Association between physical activity (PA) guidelines and body composition variables in middle-aged and older women

Archives of Gerontology and Geriatrics 55 (2012) e14–e20

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Association between physical activity (PA) guidelines and body composition variables in middle-aged and older women Jana Pelclova´ a, Alesˇ Ga´ba b,*, Lenka Tlucˇa´kova´ c, Dariusz Pos´piech d a

Center for Kinanthropology Research, Faculty of Physical Culture, Palacky´ University in Olomouc, Trˇ. Mı´ru 115, 771 11 Olomouc, Czech Republic Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky´ University in Olomouc, Trˇ. Mı´ru 115, 771 11 Olomouc, Czech Republic c Faculty of Sports, University of Presˇov, 17. novembra 13, 081 16 Presˇov, Slovak Republic d Academy of Physical Education, Mikolowska 72a, 400 65 Katowice, Poland b

A R T I C L E I N F O

A B S T R A C T

Article history: Received 8 March 2012 Received in revised form 22 June 2012 Accepted 24 June 2012 Available online 21 July 2012

The aim of this study was to investigate the association between volume and frequency of moderateintensity PA and step-based recommendations and individual body composition variables. Our cohort included 167 healthy ambulatory women (mean age 62.8  4.8 years; body mass index [BMI] 27.3  4.2 kg/m2) who carried out daily activities while wearing the ActiGraph GT1M accelerometer over a seven day period. Measurements of BMI, body fat mass index (BFMI), fat-free mass index (FFMI), waist–hip ratio (WHR) and visceral fat area (VFA) were obtained by the InBody 720 multifrequency bioelectrical impedance analysis (MFBIA) device. The significant relationship (rs = 0.66; p < 0.05) was found between moderate PA and steps per day. Moderate PA (r2 = 0.03–0.06) and steps per day (r2 = 0.05–0.20) were significantly associated with observed body composition parameters. Women spending > 300 min/week in moderate PA showed significantly lower values of BFMI (p = 0.02) than those who spent 150–300 min/week. Carrying out moderate PA for 30 min 5 days a week was significantly associated with lower BMI (p = 0.04; h2 = 0.02), BFMI (p = 0.02; h2 = 0.03) and VFA (p = 0.03; h2 = 0.03). In addition, higher amounts of daily steps were significantly associated with lower BMI (p = 0.00; h2 = 0.16), BFMI (p = 0.00; h2 = 0.21), VFA (p = 0.00; h2 = 0.20) and WHR (p = 0.00; h2 = 0.13). A clear association was found between the generally recommended PA guidelines and body composition variables for the women examined in this study. However, the concept of 10,000 steps/day appears to be the strongest predictor of health-related body composition values. ß 2012 Elsevier Ireland Ltd. All rights reserved.

Keywords: ActiGraph GT1M Walking Body mass index Body fat mass index Fat-free mass index Abdominal adiposity

1. Introduction The association between PA and health outcomes is well established (Kesaniemi et al., 2001). A generally inverse linear dose–response relationship exists between the amount of PA performed and all-cause mortality (Lee & Skerrett, 2001) in both men and women (Oguma, Sesso, Paffenbarger, & Lee, 2002). The same has been shown for total cardiovascular disease and coronary heart disease incidence and mortality, and for the incidence of type 2 diabetes mellitus (Kesaniemi et al., 2001). Furthermore, increasing PA (expressed as energy per week) is positively related to reductions in total adiposity, and the effects occur in a dose– response manner (Ross & Janssen, 2001). A protective effect of PA on site-specific cancer risk, with a dose–response association between PA and colon and pre- and postmenopausal breast cancer, has also been suggested by the particular biological mechanisms

* Corresponding author. Tel.: +420 777 945 875. E-mail address: [email protected] (A. Ga´ba). 0167-4943/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.archger.2012.06.014

that are responsible for the development of these diseases (Thune & Furberg, 2001). Based on our current understanding of the biological mechanisms underlying the dose–response relationship between PA and health, PA guidelines have been established to recommend a minimal amount of PA to the general public. By exceeding the minimal recommended PA, persons are more likely to improve their personal fitness, reduce their risk for chronic diseases and disabilities, and prevent unhealthy weight gain (Haskell et al., 2007). PA guidelines are promoted in many countries, as well as by the World Health Organization (WHO) (EU Sport Ministers, 2008). The most up-to-date recommendations for adults issued by the American College of Sports Medicine and the American Heart Association (ACSM/AHA recommendations) suggest that all healthy adults, aged 18–65 years, carry out activities of moderate-intensity aerobic PA for a minimum of 30 min five days a week or of vigorous-intensity aerobic PA for a minimum of 20 min three days a week (Haskell et al., 2007). Accordingly, WHO recommends the same PA strategies (World Health Organization, 2010). The connection between the PA profile (type, intensity and amount) and health benefits that enhance quality of life is well

J. Pelclova´ et al. / Archives of Gerontology and Geriatrics 55 (2012) e14–e20

recognized (Haskell et al., 2007). However, the optimal permutation of type, intensity, duration and frequency of PA in relation to specific health outcomes and across the lifespan remains unclear. As a result, the 2008 Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2008) suggest that a person simply accumulate a total of 150 min/week from various activities of moderate intensity, as opposed to the previously recommended moderate PA for 30 min five days a week. It is important to note that the above-mentioned public health recommendations are in addition to normal daily PA. In contrast, walking recommendations to achieve health benefits are based on total steps in a day and include all daily activity. Studies have shown that meeting the most popular walking recommendation value, ten thousand steps per day (Hatano, 1993), is associated with increased health benefits, specifically avoidance of obesity and weight gain (Levine et al., 2007) and reduction of total body fat (Hornbuckle, Bassett, & Thompson, 2005; Thompson, Rakow, & Perdue, 2004). Tudor-Locke and Bassett (2004) proposed that the step-based preliminary indices be used to classify PA in healthy adults according to the sedentary lifestyle index, which is composed of four categories: low active, somewhat active, active and highly active categories. Unfortunately, it remains unclear whether these types of recommendations are congruent in relation to health benefits. Therefore, the objectives of this study were to: (1) collect data from one week of PA and amount of daily steps in middle aged and older adult women for comparison with the current PA and step-based recommendations; (2) investigate the association between carrying out moderate PA and step-based recommendations and body composition variables; and (3) explore the association of frequency of meeting PA and step-based recommendations per week with those body composition variables. 2. Materials and methods 2.1. Subjects and design Two-hundred and twelve healthy ambulatory women were recruited by offering free PA and body composition analysis at the University of Third Age (Senior University) in the Czech Republic, Slovakia and Poland. We eventually excluded data from 45 of the participants due to technical causes or recording failures; hence, the present analysis analyzed data from 167 females. The BMI and age-related data corresponding to individuals from each country are shown in Table 1. The study was carried out according to the design and methods approved by Faculty of Physical Culture Ethics Committee at the Palacky´ University in Olomouc. This study was a cross-sectional, descriptive, and non-randomized including analysis of a quantitative data. Data collection using the accelerometer and MFBIA device was carried out in 2008 and 2009 with the verbal and written consent from all subjects. 2.2. PA PA was objectively assessed by using the ActiGraph GT1M accelerometer (Manufacturing Technology Inc., FL, USA). The data Table 1 BMI and age-related data of participants. BMI (kg/m2)

Participants country of residence

N

Age (years) M

SD

M

SD

Czech Republic Slovakia Poland

45 51 71

64.2 61.8 62.5

3.8 5.0 5.2

26.1 27.5 27.9

3.6 4.2 4.5

N: number of participants.

e15

were intentionally collected during moderate spring and autumn seasons having mean temperatures of 10 8C (according to measurements taken four times within 24 h periods), avoiding warm summers when the mean temperatures were >20 8C and cold winters with mean temperatures ranging between 5 8C and +3 8C. Participants were instructed on how to affix the accelerometer snugly by means of an elastic belt cinched at the midaxillary line of the right hip and agreed to wear the instrument during all waking hours, with the exception of times used to perform water activities. Furthermore, participants were asked to wear the accelerometer for at least 10 h a day for a consecutive eight days. For reducing subject reactivity, the first day was not included in the analysis, thus seven days of data were used to assess guideline compliance (Esliger, Copeland, Barnes, & Tremblay, 2005). Daily activity logs with compliance instructions were used for subjects to self-record times when accelerometer was worn and activity patterns (Murphy, 2009) so that we could obtain a more accurate picture of the individual’s PA profile and were able to make some judgment while adjudicating the data (Esliger et al., 2005). Using manufacture supplied software, the time sampling interval of the accelerometers was set at 1 min, an epoch usually selected by users performing free-living PA or epidemiological researchers (Esliger et al., 2005), and step mode was activated. After the eight day period, the recorded data containing activity counts and steps were downloaded with the assistance of the manufacturer’s software. McClain, Sisson, and Tudor-Locke (2007) reported that interinstrument reliability for raw variables of both total activity counts and steps remained high during free-living. Downloaded counts data were assessed and cleaned according to procedures reported by Esliger et al. (2005). Using assessment of activity logs, swimming was classified as an activity when the accelerometer was not worn; hence, this activity was assigned counts per minute equal to the metabolic equivalent (MET) value published in the Compendium of Physical Activities (Ainsworth et al., 2011). The older adult women who participated in the study were very active, and the majority of participants were younger than 65 years; therefore, the data were analyzed according to scoring for adults established by Freedson, Melanson, and Sirard (1998). In order to identify the boundary between light (<3 METs) and moderate activity (3–6 METs), and moderate and vigorous activity (>6 METs) the cut-off points of 1951 and 5724 counts/min were used, respectively. Considering our steps-based data, values were excluded if they were outside the range of 1000–30,000 steps/day, as suggested by Tudor-Locke, Burton, and Brown (2009). 2.3. Anthropometric measurements and MFBIA Body height was measured by the anthropometer P-375 (Trystom, Olomouc, Czech Republic) while the subject was in the standing position and not wearing shoes. Measurements were recorded to the nearest 0.5 cm. Body weight was determined to the nearest 0.1 kg, with the participants wearing light clothing. Impedance of arm, trunk and leg muscles was obtained by using the InBody 720 (Biospace Co., Ltd., Seoul, Korea) with an alternating current of 250 mA at multifrequency of 1 kHz, 5 kHz, 50 kHz, 250 kHz, 500 kHz and 1000 kHz. Total body impedance value was calculated by summing the segmental impedance values. To obtain measurements, the participant remained in the standing position and was barefoot, holding the eight-point tactile electrode. The surface of the hand electrode was ensured to be in contact with each of the five fingers (the thumb was placed lightly on top and the other four fingers were along the bottom of the electrode), while the subject’s heels were placed on the circular-shaped foot electrode, before the fore-foot hits the front electrode. Arms and legs were held out so as not to come in contact with any other body parts. The arms were approximately 158 from

27.5 22.5 14 16 33.3 28.2 17 20 23.5 32.4 12 23 15.7 16.9 8 12 29.4 42.3 15 30

% N

11 31.1

% N

14 28.9

% N

13 15.6

% N % N

7

N N

55.6

>12,500 steps/day 10,000– 12,500 steps/day 7500–9999 steps/day <7500 steps/day 150–300 min/week <150 min/week

Meet MPA 5  30 min/week

Steps/dayc

25

the torso and legs were 458 apart. The procedure takes less than 2 min and required no specific skills. The measurement was performed under laboratory conditions, and according to the user’s manual instructions (Biospace, 2008). MFBIA by the InBody 720 is considered a valid method for assessment of the body composition in middle-aged (Ling et al., 2011) and older adult population (Kyle, Genton, Karsegard, Slosman, & Pichard, 2001). Five body composition variables were chosen to assess health relation to PA levels based on PA and steps guidelines. BMI (kg/m2) defines obesity (World Health Organization, 1998), but it cannot provide complex information about the variability of body fat mass and fat-free mass (FFM). Therefore, we used BFMI (kg/m2) and FFMI (kg/m2) to facilitate evaluation of height-independent body fat mass and FFM (Schutz, Kyle, & Pichard, 2002). BFMI was calculated as body fat mass (kg) divided by the height squared (m2); FFMI was calculated as FFM (kg) divided by the height squared (m2). For women within the normal BMI range, derived BFMI values from 3.9 to 8.2 kg/m2 were used and FFMI values ranging from 14.6 to 16.8 kg/m2 were used (Kyle, Morabia, Schutz, & Pichard, 2004). FFM was estimated by dividing total body water by the constant 0.73. Total body water was estimated by MFBIA from area, length, volume, impedance and a specific resistivity. WHR and VFA were used to evaluate abdominal obesity (Snijder, van Dam, Visser, & Seidell, 2006), which is significantly related to increased disease risk (Janssen, Katzmarzyk, & Ross, 2004; Molarius, Seidell, Sans, Tuomilehto, & Kuulasmaa, 1999). WHR was calculated by dividing waist circumference (cm) by hip circumference (cm). VFA was defined by considering a transverse cross-section in the abdominal area at level L4–L5, and was determined by the InBody 720. Correlation of computer tomography and InBody 720 was set at r = 0.92 (Biospace, 2008).

24.4

J. Pelclova´ et al. / Archives of Gerontology and Geriatrics 55 (2012) e14–e20

Time spent in moderate PAa,b

e16

MPA: moderate physical activity. a 2008 Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2008). b ACSM/AHA, WHO (Haskell et al., 2007). c Tudor-Locke and Bassett (2004).

70.6 57.7 36 41 31.4 45.1 16 32 41.2 32.4 21 23 27.4 22.5 14 16

%

44.4 20

N %

51.1 23

N %

28.9 13 20.0

%

9

Czech Republic Slovakia Poland

>300 min/week

Table 2 Distribution of Czech, Slovak and Polish participants according to PA guidelines cut-offs.

The statistical package Statistica 9 (StatSoft, 2009) was used for data analysis with significant levels set at p < 0.05. As the data were found to be normally distributed for all variables examined, descriptive statistics were presented as means (M) and standard deviation (SD). Spearman correlation coefficient (rs) was computed to quantify the linear relationship between moderate PA and steps per day. Partial correlation analysis (rp) was used to evaluate the strength of association between body composition variables and independent PA variables while controlling for steps per day and moderate PA, respectively. We calculated coefficient of determination (the square of r) as indicator of effect size. Analysis of variance (ANOVA) was used to test whether body composition variables (dependent variables: BMI, BFMI, FFMI, WHR, VFA) were associated with achievement of different PA guidelines (independent variables): (1) 2008 Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2008) (moderate PA: <150 min/week, 150–300 min/ week, >300 min/week); (2) ACSM/AHA, WHO recommendation (Haskell et al., 2007) (moderate PA: <30 min five times a week, 30 min five times a week); (3) classification of step-based PA (Tudor-Locke & Bassett, 2004) (<7500 steps/day, 7500– 9999 steps/day, 10,000–12,500 steps/day, >12,500 steps/day). In those cases examining more than two groups as independent variables, Fisher’s LSD post hoc was used to identify the differences between groups. Furthermore, we used ANOVA and Fisher’s LSD post hoc test to assess the differences between frequencies (2/ week, 3–4/week, 5/week) of meeting PA guidelines (30 min of moderate PA/day; 10,000 steps/day) and body composition variables (BMI, BFMI, FFMI, WHR, VFA). The Eta-squared (h2 = SSeffect/ SSeffect + SSerror) was calculated as an indicator of effect size. According to suggestion of Morse (1999), the values of 0.01, 0.06 and 0.14 were interpreted as small, medium and large effect.

Do not meet MPA 5  30 min/week

2.4. Statistical data analysis

J. Pelclova´ et al. / Archives of Gerontology and Geriatrics 55 (2012) e14–e20 Table 3 Correlations between the PA and body composition variables. MPA (min/week) r 2

BMI (kg/m ) BFMI (kg/m2) FFMI (kg/m2) VFA (cm2) WHR

r *

0.21 0.20* 0.17* 0.25* 0.18*

significantly associated with observed body composition parameters. However, it is evident that increases in steps per day were associated with decreases in all body composition variables. Additionally, steps per day were a stronger predictor of healthrelated body composition values than moderate PA. Table 4 demonstrates the association observed between the PA guidelines for Americans cut-off points and body composition variables. Statistically significant differences were found among women having spent <150 min/week, 150–300 min/week and >300 min/week of moderate PA for only one BFMI (p = 0.04; h2 = 0.04). According to Fisher’s LSD post hoc test, a significant difference existed between the group that spent 150–300 min/ week and the group that spent >300 min/week of moderate PA for this variable (p = 0.02). Differences between those participants who did not meet the recommended moderate PA for 30 min five days a week and those who did met this recommendation were statistically significant for all variables, except for FFMI and WHR (Table 5). Achieving 30 min five days a week of moderate PA was associated with lower BMI (p = 0.04; h2 = 0.02), BFMI (p = 0.02; h2 = 0.03) and VFA (p = 0.03; h2 = 0.03). Based on the preliminary classification of PA suggested by Tudor-Locke and Bassett (2004) increases in daily steps was significantly associated with lower BMI (p = 0.00; h2 = 0.16), BFMI (p = 0.00; h2 = 0.21), VFA (p = 0.00; h2 = 0.20) and WHR (p = 0.00; h2 = 0.13) (Table 6). The associations between how many times/week the participants achieved 30 min of moderate PA and 10,000 steps/day and the body composition variables are shown in Tables 7 and 8. Statistically significant differences were found among women who achieved 30 min of moderate PA  2/week, 3–4/week and 5/ week and BFMI (p = 0.05; h2 = 0.03) and VFA (p = 0.05; h2 = 0.04). According to Fisher’s LSD post hoc test, a significant difference existed between the group who achieved 30 min of moderate PA 3–4/week and 5/week and BFMI (p = 0.03) and VFA (p = 0.02). Increased frequency of performing 10,000 steps/day was significantly associated with lower BMI (p = 0.00; h2 = 0.09), BFMI (p = 0.00; h2 = 0.12), VFA (p = 0.00; h2 = 0.11) and WHR (p = 0.00; h2 = 0.07).

Steps per day

2

r2

r *

0.04 0.04 0.03 0.06 0.03

0.39 0.42* 0.23* 0.45* 0.34*

e17

0.15 0.17 0.05 0.20 0.11

r2: coefficient of determination. Partial correlation was used while controlling steps per day and MPA, respectively. * p < 0.05.

3. Results PA levels classified on the basis of PA guidelines are shown in Table 2 for the participants from the Czech Republic, Slovakia and Poland. The recommendation of 150 min/week of moderate PA was accomplished by 80% of Czech, 72.6% of Slovak and 77.5% of Polish participants. In contrast, only 55.6% of Czech, 29.4% of Slovak and 42.3% of Polish participants met the recommended 30 min five days a week of moderate PA. Considering the steps/day results, 55.5% of Czech, 60.8% of Slovak and 50.7% of Polish women met the recommended 10,000 steps/day. In total, 76.6% of participants accomplished the recommended 150 min/week of moderate PA, 41.9% met the recommended 30 min five days a week of moderate PA and 55.1% achieved 10,000 steps/day. According to the suggested BMI categories of the World Health Organization (World Health Organization, 1998), only 26.3% of women were of optimal weight, while 51.5% were overweight and 21.6% were obese. Based on the BFMI and FFMI classifications (Kyle, Morabia, et al., 2004), only 26.6% of women had normal BFMI values, and 41.3% of women fell within the normal FFMI category. The significant relationship (rs = 0.66; p < 0.05) was found between moderate PA and steps per day. Therefore we calculated which the stronger predictor of body composition parameters is. Detailed results of a partial correlation analysis are presented in Table 3. Both moderate PA (r2 values ranging from 0.03 to 0.06) and steps per day (r2 values ranging from 0.05 to 0.20) were

Table 4 The effects of PA on body composition variables according to the 2008 Physical Activity Guidelines for Americans.

BMI (kg/m2) BFMI (kg/m2) FFMI (kg/m2) VFA (cm2) WHR

<150 min/week, N = 39

150–300 min/week, N = 57

>300 min/week, N = 71

M

SD

M

SD

M

SD

27.6 10.7 16.9 139.0 0.98

5.3 4.2 1.5 37.3 0.06

28.1 10.8 17.3 142.7 0.99

4.7 3.5 1.5 31.4 0.05

26.6 9.4 17.2 131.5 0.97

3.0 2.4 1.3 20.9 0.04

F

h2

2.25 3.36* 1.17 2.46 2.02

0.03 0.04 0.01 0.03 0.02

h2: indicator of effect size. *

p < 0.05.

Table 5 The effects of PA on body composition variables according to the ACSM/AHA, WHO recommendations.

BMI (kg/m2) BFMI (kg/m2) FFMI (kg/m2) VFA (cm2) WHR *

p < 0.05.

Do not meet MPA 5  30 min/ week, N = 97

Meet MPA N = 70

5  30 min/week,

M

SD

M

SD

27.9 10.7 17.2 141.2 0.98

4.9 3.7 1.5 33.9 0.05

26.6 9.4 17.2 131.5 0.97

3.0 2.5 1.0 20.3 0.04

F

h2

3.97* 5.78* 0.15 4.53* 3.23

0.02 0.03 0.01 0.03 0.02

J. Pelclova´ et al. / Archives of Gerontology and Geriatrics 55 (2012) e14–e20

e18

Table 6 The effects of PA on body composition variables according to steps/day classification.

BMI (kg/m2) BFMI (kg/m2) FFMI (kg/m2) VFA (cm2) WHR *

<7500 steps/day, N = 27

7500–9999 steps/ day, N = 48

10,000–12,500 steps/ day, N = 51

>12,500 steps/day, N = 41

M

SD

M

SD

M

SD

M

SD

30.7 13.2 17.5 162.7 1.02

3.9 3.1 1.2 25.4 0.05

28.0 10.6 17.4 142.2 0.98

4.9 3.7 1.5 32.8 0.06

26.0 9.1 16.9 128.5 0.96

3.2 2.3 1.2 22.0 0.04

26.0 8.9 17.1 124.7 0.97

3.4 2.7 1.2 23.5 0.04

F

h2

10.63* 14.62* 1.37 13.94* 8.61*

0.16 0.21 0.03 0.20 0.13

p < 0.05.

Table 7 The effects of PA on body composition variables according to frequencies/week of achieving 30 min of moderate PA. 2/week, N = 53

BMI (kg/m2) BFMI (kg/m2) FFMI (kg/m2) VFA (cm2) WHR *

3–4/week, N = 44

5/week, N = 70

M

SD

M

SD

M

SD

27.6 10.6 17.0 138.0 0.98

5.2 4.0 1.5 36.7 0.06

28.2 10.8 17.4 145.0 0.99

4.6 3.4 1.6 30.2 0.05

26.6 9.4 17.1 131.5 0.97

3.0 2.5 1.0 20.3 0.04

F

h2

2.20 2.92* 1.01 2.98* 2.08

0.03 0.03 0.01 0.04 0.02

p < 0.05.

Table 8 The effects of PA on body composition variables according to frequencies/week of achieving 10,000 steps/day. 2/week, N = 60

BMI (kg/m2) BFMI (kg/m2) FFMI (kg/m2) VFA (cm2) WHR *

3–4/week, N = 52

5/week, N = 55

M

SD

M

SD

M

SD

28.8 11.5 17.3 148.8 0.99

4.6 3.7 1.4 32.5 0.05

27.1 9.9 17.2 136.1 0.97

4.1 2.9 1.4 26.8 0.05

25.8 8.8 17.0 125.2 0.96

3.4 2.9 1.2 22.7 0.04

F

h2

7.89* 11.08* 0.63 10.36* 6.03*

0.09 0.12 0.01 0.11 0.07

p < 0.05.

4. Discussion This study aimed to investigate the association between doses of PA (based on PA guidelines) and body composition variables. Despite the fact that PA guidelines recommend weekly moderate PA or vigorous PA or equivalent combinations of the two (Haskell et al., 2007; U.S. Department of Health and Human Services, 2008), only moderate PA within different PA guidelines was analyzed to maintain focus and clarity in the study. The majority of participants performed only light- and moderate-intensity PA and not any vigorous PA. 4.1. Impact of PA on body composition Several body composition variables were chosen to identify the relationship between health and PA doses. Despite the fact that BMI is a standard value used to define obesity, it cannot provide complex information about the variability of body fat mass and FFM. Therefore, we used BFMI and FFMI to evaluate height independent body fat mass and FFM (Schutz et al., 2002). Previous studies have found that PA leads to lower risks of being overweight or obese and having high or very high BFMI (Kyle, Genton, Gremion, Slosman, & Pichard, 2004). Our study showed similar results in that the most active subjects presented with significantly lower BFMI. It is generally accepted (Hayashi et al., 2008; Seidell & Bouchard, 1997) that the total amount of body fat mass, as well as the level of visceral fat, is associated with the development of

several diseases. We observed significantly lower total visceral fat, expressed by VFA (cm2), in women that met ACSM/AHA, WHO and step-based recommendations. Our findings are consistent with those reported by Ga´ba et al. (2009) which described differences in VFA dependent on the PA levels experienced by women in the same age group. Gradual decrease in FFM, as indicated by measurements of muscle mass, is known to contribute to a decline in physical function, increased disability, frailty and loss of independence. Kyle, Genton, Slosman, and Pichard (2001) found lower FFM in men and women older than 60 years, and observed an accelerated loss in men and women older than 75 years. The values of FFMI in our sample of 60 years old women, regardless of the level of PA, were consistent with those reported in the above-mentioned study. Furthermore, Hughes et al. (2004) confirmed the lack of change in FFM in women with a mean age 60.7 years, as compared to their male counterparts. Still other research (Toth, Beckett, & Poehlman, 1999) has revealed that resistance exercise, as opposed to aerobic exercise, appears to have the additional benefit of increasing FFM. While aerobic exercise decreases fat mass, it is believed to have little effect on FFM. These findings might also help to explain the results from our study in which our participants carried out only aerobic PA. Even though the relationship between FFMI and both overall moderate PA and steps/day was statistically significant, the effect size results indicated only small effect, especially in moderate PA. Moreover, we did not detect any association between FFMI and different doses of PA based on PA guidelines.

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4.2. Comparison of two moderate PA guidelines Physical Activity Guidelines for Americans allow for a person to accumulate 150 min a week in various ways (U.S. Department of Health and Human Services, 2008), as opposed to the moderate PA for 30 min five days a week suggested by the ACSM/AHA. In our study, the recommended 150 min/week of moderate PA seems to be more easily accomplished or preferred, since 76.6% of participants achieved this activity level; only 41.9% achieved the recommended moderate PA for 30 min five days a week. Moreover, the women who participated in moderate PA 150–300 min/week had significantly higher (worse) values of body composition variables (BMI, BFMI, VFA, WHR) than those who accomplished >300 min/week. Values of body composition variables corresponding to those participants with >300 min/week of moderate PA were comparable, and nearly equal, to values of participants who achieved the 30 min of moderate PA five times a week. Out of the total sample size, 59 participants met both >300 min/week and the 30 min five times a week of moderate PA guidelines, which was approximately 84% of participants with >300 min/week of moderate PA and 83% of participants who achieved the 30 min of moderate PA five times a week. 4.3. Comparison of intensity and step-based guidelines Using the preliminary classification of steps/day suggested by Tudor-Locke and Bassett (2004), an increase in daily steps was found to be significantly associated with lower BMI, BFMI, VFA and WHR. The inverse relationship between walking and BMI values has already been well documented in several studies (Ga´ba et al., 2009; Swartz, Strath, Parker, Miller, & Cieslik, 2007; Tudor-Locke et al., 2009). Furthermore, a clear inverse association had been previously found to exist between daily accumulated steps and body composition variables (body fat percentage, WHR, waist and hip circumference), as confirmed in 69 African-American women aged 40–62 years (Hornbuckle et al., 2005) and in 80 middle-aged women from the USA state of Tennessee (Thompson et al., 2004). Based on the results we obtained in this study, the value of 10,000 steps/day seems to represent the threshold of PA associated with indicators of good health in women from Central European countries. Moreover, the body composition values were found to be significantly better in women who achieved the recommended 30 min of moderate PA five times/week, as compared to the women who did not meet this level of activity, confirming the rationale for promotion of this PA guideline in women of the age group examined in our study. Values of body composition variables were slightly better in groups whose members reached 10,000 steps/day than those who achieved the daily 30 min of moderate PA; however, lower BMI, BFMI, VFA and WHR were observed in both groups. Hultquist, Albright, and Thompson (2005) reported a general concordance between 10,000 steps/day and 30 min walk/day in previously inactive women. Moreover, a comparative analysis by TudorLocke and Bassett (2004) suggested that accumulating 30 min/day of moderate PA (walking) as a supplement to routine daily activity fairly agrees with the benefits from the 10,000 steps/day guideline. Likewise in this study, the strong relationship was confirmed between moderate PA and steps per day. However, detailed results of partial correlation analysis suggested that steps per day were a stronger predictor of health-related body composition values than moderate PA. The results of our study showed that women who met the 10,000 steps/day guideline had comparable body composition variables to women who accomplished 2008 Physical Activity Guidelines for Americans, suggesting that accumulation of 300 min/week of moderate PA provided significant health benefits.

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These results are in agreement with the findings of the pilot study carried out in the Czech Republic using 56–73-year-old women (Ga´ba et al., 2009); the women were tracked as they performed >300 min of moderate PA and were found to have attained similar health benefits to taking 10,000 steps a day. In contrast, those women who attained the general recommendations of at least 150 min/week were found to have taken an average of only 8430 steps/day. 4.4. Frequencies/weeks of achieving moderate intensity PA and stepbased guidelines The study presented herein also aimed to explore the association of frequency of achieving the moderate PA and stepbased recommendations per week with body composition variables. The analysis of frequency of carrying out at least 10,000 steps/day indicated that the participants who accomplished 10,000 steps or 30 min of moderate PA five or more times/ week had the best values of BMI, BFMI, VFA and WHR, as compared to participants meeting the respective recommendation four or less times a week. These findings suggest the current PA guidelines (ACSM/AHA recommendations) are effective as the frequency of moderate PA five or more times a week yields health-related benefits and might decrease the risk of obesity. Although our study was cross-sectional in design, and did not allow for the identification of any causal relationships, it is unique in the way it combined PA measurement using motion sensors and MFBIA in order to identify the significantly associated body composition variables. Moreover, the strengths of the study include analysis of both intensity-based and step-based PA guidelines in relation to indexes specific for obesity (BMI, BFMI) and abdominal obesity (VFA, WHR). However, this study has several limitations that must be considered when interpreting the results. We are aware that the health status of participants should be evaluated more complex. Except for body composition parameters, the study procedure might possibly include analysis of specific markers such as nutritional status, drug use, blood pressure measuring, evaluation of triglycerides and high-density lipoprotein cholesterol level. Although women from three countries in Central Europe were examined, and their PA level and body composition parameters encompassed a wide range, the sample selection was not random was restricted to only attendees at the Universities of Third Age. Thus, the results might be generalized in limited manner. Furthermore, some guidelines stipulate that the total activity should be accumulated from continuous bouts of at least 10 min in duration. However, we did not take into account this strategy while processing our data. This should be considered in subsequent studies aimed at further analyzing the association between PA guidelines and body composition variables. In conclusion, a clear association was found to exist between PA guidelines and body composition variables for the women examined in this study. Despite the limitations discussed above, the results of this research suggest that meeting either step-based recommendation 10,000 steps/day or the 30 min of moderate PA five times a week may bring more health benefits than meeting 150 min a week of moderate PA. Hence, meeting three guidelines values, specifically more than 300 min/week of moderate PA, the 30 min of moderate PA five times a week, and 10,000 steps/day, might be comparable for receiving the body composition values indicating good health in ambulatory women aged 60–65 years. However, the concept of 10,000 steps/day appears to be the strongest predictor of health-related body composition values. Finally, the results of this study might serve as a rationale for promotion of analyzed PA and step-based guidelines for women in Central European countries.

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