https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61382-8.pdf

COPD exacerbations: defining their cause and prevention.

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

/pdf/how-many-steps-day-are-enough-for-older-adults-and-special-3uwaau56vr.pdf

How many steps/day are enough? For older adults and special populations

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day.

/pdf/how-many-steps-day-are-enough-for-adults-2nie89hf0t.pdf

How many steps/day are enough? for adults

Background Diseases caused by Streptococcus pneumoniae (S. pneumoniae) continue to cause substantial morbidity and mortality globally. Whilst pneumococcal polysaccharide vaccines (PPVs) have the potential to prevent disease and death, the degree of protection afforded against various clinical endpoints and within different populations is uncertain. Objectives To assess the efficacy and effectiveness of PPVs in preventing pneumococcal disease or death in adults. We did not assess adverse events. Search methods We searched CENTRAL 2012, Issue 6, MEDLINE (January 1966 to June Week 2, 2012) and EMBASE (1974 to June 2012). Selection criteria We considered randomised controlled trials (RCTs) in adults, provided the study outcome met the definition of the outcome considered in the review. We also considered non-RCTs in adults, where the study assessed PPV effectiveness against culture-confirmed invasive pneumococcal disease (IPD), provided the study controlled for important confounding factors. Data collection and analysis Two review authors assessed trial quality of RCTs and three review authors extracted the data. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model. Two review authors assessed study quality and extracted data for non-RCTs. We calculated ORs and 95% CIs using a random-effects model following the conversion of each study outcome to a log OR and standard error (SE). Main results Twenty-five studies met our inclusion criteria (18 RCTs involving 64,852 participants and seven non-RCTs involving 62,294 participants). Meta-analysis of the RCTs found strong evidence of PPV efficacy against IPD with no statistical heterogeneity (OR 0.26, 95% CI 0.14 to 0.45; random-effects model, I(2) statistic = 0%). There was efficacy against all-cause pneumonia in low-income (OR 0.54, 95% CI 0.43 to 0.67, I(2) statistic = 19%) but not high-income countries in either the general population (OR 0.71, 95% CI 0.45 to 1.12, I(2) statistic = 93%) or in adults with chronic illness (OR 0.93, 95% CI 0.73 to 1.19, I(2) statistic = 10%). PPV was not associated with substantial reductions in all-cause mortality (OR 0.90, 95% CI 0.74 to 1.09; random-effects model, I(2) statistic = 69%). Vaccine efficacy against primary outcomes appeared poorer in adults with chronic illness. Non-RCTs provided evidence for protection against IPD in populations for whom the vaccine is currently utilised (OR 0.48, 95% CI 0.37 to 0.61; random-effects model, I(2) statistic = 31%). This review did not consider adverse events as it was outside the scope of the review. Authors' conclusions This meta-analysis provides evidence supporting the recommendation for PPV to prevent IPD in adults. The evidence from RCTs is less clear with respect to adults with chronic illness. This might be because of lack of effect or lack of power in the studies. The meta-analysis does not provide evidence to support the routine use of PPV to prevent all-cause pneumonia or mortality.

/pdf/vaccines-for-preventing-pneumococcal-infection-in-adults-8j1no1z16o.pdf

Vaccines for preventing pneumococcal infection in adults.

https://www.atsjournals.org/doi/pdf/10.1513/pats.200512-129SF

Chronic obstructive pulmonary disease

Background: Physical activity (PA) is inversely associated with obesity but the effect has been difficult to quantify using questionnaires. In particular, the shape of the association has not yet been well described. Pedometers provide an opportunity to better characterize the association. Methods: Residents of households over the age of 25 years in randomly selected census districts in Tasmania were eligible to participate in the AusDiab cross-sectional survey conducted in 1999–2000. 1848 completed the AusDiab survey and 1126 of these (609 women and 517 men) wore a pedometer for 2-weekdays. Questionnaire data on recent PA, TV time and other factors were obtained. The outcomes were waist circumference (in cm) and body mass index (BMI) (kg/m2). Results: Increasing daily steps were associated with a decline in the obesity measures. The logarithmic nature of the associations was indicated by a sharper decline for those with lower daily steps. For example, an additional 2000 steps for those taking only 2000 steps per day was associated with a reduction of 2.8 (95% confidence interval (CI): 2.1,4.4) cm in waist circumference among men (for women; 2.2 (95% CI: 0.6, 3.9 cm)) with a baseline of only 2000, steps compared to a 0.7 (95% CI 0.3, 1.1) cm reduction (for women; 0.6 (95% CI: 0.2, 1.0)) for those already walking 10 000 steps daily. In the multivariable analysis, clearer associations were detected for PA and these obesity measures using daily step number rather than PA time by questionnaire. Interpretation: Pedometer measures of activity indicate that the inverse association between recent PA and obesity is logarithmic in form with the greatest impact for a given arithmetic step number increase seen at lower levels of baseline activity. The findings from this study need to be examined in prospective settings.

The inverse relationship between number of steps per day and obesity in a population-based sample – the AusDiab study

Human studies of dietary fat as a possible risk factor for cutaneous malignant melanoma (CMM) and non-melanoma skin cancer (NMSC) – principally basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – have produced inconsistent results. We had the opportunity to examine the association concurrently for all three types of skin cancer in a population-based study in Tasmania, Australia, involving 652 cases of CMM, BCC and SCC and a common set of 471 controls. Histopathologically-confirmed cases of CMM, BCC and SCC were ascertained from the Tasmanian Cancer Registry (TCR), and controls were selected at random from the state's electoral roll. We compared subjects categorised by thirds of dietary fat intake score measured by the 'Dobson short fat questionnaire', with logistic regression models that adjusted for age, sex, skin type and usual sun exposure. We then followed all subjects for 56–80 months until 31 August, 2004 for a new NMSC using record linkage with both the TCR and the Births, Deaths, and Marriages registry. Incidence rates were calculated and ratios of rates were estimated using Poisson models. Relative to subjects in the lowest fat intake category, the odds ratios (OR) comparing cases and controls were OR = 0.76 (95% CI: 0.56–1.03) for medium fat intake, and OR = 0.62 (95% CI: 0.45–0.85) for high fat intake, with a significant (p < 0.01) trend of reduced odds ratio with higher category dietary fat intake. Among cases, the incidence rate ratio (IRR) relative to those with lowest fat score was IRR = 0.72 (95% CI: 0.50–1.03) for medium fat intake, and IRR = 0.82 (95% CI: 0.56–1.20) for highest fat intake (linear trend p = 0.30). Using the same dietary instrument with two study designs in the same Caucasian population, we found no evidence that high fat intake increases the risk of developing melanoma or non-melanoma skin cancers. Instead, our results suggest a risk reduction for high fat intake.

/pdf/association-between-dietary-fat-and-skin-cancer-in-an-4tnx73dazx.pdf

Association between dietary fat and skin cancer in an Australian population using case-control and cohort study designs

This study examined physical activity in leisure time and at work as estimated by the Global Physical Activity Questionnaire (GPAQ) and the associations between both total and domain-specific physical activity with cardiovascular risk factors in a population-based Vietnamese sample. Participants (n = 1978) were 25- to 64-year-old adults selected by stratified multistage sampling. Leisure activity contributed to <5% of total moderate and vigorous activity and was not associated with cardiovascular risk factors. Total moderate and vigorous activity was associated with body composition (r = -0.16 to -0.22; P < .001), blood glucose (r = -0.07; P < .05), and total cholesterol (r = -0.17; P < .001) for men and with total cholesterol (r = -0.07; P < .05) for women after adjusting for age. Further adjustment for smoking and alcohol intake made negligible changes. These associations were largely driven by work activity, which accounted for 80% of total activity.

Physical Activity and Its Association With Cardiovascular Risk Factors in Vietnam

Oxygen as a therapy for reducing nicotine withdrawal symptoms.

Injectable vaccines for preventing pneumococcal infection in patients with COPD- a systematic review

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