Six-minute walk test closely correlates to "real-life" outdoor walking capacity and quality of life in patients with intermittent claudication. Home training with and without additional group training in physically frail old people living at home: effect on health-related quality of life and ambulation Predictors of falls in the elderly by location Quantification of Outdoor Mobility by Use of Accelerometer-Measured Physical Behaviour Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. Exercise on a treadmill or walking outdoors? A randomized controlled trial comparing effectiveness of two walking exercise programmes late after stroke The effects of a walking exercise program on physical function and emotional state of elderly Korean women. Affective responses in mountain hiking—A randomized crossover trial focusing on differences between indoor and outdoor activity Outdoor Walking Training Compared To Cycle Ergometer Training in Severe COPD: A Randomized Controlled Feasibility Trial Cost effectiveness of preventive home visits to the elderly A cluster randomized controlled trial of an incentive-based outdoor physical activity program. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial The effect of exercise on salivary IgA levels and the incidence of upper respiratory tract infections in postmenopausal women. Portable oxygen therapy: use and benefit in hypoxaemic COPD patients on long-term oxygen therapy. Cluster-randomised trial on participatory community-based outdoor physical activity promotion programs in adults aged 65–75 years in Germany: protocol of the OUTDOOR ACTIVE intervention trial Rationale and study protocol for the 'eCoFit' randomized controlled trial: Integrating smartphone technology, social support and the outdoor physical environment to improve health-related fitness among adults at risk of, or diagnosed with, Type 2 Diabetes. Using Ecological Momentary Assessment to Understand Where and With Whom Adults’ Physical and Sedentary Activity Occur Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults. Fear of walking outdoors. A multilevel ecologic analysis of crime and disorder. Efficacy of the Rehabilitation of Elderly Primary Health Care Patients After Short-Stay Hospital Treatment Going Outdoors Daily Predicts Long-Term Functional and Health Benefits Among Ambulatory Older People Physiological and Psychological Responses to Outdoor vs. Laboratory Cycling Deliberate Play and Preparation Jointly Benefit Motor and Cognitive Development: Mediated and Moderated Effects
OBJECTIVE We used outdoor walking distance measured during 40 minutes as " real-life " outdoor walking capacity in 49 patients with intermittent claudication ( IC ) . The outdoor walking distance was measured by a global positioning system application for a smartphone . The relationships of self-reported maximum walking distance ( SR-MWD ) , the MWD on a grade d treadmill test , and the 6-minute maximum walk distance ( 6MWD ) vs outdoors walking capacity were investigated . Also studied were the associations of SR-MWD , MWD , and 6MWD with health-related quality of life assessed with the disease-specific instrument the  Vascular Quality of Life Question naire ( VascuQoL ) . METHODS In this prospect i ve observational cohort study , 49 IC patients underwent an  outdoor walking capacity test for 40 minutes , and MWD and 6MWD were measured . SR-MWD was recorded , and all subjects completed the VascuQoL question naire . Associations between the different walk estimates and outdoor walking capacity and health-related quality of life were investigated by correlation analysis ( Spearman ρ ) . RESULTS Outdoor walking distance during 40 minutes was a median 2495 m ( range , 1110 - 3300 m ) . SR-MWD correlated moderately and MWD correlated strongly to outdoor walking capacity ( r = 0.56 and r = 0.65 ; P < .001 , respectively ) . The 6MWD test showed the largest correlation to the outdoor walking capacity ( r = 0.78 ; P < .001 ) . The 6MWD was the only test that showed correlations with the VascuQoL sum score ( r = 0.53 ; P < .01 ) and all of the domain scores , whereas SR-MWD and MWD showed weak correlations to the VascuQoL. CONCLUSIONS The distance walked during the 6-minute walk test is closely correlated to outdoor walking capacity and health-related quality of life in IC patients . Our data support the use of 6MWD for routine clinical evaluation of walking capacity in IC patients Objective : To test the effect of two exercise regimes on health-related quality of life ( HRQoL ) and ambulatory capacity . Design : R and omized controlled trial . Subjects : Seventy-seven community-dwelling physically frail people over 75 years of age ( mean=81 , SD=4.5 ) . Interventions : Home training ( HT , N = 38 ) comprised twice daily functional balance and strength exercises and three group meetings . Combined training ( CT , N = 39 ) included group training twice weekly and the same home exercises . Interventions lasted 12 weeks . Physiotherapists ran both programmes . Home exercises were recorded daily . Main measures : HRQoL was assessed by SF-36 , and ambulatory capacity by walking speed and frequency and duration of outdoor walks . Results : Following intervention , CT improved the SF-36 mental health index significantly more than HT ( p = 0.01 ) . The SF-36 physical health index ( p = 0.002 ) and walking speed ( p = 0.02 ) demonstrated improvements , but no group differences . Six months after cessation of intervention there was still overall improvements on the mental health index ( p = 0.032 ) , borderline overall improvements on the physical health index ( p = 0.057 ) , higher weekly number of outdoor walks for the CT group than for the HT group ( p = 0.027 ) and an improved habitual walking speed in the CT group only ( p = 0.022 ) . Conclusions : HT improved HRQoL and walking speed , but additional group training gave larger benefits on mental health . Group training away from home may be beneficial for mental health and ambulatory capacity Background and aims : In the elderly , balance and walking impairments are assumed to play an important role in causing falls . We have assessed prospect ively the predictive ability of health , function and balance variables regarding falls and their location . Methods : Falls which occurred during one year in a r and om sample of 307 women aged 75 years and over ( mean 80.8 years , response rate 74.5 % ) living in the community were recorded and related to baseline registration s of health , medication and tests of walking and balance . Results : In all , 155 women ( 50.5 % ) reported 308 falls . Outdoor falls were significantly more frequent than indoor falls ( 57.5 vs 42.5 % ) . The variables having had a fall before the start of the study , osteoporosis , hypertension , feeling depressed , unable to climb 40 cm high steps and walking slowly , all independently predicted a higher number of falls overall . Regarding fall location , having experienced a fall before study start was associated with more falls indoors as well as outdoors . Vision impairment , symptoms of depression , a faster comfortable walking speed , and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure . A slower comfortable walking speed , a higher amplitude of the center of pressure movements in the frontal plane , a poorer score on the Timed Up & Go test , multi-morbidity , poor cognition and hypertension were independent risk factors for indoor falls . Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study . Conclusions : The findings of this study suggest that risk factors for  indoor and outdoor falls  are different . Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information Hip fractures in older persons are associated with both low levels of daily physical activity and loss of outdoor mobility . The aim was to investigate if accelerometer-based measures of physical behaviour can be used to determine if people undertake outdoor walking and to provide reference values for physical behaviour outcomes related to outdoor mobility . Older persons ( n = 245 ) , ≥70 years , one year after hip fracture , participated .  Six objective measures of physical behaviour collected by an activity monitor were compared with self-reported outdoor mobility assessed with the Nottingham Extended ADL scale . All measures of time and length in upright periods were significantly lower in participants who reported not walking outdoors ( p < 0.001 ) . A set of cut-off points for the different physical behaviour variables was generated . Maximum length of upright events discriminated best between groups , with 31 minutes as a threshold to determine if a person is more likely to report that they walk outdoors ( sensitivity : 0.805 , specificity : 0.704 , and AUC : 0.871 ) or 41 minutes or more to determine if a person is more likely to report outdoor walking on their own ( AUC : 0.891 ) . Physical behaviour  variables from activity monitoring can provide information about patterns of physical behaviour related to outdoor activity performance OBJECTIVES To investigate the feasibility of an outdoor 6-minute walk test ( 6MWT ) as a measure of functional status among individuals with chronic obstructive pulmonary disease ( COPD ) , and to examine the relationship between performance on an indoor and an outdoor 6MWT . DESIGN An experimental , repeated- measures crossover design . Subjects were studied on 2 separate days in the same week . Two 6MWTs-one indoors and the other outdoors-were performed on each study day , with a rest in between . The test order was r and omly selected on the first day and reversed on the second day . Outdoor tests were performed on days of moderate weather conditions ( mean temperature + /- st and ard deviation , 21 degrees + /-3 degrees C ; mean wind speed , 15+/-7 km/h ; no precipitation ) and on a flat surface ( sidewalk ) . SETTING  Outpatient rehabilitation program in Ontario . PARTICIPANTS Eighteen subjects with COPD ( 10 men , 8 women ; age , 70+/-8y ) , 5 using supplemental oxygen at rest ( forced expiratory volume in 1s , 1.0+/-0.3L ; 42%+/-8 % of predicted ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Distance walked in 6 minutes ( in meters ) , duration of rest ( in seconds ) , and change in rate of perceived dyspnea . RESULTS There was no significant effect of setting ( indoors vs outdoors ) on distance walked ( 394+/-86 m vs 398+/-84 m , P=0.4 ) , duration of rest ( 13+/-28s vs 9+/-20s , P=0.4 ) , or change in rate of perceived dyspnea ( 2.3+/-1.7 vs 2.3+/-2.0 , P=0.8 ) . Testing day had no significant effect on walk test performance ( all P>0.1 ) . CONCLUSIONS The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors Objective : To evaluate spatial and temporal gait characteristics and endurance late after stroke in people who had received two different walking exercises .  A secondary aim was to compare the outcomes in relation to length of time exercising and number of exercise occasions between the two . Design : A r and omized controlled trial . Setting : A private rehabilitation centre . Subjects : Thirty-nine people with stroke entered the study , and five dropped out . Interventions : Treadmill training versus walking outdoors . Main measures : Six-Minute Walk Test , a 10-metre walk test and pulse rates at rest and in activity . Results : There were significant differences in favour of the treadmill group in Six-Minute Walk Test distance ( P = 0.04 ) , Six-Minute Walk Test speed ( P = 0.03 ) , 10-m walking speed ( P = 0.03 ) , bilateral stride length ( right leg ; P = 0.009 , left leg ; P = 0.003 ) and step width ( P = 0.01 ) , indicating more symmetrical use of the legs in the treadmill group ( 1.02—1.10 m versus 0.97—0.92 m ) . There were no significant differences between groups in cadence ( P = 0.78 ) . All participants complied 100 % with their respective programmes . Exercise frequency did not differ between the groups but significantly less time was spent exercising on the treadmill compared with walking exercise outdoors ( 107 versus 316 minutes , P = 0.002 ) . There were no differences in use of assistive aids between the groups on arrival at the clinic or at departure . Conclusion : The results indicate that treadmill walking improves spatial and temporal gait characteristics more effectively than walking outdoors Exercise is an important strategy for preventing chronic diseases and promoting the health of older adults . The purpose of this research was to evaluate the effects of an outdoor walking exercise program on the cardiorespiratory function , the flexibility , and the emotional state of elderly Korean women . A nonequivalent control group , pretest-posttest design was used to measure the effects of the exercise program . The subjects were 27 females between the ages of 60 to 75 years . The intensity of the walking program was 40 - 60 % of the target heart-rate with a duration of 50 - 60 min , 3 times per week at an outdoor track for 8 weeks . The effects of the program were assessed by maximal oxygen uptake ( VO2max ) , resting pulse rate , blood pressure Forced Vital Capacity ( FVC ) , Forced Expiratory Volume per 1 second ( FEV1 ) for cardiorespiratory function , the " sit and reach test " for flexibility , and by the Profile of Mood States ( POMS ) for emotional state . The physical function and the emotional state of the experimental group improved significantly more than that of the control group except FEV1 and the anger factor of POMS . The VO2max and the flexibility of elderly women in the experimental group progressively improved as the duration of the exercise period continued . The results of this study suggest a practical and easy method of exercise to enhance the health of older women Introduction Affective responses during physical activity ( PA ) are important for engagement in PA programs and for adherence to a physically active lifestyle . Little is known about the affective responses to PA bouts lasting longer than 45 minutes . Therefore , the aims of the present study were to analyse acute effects on affective responses of a three-hour outdoor PA intervention ( mountain hiking ) compared to a sedentary control situation and to an indoor treadmill condition . Methods Using a r and omized crossover design , 42 healthy participants were r and omly exposed to three different conditions : outdoor mountain hiking , indoor treadmill walking , and sedentary control situation ( approximately three hours each ) . Measures included the Feeling Scale , Felt Arousal Scale and a Mood Survey Scale . Repeated measures ANOVAs were used to analyse differences between the conditions . Results Compared to the control situation , the participants showed a significant increase in affective valence ( d = 1.21 , p < .001 ) , activation ( d = 0.81 , p = .004 ) , elation ( d = 1.07 , p < .001 ) , and calmness ( d = 0.84 , p = .004 ) , and a significant decrease in fatigue ( d = -1.19 , p < .001 ) and anxiety ( d = -.79 , p < .001 ) after mountain hiking . Outdoor mountain hiking showed significantly greater positive effects on affective valence , activation , and fatigue compared to indoor treadmill walking . Discussion The results indicate that a three-hour PA intervention ( mountain hiking ) elicits higher positive and lower negative affective responses compared to a sedentary control situation and to an indoor PA condition . Outdoor mountain hiking can be recommended by health professionals as a form of PA with the potential to positively influence affective responses . Trial registration Clinical Trials.gov NCT02853760 . https:// clinical trials.gov/. Date of registration : 08/02/2016 ( retrospectively registered ) . Date of enrolment of the first participant to the trial : 05/01/2014 Abstract Exercise can improve walking capacity in persons with chronic obstructive pulmonary disease ( COPD ) . However , most endurance training programs use cycle ergometers . The objectives of this study were : ( i ) to evaluate the feasibility of a r and omized controlled trial ( RCT ) comparing outdoor walking training ( OWT ) to cycle ergometer training ( CT ) during inpatient rehabilitation in persons with severe COPD ; ( ii ) to estimate the effect of OWT and CT on health-related quality of life , physical capacity and physical activity ; and ( iii ) to estimate the required sample size for a RCT . A single-blind r and omized controlled feasibility trial was conducted with three months ' follow-up in the rehabilitation center in Walenstadtberg , Switzerl and . Sixteen patients were included in the study , which had a recruitment rate of 33 % ( 16/48 ) . Patients were allocated to an OWT ( n = 8) or CT ( n = 8) group . Participants completed 75 % of scheduled training and the follow-up rate was 75 % . All participants in the OWT group were satisfied with the training . The OWT group had better health-related quality of life after three weeks ' training compared to the CT group ( p = 0.042 , 95 % confidence interval ( 95 % CI ) 1.06–49.94 , effect size (d)=1.19 ) . No exacerbations occurred in the OWT group , but three occurred in the CT group after three months ’ follow-up . There was no significant difference in the other outcomes . In conclusion , the study design and the OWT are feasible . Health-related quality of life improved in the OWT group compared to the CT group after three weeks ' inpatient rehabilitation . A minimum of 46 participants is needed for a RCT . Trial registration : www.who.int/trial search We evaluated the cost effectiveness of preventive home visits  to elderly persons in Denmark alongside a 3-year r and omized controlled study . The main outcome measure was incremental costs per active life-year gained . The number of active life-years was defined as those during which the person is able independently to transfer , walk indoors , go outdoors , walk outdoors in both pleasant and poor weather , and climb stairs . In 17 of 34 municipalities health visitors and general practitioners were offered geriatric training , which focused on early signs of disability , physical activity , and interdisciplinary follow-up . The remaining 17 municipalities offered preventive home visits as usual . Outcomes were measured in 4,034 persons aged 75 or 80 years old and dwelling at home .  The difference in mean total costs between the intervention and the control group discounted at 3 % was € −856 ( 95 % CI −2,455 to 744 ) in 75-year-olds and € 694 ( −2,684 to 4,071 ) in 80-year-olds . The discounted difference in mean active life-years was 0.034 ( −0.058 to 0.125 ) and 0.197 ( 0.013 to 0.380 ) , respectively . The study did not provide conclusive evidence on the cost effectiveness of the programs under consideration OBJECTIVE To evaluate an incentive-based physical activity intervention to increase physical activity and fitness among children in a 9-month cluster r and omized controlled trial . STUDY DESIGN Children aged 6 - 12 years were r and omized to control ( n = 138 from 106 families ) or intervention arm ( n = 147 from 106 families ) . The intervention included incentives for meeting step targets as measured by pedometers and structured weekend outdoor activities . Outcomes included trends in activity for the intervention group and between-group differences in pedometer steps , 6-minute walk test , body mass index , and parent-reported Pediatric Quality of Life Inventory . RESULTS At follow-up , children in the intervention group recorded significantly more pedometer steps than controls over the entire week ( 8660 vs 7767 ; P = .010 ) , on weekdays ( 8646 vs 7826 ; P = .041 ) , and on weekends ( 8779 vs 7684 ; P = .018 ) . Three different trajectory classes were identified . The first group increased activity but was not sustained , the second group met the target step levels , and the third group significantly surpassed the step goals . The intervention group showed trends toward longer 6-minute walk test times and higher Pediatric Quality of Life Inventory scores , but the differences were not statistically significant . CONCLUSION Incentives for increased step activity were effective in producing greater steps and showed a ( nonsignificant ) trend toward improvements in other health outcomes . Thus , future incentive trials should be incorporate greater step targets and longer follow-up periods to provide evidence of the long-term effect of these incentives on children 's health Objective To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls . Design Parallel r and omised controlled trial stratified by recruitment site and source of referral , with 13 months ’ follow-up and outcome assessors blinded to group allocation . Setting Community recruitment and treatment room assessment s in Sydney and Illawarra regions of NSW , Australia . Participants 606 regular wearers of multifocal glasses ( mean age 80 ( SD 7 ) years ) . Inclusion criteria included increased risk of falls ( fall in previous year or timed up and go test > 15 seconds ) and outdoor use of multifocal glasses at least three times a week . Interventions Provision of single lens distance glasses with recommendations for wearing them for walking and outdoor activities compared with usual care . Main outcome measures Number of falls and injuries result ing from falls during follow-up . Results Single lens glasses were provided to 275 ( 90 % ) of the 305 intervention group participants within two months ; 162 ( 54 % ) of the intervention group reported satisfactory use of distance glasses for walking and outdoor activities for at least 7/12 months after dispensing . In the 299 intervention and 298 control participants available to follow-up , the intervention result ed in an 8 % reduction in falls ( incidence rate ratio 0.92 , 95 % confidence interval 0.73 to 1.16 ) . Pre-planned sub-group analyses showed that the intervention was effective in significantly reducing all falls ( incidence rate ratio 0.60 , 0.42 to 0.87 ) , outside falls , and injurious falls in people who regularly took part in outside activities . A significant increase in outside falls occurred in people in the intervention group who took part in little outside activity . Conclusions With appropriate counselling , provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy . The intervention may be harmful , however , in multifocal glasses wearers with low levels of outdoor activity . Trial registration Clinical trials NCT00350855 OBJECTIVES To examine the patterns of upper respiratory tract infections  ( URTI ) in postmenopausal Turkish women and the relationship of moderate aerobic exercise with secretion of salivary IgA and episodes of URTI . MATERIAL S AND METHODS Ninety healthy , sedentary women at ages 45 to 65 years volunteered to participate in a 12-week prospect i ve study . They were r and omized to three groups equal in number : indoor exercise , outdoor exercise , and no exercise . The exercising women were supervised during 30 min indoor treadmill walk or outdoor track walking sessions during 5 days/week at 60 % of their calculated maximal heart rate . During a 12-week exercise program , episodes suggestive of URTI were recorded . Non-exercising women were followed with weekly telephone calls . The salivary IgA levels were measured in all the subjects before and at the end of the study . RESULTS There were significant differences between the exercising and non-exercising women with respect to the number of URTI episodes and the length of URTI symptomatology per episode in favor of exercise . No significant difference was found between the indoor and outdoor exercising groups . The salivary IgA levels showed no significant differences between the three groups and within each group . CONCLUSION Moderate intensity aerobic exercise is associated with fewer episodes of URTI and fewer days of URTI symptomatology per episode in healthy postmenopausal Turkish women , but this does not seem to be related to salivary IgA concentrations In 159 chronic obstructive pulmonary disease ( COPD ) patients ( 139 males , mean age 62 + /- 8 yrs , arterial oxygen tension ( PaO2 ) 7.2 + /- 0.9 kPa ) , on long-term oxygen therapy ( LTOT ) , we evaluated the effects of portable oxygen therapy both on the daily duration of oxygen therapy and on daily activities . They were given two types of LTOT at r and om : group A ( n = 75 ) , oxygen concentrators only ( OC ) ; group B ( n = 84 ) , either small oxygen cylinders plus OC ( B1 = 51 ) or liquid oxygen ( B2 = 33 ) . The patients were followed-up for one year by means of : a ) medical examination every three months ; b ) monthly home interviews concerning the daily duration of oxygen therapy , the utilization of the devices and the daily activities of the patients ; c ) a measurement of the  daily oxygen usage .  The results show that : 1 ) there are no significant clinical and functional differences between groups A and B at the onset of and throughout the study ; 2 ) in group B the daily use of oxygen therapy is significantly longer than in group A ( 17 + /- 3.5 h.day-1 vs 14 + /- 3 h.day-1 , p less than 0.01 ) without any difference between groups B1 and B2 ; 3 ) outdoor walking activities are different between groups A and B , at least in those patients using oxygen more than 18 h.day-1 . Only 60 % of patients in group B ( 55 % of B1 ; 67 % of B2 ) use their portable devices outdoors and for walking . No strict predictive criterion of this use is found in our study . ( ABSTRACT TRUNCATED AT 250 WORDS Background Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany . Physical activity promotion programs for older adults are often not successful , one reason is insufficient relevance of intervention measures for the study population . Community-based participatory research ( CBPR ) is a possible key strategy for tailoring more meaningful intervention programs to a specific community . However , evidence for the effectiveness of CBPR in the general population is scarce . This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults . Methods / design The OUTDOOR ACTIVE intervention trial is a cluster-r and omised intervention study carried out in a r and om sample of eight subdistricts in the city of Bremen , Germany . The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and l and use mix of the subdistrict . Within the pairs , the subdistricts are assigned r and omly to the two study arms : participatory development and implementation of a community-based program to promote outdoor physical activity ( intervention ) versus no intervention ( controls ) . For evaluation , a survey is carried out before ( baseline ) and after ( follow-up ) the intervention period . The measurements include 7-day accelerometer measurement , physical fitness test , blood pressure , basic anthropometry , and self-administered question naire . Discussion The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting . Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group , and it will inform policy makers and other stakeholders how to benefit from the results .Trial registration German Clinical Trials Register DRKS00015117 ( Date of registration 17 - 07 - 2018 ) INTRODUCTION The prevalence and risk of Type 2 Diabetes ( T2D ) has dramatically increased over the past decade . Physical activity ( PA ) has significant benefits for the treatment and prevention of T2D . The aim of this study is to develop , implement and evaluate a community-based PA intervention to improve aerobic and muscular fitness among adults at risk of , or diagnosed with T2D . RESEARCH DESIGN AND METHODS The eCoFit pilot intervention will be evaluated using a r and omized controlled trial ( RCT ) design . The 20-week ( Phases 1 and 2 ) multi-component intervention was guided by Social Cognitive Theory , Health Action Process Approach Model , and Cognitive Behavior Therapy strategies . Phase 1 ( Weeks 1 - 10 ) includes : i ) 5 group face-to-face sessions consisting of outdoor training and cognitive mentoring ; and ii ) the use of the eCoFit smartphone application with a description of where and how to use the outdoor environment to be more physically active . Phase 2 ( Weeks 11 - 20 ) includes the use of the eCoFit smartphone application only . Assessment s are to be conducted at baseline , 10-weeks ( primary end-point ) and 20-weeks ( secondary end-point ) post-baseline . Primary outcomes are cardio-respiratory fitness and muscular fitness ( lower body ) . Secondary outcomes include physical , behavioral , mental health and quality of life , and social-cognitive outcomes . DISCUSSION eCoFit is an innovative , multi-component intervention , which integrates smartphone technology , social support and the outdoor physical environment to promote aerobic and resistance training PA among adults at risk of , or diagnosed with T2D . The findings will be used to guide future interventions and to develop and implement effective community-based prevention programs . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry No : ACTRN12615000990527 Purpose This study used Ecological Momentary Assessment ( EMA ) , a real-time self-report strategy , to describe the physical and social context s of adults ’ physical activity and sedentary activity during their everyday lives and to determine whether these patterns and relationships differ for men and women . Methods Data from 114 adults were collected through mobile phones across 4 days . Eight electronic EMA surveys were r and omly prompted each day asking about current activities ( e.g. , physical or sedentary activity ) , physical and social context s , and perceived outdoor environmental features ( e.g. , greenness/vegetation , safety , and traffic ) . All participants also wore accelerometers during this period to objective ly measure moderate-to-vigorous physical activity ( MVPA ) and sedentary activity . Results Home was the most common physical context for EMA-reported physical and sedentary activity . Most of these activities occurred when participants were alone . When alone , the most commonly EMA-reported physical activity and sedentary activity was walking and reading/using computer , respectively . When in outdoor home locations ( e.g. , yard and driveway ) women demonstrated higher levels of MVPA , whereas men demonstrated higher levels of MVPA when in outdoor park setting s ( ps < .05 ) . Men but not women demonstrated higher levels of MVPA in setting s with a greater degree of perceived greenness and vegetation ( p < .05 ) . Conclusions The current study shows how EMA via mobile phones and accelerometers can be combined to offer an innovative approach to assess the context s of adults ’ daily physical and sedentary activity . Future studies could consider utilizing this method in more representative sample s to gather context -specific information to inform the development of physical activity interventions The primary purpose of this study was to investigate the accuracy of the activPAL physical activity monitor in measuring step number and cadence in older adults .  Two pedometers ( New-Lifestyles Digi-Walker SW-200 and New-Lifestyles NL2000 ) used in clinical practice to count steps were simultaneously evaluated . Observation was the criterion measure . Twenty-one participants ( 65 - 87 yr old ) recruited from community-based exercise classes walked on a treadmill at 5 speeds ( 0.67 , 0.90 , 1.12 , 1.33 , and 1.56 m/s ) and outdoors at 3 self-selected speeds ( slow , normal , and fast ) . The absolute percentage error of the activPAL was < 1 % for all treadmill and outdoor conditions for measuring steps and cadence . With the exception of the slowest treadmill speed , the NL-2000 error was < 2 % . The SW-200 was the least accurate device , particularly at slower walking speeds . The activPAL monitor accurately recorded step number and cadence . Combined with its ability to identify primary postures , the activPAL might be a useful and versatile device for measuring activity in older adults BACKGROUND Although a number of studies have tested ecologic models that postulate relationships among social networks , the built environment , and active living , few neighborhood-based studies have considered the role of crime and violence . This study investigates the degree to which individual-level demographic characteristics and neighborhood-level physical and social characteristics are associated with increased fear of crime . METHODS Data were analyzed in 2007 from a 2005 survey of 901 r and omly selected individuals living in 55 neighborhoods in Washington DC .  Multilevel ordered logit regression was used to examine associations between individual-level and neighborhood-level characteristics and how often fear of crime prevents a respondent from walking outdoors . RESULTS Age and female gender were associated with an increase in fear ; the percentage of a resident 's life spent in the same neighborhood was associated with a decrease in fear . Results of cross-level interactions showed that at the neighborhood level , women were more fearful than men in neighborhoods without violence , but that the difference in fear between men and women shrinks as neighborhood violence increases . Collective efficacy was found to increase fear among black respondents and had no effect on fear among nonblack respondents . CONCLUSIONS If the study of neighborhoods and active living is to progress and contribute to both etiologic underst and ing and policy formation , it is essential that theoretical and empirical models consider the impact of violence and fear on walking . Efforts to increase active living in urban neighborhoods that do not account for the impact of crime and fear may fall short of their intended outcomes The purpose of this study was to evaluate the impact of a primary home care intervention program on patient outcomes after selected patients were discharged from a short-stay hospital . R and om assignment of 249 frail , elderly patients was made to a group provided with physician-led primary home care , and home assistance service on a 24-hour basis , or to a control group given st and ard care . At r and omization , patients were considerably disabled , had a mean age of 80.5 years , and had a high likelihood of long-stay hospital care .  Medical and functional data were essentially the same at baseline for both groups . At 6-months follow-up , significant improvement in instrumental activities of daily living ( P = 0.04 ) and outdoor walking ( P = 0.03 ) , and medical condition was found in the primary care intervention group compared with the controls and less utilization of long-stay hospital facilities was displayed in the team patients ( P < 0.001 ) than in the controls . A selection of elderly , dependent patients can be cared for in their homes after short-stay hospital discharge and benefit from this primary home care intervention program in terms of improved medical and functional outcomes and less long-stay hospitalization Objective : This article examines the association between frequency of going out of the house and health and functional status among older people . Method : A r and omly chosen cohort of ambulatory participants born in 1920 or 1921 from the Jerusalem Longitudinal Study underwent assessment s for health , functional , and psychosocial variables at ages 70 and 77 . Twelve-year mortality data were collected . Results : Women went out daily less than did men . Participants going out daily at age 70 reported significantly fewer new complaints at age 77 of musculoskeletal pain , sleep problems , urinary incontinence , and decline in activities of daily living ( ADLs ) . Logistic regression analysis indicated that not going out daily at age 70 was predictive of subsequent dependence in ADL , poor self-rated health , and urinary incontinence at age 77 . Discussion : Going out daily is beneficial among independent older people , correlating with reduced functional decline and improved health measures Abstract Mieras , ME , Heesch , MWS , and Slivka , DR . Physiological and psychological responses to outdoor vs. laboratory cycling . J Strength Cond Res 28(8 ) : 2324–2329 , 2014—The purpose of this study was to determine the physiological and psychological responses to laboratory vs. outdoor cycling .  Twelve recreationally trained male cyclists participated in an initial descriptive testing session and 2 experimental trials consisting of 1 laboratory and 1 outdoor session , in a r and omized order . Participants were given a st and ardized statement instructing them to give the same perceived effort for both the laboratory and outdoor 40-km trials . Variables measured include power output , heart rate ( HR ) , core temperature , skin temperature , body weight , urine specific gravity ( USG ) , Rating of Perceived Exertion ( RPE ) , attentional focus , and environmental conditions . Wind speed was higher in the outdoor trial than in the laboratory trial ( 2.5 ± 0.6 vs. 0.0 ± 0.0 m·s−1 , p = 0.02 ) whereas all other environmental conditions were similar . Power output ( 208.1 ± 10.2 vs. 163.4 ± 11.8 W , respectively , p < 0.001 ) and HR ( 152 ± 4 and 143 ± 6 b·min−1 , respectively , p = 0.04 ) were higher in the outdoor trial than in the laboratory trial . Core temperature was similar , whereas skin temperature was cooler during the outdoor trial than during the laboratory trial ( 31.4 ± 0.3 vs. 33.0 ± 0.2 ° C , respectively , p < 0.001 ) , thus creating a larger thermal gradient between the core and skin outdoors . No significant differences in body weight , USG , RPE , or attentional focus were observed between trials . These data indicate that outdoor cycling allows cyclists to exercise at a higher intensity than in laboratory cycling , despite similar environmental conditions and perceived exertion . In light of this , cyclists may want to ride at a higher perceived exertion in indoor setting s to acquire the same benefit as they would from an outdoor ride In light of the interrelation between motor and cognitive development and the predictive value of the former for the latter , the secular decline observed in motor coordination ability as early as preschool urges identification of interventions that may jointly impact motor and cognitive efficiency . The aim of this study was twofold . It ( 1 ) explored the outcomes of enriched physical education ( PE ) , centered on deliberate play and cognitively challenging variability of practice , on motor coordination and cognitive processing ; ( 2 ) examined whether motor coordination outcomes mediate intervention effects on children ’s cognition , while controlling for moderation by lifestyle factors as outdoor play habits and weight status . Four hundred and sixty children aged 5–10 years participated in a 6-month group r and omized intervention in PE , with or without playful coordinative and cognitive enrichment . The weight status and spontaneous outdoor play habits of children ( parental report of outdoor play ) were evaluated at baseline . Before and after the intervention , motor developmental level ( Movement Assessment Battery for Children ) was evaluated in all children , who were then assessed either with a test of working memory ( R and om Number Generation task ) , or with a test of attention ( from the Cognitive Assessment System ) . Children assigned to the ‘ enriched ’ intervention showed more pronounced improvements in all motor coordination assessment s ( manual dexterity , ball skills , static/dynamic balance ) . The beneficial effect on ball skills was amplified by the level of spontaneous outdoor play and weight status . Among indices of executive function and attention , only that of inhibition showed a differential effect of intervention type . Moderated mediation showed that the better outcome of the enriched PE on ball skills mediated the better inhibition outcome , but only when the enrichment intervention was paralleled by a medium-to-high level of outdoor play . Results suggest that specifically tailored physical activity ( PA ) games provide a unique form of enrichment that impacts  children ’s cognitive development through motor coordination improvement , particularly object control skills , which are linked to children ’s PA habits later in life . Outdoor play appears to offer the natural ground for the stimulation by design ed PA games to take root in children ’s mind
There is evidence that walking groups have wide-ranging health benefits .
The evidence was less clear for other outcomes such as waist circumference fasting glucose , SF-36 ( mental health ) and serum lipids such as high-density lipids .
There were no notable adverse side effects reported in any of the studies .
CONCLUSIONS Walking groups are effective and safe with good adherence and wide-ranging health benefits .
They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity
OBJECTIVE To assess the health benefits of  outdoor walking groups .