The effects of green space and physical activity on muscle strength: a national cross-sectional survey with 128,759 Chinese adults.

Background: Muscle strength is closely related to chronic noncommunicable diseases; specifically, a decline in handgrip strength (HS) is predominant globally. Exposure to green space-built environment components used for health intervention-reportedly decreases the risk of certain diseases and all-cause mortality. However, evidence in this area is limited. Objective: We aimed to explore the association between green space exposure and muscle strength and ascertain the combined effect of physical activity and green space exposure on muscle strength. Method: Data from 128,759 participants (aged 20-79 years) were obtained using a complex stratified multistage probability cluster sampling design. The green space was assessed as normalized difference vegetation index (NDVI) data for a 500-m buffer zone based on the geolocation information of sampling sites. We used a questionnaire to investigate transportation, occupation, physical activity, leisure-time exercise behaviors, and sedentary time within a usual week of the preceding year. The outcome was low relative HS, defined as HS-to-body weight ratio, and the percentage of men and women with relative HS in the lower third. We defined adequate physical activity as 150 min of moderate-intensity or 75 min of vigorous physical activity per week and calculated the weighted proportion of participants with insufficient physical activity. Categorical variables of NDVI and physical activity were used as exposure variables and their interrelationship was evaluated in a generalized linear mixed model (GLMM) to estimate the odds ratios (ORs) and 95% confidence intervals (95% CI). We measured interaction on an additive or multiplicative scale using a GLMM to test the interaction between green space exposure and physical activity. All analyses were performed for the total sample and subgroups (urban and rural). Result: The high NDVI group had a lower risk of low relative HS than the low NDVI group (OR [95% CI]: 0.92 [0.88-0.95]). The sufficient physical activity group had a lower risk of low relative HS than the insufficient physical activity group (OR [95% CI]: 0.85 [0.81-0.88]). There was an interactive effect on the additive scale (relative excess risk owing to interaction: 0.29, 95% CI 0.22-0.36, p < 0.001) between green space exposure and physical activity. Conclusion: High NDVI and adequate physical activity were protective factors against low relative HS in Chinese adults. Increasing green space exposure and physical activity together may have a greater potentiating effect on muscle strength improvement than these two protective factors individually. Green spaces should be incorporated into city design or built environments.

Accelerometer-Measured Physical Activity in Children and Adolescents at Altitudes over 3500 Meters: A Cross-Sectional Study in Tibet.

There is a scarcity of studies on the physical activity (PA) of children and adolescents who live at high altitudes. This study aimed to objectively assess PA of children and adolescents living in the Tibet at altitudes over 3500 m and to examine its difference by ethnicity, gender, age/grade, and body weight status groups. A sample of 397 students aged 9⁻18 years were recruited from 7 schools in Lhasa, Tibet. PA was measured using accelerometers (ActiGraph GT3X) for seven consecutive days and moderate to vigorous PA (MVPA) was identified using the Evenson (2008) cut-points. Participant MVPA was 62.3 min/day, with 65.5 min/day during weekdays and 54.1 min/day on weekends. Indigenous Tibetans were more active than Hans, and boys had more MVPA than girls. Age had a significantly weak negative correlation with MVPA. There was no significant difference in MVPA between the non-overweight and overweight/obese groups. Overall, only 9.1% (13.8% in boys and 4.5% in girls) accumulated at least 60 min of MVPA per day. Compared to their counterparts in other regions, the daily MVPA of children and adolescents living on the Tibetan Plateau at altitudes over 3500 m was relatively high. However, the proportion of meeting the WHO's PA recommendations was extremely low.