Exercise is Medicine for Underserved Populations: Integrating Physical Activity Screening on a Community Mobile Health Unit

Translational Journal of the American College of Sports Medicine · 2026-04-01

Introduction: Exercise is Medicine (EIM) is a physical activity (PA) promotion strategy designed for use in clinical and community settings. Purpose: The purpose of this feasibility study was to test the integration of the Physical Activity Vital Sign into a mobile health unit (the Wellness Bus) and examine the potential of the EIM process to support promotion of other behavioral and psychosocial outcomes. Methods: Using an integrated research–practice partnership approach, the My Own Health Report tool, including the Physical Activity Vital Sign, was added to the Wellness Bus intake process to examine feasibility, prevalence of meeting recommended behavioral guidelines, and differences across demographic subgroups. Prevalence differences across subgroups were analyzed using robust Poisson regression. Interviews and rapid qualitative analysis of Wellness Bus staff ( n = 4) perceptions of feasibility were thematically coded using the Practical Robust Implementation and Sustainability Model. Results: Over 3 months, all 389 Wellness Bus visitors (84% Hispanic/Latino, 46% females, 67% uninsured) completed the full assessment, and over 90% provided valid responses to PA questions. Most participants did not meet PA (75% inactive or insufficiently active) or dietary recommendations based on fruit and vegetable (59%) or sugary beverage (52%) intake. Participants who were female, Hispanic/Latino, or uninsured were less likely to meet PA guidelines (all P ’s < 0.05). Qualitative data indicated that the tool was acceptable to staff and integrated well into the workflow, with suggestions for improved referral processes and resource linkage. These findings highlight both the feasibility of implementation and the need for structured health behavior supports. Conclusion: This study demonstrates how an integrated research–practice partnership and Practical Robust Implementation and Sustainability Model-informed strategy enabled the integration of EIM screening into a mobile health unit’s workflow. Future research should prioritize building referral linkages to evidence-based PA programs to fully realize the potential of EIM for underserved populations.

The synergic relationship between muscular fitness and adiposity with cardiometabolic risk: a longitudinal mediation analysis

Sport Sciences for Health · 2026-03-05

Abstract Purpose The study aimed to examine whether muscular fitness and adiposity at baseline (age range: 7–16) are associated with clustered cardiometabolic risk at a 3-year follow-up, independent of cardiorespiratory fitness; and to investigate the distinct mediating roles of muscular fitness and adiposity in their potential associations with clustered cardiometabolic risk in a sample of children and adolescents from Southern Brazil. Methods An observational 3-year longitudinal study was conducted including 411 children and adolescents (10.51 ± 2.03 years of age at baseline; 56.4% females). Waist circumference was measured in addition to field-based tests of cardiorespiratory fitness, lower limb power, and abdominal muscular endurance. A clustered cardiometabolic risk score was calculated from fasting glucose, systolic blood pressure, total cholesterol/HDL-C ratio, and triglycerides z-scores, which were subsequently summed up and divided by four. Structural equation modeling with bootstrap was applied. Results Both waist circumference and muscular fitness at baseline were significantly associated with the clustered cardiometabolic risk score at follow-up, independently of cardiorespiratory fitness. Specifically, waist circumference showed both direct ( β = 0.095; 95% CI 0.025–0.169) and indirect associations through muscular fitness ( β = − 0.042; 95% CI − 0.085 to − 0.013) with cardiometabolic risk. The association between muscular fitness and cardiometabolic risk was explained by waist circumference ( β = − 0.179; 95% CI − 0.511 to − 0.059). Conclusion This study identified a complex longitudinal and synergistic relationship between muscular fitness, adiposity, and cardiometabolic risk. These findings highlight the importance of considering this interplay when designing strategies to improve cardiometabolic health in children and adolescents.

Comparative effectiveness of school- and office-based technology-enhanced interventions for physical activity promotion: A systematic review and meta-analysis

Preventive Medicine Reports · 2026-02-13

School students and office workers can have higher levels of physical inactivity. Comparative effectiveness of interventions that use technology-based strategies to promote physical activity (PA) between these two populations is lacking. The purpose of this review was to compare effectiveness of technology-based interventions to promote PA in school and office settings. A literature search was conducted from each database's inception with no place restriction using PubMed/MEDLINE (1946), Scopus (2004), Web of Science (1964), Embase (1974), and Cochrane Library (1995) through January 1st, 2025. Inclusion criteria included randomized controlled trials examining school-aged children/adolescents or adult office workers participating in a technology-based intervention to promote PA. Effectiveness was examined using random-effects meta-analyses. Ten school-based and five office-based studies were examined. Two of 10 (20%) school-based studies and two of five (40%) office-based studies showed high risk of bias. There was a significant but small positive effect for school-based interventions to improve PA (Hedges' g = 0.35, 95%CI [0.02, 0.68]) but not for office-based interventions (Hedges' g = 0.07, 95%CI [−0.19, 0.33]). School-based interventions using technology showed a small positive effect for improving PA. More novel, undisruptive, and effective strategies using technology should be derived and rigorously tested in school and office settings. • School interventions using technologies are effective to promote physical activity. • There is large heterogeneity in school interventions using technology. • Office-based studies using technology does not show effectiveness. • There are limited quality physical activity interventions using technology. • More physical activity interventions using technology need testing.

The association of an exercise and rehabilitation clinical workflow algorithm on sedentary behavior and performance status from time of breast cancer diagnosis and throughout care

Breast Cancer Research and Treatment · 2026-04-17

Effects of Telerehabilitation on Quality of Life, Physical Capacity, and Symptom Burden within the Post–COVID-19 Condition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (Preprint)

2026-03-15

<sec> <title>BACKGROUND</title> Telerehabilitation (TR) is an important option for patients with post-COVID-19 condition (PCC). However, current evidence on its effectiveness remains inconsistent, and the impact of different delivery modes is not fully understood. </sec> <sec> <title>OBJECTIVE</title> This study evaluated the effects of telerehabilitation on health-related quality of life (HRQoL), physical capacity, and symptom burden in adults with PCC, and to determine whether delivery mode (synchronous vs. asynchronous) modified these effects. </sec> <sec> <title>METHODS</title> We searched PubMed/MEDLINE, Cochrane Library, Web of Science, Scopus, Embase, EBSCO, and PEDro for randomized controlled trials (RCTs) published from January 2020 to December 2025. The primary outcome was HRQoL; secondary outcomes included functional capacity (6MWT, STS), dyspnea, fatigue, and HADS scores. Risk of bias was assessed using the Cochrane RoB 2 tool. Data were pooled using random-effects models with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. </sec> <sec> <title>RESULTS</title> Twenty-three RCTs involving 2,320 participants were included. TR resulted in significant improvements in HRQoL (standardized mean difference [SMD] 1.26, 95% CI 0.07 to 2.45; P=.04), dyspnea (SMD 1.95, 95% CI 0.60 to 3.31; P=.005), and functional aerobic capacity (6MWT: mean difference [MD] 77.79 m, 95% CI 30.44 to 125.14; P=.001). Fatigue was also significantly reduced (SMD 0.89 95% CI: 0.16 to 1.62; P=.02), but no significant effects were observed for lower limb strength (STS: SMD 0.55, 95% CI -0.15 to 1.25; P=.12) or mental health outcomes (HADS: SMD 0.12, 95% CI −0.13 to 0.38; P=.36). No significant differences were observed be-tween delivery modes for most outcomes (P&gt;.05), except for lower limb strength, where a significant subgroup difference was noted (P=.02). </sec> <sec> <title>CONCLUSIONS</title> Telerehabilitation is effective for improving quality of life, aerobic capacity, and alleviating persistent symptoms in PCC patients. Asynchronous delivery appears sufficient for general conditioning, while synchronous supervision may be necessary for strength training. </sec> <sec> <title>CLINICALTRIAL</title> PROSPERO CRD42023490863; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023490863 </sec>

Evaluation of Optimal Epoch Lengths for Real-Time Physical Activity Measurement for mHealth Applications: Cross-Sectional Study (Preprint)

2025-10-31

<sec> <title>BACKGROUND</title> Wearable accelerometers have become integral to mobile health (mHealth) research, particularly for delivering real-time physical activity (PA) monitoring and applications in interventions such as Just-in-Time Adaptive Interventions (JITAIs). One critical yet underexplored factor in real-time PA monitoring is epoch length, which is the time interval over which raw accelerometry data are aggregated to classify activity intensities and levels. Shorter epochs (e.g., 1 second) enhance precision but increase computational and battery demands, while longer epochs (e.g., 60 seconds) reduce data burden but may miss brief activity bouts. Although previous studies have examined epoch effects using post-processed data, limited evidence exists regarding their influence on real-time, wrist-based PA estimates, especially for moderate-to-vigorous PA (MVPA). Identifying an optimal epoch length for real-time PA measurement remains a critical gap in supporting scalable and efficient mHealth interventions. </sec> <sec> <title>OBJECTIVE</title> This study determined the impact of varying epoch lengths on real-time MVPA estimates derived from a wrist-worn accelerometer to identify an optimal epoch that balances measurement accuracy with practical feasibility for mHealth applications. </sec> <sec> <title>METHODS</title> Twenty adults (Age: 32.5 ± 15.1 years) completed a series of carefully selected simulated free-living activities in a controlled laboratory setting. Participants wore the MotionSense HRV wristband, which computed real-time Euclidean Norm Minus One (ENMO) values, and a COSMED K5 indirect calorimetry for metabolic reference. ENMO values were aggregated into 5-, 10-, 15-, 30-, and 60-second epochs. MVPA was classified using validated ENMO cut-points. Epoch-level MVPA estimates were compared against the 1-second reference using mean absolute percent error (MAPE), Pearson’s correlations, Bland-Altman (BA) plots, and equivalence testing with a ±10% equivalence zone. </sec> <sec> <title>RESULTS</title> MVPA estimates from all epoch lengths were statistically equivalent to the 1-second standard. The 15-second epoch demonstrated the best trade-off between accuracy and efficiency, with minimal bias (0.05 min), low MAPE (6.3%), and strong correlation (r = 0.97). However, indicators of individual-level error increased with longer epochs; MAPE increased to 9.5% at 60 seconds, and the limits of agreement widened (from ± 2.9 min at 15s to ± 4.9 min at 60s), suggesting greater potential misclassifications in estimating MVPA with longer epochs. </sec> <sec> <title>CONCLUSIONS</title> Although MVPA estimates using the MotionSense HRV wristband were robust across all epoch lengths, findings from this study suggest that a 15-second epoch provides an optimal balance between measurement precision and processing efficiency, making it well-suited for mHealth interventions, such as JITAIs that rely on timely activity detection. </sec>

Effectiveness and feasibility of family and peer challenge intervention with wearable technology on physical activity among middle schoolers in Utah: A pilot trial

Preventive Medicine Reports · 2025-05-02 · 1 citations

To examine the preliminary effectiveness and feasibility of physical activity (PA) intervention in middle schoolers. This 6-week, multi-component PA intervention was conducted in Salt Lake City, Utah, between November 2021 and January 2022. The intervention included tracking daily PA using a wearable activity monitor, education on PA and health, weekly motivational videos, and group challenges within family or peer groups. Three classes from one public middle school ( N = 75; 51 % girls, aged 12–13 years) were randomly allocated into the intervention (i.e., family or peer challenges) or control groups. Changes in daily activity time between pre- and post-intervention were assessed using ActiGraph accelerometers. The feasibility of the intervention was evaluated through measures of adherence, retention, and acceptability. After the intervention, 51 (girls: 51 %; age: 13.0 ± 0.7) of all participants completed the entire study protocol. Linear mixed models showed no statistically significant differences between interventions and control in daily sedentary behavior and PA times. Adherence to the intervention was moderately high (> 60 %), with a retention of 68 %. We also observed high satisfaction with wearable technology (≥ 78 %) in middle school students. However, only 39 % of participants frequently used the mobile app for their group challenge. Wearable technology in PA intervention may be of interest to young adolescents but not effectively change youth PA behavior during a 6-week intervention. Further research with larger samples, longer intervention durations, and refined engagement strategies is required to more accurately evaluate the impact and feasibility of this intervention. • A six-week wearable tech intervention targeted middle schoolers' physical activity. • The intervention used goal setting, self-monitoring, and social support. • No significant physical activity difference was found between study groups. • High satisfaction with wearables, but Fitbit app and group challenge use were low.

Associations between body mass index and sleep duration in Brazilian children and adolescents: the moderating role of screen time

Journal of Pediatric Endocrinology and Metabolism · 2025-02-13 · 1 citations

OBJECTIVES: To verify the moderating role of screen time in the relationship between body mass index (BMI) and sleep duration in children and adolescents. METHODS: This cross-sectional study involved 1,338 children and adolescents (aged 6-17 years old; 761 girls) recruited from a municipality in south Brazil. Body weight and height were assessed to calculate BMI. Information regarding screen time, sleep duration, age, sex, sexual maturation, housing area, and socioeconomic status was obtained through a self-reported questionnaire. Moderation was tested using multiple linear regression modelling through an SPSS program extension. All models were adjusted for sex, age, sexual maturation, housing area, and socioeconomic status. RESULTS: No association was found between BMI and sleep duration (β=0.830; 95 % CI=-0.943; 2.603). However, when the role of screen time was considered, it was observed that this variable significantly moderated the relationship between BMI and sleep duration (β=-0.006; 95 % CI=-0.011; -0.001). Specifically, children and adolescents who spent more than 360 min per day in front of the screens presented higher BMI and shorter sleep durations. CONCLUSIONS: The more time children and adolescents spend in front of screens, the higher the likelihood it will negatively affect their BMI and sleep duration. These findings emphasize the need for interventions that promote healthy screen habits and encourage behaviors that support optimal sleep duration to mitigate the potential negative effects on body weight and overall health.

Association between physical activity, performance scores, and clinical trial enrollment in cancer survivors

BMC Cancer · 2025-08-26 · 1 citations

BACKGROUND: To investigate the association between patient-reported habitual physical activity (PA) and physician-assessed physical performance scores, specifically the Eastern Cooperative Oncology Group (ECOG) score, and experimental therapeutic clinical trial enrollment in adult cancer survivors. METHODS: This was a secondary data analysis of patient-reported and clinical cancer data from the Total Cancer Care (TCC) cohort at the Huntsman Cancer Institute between 2016 and 2022. Patients completed a modified Godin questionnaire to assess average weekly PA (MET/hrs-week) for the previous 12 months. A demographics questionnaire collected information on sex, race, ethnicity, education level, and income status. ECOG performance scores were retrieved from the medical record and classified as either "Good" (ECOG of 0 or 1) or "Poor" (ECOG of 2, 3 or 4) physical function. Binary logistic regressions were used to assess the relationship between PA levels (total PA, moderate-vigorous PA, and light PA) and ECOG ratings, and PA levels and clinical trial enrollment (yes/no). Models were adjusted for demographics and cancer characteristics. RESULTS: Patients who completed the TCC questionnaire packet (n = 603) were primarily female (51%), non-Hispanic (95%), white (95%) with an average age of 61.9 ± 15.5 years. The top three cancer types represented were Head and Neck (30%), Thyroid (24%), and Lung (24%); all cancer stages were represented. Higher PA levels were linked with increased odds of having a good ECOG rating in unadjusted models (OR 1.01, 95% CI 1.00 to 1.02), but not in adjusted models (OR 1.01, 95% CI 0.99 to 1.03). Higher levels of light PA were linked with greater odds of having good ECOG rating in unadjusted and adjusted models (OR 1.05, 95% CI 1.00 to 1.11; OR 1.072, 95% CI 1.01 to 1.13; respectively). Statistically significant associations were not observed between moderate-vigorous PA and ECOG rating, and PA and clinical trial enrollment. CONCLUSIONS: Patient-reported light PA may serve utility in physician decision making of ECOG rating. More work is needed identifying patient centered subjective and objective tools to complement physician-assessed ECOG scores considering the implications of ECOG in cancer treatment decisions and eligibility for clinical trials.

Associations of Parental Perceived Health with Child Movement Behaviors within Two-Parent Households

International Journal of Physical Activity and Health · 2025-02-25

This study aimed to examine how perceived parental mental and physical health status was associated with child physical activity, screen time, and sleep. Participants were 6- to 17-year-old minors (N = 20,156; 47.9% female) from the 2022 US National Survey of Children’s Health. Dependent variables were children’s physical activity frequency, screen time, and sleep. Independent variables were parents’ physical and mental health status. Using the Actor-Partner Interdependence Model, two adjusted path models were constructed. One for parent mental health associating with parental physical health, another for parent physical health associating with parental mental health–both further associating with child movement behaviors. Path models also examined the covariance within parental dyads. Approximately 20.1% of children adhered to physical activity recommendations, 61.2% to screentime recommendations, and 66.4% to sleep recommendations. Parental physical health status mediated the association of parents' mental health status on child movement behaviors, and vice-versa. Mediated associations represented 20.1% to 50.5% of the total associations. Dyadic correlations were moderate (r = 0.52 – 0.60). Most of the dyadic correlations and covariance were explained by actor-driven effects, suggesting that the mediated parental association with child behaviors may be due to health perceptions related to the individual parent and not the other parent.