychosocial Outcomes During Single- and Double-Player Exergaming.

McDonough, DJ, Pope, ZC, Zeng, N, Lee, JE, and Gao, Z. Retired elite athletes' physical activity, physiological, and psychosocial outcomes during single- and double-player exergaming. J Strength Cond Res 33(12): 3220-3225, 2019-Elite athletes (i.e., athletes who play sport professionally) are a population who commonly exceed recommended physical activity (PA) guidelines and have higher health statuses compared with the general population. However, elite athletes transitioning into retirement often become physically inactive given they no longer require long hours of training and competition, and their physiological and psychosocial health suffers as a result. Therefore, this study's purpose was to examine differences in retired elite athletes' acute PA, physiological, and psychosocial outcomes during single- and double-player exergaming. Twenty retired Olympic athletes (18 females; (Equation is included in full-text article.)= 27.3 ± 4.3 years) participated in 2 separate 20-minute exergaming sessions (a): Xbox 360 Reflex Ridge single player and (b) Xbox 360 Reflex Ridge double player. Subjects' situational interest, enjoyment, and self-efficacy were examined using validated questionnaires; rating of perceived exertion (RPE) using the modified Borg RPE scale; and moderate-to-vigorous PA, steps, and energy expenditure tracked using ActiGraph GT3X+ accelerometers. Repeated-measures analysis of variances revealed no significant differences for any outcome between the 2 exercise sessions except for RPE (F (1, 38) = 4.6; p < 0.05; η = 0.11), which was higher in the single-player session compared with the double-player session (10.3 ± 2.3; 8.7 ± 1.6, respectively). Observations indicated double-player exergaming to be perceived as less intense than single-player exergaming despite similar PA and physiological outcomes, suggesting retired elite athletes may better adhere to exergaming in a double-player mode.