慢性失眠患者体力活动状况及影响因素分析

摘要：目的　研究慢性失眠患者体力活动状况及影响因素分析。方法　对象为中山大学附属第三医院精神
科门诊慢性失眠患者９０例及健康对照组８２例,研究组年龄（４０．３±８．４）岁,男性４２例,女性４８例,失
眠病程（４．０２±２．２５）年。采用国际体力活动问卷中文版长卷调查其体力活动状况。睡眠相关量表评定包
括匹茨堡睡眠质量指数量表（ｐｉｔｔｓｂｕｒｇｈｓｌｅｅｐｑｕａｌｉｔｙｉｎｄｅｘ,ＰＳＱＩ）、Ｅｐｗｏｒｔｈ 嗜睡量表（ｅｐｗｏｒｔｈｓｌｅｅｐｉ
ｎｅｓｓｓｃａｌｅ,ＥＳＳ）、疲劳量表 １４ （ｆａｔｉｇｕｅｓｃａｌｅ,ＦＳ １４）、睡眠个人信念和态度量表（ｂｅｌｉｅｆｓａｎｄａｔｔｉｔｕｄｅｓａ
ｂｏｕｔｓｌｅｅｐｓｃａｌｅ,ＤＢＡＳ）。结果　研究组体力活动活动活跃程度依次为： 低３９ 例（４２．９％）、中３４ 例
（３７．４％）、高１７例（１８．７％）,对照组依次为低１５例（１８．３％）、中３９例（４７．６％）、高２８例（３４．１％）,
两组差异有统计学意义（χ
２＝１２．２６８,犘＝０．０００）;对研究组体力活动活跃程度影响因素进行ｌｏｇｉｓｔｉｃ回归
分析,结果显示,体力活动水平和ＤＢＡＳ分呈正相关,和ＰＳＱＩ分、ＦＳ １４分呈负相关（犘＜０．０５）。结论
　慢性失眠患者体力活动水平偏低,改善其睡眠质量、日间疲劳症状及纠正其歪曲认知可能有利于提高体
力活动水平。
关键词：失眠;体力活动;国际体力活动问卷
中图分类号：Ｒ７４　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０１ ００２４ ０４     

Ⅱ型糖尿病患者的体力活动水平、静坐时间与其糖脂代谢的关系

目的探索Ⅱ型糖尿病患者的体力活动水平、静坐时间与其糖脂代谢的关系。方法对469名Ⅱ型糖尿病患者的体力活动及其血糖血脂代谢情况进行调查。结果调查对象的总体力活动量均值为1 581.59 MET*min/w,总体力活动水平为中等,其中体力活动不足者有98人,占20.9%,体力活动中等者292人,占62.3%,体力活动高等者79人,占16.8%。体力活动不足组的空腹血糖、餐后血糖和糖化血红蛋白水平分别为(7.00±0.69)mmol/l、(7.16±0.49)mmol/l和(11.79±0.51)%,显著性高于体力活动水平中等组和高等组;体力活动不足组的低密度脂蛋白和甘油三酯分别为(1.93±0.64)mmol/l和(2.79±0.56)mmol/l,显著高于体力活动水平中等组和高等组患者,而体力活动不足的Ⅱ型糖尿病患者的高密度脂蛋白水平为(0.93±0.38)mmol/l,显著低于体力活动水平中等组和高等组患者。Ⅱ型糖尿病患者静坐时间与高密度脂蛋白水平呈负相关,与低密度脂蛋白和甘油三脂水平呈正相关。结论Ⅱ型糖尿病患者的体力活动水平和静坐时间均明显影响其糖脂代谢,体力活动水平越高,其糖脂代谢情况越良好;静坐时间越长,其脂代谢越紊乱。     

体力活动咨询对稳定期抑郁症患者体力活动水平的影响

目的研究体力活动咨询对稳定期抑郁症患者体力活动的影响,为提高临床治疗效果提供依据。方法选取2014年6-12月中山大学附属第三医院精神科门诊48例康复期抑郁症患者为研究对象,随机分为体力活动咨询组和对照组,每组24例,其中男性20例,女性28例,年龄22~55岁,平均(34.8±7.9)岁;病程4~18个月。对照组予以简单的"增加体力活动"的建议,体力活动咨询组予以体力活动咨询,基线、2周末、4周末、6周末各访谈1次,评价指标包括中、高强度体力活动次数、时间,汉密尔顿抑郁量表、匹兹堡睡眠质量指数(PSQI)和疲劳量表-14(FS-14),基线和6周末各评定1次。应用SPSS 16.0软件对数据进行χ2检验及t检验。结果 6周末,体力活动咨询组中等强度体力活动次数[(3.79±0.88)次、时间[(127.92±43.13)min/周]、高强度体力活动时间[45(0,60)min/周]、增加体力活动的信心[(6.45±1.62)分)]和意愿[(7.74±3.33)分]均高于对照组[分别为(2.13±1.09)次、(64.00±38.67)min/周、0(0,35)min/周、(4.02±1.95)分和(5.63±2.83)分],差异均有统计学意义(P0.01,P0.05);体力活动咨询组FS-14和PSQI量表评分[分别为(3.08±1.33)和(3.83±1.30)分]低于对照组[分别为(5.88±1.31)和(4.46±1.53)分],差异均有统计学意义(P0.05,P0.01)。结论体力活动咨询可有效提高稳定期抑郁症患者的体力活动水平,并且有助于改善其失眠情况,值得推广。     

童年期虐待经历和体力活动与安徽医学专科生抑郁症状的关联

目的 分析童年期虐待经历和体力活动与抑郁症状的关联,为抑郁症状的预防与干预提供了依据。方法 本研究在2019年11至12月抽取了安徽2所医学专科院校一、二年级在校为研究对象,采用“问卷星”平台进行问卷调查,最终有7 534名医学专科生纳入研究。使用儿童期虐待问卷、国际体力活动简版问卷以及抑郁自评量表分别对医学专科生童年期虐待经历、体力活动以及抑郁症状资料收集。通过多因素logistic回归模型,分析童年期虐待经历和体力活动的不同水平与抑郁症状的关联。结果 医学专科生抑郁症状的检出率为16.1%,男生抑郁症状检出率为19.6%,高于女生的14.9%（P值＜0.05）。多因素logistic回归分析显示,调整混杂因素后,有童年期虐待经历（OR = 4.01,95%CI:3.17～5.08）和低体力活动水平（OR = 1.44,95%CI:1.20～1.74）均与医学专科生抑郁症状风险增加有关（P值均＜0.05）。与无童年期虐待经历和高体力活动水平相比,无童年期虐待经历和低体力活动水平（OR = 2.08,95%CI:1.03～4.20）,有童年期虐待经历和低体力活动水平（OR = 7.18,95%CI:4.05～12.71）、有童年期虐待经历和中体力活动水平（OR = 5.22,95%CI:2.97～9.18）、有童年期虐待经历和高体力活动水平（OR = 5.11,95%CI:2.88～9.08）均与医学专科生抑郁症状风险增加有关（P值均＜0.05）。结论 童年期虐待经历和低体力活动水平均与医学专科生抑郁症状存在正向关联,适当增加体力活动可能有利于缓解童年期虐待经历对医学专科生抑郁症状的影响。     

体力活动与视屏时间对中小学生生活质量的联合效应

了解南京地区中小学生体力活动、视屏时间与生活质量的联合效应,为制定提高学生人群生活质量的综合措施提供参考.方法 2018年在南京市随机抽取小学四年级至高中三年级的4 388名学生为研究对象,使用混合效应模型计算组间均数差值和95%CI分析体力活动、视屏时间与生活质量之间的关联.结果 在调整混杂因素和班级水平的聚集性后,与体力活动不足者相比,体力活动充足者的健康相关生活质量评分增加0.03(95%CI=0.01~0.05);与视屏时间达到2 h/d者相比,视屏时间不足2 h/d者的CHU9D评分增加0.05(95%CI=0.02~0.08);与体力活动不足且视屏时间达到2 h/d的学生相比,体力活动不足且视屏时间不足2 h/d者的健康相关生活质量评分增加0.05(95%CI=0.02~0.09)、体力活动充足而视屏时间达到2 h/d者的评分增加0.03(95%CI=~0.03~0.10)、体力活动充足且视屏时间不足2 h/d者的评分增加0.08(95%CI=0.05~0.12).结论 充足体力活动和较少视屏时间均可增加中小学生人群的生活质量评分,且两者对生活质量评分具有联合效应.     

心血管疾病患者体力活动及其影响因素的中英研究比较

目的 探究中英心血管疾病（CVD）患者体力活动差异，并比较其影响因素。方法 利用中国慢性病前瞻性研究（CKB）项目和英国生物银行（UKB）基线调查数据，根据问卷中自报的疾病史确定病例组和对照组。以代谢当量（MET）作为体力活动水平的衡量指标，并按不同年龄、性别的MET值三分位数进行分级，使用多重logistic回归分析CVD患病与体力活动水平的相关性。结果 共纳入509 170名中国成年人和360 360名英国成年人作为研究对象，多因素调整分析结果显示，CKB和UKB人群CVD患病与低体力活动水平均呈正相关（CKB：OR=1.21，95%CI：1.17~1.25；UKB：OR=1.24，95%CI：1.20~1.28）。CKB中男性CVD患病与低体力活动水平有较高相关性（OR=1.33，95%CI：1.27~1.40）。与UKB人群不同，CKB人群随着CVD患病年限的延长，体力活动水平逐渐恢复并接近非CVD人群，且患有脑卒中与低体力活动水平呈正相关（OR=1.46，95%CI：1.38~1.53）。CKB和UKB人群均表现出低文化程度、当前吸烟或已戒烟、已戒酒、患有其他慢性病与低体力活动水平有较高相关性。CKB中，农村地区人群和非退休人群CVD患病与低体力活动水平之间的相关性较高。UKB中则表现出城市人群和非在职人群CVD患病与低体力活动水平之间的相关性较高。结论 中英CVD患者体力活动水平均较低于非CVD人群。除了低文化程度者、当前吸烟或已戒烟者、已戒酒者，以及患有其他慢性病者外，在中国患者中尤其应关注农村、男性、非退休者的体力活动水平。     

慢性阻塞性肺疾病患者体力活动水平及影响因素分析的中英比较研究

目的 比较中英慢性阻塞性肺疾病（COPD）患者体力活动水平及影响因素差异。方法 利用中国慢性病前瞻性研究和英国生物银行基线调查数据,以一秒率（FEV₁/FVC）<70%作为COPD诊断标准,以代谢当量（MET）作为体力活动水平的衡量指标并按性别、年龄分层的MET值三分位数分为低、中、高3级,分别使用多元逐步logistic回归探究体力活动水平与COPD及慢性阻塞性肺疾病全球倡议（GOLD）分级的关系,并进行亚组分析。结果 共纳入506 073名中国成年人和231 884名英国成年人为研究对象。与非COPD人群相比,中英COPD患者低水平体力活动的OR值（95%CI）分别为1.07（1.03~1.10）、1.03（1.01~1.06）;GOLD分级与体力活动水平呈负相关,且在中国人群中存在线性趋势（趋势检验P<0.001）。亚组分析显示,中英人群中高龄、受教育年限少、经济水平低、过去吸烟、有呼吸系统疾病史的COPD患者体力活动水平下降的可能性更大。中国农村COPD患者体力活动下降的可能性更大。结论 COPD与体力活动水平呈负相关,且GOLD分级与体力活动水平呈剂量反应关系,应鼓励和促进COPD患者尤其高危人群多进行体力活动。     

体力活动与成年人缺血性脑卒中发病关联的前瞻性研究

目的 探讨体力活动和成年人缺血性脑卒中发病的关联。方法 使用中国慢性病前瞻性研究浙江省桐乡市数据,剔除基线时自报患有恶性肿瘤、心脏病、脑卒中和糖尿病患者后,纳入分析30~79岁53 916名研究对象。体力活动分组采用五分位数。采用Cox比例风险回归模型计算缺血性脑卒中发病风险比（HR）值。结果 调查对象体力活动水平为（30.63±15.25）代谢当量（MET）-h/d,男性体力活动水平［（31.04±15.48）MET-h/d］高于女性［（30.33±15.07）MET-h/d ］（P<0.001）。调查对象累计随访595 526人年（平均随访11.4年）。随访期间,1 138名男性和1 082名女性被新诊断为缺血性脑卒中。在调整了社会人口学因素、行为生活方式、BMI、腰围和SBP等多种危险因素后,缺血性脑卒中发病风险随体力活动的增加而降低,趋势检验结果均有统计学意义（P<0.001）。与体力活动最低组（<16.17 MET-h/d）人群相比,中低组（16.17~24.94 MET-h/d）、中等组（24.95~35.63 MET-h/d）、中高组（35.64~43.86 MET-h/d）和最高组（≥43.87 MET-h/d）人群缺血性脑卒中发病HR值分别为0.93（95%CI：0.83~1.04）、0.87（95%CI：0.76~0.98）、0.82（95%CI：0.71~0.95）和0.76（95%CI：0.64~0.89）。结论 增加体力活动可以降低缺血性脑卒中的发病风险。     

南京市城市居民膳食模式与体力活动对高血压发病联合作用

目的探讨膳食模式与体力活动水平对江苏省南京市居民高血压发病风险的联合作用,为高血压的预防控制提供参考依据。方法于2007年5—7月采用多阶段分层整群随机抽样方法在南京市秦淮、白下2个行政区抽取7个社区共3 376名30~75岁城市居民进行高血压筛查,将其中筛查出的418例新发高血压患者和782名未患高血压人群分别作为病例组和对照组进行问卷调查和体格检查。结果 418例病例组新发高血压患者中,采用西式膳食模式(WDP)和精明膳食模式(PDP)者分别占58.37%和41.63%,体力活动不足和充足者分别占56.22%和43.78%;782名对照组未患高血压人群中,采用WDP和PDP者分别占23.40%和76.60%,体力活动不足和充足者分别占48.98%和51.02%;在调整了性别、年龄、文化程度、婚姻状况、职业、家庭年均收入、体质指数(BMI)等混杂因素后,多因素条件logistic回归分析结果显示,采用PDP者发生高血压的风险为采用WDP者的0.208倍(OR=0.208,95%CI=0.160~0.270),体力活动充足者发生高血压的风险为体力活动不足者的0.756倍(OR=0.756,95%CI=0.593~0.962),采用PDP且体力活动不足者、采用WDP且体力活动充足者和采用PDP且体力活动充足者发生高血压的风险分别为采用WDP且体力活动不足者的0.124倍(OR=0.124,95%CI=0.084~0.183)、0.357倍(OR=0.357,95%CI=0.237~0.539)和0.103倍(OR=0.103,95%CI=0.068~0.156)。结论采用健康的膳食模式和保持充足的体力活动均可降低高血压的发病风险,2种方式联合降低高血压发病风险的效果更好。     

慢性肾脏病患者中体力活动与死亡风险的前瞻性关联研究

目的 探究中国成年慢性肾脏病（CKD）患者中体力活动与全因死亡、心血管疾病（CVD）死亡和CKD死亡风险的前瞻性关联。方法 利用中国慢性病前瞻性研究基线调查的数据,采用Cox比例风险回归模型分析总体力活动、不同类型、不同强度体力活动水平与全因死亡、CVD死亡、CKD死亡风险的关联。结果 共纳入6 676名CKD患者,随访时间M（Q₁,Q₃）为11.99（11.13,13.03）年,死亡698名（10.46%）。与总体力活动水平最低组相比,总体力活动水平最高组全因死亡、CVD死亡、CKD死亡风险较低,风险比（HR）值（95%CI）分别为0.61（0.47~0.80）、0.40（0.25~0.65）、0.25（0.07~0.85）。工作、交通、家务相关体力活动与全因死亡、CVD死亡风险呈不同程度的负相关。其中,与工作相关体力活动水平最低组相比,最高组全因死亡（HR=0.56,95%CI：0.38~0.82）、CVD死亡（HR=0.39,95%CI：0.20~0.74）风险较低;与交通相关体力活动水平最低组相比,最高组CVD死亡风险较低（HR=0.43,95%CI：0.22~0.84）;与家务相关体力活动水平最低组相比,最高组全因死亡（HR=0.61,95%CI：0.45~0.82）、CVD死亡（HR=0.44,95%CI：0.26~0.76）、CKD死亡（HR=0.03,95%CI：0.01~0.17）风险较低;未发现休闲相关体力活动与死亡风险间的关联。低强度、中高强度体力活动均与全因死亡、CVD死亡、CKD死亡风险呈负相关,低强度体力活动水平最高组对应的HR值（95%CI）分别为0.64（0.50~0.82）、0.42（0.26~0.66）、0.29（0.10~0.83）,中高强度体力活动水平最高组对应的HR值（95%CI）分别为0.63（0.48~0.82）、0.39（0.24~0.64）、0.23（0.07~0.73）。结论 体力活动可以降低CKD患者全因死亡、CVD死亡和CKD死亡的风险。     

Physician advice and support for physical activity: results from a national survey

BACKGROUND: It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey. METHODS: A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues. RESULTS: Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor. CONCLUSIONS: Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.     

量化的运动与膳食指导在高血压患者中的应用评价

目的观察量化的运动与膳食指导在高血压患者中的应用效果,为高血压社区综合防治提供科学依据。方法按便利抽样的方法在广州市海珠区南华西街抽取254例高血压患者作为研究对象,将研究对象随机分为常规组与干预组。常规组进行以集体宣教方式为主的健康教育干预及血压随访管理,干预组增加量化的运动与膳食指导进行干预。结果干预后干预组的体育锻炼率（77．95％）高于常规组（59．06％）,食油量降幅（4．45g）大于常规组（2．24g）,蔬菜摄入量的增幅（95．81g）大于常规组（27．54g）,水果摄入达标率（70．87％）高于常规组（47．24％）,体质指数降幅[（0．69±1．23）kg／m^2]大于常规组[（-0．17±1．18）kg／m^2],腹围减幅[（1．83±3．90）cm]大于常规组[（0．33±2．95）cm],收缩压降幅[（7．71±13．57）mmHg]和舒张压降幅[（5．34±10．69）mmHg]分别大于常规组[（3．65±13．03）、（1．96±9．18）mmHg],高血压控制率（84．25％）高于常规组（64．57％）,差异均有统计学意义（P〈0．05）。血压控制影响因素的logistic多因素回归分析结果显示,量化的运动与膳食指导、体育锻炼、低体质指数和按医嘱服药是血压控制的有利因素（P〈0．05）。结论在以集体宣教方式为主的健康教育干预及血压随访管理的基础上,增加量化的运动与膳食指导,更能促进患者进行体育锻炼,合理摄入蔬菜水果,减少油的摄入,更能降低血压,提高高血压控制率,并能减小体质指数,缩小腹围。     

Effects of a computer-based,telephone-counseling system on physical activity

BACKGROUND: There is increasing interest in developing interventions to promote physical activity (PA) that do not involve face-to-face contact with health professionals. We developed a fully automated PA counseling system (telephone-linked communication, TLC-PA) that was delivered via telephone. DESIGN: A randomized, controlled trial with 298 adult, sedentary members (mean age, 45.9 years; 72% women; 45% white; and 45% African American) of a multi-site medical practice. The comparison group (TLC-Eat) received an automated intervention promoting healthy eating, which was also delivered via telephone. INTERVENTION: The TLC-PA promoted moderate-intensity PA (MI-PA) based on the transtheoretical model of behavior change and social cognitive theory. The system was available to participants for 6 months. MAIN OUTCOMES: Energy expenditure in MI-PA, proportion of participants who met recommendations for MI-PA, and motivational readiness for PA. MEASURES: Self-reports of PA behavior and motivational readiness at baseline, 3 months, and 6 months. RESULTS: At 3 months, intention-to-treat analyses showed that the TLC-PA group was more likely to meet recommendations for MI- or vigorous-intensity PA (VI-PA) compared to the TLC-Eat group (TLC-PA=26% vs TLC-Eat=19.6%, p=0.04). Among study completers, TLC-PA subjects reported significantly higher daily kilocalorie energy expenditure in MI-PA (2.3 kcal/kg/d vs 2.0 kcal/kg/d, p=0.02); a larger proportion met recommendations for MI- or VI-PA (31.2% vs 21.3%, p=0.02) and were in more advanced stages of motivational readiness than TLC-Eat subjects (TLC-PA=52.5% vs TLC-Eat=42.2%, p=0.04). Results were not maintained at 6 months. The proportion of TLC-PA users decreased significantly over the intervention period. CONCLUSIONS: A fully automated counseling system had positive short-term effects on PA among sedentary adults. Lack of maintenance of effects may be due to a decrease in the number of participants who continued to use the system.     

The effectiveness of physical activity monitoring and distance counseling in an occupational setting - Results from a randomized controlled trial (CoAct)

ABSTRACT: BACKGROUND: Lack of physical activity (PA) is a known risk factor for many health conditions. The workplace is a setting often used to promote activity and health. We investigated the effectiveness of an intervention on PA and productivity-related outcomes in an occupational setting. METHODS: We conducted a randomized controlled trial of 12 months duration with two 1:1 allocated parallel groups of insurance company employees. Eligibility criteria included permanent employment and absence of any condition that risked the participant's health during PA. Subjects in the intervention group monitored their daily PA with an accelerometer, set goals, had access to an online service to help them track their activity levels, and received counseling via telephone or web messages for 12 months. The control group received the results of a fitness test and an information leaflet on PA at the beginning of the study. The intervention's aim was to increase PA, improve work productivity, and decrease sickness absence. Primary outcomes were PA (measured as MET minutes per week), work productivity (quantity and quality of work; QQ index), and sickness absence (SA) days at 12 months. Participants were assigned to groups using block randomization with a computer-generated scheme. The study was not blinded. RESULTS: There were 544 randomized participants, of which 521 were included in the analysis (64% female, mean age 43 years). At 12 months, there was no significant difference in physical activity levels between the intervention group (n=264) and the control group (n=257). The adjusted mean difference was -206 MET min/week [95% Bayesian credible interval -540 to 128; negative values favor control group]. There was also no significant difference in the QQ index (-0.5 [-4.4 to 3.3]) or SA days (0.0 [-1.2 to 0.9]). Of secondary outcomes, body weight (0.5 kg [0.0 to 1.0]) and percentage of body fat (0.6% [0.2% to 1.1%]) were slightly higher in the intervention group. An exploratory subgroup analysis revealed no subgroups in which the intervention affected physical activity. No adverse events were reported. CONCLUSIONS: The intervention was not found effective, and this study does not provide support for the effectiveness of the workplace PA intervention used here. Key terms Physical activity, health behavior, physical activity intervention, lifestyle intervention, distance counseling, work productivity, outcomes, randomized controlled trial Trial registration ClinicalTrials.gov identifier: NCT00994565.     

A survey to assess physical activity promotion by Registered Dietitians

Background Convincing evidence has emerged in recent years for the role of physical activity (PA) in the prevention and treatment of many chronic diseases. These include both physical and mental health problems, which are likely to be encountered by practicing dietitians. This study aimed to identify whether NHS based Registered Dietitians (RDs) currently promote PA to their patients and if so, how they do it and with which patients. Method An anonymous questionnaire sent to 516 RDs in NHS teaching hospitals achieved a 77% (n = 397) return rate. Results Ninety‐three per cent of respondents reported regularly promoting PA particularly with new patients. Among active PA promoters, 87% reported encouraged daily accumulation of PA, 50% focused on sport and exercise and 52% referred patients to GPs or Physiotherapists for advice. Distinctive levels and styles of PA promotion were found to be related to levels of recent training in the field although fewer than one in four had actually received any formal training. Conclusions A high interest in further PA‐specific training (95% of all respondents), together with high variability in the type and quality of advice suggests the need to develop further in‐service training specifically for RDs.     

The role of measurement error in estimating levels of physical activity

Epidemiologic studies have demonstrated that physical inactivity is an important determinant of numerous chronic diseases. However, self-reported estimates of physical activity contain measurement errors responsible for attenuating relative risk estimates. A validation study conducted in 2002-2003 at the Alberta Cancer Board (Canada) included a physical activity questionnaire, four 7-day physical activity logs, and four sets of accelerometer data from 154 study subjects (51% women) aged 35-65 years. The authors used a measurement error model to evaluate validity of the different types of physical activity assessment, and the attenuation factors, after taking into account error correlations between self-reported measurements. The validity coefficients, which express the correlation between measured and true exposure, were higher for accelerometers (0.81, 95% confidence interval (CI): 0.76, 0.85) compared with the physical activity log (0.57, 95% CI: 0.47, 0.66) and questionnaire measurements (0.26, 95% CI: 0.12, 0.40). The estimate of the attenuation factor for questionnaires was 0.13 (95% CI: 0.05, 0.23). Accuracy of physical activity questionnaire measurements was higher for men than for women, for younger individuals, and for those with a lower body mass index. Because the degree of attenuation in relative risk estimates is substantial, after the role of error correlations was considered, validation studies quantifying the impact of measurement errors on physical activity estimates are essential to evaluate the impact of physical inactivity on health.     

Effect of physical activity counseling on physical activity of older people in Finland (ISRCTN 07330512)

The aim of this study was to describe the underlying theory and the implementation of a 2-year individualized physical activity counseling intervention and to evaluate whether benefits persisted 1.5 years after the intervention. The sample included 632 sedentary 75- to 81-year-old participants. Data were collected in 2003-2005. The participants were randomly assigned to an intervention group and a control group. The intervention consisted of an individualized face-to-face meeting followed by telephone contacts every 4 months for 2 years, with the aim to increase participation in specific physical activities as well as to increase habitual physical activity. At the 2-year follow-up, the prevalence of physical activities in the intervention group vs. control group was as follows: supervised calisthenics training 20 vs. 16%, walking for fitness 69 vs. 62%, weight training 13 vs. 8% and water aerobics 19 vs. 7%. For water aerobics and walking for fitness, the treatment effect was significant [water aerobics odds ratio (OR) 2.49, 95% confidence interval (CI) 1.16-5.36, walking for fitness OR 1.58, 95% CI 1.05-2.40]. As to the other activities, the effect did not reach statistical significance. At the 1.5-year post-intervention, the follow-up results indicated that the intervention effect was still evident. The subgroup analyses suggested that physical activity counseling may be most efficacious among people with intact mobility, while those having manifest mobility limitations may not benefit from it. Older people who have manifest mobility limitations may need more face-to-face counseling.     

慢性失眠患者超说明书范围使用非典型抗精神病药物情况

目的调查非典型抗精神病药（atypical antipsychotics,AAPs）在门诊慢性失眠患者中8年前后的使用情况及对苯二氮卓类药物（benzodiazepines,BZDs）的影响,为临床用药提供依据。方法选择2012年（135例）与2005年（113例）在门诊就诊的慢性失眠患者进行AAPs及BZDs使用情况的回顾性调查。结果 2005年患者组BZDs使用率（89.4%）、使用时间[（8.21±3.76）月]、使用剂量[（12.32±3.43）mg/d]高于2012年患者组[分别为79.3%、（5.46±2.05）月、（5.36±2.87）mg/d）],AAPs使用率（15.9%）、依赖综合征发生率（11.1%）低于2012年患者组（分别为42.2%、40.4%）,差异均有统计学意义（P〈0.05,P〈0.01）。2012年使用AAPs患者组的BZDs使用剂量[（3.42±3.11）mg/d]、长期使用率（39.1%）低于无AAPs组[分别为（6.82±3.32）mg/d、60.7%],差异有统计学意义（P〈0.05）。结论 AAPs在门诊慢性失眠患者中的使用有明显增加趋势,有助于减少BZDs的不合理使用,但其自身也存在不合理使用及依赖综合征的情况,需要引起高度重视。