Kelly R Evenson’s research while affiliated with University of North Carolina at Chapel Hill and other places

Background Baseball clinicians, coaches, and players have sought to leverage biomechanical devices to inform training and prevent injury. However, discerning feasibility is sparse for novel biomechanical devices to inform adoption of these technologies. The objective of this study was to investigate the uptake (i.e., proportion of initial use) and adherence (i.e., proportion of continued use) of wearable and portable biomechanical devices among collegiate baseball pitchers during a single summer training season. Methods Uptake, adherence and 95% confidence intervals (95% CI) were calculated for a commercially available biomechanical pitching sleeve during practice, and use of a force plate during a countermovement jump task for a minimum of one time per week per the established protocol. Potential non-response bias analyses were assessed descriptively by comparing medical history, clinical measures, and pitching patterns among athletes that continued and discontinued using the biomechanical devices. Results Twenty-two pitchers participated. The uptake for initiating force plate use was 0.32 (95%CI: 0.14, 0.55); uptake for the pitching sleeve was 0.55 (0.32, 0.76). Adherence for force plate use was 0.46 (0.31, 0.70), compared to 0.13 (0.09, 0.17) for the pitch sleeve. Potential non-response bias analysis revealed pitchers with no previous upper extremity injury in the prior season (n=14) were more likely to use the pitching sleeve beyond the first session (43%) than those who had reported a previous season UE injury at study baseline (13%). Conclusions Variable uptake and adherence was observed across devices and players. Addressing barriers/facilitators to increase uptake and adherence is necessary to inform future studies on the effect of these devices on preventing injury using training load, kinetic, and kinematic data monitoring.

The Physical Activity Guidelines for Americans supports sitting less and moving more. Growing evidence suggests that a waking behavior profile with less sedentary behavior and more light-intensity physical activity is associated with more favorable cardiovascular health. Remarkably, little is known about how these behaviors relate to cardiovascular health during pregnancy. The purpose of this American Heart Association science advisory is to describe the existing evidence on device-measured sedentary behavior and light-intensity physical activity in relation to cardiovascular health during pregnancy and to make specific calls to action for future research to improve health outcomes and to promote health equity. Outcomes included adverse pregnancy outcomes associated with increased risk of cardiovascular disease and the American Heart Association’s Life’s Essential 8 health factor components (blood pressure, lipids, glucose, and gestational weight gain). Findings from observational studies are mixed, with preliminary evidence demonstrating an association between high sedentary behavior and increased risk of hypertensive disorders of pregnancy, shorter gestational age at delivery, low or high birth weight, and elevated maternal blood pressure, lipids, glucose, and gestational weight gain. Findings for light-intensity physical activity are limited by fewer studies and are less compelling. Experimental evidence evaluating the impact of decreasing sedentary behavior or increasing light-intensity physical activity on pregnancy cardiovascular health is weak. Future observational studies with rigorous longitudinal designs and larger, diverse samples are needed to characterize associations and to inform the design of adequately powered randomized controlled trials testing the impact of decreasing sedentary behavior and increasing light-intensity physical activity on cardiovascular health during pregnancy.

Background Data on prospective associations of accelerometer-measured physical activity, sedentary behavior, and mortality among cancer survivors are lacking. Our study examined accelerometer-measured daily physical activity (including light, moderate to vigorous, total, and steps), sedentary behavior (sitting time and mean bout duration), and mortality among cancer survivors in the Women’s Health Accelerometry Collaboration. Methods Postmenopausal women in the Collaboration who reported a cancer diagnosis at least 1 year prior to wearing an ActiGraph GT3X+ device on the hip for at least 4 of 7 days from 2011 to 2015 were included. Outcomes included all-cause, cancer-related, and cardiovascular disease (CVD)–related mortality. Covariate-adjusted Cox regression estimated hazard ratios (HRs) and 95% CIs for each physical activity and sedentary behavior measure in association with mortality. Results Overall, 2479 cancer survivors (mean [SD] age, 74.2 [6.7] years) were followed up for 8.3 years. For all-cause mortality (n = 594 cases), every 78.1 minutes per day in light physical activity, 96.5 minutes per day in total physical activity, 102.2 minutes per day in sitting time, and 4.8 minutes in a sitting bout duration had hazard ratios of 0.92 (95% CI = 0.84 to 1.01), 0.89 (95% CI = 0.80 to 0.98), 1.12 (95% CI = 1.02 to 1.24), and 1.04 (95% CI = 0.96 to 1.12), respectively. Linear associations for cancer mortality (n = 168) and CVD mortality (n = 109) were not statistically significant, except for steps (hazard ratio per 2469 steps/d = 0.66, 95% CI = 0.45 to 0.96) and sitting time (hazard ratio = 1.30, 95% CI = 1.02 to 1.67) for CVD mortality. Nonlinear associations showed benefits of moderate to vigorous physical activity (for all-cause and CVD mortality) and steps (all-cause mortality only) maximized at approximately 60 minutes per day and 5000–6000 steps per day, respectively. Conclusions Among postmenopausal cancer survivors, higher physical activity and lower sedentary behavior was associated with reduced hazards of all-cause and CVD mortality.

Introduction: The relationship between physical activity (PA) and sedentary behavior (SB) with mortality among women after a cancer diagnosis is understudied. We examined accelerometer-measured daily PA and SB in relation to all-cause and cardiovascular disease (CVD) mortality among postmenopausal cancer survivors in the Women’s Health Accelerometry Collaboration (WHAC). Methods: This study included 2,616 WHAC participants who reported a cancer diagnosis prior to baseline. From 2011–2015, WHAC participants wore an ActiGraph GT3X+ on the hip for ≥10 hours per day for ≥4 of 7 days. Daily accelerometer PA measures included light PA, moderate-to-vigorous PA (MVPA), total PA, and steps. SB measures were total sitting time and mean sitting bout duration. Mortality outcomes were ascertained through 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable stratified Cox regression for each PA and SB measure in association with all-cause and CVD mortality. Models were adjusted for age, race/ethnicity, education, smoking status, alcohol use, general health, postmenopausal hormone use, diabetes, CVD, BMI, physical function, cancer type, and years since cancer diagnosis. Evidence of non-linearity was explored using restricted cubic splines. Results: Overall, the 2,616 cancer survivors (mean [Standard Deviation, SD] age, 74.3 [6.7] years) were followed for a mean of 8.2 years. For all-cause mortality (n=646 cases), 1-SD increments in light PA (78.3 min/day), total PA (96.7 min/day) sitting time (102.3 min/day) and sitting bout duration (4.7 min/bout) were associated with adjusted HRs (95% CIs) of 0.92 (0.84, 1.00), 0.89 (0.80, 0.98), 1.12 (1.02, 1.23), and 1.05 (0.97, 1.13), respectively. Statistically significant nonlinear associations were observed for MVPA and steps ( Figure ). The dose-response curve for steps shows the maximal benefit occurs around 5,000 steps/day before leveling off. The maximal mortality benefit for MVPA was near 50 min/day. For CVD mortality (n=119 cases), 1-SD increments in MVPA (32.9 min/day) and steps (2470 steps/day) were associated with adjusted HRs (95% CIs) of 0.59 (0.41, 0.84) and 0.64 (0.45, 0.93), respectively, while associations for light PA, total PA, and SBs were not significant. Conclusions: Among postmenopausal cancer survivors, higher PA and lower sitting time are associated with reduced risk of all-cause mortality, while more MVPA and steps were associated with reduced CVD mortality risk.

Background Physical activity fragmentation represents the frequency of transitioning from an active to sedentary state. The prognostic information of physical activity fragmentation is unclear in Hispanics/Latinos. This study examined the association of PA fragmentation with all-cause mortality in Hispanic/Latino adults. Methods We investigated 11,992 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (18–74 yr; 52.2% women), from four United States urban communities (Bronx, New York; Chicago, Illinois; Miami, Florida; San Diego, California), that wore an accelerometer for one week. Physical activity fragmentation was calculated using the active-to-sedentary transition probability (ASTP) as the reciprocal of the average active bout duration. Daily total log-transformed activity count (TLAC) was used as a measure of total physical activity. The residual of ASTP regressed on TLAC (TLAC-adjusted ASTP) was explored to investigate the association of ASTP independent of total physical activity. Deaths were identified from annual follow-up interviews, obituary searches, or matches to the National Death Index through December 31, 2021. Cox regression models were fitted according to physical activity fragmentation. Findings There were 745 deaths (6.2%) over a mean follow-up of 11.2 (SD 2.2) years. The highest compared to the lowest tertile of ASTP showed a HR of 1.45 (95% CI 1.10–1.92) of all-cause mortality after accounting for confounders. The mortality risk also increased for each 0.10-unit increase of ASTP, as a continuous variable, by 22% (HR 1.22; 95% CI 1.07–1.39). The results were similar considering TLAC-adjusted ASTP. Interpretation Among Hispanic/Latino adults, more fragmented physical activity was associated with elevated all-cause mortality, independent of total physical activity volume. Funding HCHS/SOL was supported by the 10.13039/100000002National Institutes of Health.

Background: Although movement behaviors are linked to mortality risk, few studies investigated the associations between daily steps and movement behaviors and all-cause mortality in low- and middle-income countries. Objective: We investigated associations of step count, total activity volume, moderate-and-vigorous physical activity (MVPA), light-intensity physical activity (LPA), sedentary behavior, sleep duration, and various isotemporal substitutions with all-cause mortality in middle-aged and older Brazilian adults. Methods: ELSA-Brasil cohort study 3rd wave (2017-2019) participants wore an ActiGraph wGT3X-BT on the waist for seven days and completed a sleep diary. We followed participants to January 1st, 2024. Using Cox regression models, we estimated adjusted hazard ratios (HR). Using compositional data analysis, we examined changes in mortality associated with isotemporal substitutions. Results: Overall, 8832 participants (55.8 % female, age 59.2 ± 8.6) were followed for a median of 5.43 person-years (total 46,793.2), with 216 deaths. All behaviors except sleep showed curvilinear associations with mortality. Mortality declined with a plateauing effect at a daily total activity volume of 15.9 millii-g (HR 0.36, reference 7.83), 7300 steps (HR 0.48, reference 3881), 49.4 MVPA minutes (HR 0.28, reference 11.34), and 245.8 LPA minutes (HR 0.67, reference 135.6). Engaging in less than 842 sedentary behavior minutes/day was linked with an HR of 0.67. Reallocating 10 daily minutes from other behaviors to MVPA showed a consistent 10 % decrease in mortality. Conclusion: In Brazilian adults, step count, total activity volume, MVPA, LPA, and sedentary behavior were non-linearly associated with lower mortality. Reallocating any time from other behaviors to MVPA predicted lower mortality.

Despite increasing interest in the role of parks on children’s health, there has been little empirical research on the impact of park interventions. We used a quasi-experimental pre-post study design with matched controls to evaluate the effects of park redesign and renovation on children’s health-related quality of life (QoL) in underserved neighborhoods in New York City, with predominantly Hispanic and Black populations. Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported health-related QoL of 201 children aged 3–11 years living within a 0.3-mile radius of 13 renovated parks compared to 197 children living near 11 control parks before and after the park intervention. Health-related QoL was measured using a modified version of the KINDL questionnaire that assessed children’s physical and emotional well-being, self-esteem, and well-being in home, peer, and school functioning. Linear mixed regression model was used to examine the difference in difference (DID) between the intervention vs. control group for QoL. We found a significant differential improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID = 6.35, 95% confidence interval [CI] = 0.85–11.85, p = 0.024). The effect was particularly strong among girls (DID = 7.88, p = 0.023) and children of the lowest socio-economic background (p < 0.05). No significant DID was found in other KINDL domains. Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings lend support for investments in neighborhood parks to advance health equity.

Background: Few studies have examined how cancer incidence varies by country of origin among United States Hispanic/Latino adults. Herein, we describe the incidence rates of cancer overall and for screen-detectable, tobacco-related, and obesity-related cancers among 16,415 participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an ongoing population-based cohort study of Hispanic/Latino adults from diverse backgrounds. Methods: Cohort participant records were linked to the state cancer registries in New York, Florida, California, and Illinois to ascertain cancer incidence from baseline (2008-2011) through 2021. We estimated weighted age-adjusted incidence rates (IRs), and age- and sex-adjusted hazard ratios (HRs). Results: Over a mean follow-up of 10.7 (SD=2.0) years, 715 incident invasive cancers were diagnosed including 118 female breast, 102 prostate, and 79 bronchus and lung cancers. The IR of all cancers combined was 26.2 [95% confidence interval (CI)=22.6-30.2] per 10,000 (10K) person-years (py). The IRs were lowest among persons of Mexican descent [IR=19.0 (95%CI=15.0-24.1) per 10K-py] and highest for those of Puerto Rican [IR=36.6 (95%CI=28.4-47.0) per 10K-py] descent. Compared to those of Mexican descent, those of Puerto Rican, Cuban, and Dominican descent had higher hazards of cancer incidence; the incidence of obesity-related (HR=2.37; 95%CI=1.43-3.95) and tobacco-related (HR=3.00; 95%CI=1.58-5.71) cancers were also the highest among Puerto Ricans. Conclusions: Cancer incidence rates varied by Hispanic/Latino heritage and were masked when Hispanics/Latinos were aggregated into a single group. Impact: Understanding disparities in cancer risk by Hispanic/Latino heritage may help tailor cancer prevention and control strategies.