Benefits of a worksite or home‐based bench stepping intervention for sedentary middle‐aged adults – a pilot study Very short intermittent vs continuous bouts of activity in sedentary adults. Moderate to Vigorous Physical Activity and Weight Outcomes: Does Every Minute Count? The effects of 60 minutes of brisk walking per week, accumulated in two different patterns, on cardiovascular risk. A randomized trial comparing structured and lifestyle goals in an internet-mediated walking program for people with type 2 diabetes The Effects of Single Long and Accumulated Short Bouts of Exercise on Cardiovascular Risks in Male Japanese Workers: A Randomized Controlled Study Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults Spectral and bout detection analysis of physical activity patterns in healthy, prepubertal boys and girls Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study A randomized controlled trial of continuous activity, short bouts, and a 10,000 step guideline in inactive adults. The influence of dietary creatine supplementation on performance during repeated bouts of maximal isokinetic cycling in man Training effects of short bouts of stair climbing on cardiorespiratory fitness, blood lipids, and homocysteine in sedentary young women Systematic review of exercise effects on health outcomes in women with breast cancer. Effects of Long versus Short Bout Exercise on Fitness and Weight Loss in Overweight Females The effects of exercise on cognition in Parkinson’s disease: a systematic review Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients.
The aim of this study was to investigate the benefits of a low‐volume , vigorous intensity bench stepping programme in sedentary middle‐aged adults . Thirty‐one healthy but sedentary adults ( 12 men ; 55–64 years ) took part in the study . Participants accumulated up to 9 min per day of stepping exercise on three days per week over the 4‐week experimental period  . Parameters of cardiorespiratory fitness , body composition and lower limb muscle strength were measured on three occasions : TS1 ( baseline test ) , TS2 ( following a 4‐week control period ) and TS3 ( following the 4‐week intervention ) . Data were analysed using a repeated‐ measures ANOVA . Adherence to the programme was excellent ( 96 % ) . Relative to the insignificant changes following the control period , parameters of cardiorespiratory fitness were significantly improved following training . No alterations in body composition or lower limb muscle strength were detected . These results show that less than 30 min per week of bench step exercise , accumulated in short bouts throughout the day , can improve parameters of cardiorespiratory fitness after only 4 weeks in previously sedentary middle‐aged adults . Due to its low‐cost , time‐efficient and discrete aspects , stepping exercise may have important implication s for public health initiatives that promote physical activity in a population who commonly report ‘ lack of time ’ as a barrier to physical activity OBJECTIVE Whether accumulating short intermittent bouts of light-to-moderate physical activity ( LMPA ) can elicit significant improvements in the fitness of sedentary adults , compared to one longer continuous bout . METHODS Fifty sedentary 35- to 60-year-old adults in Hong Kong were r and omly appointed to one of two gender-balanced intervention programs : Exercise Prescription Model ( EPM ) of 30-minute continuous activity , 3 - 4 days per week , or a Lifestyle group ( LIFE ) of 6-minute activity , 5 times per day , 4 - 5 days per week . Aerobic fitness ( VO(2)max ) , mass , body composition , blood pressure , waist-to-hip ratio , and body mass index ( BMI ) were assessed at baseline ( December 1995 ) and after 8 weeks . RESULTS Nearly half of bouts by the LIFE group were < or = 6 min , while 85 % of the EPM bouts were > or = 30 min , with no differences in additional energy expenditure between groups ( EPM : 163.0+/-89.6 MET h vs LIFE : 148.2+/-71.6 MET h ) . Both groups significantly improved their VO(2)max , 7.4 % ( ES=0.36 ) and 5.3 % ( ES=0.24 ) for the EPM and Lifestyle groups respectively ( F((1,43))=34.0 , p<0.0001 ) . CONCLUSIONS Accumulating multiple short bouts of LMPA , of which approximately 50 % were < or = 6 min , can provide significant improvements in the fitness of sedentary adults that is not dissimilar as one continuous bout of similar total duration Purpose . The purpose of this study was to test if moderate to vigorous physical activity ( MVPA ) in less than the recommended ≥ 10-minute bouts related to weight outcomes . Design . Secondary data analysis . Setting . R and om sample from the U.S. civilian noninstitutionalized population included in the National Health and Nutrition Examination Survey ( NHANES ) . Participants . A total of 4511 adults aged 18 to 64 years from the 2003–2006 NHANES . Method . Clinical ly measured body mass index ( BMI ) and overweight/obese status were regressed on accelerometer measures of minutes per day in higher-intensity long bouts ( ≥ 10 minutes , ≥ 2020 accelerometer counts per minute [ cpm ] ) , higher-intensity short bouts ( < 10 minutes , ≥ 2020 cpm ) , lower-intensity long bouts ( ≥ 10 minutes , 760–2019 cpm ) , and lower-intensity short bouts ( < 10 minutes , 760–2019 cpm ) . Socioeconomic and demographic characteristics were controlled . Results . Both higher-intensity short bouts and long bouts of PA  related to lower BMI and risk of overweight/obesity . Neither lower-intensity short bouts nor long bouts related to BMI or risk of overweight/obesity Conclusion . The current ≥ 10-minute MVPA bouts guideline was based on health benefits other than weight outcomes . Our findings showed that for weight gain prevention , accumulated higher-intensity PA bouts of < 10 minutes are highly beneficial , supporting the public health promotion message that “ every minute counts . BACKGROUND Current ACSM guidelines recommend that adults should exercise for 20 - 60 min on 3 - 5 days.week(-1 ) ( M.L. Pollock , et al. , The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness , and flexibility in healthy adults . Medicine and Science in Sports and Exercise , 30 ( 6 ) ( 1998 ) 975 - 991 . ) . For individuals constrained by a busy lifestyle , an exercise prescription that delivers benefits with the minimum investment of time is attractive . The purpose of the present study , therefore , was to examine the effect of instructing sedentary individuals to undertake 20 min of brisk walking , in two different patterns , 3 days per week , on fitness and other cardiovascular disease ( CVD ) risk factors . METHODS Forty-eight subjects ( 31 women ) mean ( + /-SD ) age 45.7 + /- 9.4 year were r and omly assigned to either one 20-min walk ( single bout ) , two 10-min walks ( accumulated bouts ) 3 days week(-1 ) for 12-week , or no training ( control ) . Oxygen consumption ( VO2 ) , heart rate ( HR ) , and ratings of perceived exertion ( RPE ) were measured during a 4-stage treadmill test at pre- and post-intervention . Body composition , resting blood pressure and fasting lipoproteins were also assessed . Thirty-two subjects completed the study . RESULTS There was a significant difference between single-bout and accumulated-bout walkers in the reduction of HR at stages 2 and 3 of the treadmill test from pre- to post-intervention ( P < 0.05 ) . There were no differences between groups for changes in VO2 or RPE from pre- to post-intervention . There were also no changes in body mass , adiposity , blood pressure , waist and hip circumferences , or lipid/lipoproteins . CONCLUSION Brisk walking for 20 min on 3 days of the week fails to alter cardiovascular disease risk factors in previously sedentary adults Background The majority of individuals with type 2 diabetes do not exercise regularly . Pedometer-based walking interventions can help ; however , pedometer-based interventions targeting only total daily accumulated steps might not yield the same health benefits as physical activity programs specifying a minimum duration and intensity of physical activity bouts . Methods This pilot r and omized trial compared two goal - setting strategies : 1 ) lifestyle goals targeting total daily accumulated step counts and 2 ) structured goals targeting bout steps defined as walking that lasts for 10 minutes or longer at a pace of at least 60 steps per minute . We sought to determine which goal - setting strategy was more effective at increasing bout steps . Participants were sedentary adults with type 2 diabetes . All participants : wore enhanced pedometers with embedded USB ports ; uploaded detailed , time-stamped step-count data to a website called Stepping Up to Health ; and received automated step-count feedback , automatically calculated goals , and tailored motivational messages throughout the six-week intervention . Only the automated goal calculations and step-count feedback differed between the two groups . The primary outcome of interest was increase in steps taken during the previously defined bouts of walking ( lasting at least 10 minutes or longer at a pace of at least 60 steps per minute ) between baseline and end of the intervention . Results Thirty-five participants were r and omized and 30 ( 86 % ) completed the pilot study . Both groups significantly increased bout steps , but there was no statistically significant difference between groups . Among study completers , bout steps increased by 1921 ± 2729 steps a day . Those who received lifestyle goals were more satisfied with the intervention ( p = 0.006 ) and wore the pedometer more often ( p < 0.001 ) than those who received structured goals . Conclusion In this six-week intervention , Lifestyle Goals group participants achieved increases in bout steps comparable to the increases seen in the Structured Goals group , representing almost a mile a day of additional moderate intensity bout activity . Pedometer-based walking programs that emphasize total accumulated step counts are more acceptable to participants and are as effective at increasing moderate intensity bouts of physical activity as programs that use structured goals .Trial registration The aim of this study was to determine whether accumulated short bouts of exercise can achieve the same cardiovascular benefits as a single long bout of exercise in sedentary male Japanese workers and to compare the programs ’ relative effects on oxidative stress . Twenty-three sedentary male workers were r and omly assigned into 2 different exercise programs : a Long-bout group , which performed a single period of continuous exercise ( Long-bout group : 30 min × 1 ) 3 d per week , and a Short-bouts group , which performed 3 short bouts of exercise ( Short-bouts group : 10 min × 3 ) 3 d per week . Cardiovascular risk factors , including the plasma thiobarbituric acid-reactive substances ( TBARS ) level , were examined at baseline and after both 10 and 20 wk . In the Long-bout group , waist circumference and maximum oxygen uptake ( VO2max ) significantly improved after 20 wk . The Short-bouts group demonstrated significant increases in VO2max after 10 weeks and in HDL-C after 20 wk . Plasma TBARS significantly decreased after 20 weeks in the Long-bout group and tended to decrease ( but not significantly ) in the Short-bouts group . These results indicate that accumulated short bouts of exercise are an effective option , especially for busy workers , for incorporating exercise into one ’s lifestyle Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Adults are sedentary for an alarming 9 to 10 hours per day ( 1 ) . Accordingly , the popular press has coined the phrase sitting is the new smoking to describe a current epidemic of developed nations ( 24 ) . Evidence indicates that sedentary time is associated with incident cardiovascular disease , incidence of cardiovascular diseaserelated risk factors , and mortality ( 5 , 6 ) . Of note , the risk conferred by prolonged sedentariness is eliminated only by high levels of moderate- to vigorous-intensity physical activity ( MVPA ) ( about 60 to 75 min/d ) , which exceed physical activity recommendations ( 7 , 8) . As such , sedentary behavior is now believed to represent a clinical ly important aspect of a person 's physical activity profile and is no longer considered simply the extreme low end of the physical activity continuum ( 5 ) . Studies linking sedentary behavior to health outcomes have relied almost exclusively on self-reported  sedentary time  , which is subject to reporting bias and measurement error ( 9 ) . A 2015 systematic review ( 5 ) identified only 1 study ( NHANES [ National Health and Nutrition Examination Survey ] ) that examined the association between objective ly measured sedentary time and health outcomes , a study limited by a small event rate ( 10 ) . New studies using NHANES data have since been published , with longer follow-up and higher event rates ( 1115 ) . However , some of these studies have reported an association between objective ly measured sedentary time and mortality ( 11 , 14 , 15 ) , but others have not ( 12 , 13 ) . Additional cohort studies are thus needed to rectify evidence gaps . Furthermore , studies using accelerometers to objective ly measure sedentary behavior conventionally operationalize sedentary time as the total number of sedentary minutes per day . This approach ignores patterns of accumulated sedentary behavior over time . For example , accumulation of sedentary time in a few long bouts or many short bouts represents 2 distinct patterns of sedentary time accrual . Experimental studies have shown that acute periods of prolonged , uninterrupted sedentary behavior cause greater detrimental cardiometabolic effects than sedentary behavior that is periodically interrupted ( 1618 ) , suggestive that it is not just total sedentary time that is relevant to health outcomes , but also the manner in which it is accumulated . Few longitudinal studies , however , have explored the association between prolonged , uninterrupted sedentary behavior and mortality to corroborate these findings . To inform guidelines on reducing sedentary behavior ( target reductions in overall sedentary time or target interruption of prolonged sedentary bouts ) , evidence from prospect i ve studies is needed to 1 ) confirm the association between total sedentary time and mortality using objective measures , 2 ) determine whether prolonged sedentary bouts confer risk for death , and 3 ) eluci date whether the total volume of sedentary time and its pattern of accumulation individually or jointly contribute to risk for death . The purpose of this study , therefore , was to examine the association between objective ly measured sedentary time ( both total volume and accrual in prolonged bouts ) and all-cause mortality in a national cohort of U.S. middle-aged and older adults enrolled in the REGARDS ( Reasons for Geographic and Racial Differences in Stroke ) study . Methods Study Population REGARDS is a population -based study design ed to examine racial and regional disparities in stroke . It comprises 30239 white and black adults aged 45 years or older enrolled between 2003 and 2007 from across the contiguous United States ( 19 , 20 ) . Detailed design and methods for REGARDS are described elsewhere ( 21 ) . Briefly , demographic and cardiovascular risk factor data were collected by telephone interview and an in-home physical assessment on enrollment . A detailed summary of baseline measures is provided in the Supplement . Participants ( or their proxies ) were then followed for 6-month intervals to ascertain vital status . Objective measurements of sedentary behavior were collected from active REGARDS participants from 2009 to 2013 ( mean time from study enrollment , 5.7 years [ SD , 1.5 ] ; range , 1.9 to 9.5 years ) ( 22 ) . A total of 7985 participants adhered to accelerometer wear requirements ( 4 days with accelerometer wear 10 hours ) , provided follow-up data , and were available for the current analyses ( Supplement Figure 1 ) . Supplement Table 1 shows the characteristics of included versus excluded REGARDS participants . The REGARDS study protocol was approved by the institutional review boards of participating institutions . All participants provided informed consent . Supplement . Supplementary Material Accelerometer Data Collection Methods for accelerometer data collection are described elsewhere ( 22 ) . Briefly , participants were fitted with an Actical ( Philips Respironics ) accelerometer secured to their right hip using a nylon belt and were instructed to wear the device during waking hours for 7 consecutive days . The Actical had been vali date d formeasurement of physical activity and sedentary behavior and was shown to have acceptable reliability ( 2325 ) . Activity counts were summed over 1-minute epochs . Nonwear periods were defined as at least 150 consecutive minutes of 0 activity counts . This nonwear algorithm was previously vali date d against daily log sheets in REGARDS participants ( 26 ) . Measurements of 0 to 49 , 50 to 1064 , and at least 1065 counts per minute were defined as sedentary behavior , light-intensity physical activity , and MVPA , respectively , as determined in a laboratory-based calibration study ( 27 ) . A sedentary bout was defined as consecutive minutes in which the accelerometer registered fewer than 50 counts per minute . A sedentary break was defined as at least 1 minute in which 50 or more counts per minute were registered after a sedentary bout . Both sedentary bouts and breaks were exclusively continuous periods , with no interruptions or nonwear intervals allowed in the definition . Outcome Ascertainment All-cause mortality was the primary outcome , defined as any death after completion of the accelerometer protocol regardless of cause . Date s of death were confirmed through review of death certificates , medical records , and administrative data bases . Deaths through 4 September 2015 were included in the current analysis . Statistical Analysis Sedentary and physical activity variables were averaged across compliant days ( 10 hours of wear ) . Because of a high correlation between total sedentary time and wear time ( Supplement Figure 2 ) , we corrected for the influence of wear time by st and ardizing total sedentary time to 16 hours of wear time per day using the residuals obtained when regressing total sedentary time on wear time ( see Methods section of the Supplement ) ( 2830 ) . Participants were stratified into quartiles according to total sedentary time and , separately , mean sedentary bout duration ( a measure of overall prolonged , uninterrupted sedentary behavior ) . Cox proportional hazards regression modeling was used to calculate the hazard ratio ( HR ) for all-cause mortality associated with quartiles of total sedentary time ( and separately , mean sedentary bout length ) . Crude HRs were initially calculated . Subsequent HRs were calculated after adjustment for age , race , sex , region of residence , education , and season the accelerometer was worn ( model 1 ) , with further adjustment for current smoking , alcohol use , body mass index ( BMI ) , diabetes , hypertension , dyslipidemia , estimated glomerular filtration rate less than 60 mL/min/1.73 m2 , atrial fibrillation , history of coronary heart disease , and history of stroke ( model 2 ) . Models were additionally adjusted for MVPA expressed continuously ( model 3 ) . Tests for linear trend across quartiles were conducted by including the quartile for each participant as an ordinal variable in regression models . Proportional hazards assumptions were confirmed with a Kolmogorov-type supremum test ( 31 ) . The above analyses were then repeated in a fully adjusted model , testing interactions for age ( < 65 and 65 years ) , sex ( male and female ) , race ( black and white ) , BMI category ( normal weight and overweight or obese ) , and MVPA category ( < 150 min/wk and 150 min/wk ) . As a secondary analysis , we examined the continuous doseresponse relationship between each sedentary characteristic and all-cause mortality in a fully adjusted model ( model 3 ) using restricted cubic splines ( 32 ) . Cubic polynomials were fitted with the mean of each sedentary characteristic set as the reference and knots placed at the 5th , 35th , 65th , and 95th percentiles ( 33 ) . Nonlinear associations were evaluated using the likelihood ratio test . For nonlinear associations , spline models were used to describe the associations and when the association was determined to be linear , a linear model was used . Because of multicollinearity between total sedentary time and mean sedentary bout duration ( r= 0.61 ) , both variables were not included in the same model . Alternatively , to examine the individual and joint associations of total sedentary time and prolonged , uninterrupted sedentary behavior with mortality , participants were classified into 4 categories : low total sedentary time ( < 750 min/d ) and low prolonged sedentary bout time ( < 10 min/bout ) , low total sedentary time  and high prolonged sedentary bout time  ( 10 min/bout ) , high total sedentary time  ( 750 min/d ) and low prolonged sedentary bout time , and high total sedentary time and high prolonged sedentary bout time . Hazard ratios for all-cause mortality were calculated for each joint category in comparison with the lowlow group in a fully adjusted model ( model 3 ) . Thresholds for total sedentary time ( 750 min/d ) and mean sedentary bout duration ( 10 min/bout ) were selected on the basis of the restricted cubic splines and were confirmed using a method described by Contal and O'Quigley ( see Methods section of the Supplement ) ( 34 ) . To allow for the possibility that sedentary bouts Little is known about the frequency‐intensity patterns of naturally occurring physical activity in children . A data set obtained previously by direct observation of  physical activity in 8 girls and 7 boys ( all prepubertal , ages 6–10 ) was analyzed with spectral analysis to detect significant frequency‐intensity relationships . Pulse detection algorithms were used to characterize the number of exercise bouts , their duration and relative intensity . Spectral analysis revealed that physical activity bouts were frequent , pulsatile , and r and om with no significant frequencies detected during many 24‐min periods of observation . An average of 83 ± 11 bouts per hour were observed in boys and 89 ± 12 bouts per hour in girls , and the mean duration of an exercise bout was 21 ± 5 sec for boys and 20 ± 4 sec for girls ( NS ) . While high‐intensity exercise bouts comprised less than 20 % of the time spent in physical activity , duration of high intensity exercise bouts tended to be longer and accounted for about 40 % of the energy expenditure associated with physical activity . Spontaneous physical activity in prepubertal children is characterized by frequent bouts of brief , mostly low intensity exercise , r and omly interspersed with less frequent , but metabolically substantial high intensity bouts . These findings are potentially useful in assessing the impact of disease on quality of life in children , investigating the relationship between physical activity and mechanisms of growth and development , and creating new approaches for in‐laboratory exercise testing in children . Am . J. Hum . Biol . 10:289–297 , 1998 . © 1998 Wiley‐Liss , Background Most preschool centers provide two 30-min sessions of gross-motor/outdoor playtime per preschool day . Within this time frame , children accumulate most of their activity within the first 10 min . This paper describes the design and baseline participant characteristics of the Short bouTs of Exercise for Preschoolers ( STEP ) study . The STEP study is a cluster r and omized controlled study design ed to examine the effects of short bouts of structured physical activity ( SBS-PA ) implemented within the classroom setting as part of design ated gross-motor playtime on during-school physical activity ( PA ) in preschoolers . Methods / Design Ten preschool centers serving low-income families were r and omized into  SBS-PA versus unstructured PA ( UPA ) . SBS-PA schools were asked to implement age-appropriate 10 min structured PA routines within the classroom setting , twice daily , followed by 20 min of usual unstructured playtime . UPA intervention consisted of 30 min of supervised unstructured free playtime twice daily . Interventions were implemented during the morning and afternoon design ated gross-motor playtime for 30 min/session , five days/week for six months . Outcome measures were between group difference in during-preschool PA ( accelerometers and direct observation ) over six-months . Ten preschool centers , representing 34 classrooms and 315 children , enrolled in the study . The average age and BMI percentile for the participants was 4.1 ± 0.8 years and 69th percentile , respectively . Participants spent 74 % and 6 % of their preschool day engaged in sedentary and MVPA , respectively . Discussion Results from the STEP intervention could provide evidence that a PA policy that exposes preschoolers to shorter bouts of structured PA throughout the preschool day could potentially increase preschoolers ’ PA levels . Trial registration Clinical trials.gov , OBJECTIVE Although several studies have examined the effect of accumulated bouts on health outcomes , the impact of recommending short bouts on activity-related behavior in health promotion efforts has received minimal investigation . METHOD During this 5-week study in 2007 - 2008 , 43 university employees ( 8 male , 35 female ) in the Southeastern United States were r and omly assigned to a group recommended to achieve ( a ) 10,000 steps ( 10 K ) , ( b ) 30-minutes ( 30 min ) of continuous physical activity , or ( c ) 30-minutes of activity in bouts of at least 10 minutes ( bouts ) . RESULTS AND CONCLUSIONS Repeated measures ANOVA revealed that the 10 K group showed the largest increase in step counts whereas the bouts group showed the smallest change over the intervention period , p=0.01 . Condition differences were most pronounced on days in which participants met their activity recommendation . Accelerometer results revealed that the 10 K ( d=1.1 ) and 30 min groups ( d=0.89 ) showed large increases in minutes of moderate to vigorous activity ( MVPA ) , whereas the bouts group showed minimal change ( d=0.11 ) . Although activity recommendations did not differentially affect self-efficacy , participants from all conditions showed decreased self-efficacy across the intervention ( p=0.02 ) , highlighting the need to develop strategies to increase self-efficacy in activity promotion efforts The effect of dietary creatine ( Cr ) supplementation on performance during 3 , 30 s bouts maximal isokinetic cycling and on plasma ammonia and blood lactate accumulation during exercise was investigated . Placebo ( P ) ingestion had no effect on peak power output ( PPO ) , mean power output ( MPO ) and total work output during each bout of exercise . Cr ingestion ( 4 × 5 g.day−1 for 5 days ) significantly increased PPO in exercise bout 1 ( p<0.05 ) and IMO and total work output in exercise bouts 1 ( p<0.05 , p<0.05 , respectively ) and 2 ( p<0.05 , p<0.05 , respectively ) . Cr ingestion had no effect on any of the measures of performance during exercise bout 3 . No difference was observed in peak plasma ammonia accumulation before ( 146 + 30 μmol.l−1 ) and after ( 122 ±17 μmol.l−1 ) P ingestion , however the corresponding concentration was lower following Cr ingestion ( 129 ± 22 μmol.l−1 ) compared with before Cr ingestion ( 160 ± 18 μmol.l−1 , p<0.05 ) , despite subjects performing more work . No difference in peak blood lactate accumulation was observed before and after P or Cr ingestion . The results demonstrate that Cr ingestion can increase whole body exercise performance during the initial two , but not a third , successive bout of maximal exercise lasting 30 s. The lower accumulation of plasma ammonia under these conditions suggests this response is achieved by an effect on muscle ATP turnover Objectives : To study the training effects of eight weeks of stair climbing on Vo2max , blood lipids , and homocysteine in sedentary , but otherwise healthy young women . Methods : Fifteen women ( mean ( SD ) age 18.8 ( 0.7 ) years ) were r and omly assigned to control ( n = 7 ) or stair climbing ( n = 8) groups . Stair climbing was progressively increased from one ascent a day in week 1 to five ascents a day in weeks 7 and 8 . Training took place five days a week on a public access staircase ( 199 steps ) , at a stepping rate of 90 steps a minute . Each ascent took about two minutes to complete . Subjects agreed not to change their diet or lifestyle over the experimental period . Results : Relative to controls , the stair climbing group displayed a 17.1 % increase in Vo2max and a 7.7 % reduction in low density lipoprotein cholesterol ( p<0.05 ) over the training period . No change occurred in total cholesterol , high density lipoprotein cholesterol , triglycerides , or homocysteine . Conclusions : The study confirms that accumulating short bouts of stair climbing activity throughout the day can favourably alter important cardiovascular risk factors in previously sedentary young women . Such exercise may be easily incorporated into the working day and therefore should be promoted by public health guidelines PURPOSE Exercise is commonly recommended to women after breast cancer surgery , yet it is difficult for patients and health professionals to adopt safe and beneficial types and modes of exercise . Thus studies on exercise interventions targeting women with breast cancer treatment were systematic ally review ed . METHODS The review process and quality assessment of the studies followed the guideline of the National Evidence -based Healthcare Collaborating Agency . Relevant studies were obtained from electronic data bases , and two trained review ers independently analyzed the studies . Of the 902 articles sorted , 11 were selected . Then , quality assessment for each study was carried out with the Scottish Intercollegiate Guideline Network ( SIGN ) checklist . RESULTS Seven different types of  exercise interventions were identified from 3 quasi-experimental and 8 r and omized controlled trial studies . The interventions varied in duration from several days to 13 weeks , and tended to show significant effects on psychological outcomes and upper body functions within a short-term period and were effective in alleviating lymphedema at a longer 1-year point . Supervised , professional intervention had significant effects on health indicators and a higher adherence rate . CONCLUSION Well- design ed exercises are effective and beneficial for improving women 's physical , physiological , and psychological health outcomes after breast cancer treatment as well as to facilitate changes in exercise behaviors . The feasibility of applying intervention protocol s , efficiency of interventions , and strengths of exercise protocol s should be further examined Objective : The specific aim of this study was to determine if three 10 minute bouts of exercise per day ( 3 × 10 ) and two 15 minute bouts per day ( 2 × 15 ) were as effective as one 30 minute bout per day ( 1 × 30 ) for improving VO2 max and weight loss . Methods : Overweight , female college students ( body mass index ≥28 kg/m2 ) were recruited and assessed at baseline and post-treatment for aerobic fitness ( Astr and maximal cycle test ) , weight , skinfold thickness ( 7-site ) , and circumference measures ( 4-site ) . Following measurement of  resting energy expenditure ( REE ) , subjects were asked to follow a self-monitored calorie restricted diet ( 80 % of REE ) for the twelve week duration of the study and were assigned ( non-r and om ) to one of four treatment groups : 1 ) a nonexercising control group ( control , n = 8) , 2 ) a 30 minutes continuous exercise group ( 1 × 30 , n = 12 ) , 3 ) a 30 minutes accumulated exercise group ( 2 × 15 , n = 10 ) and 4 ) a second 30 minutes accumulated exercise group ( 3 × 10 , n = 8) . The exercising subjects participated in aerobic exercise training at 75 % of heart rate reserve three to five days per week with all exercise monitored . Results : VO2 max increased significantly while weight , body mass index , sum of skinfolds , and sum of circumferences decreased significantly from baseline to post-treatment in the 1 × 30 , 2 × 15 and the 3 × 10 groups , but not in the control group . A tertiary finding was that exercise participation did not differ among the exercising groups with regard to the average number of days per week . Conclusions : These results support the hypothesis that exercise accumulated in several short bouts has similar effects as one continuous bout with regard to aerobic fitness and weight loss during caloric restriction in overweight , young women Cognitive impairments are highly prevalent in Parkinson ’s disease ( PD ) and can substantially affect a patient ’s quality of life . These impairments remain difficult to manage with current clinical therapies , but exercise has been identified as a possible treatment . The objective of this systematic review was to accumulate and analyze evidence for the effects of exercise on cognition in both animal models of PD and human disease . This systematic review was conducted according to the Preferred Reporting Items for Systematic review s and Meta-Analyses ( PRISMA ) statement . Fourteen original reports were identified , including six pre- clinical animal studies and eight human clinical studies . These studies used various exercise interventions and evaluated many different outcome measures ; therefore , only a qualitative synthesis was performed . The evidence from animal studies supports the role of exercise to improve cognition in humans through the promotion of neuronal proliferation , neuroprotection and neurogenesis . These findings warrant more research to determine what roles these neural mechanisms play in clinical population s. The reports on cognitive changes in clinical studies demonstrate that a range of exercise programs can improve cognition in humans . While each clinical study demonstrated improvements in a marker of cognition , there were limitations in each study , including non-r and omized design s and risk of bias . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system was used and the quality of the evidence for human studies were rated from “ low ” to “ moderate ” and the strength of the recommendations were rated from “ weak ” to “ strong ” . Studies that assessed executive function , compared to general cognitive abilities , received a higher GRADE rating . Overall , this systematic review found that in animal models exercise  results in behavioral and corresponding neurobiological changes in the basal ganglia related to cognition . The clinical studies showed that various types of exercise , including aerobic , resistance and dance can improve cognitive function , although the optimal type , amount , mechanisms , and duration of exercise are unclear . With growing support for exercise to improve not only motor symptoms , but also cognitive impairments in PD , health care providers and policy makers should recommend exercise as part of routine management and neurorehabilitation for this disorder BACKGROUND This study examines whether performance of bout-related physical activity ( PA ) during morning hours is related to greater overall bout-related PA increases within a preoperative PA intervention for bariatric surgery ( BS ) patients . METHODS Participants with severe obesity ( n = 33 ; mean age = 45.6 ± 9.6 years ; BMI = 45.7 ± 7.0 kg/m2 ) seeking BS were r and omized to and completed 6 weeks of preoperative PA counseling ( retention = 82.5 % ) . Participants were encouraged to walk daily at a moderate intensity in bouts ≥ 10 minutes during morning hours to overcome time-related obstacles and establish a PA habit . Timing and amount of bout-related moderate-to-vigorous PA ( MVPA )  was assessed via objective monitor at pre- and postintervention . RESULTS Greater proportion of bout-related MVPA performed during morning hours ( 4:00 AM-12:00 PM ) at postintervention was associated with larger total increases in bout-related MVPA minutes/day ( β = .40 , P = .03 ) . At postintervention , a greater proportion of participants whose longest MVPA bouts occurred during morning hours ( n = 11 ) achieved the public health guideline ( ie , ≥150 bout-related MVPA minutes/week ) versus those whose longest MVPA bouts occurred during nonmorning hours ( n = 19 ; 63.6 % vs. 26.3 % , P = .04 ) . CONCLUSIONS Intervention-related increases in PA  tended to be greatest when PA was performed in the morning . Morning exercise may be a viable strategy for promoting habitual PA in inactive BS patients
There is no difference between continuous and accumulated patterns of exercise in terms of effects on fitness , blood pressure , lipids , insulin and glucose .
There is some evidence from a small number of studies that changes in body mass and LDL cholesterol are more favourable following the accumulated condition .
Collectively our findings suggest that adults are likely to accrue similar health benefits from exercising in a single bout or accumulating activity from shorter bouts throughout the day .
Public health guidelines suggest that physical activity can be accumulated in multiple short bouts dispersed through the day .
A synthesis of the evidence for this approach is lacking .
Our objective was to undertake a systematic review and meta- analysis to examine if exercise interventions consisting of a single bout of exercise compared with interventions comprising the same total duration , mode , and intensity of exercise accumulated over the course of the day have different effects on health outcomes in adults .