Paper Session 01: Physical Activity

Background: Cardiovascular disease (CVD) poses major health risks for U.S. firefighters, largely resultant from modifiable factors such as physical inactivity and poor sleep. Behavior change interventions often fail to produce lasting benefit, in part due to misalignment with firefighters’ occupational routines and poor intervention uptake and engagement. We developed and evaluated the Firefighter Integrated Health Optimization Training (FI-HOT) program; an occupationally tailored Ecological Momentary Intervention (EMI), guided by design thinking principles to optimize user experience, that aims to improve physical activity and sleep behaviors.
Methods: This multi-phase study included: Phase 1) semi-structured interviews, Phase 2) pilot testing to assess acceptability, and Phase 3) a single-arm, 12-week Phase I trial of the complete program. Phase 3 included two in-person visits, ambulatory monitoring of physical activity and sleep, and daily diary surveys. During the 8-week intervention, participants received four brief EMIs (<10 min; two targeting physical activity, two targeting sleep hygiene) per week via smartphone. Mixed-effects models were used to assess changes over time in physical activity and sleep.
Results: Phase 1 interviews (N= 24) and Phase 2 pilot testing (N=14) informed refinements to recruitment strategies, delivery methods, and program content. Phase 3 enrolled 130 active career firefighters (M age = 36.3, SD = 8.7) to the FI-HOT program. Participants completed ~82% of sleep and 81% of physical activity micro-interventions. Mixed-effects models showed increased total activity minutes on non-intervention days (p = .02), improved occupational performance (p = .004), increased sleep efficiency (p = .01) on intervention days, increased total sleep time (p = .03), and decreased waking after sleep onset (p = .03) across all study days. There was an unexpected increase in self-reported sedentary behavior (p=<.0001).
Conclusion: Findings support the feasibility and acceptability of the novel FI-HOT program for career firefighters. Strong engagement and improvements in activity and sleep suggest potential for broader application in high-risk occupations. The success of user-centered design principles highlight the value of tailoring interventions to occupational contexts and future work should explore long-term efficacy and scalability across diverse populations and occupational contexts.

Presenter - Shannon White, PhD, The Ohio State University
Co-Author - Chris Sciamanna, MD, Penn State College of Medicine
Co-Author - Joshua Smyth, PhD, FSBM, The Ohio State University

Introduction: Extreme heat has been shown to hinder children’s physical activity in school and childcare settings; however, limited data exist on how temperature affects children’s active school commuting, a form of physical activity that mitigates climate change when replacing car trips. We determined the association between temperature and children’s active school commuting in a humid subtropical climate.

Methods: Data from children (n = 347) living within one mile of school (n = 35) in Austin, Texas, originated from the STREETS study. STREETS enrolled third-grade children at baseline and followed them through fifth grade, measuring whether children walked, cycled, or rode in a motor vehicle to and from school by accelerometers (wGT3X-BT) and global positioning system devices (BT-Q1000XT) over a full school week during waking hours across each school year (2019–2024). Weather data originated from the federally maintained weather station nearest to each school. We conducted mixed effects logistic regression modeling to assess the association between air temperature and whether children walked or cycled to or from school. Final models adjusted for day-level (relative humidity, precipitation, wind speed), child-level (sex, race/ethnicity, parent education, active commuting history), and school-level (sidewalks, bicycle lanes, street connectivity, tree canopy) variables, and included random intercepts at the child and school levels. We included a piecewise linear term following evidence of a non-linear association between temperature and commuting identified by the Davies test.

Results: Temperatures on study days (n = 301) throughout the year ranged -2.2–36.7°C (28–98°F) and averaged 19.0°C (66°F). Few (13%) of the measured school commutes (n = 2,642) by children were active. Temperature exhibited an inverted U-shaped relationship with the percentage of children active commuting. In the fully adjusted model, each 1°C increase in temperature was associated with higher odds of active commuting (aOR = 1.07; 95% CI = 1.04, 1.11), until 21.9°C (71°F) when the association changed to decreasing odds per 1°C increase (aOR = 0.93; 95% CI = 0.88, 0.99).

Conclusion: Findings reveal very low or high temperatures may reduce active school commuting of children. With temperatures expected to continue increasing due to climate change and urban development patterns, municipalities should consider adaptation strategies (e.g., tree planting) to support active commuting.

Co-Author - Kevin Lanza, PhD, UTHealth Houston School of Public Health
Co-Author - Baojiang Chen, PhD, UTHealth Houston School of Public Health
Co-Author - Perry Sheffield, MD, PhD, Mount Sinai School of Medicine
Co-Author - David Gimeno Ruiz de Porras, PhD, The University of Texas Health Science Center at San Antonio
Co-Author - Yuzi Zhang, PhD, UTHealth Houston School of Public Health
Co-Author - Deborah Salvo, PhD, The University of Texas at Austin
Co-Author - Deanna Hoelscher, PhD, UTHealth Houston School of Public Health
Presenter - Tyson Murray, PhD, UTHealth Houston School of Public Health
Co-Author - Julia Gohlke, PhD, Virginia Tech

Background: Neighborhood conditions, as key social determinants of health, are critical to healthy aging. Integrating contextual measures into behavioral medicine interventions is essential for developing adaptable, equity-focused health solutions. Yet, few physical activity (PA) interventions explicitly evaluate how these factors influence effectiveness. We conducted a secondary analysis of the Computerized Physical Activity Support for Seniors (COMPASS) Trial to examine whether neighborhood-level conditions, measured by the California Healthy Places Index (HPI), moderated changes in PA among Latino/a older adults.
Methods: The COMPASS trial was a single-blind, cluster-randomized non-inferiority trial comparing an interactive virtual advisor (reference arm) with a trained human peer advisor. PA outcomes, including weekly minutes of walking and moderate-to-vigorous physical activity (MVPA), were assessed with the CHAMPS questionnaire at baseline and 12 months. The HPI is a composite index of 25 indicators across eight domains (e.g., housing, education, transportation), scaled from 0 to 100, with higher scores reflecting more health-supportive neighborhood conditions. Mixed-effects ANCOVA models adjusted for baseline PA, age, and gender, with a random intercept for study site, and tested moderation via interaction terms between intervention arm and HPI.
Results: Among 245 Latino/a participants (mean age 62.3 years; 78.8% female), HPI significantly moderated intervention effects. When modeled continuously, significant interaction effects were observed for 12-month change in walking (β = –2.93; P = .041) and MVPA (β = –2.54 min/week per HPI point; P = .033). These coefficients indicated that the human advisor was more effective in lower-HPI neighborhoods, whereas the virtual advisor was more effective in higher-HPI neighborhoods for both outcomes. Sensitivity analyses using dichotomized HPI yielded consistent patterns.
Conclusions: Neighborhood context moderated the relative effectiveness of digital versus human-delivered PA interventions. Tailoring delivery strategies, leveraging digital tools in advantaged areas and peer support in under-resourced neighborhoods, may enhance equity in health promotion for older Latino/a adults.

Presenter - Astrid Zamora, PhD, MPH, Stanford University School of Medicine
Co-Author - Maria Campero, BA, Stanford University School of Medicine
Co-Author - Dulce Garcia, BA, Stanford University School of Medicine
Co-Author - Timothy Bickmore, PhD, Northeastern University
Co-Author - Abby King, PhD, FSBM, Stanford University Medical School

Survivors of childhood cancer are at elevated risk for chronic health conditions largely due to the long-term effects of cancer therapies. While regular exercise can mitigate risks, survivors are often inhibited by physical function impairments. Tailored interventions may be more acceptable and efficacious for childhood cancer survivors to engage in regular physical activity.

A single-blind randomized controlled trial enrolled adult survivors of childhood cancer with reduced exercise capacity (<85% predicted VO₂peak) to a 20-week tailored, home-based aerobic and strengthening intervention (n=79) or to a attention control group (n=77). The intervention, supervised by exercise specialists to accommodate physical impairments and preferences, was delivered remotely via web-based platform; supervision was tapered over the 20 weeks to be primarily unsupervised. Efficacy outcomes were assessed at baseline, 20 and 44 weeks. The primary outcome was change in VO₂peak estimated from the 2-minute step-in-place test. Adherence (% of sessions completed) and acceptability of the intervention were measured post-intervention using the Service User Technology Acceptability Questionnaire (SUTAQ, 22 questions on a 5-point Likert scale) and interviews with 8 intervention participants. A linear mixed model assessed the pattern of change in VO2peak. Interview data were analyzed via rapid qualitative analysis.

156 participants (mean age=29.2 ±5.6 years) were 44.9% male and 85.3% white, with 84% completing the study. From baseline to 20 weeks, mean (standard error) VO2peak increased by 1.00±0.27 mL/kg/min (p<0.001) in the intervention group versus 0.43±0.25 mL/kg/min (p=0.09) in controls (interaction p=0.12). From baseline to 44 weeks, changes were 1.03±0.26 mL/kg/min (p<0.0001) vs. 0.69 mL/kg/min (p=0.08) (interaction p=0.34). Mean adherence was 69.5%±22.4% and acceptability was high (SUTA 5.0±0.9 at 20 weeks; 5.1±0.9 at 44 weeks). Participants liked the accountability and support from exercise specialists, convenience of the platform, and the structured program. Challenges were scheduling, technical issues, and independently maintaining routines.

Remotely delivered exercise is acceptable and improves exercise capacity in childhood cancer survivors, with potential as a scalable component of long-term survivorship care. Future research should optimize delivery, assess long-term impacts, and evaluate strategies to reach a broader population of survivors.

Co-Author - Sarah Terrell, MS, St. Jude Children's Research Hospital
Co-Author - Robyn Partin, MS, St. Jude Children's Research Hospital
Co-Author - Sean O'Neil, MA, St. Jude Children's Research Hospital
Co-Author - Matthew Ehrhardt, MD, St. Jude Children's Research Hospital
Co-Author - Tara Brinkman, PhD, St. Jude Children's Research Hospital
Co-Author - Zhaoming Wang, PhD, St. Jude Children's Research Hospital
Co-Author - Deokumar Srivastava, PhD, St. Jude Children's Research Hospital
Co-Author - Melissa Hudson, MD, St. Jude Children's Research Hospital
Co-Author - Gregory Armstrong, MD, St. Jude Children's Research Hospital
Co-Author - Daniel Mulrooney, MD, St. Jude Children's Research Hospital
Co-Author - Kirsten Ness, PT, PhD, FAPTA, St. Jude Children's Research Hospital