Abstract 38: Prospective Study of Midlife Sedentary Behavior, Physical Activity, and Cognitive Function: The CARDIA Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kara M Whitaker ◽  
Kelley Pettee Gabriel ◽  
Baojiang Chen ◽  
Monica Ahrens ◽  
Barbara Sternfeld ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cognitive Function ◽  
Sedentary Behavior ◽  
Repeated Measures ◽  
Adult Population ◽  
Verbal Learning ◽  
Stroop Test ◽  
Digit Symbol Substitution Test ◽  
Beneficial Effects ◽  
Intensity Physical Activity

Introduction: Evidence suggests moderate to vigorous intensity physical activity (MVPA) has beneficial effects on various domains of cognitive function; however, less than half of adults meet MVPA guidelines. Alternate approaches, such as reducing sedentary behavior (SED) with concurrent increases in light-intensity physical activity (LPA) may resonate more strongly with the adult population. Objective: To determine if accelerometer measured SED, LPA, and MVPA at ages 38-50 years is prospectively associated with measures of cognitive function. Methods: We studied 1,842 Black and White men and women enrolled in CARDIA who participated in the year 20 (2005-06) and year 25 (2010-11) and/or year 30 (2015-16) exams. SED, LPA, and MVPA were measured by the ActiGraph 7164 accelerometer at year 20. Cognitive function tests at the year 25 and 30 exams included the Rey Auditory Verbal Learning Test (RAVLT, memory), Digit Symbol Substitution Test (DSST, processing speed), and Stroop Test (executive function). Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA at year 20 with repeated measures (unstructured covariance) of the cognitive function raw test scores at years 25 and 30. Results: In men, substituting 30 minutes of SED with 30 minutes of LPA was associated with a decrease in the RAVLT (-0.05) and DSST (-0.76), and increase in Stroop (0.45) scores, indicating worse performance (see Table ). Substituting SED or LPA with MVPA was associated with an increase in RAVLT (0.15, 0.20) and DSST (1.21, 2.00), and decrease in Stroop (-0.68, -1.17) scores, respectively, indicating better performance. In women, who had higher cognitive function scores than men, substituting SED or LPA with MVPA was associated with worse performance on the Stroop test (0.70, 0.63), contrary to our hypothesis. Conclusions: Statistical substitution of time from lower-intensity activities (SED or LPA) with MVPA, but not SED with LPA, resulted in better cognitive performance in men, but not women, over 10 years.

The Association Between Sedentary Behavior and Cognitive Function Among Older Adults May Be Attenuated With Adequate Physical Activity

2017 ◽  
Vol 14 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Meghan K. Edwards ◽  
Paul D. Loprinzi
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cognitive Function ◽  
Sedentary Behavior ◽  
Sedentary Time ◽  
Vigorous Physical Activity ◽  
Adult Population ◽  
Digit Symbol Substitution Test ◽  
Independent Association ◽  
Adjusted Model

Objective:Examine the independent association of sedentary behavior and cognitive function in older adults, as well as whether physical activity attenuates this potential association.Methods:Data from the 1999–2002 National Health and Nutrition Examination Survey were used (N = 2472 adults 60 to 85 yrs). Sedentary behavior was subjectively assessed and the Digit Symbol Substitution Test (DSST) was employed to assess cognitive function.Results:Among an unadjusted and an adjusted model not accounting for physical activity, only 5+ hrs/day (vs. < 1 hr) of sedentary time was independently associated with lower DSST scores (β = –3.1; 95% CI: –5.8 to –0.4; P= .02). However, a fully adjusted model (adding in moderate-to-vigorous physical activity as a covariate) did not yield a statistically significant association between 5+ hrs/day of sedentary time and DSST scores (β = –2.5; 95% CI: –5.1 to 0.2; P = .07).Conclusion:Accumulated daily sedentary behavior of 5+ hrs is associated with lower cognitive function in an older adult population when physical activity is not taken into account. However, physical activity may account for 19% of the total association between sedentary behavior and cognitive function, thus attenuating the sedentary-cognitive function association. Efforts should be made to promote physical activity in the aging population.

scholarly journals Intake of Vegetables and Fruits Through Young Adulthood Is Associated with Better Cognitive Function in Midlife in the US General Population

2019 ◽  
Vol 149 (8) ◽  
pp. 1424-1433
Author(s):  
Xuanxia Mao ◽  
Cheng Chen ◽  
Pengcheng Xun ◽  
Martha L Daviglus ◽  
Lyn M Steffen ◽  
...  
Keyword(s):  
Cognitive Function ◽  
General Population ◽  
Cognitive Performance ◽  
Young Adulthood ◽  
Verbal Learning ◽  
Stroop Test ◽  
Fruit Juices ◽  
Digit Symbol Substitution Test ◽  
Vegetables And Fruits

ABSTRACT Background Vegetables and fruits (VF) may differentially affect cognitive functions, presumably due to their various nutrient contents, but evidence from epidemiologic studies is limited. Objectives The aim of this study was to examine the long-term association between VF intakes, including VF subgroups, in young adulthood and cognitive function in midlife. Methods A biracial cohort of 3231 men and women aged 18–30 y at baseline in 1985–1986 were followed up for 25 y in the Coronary Artery Risk Development in Young Adults Study. Diet was measured at baseline, and in examination years 7 and 20. Cognitive function was assessed at examination year 25 through the use of 3 tests: the Rey Auditory Verbal Learning Test (RAVLT), the Digit Symbol Substitution Test (DSST), and the Stroop test. The mean differences (MDs) with 95% CIs in cognitive scores across intake categories were estimated through the use of the multivariable-adjusted general linear regression model. Results Excluding potatoes, intake of whole vegetables was significantly associated with a better cognitive performance after adjustment for potential confounders in all 3 cognitive tests (quintile 5 compared with quintile 1—RAVLT, MD: 0.33; 95% CI: 0.01, 0.64; P-trend = 0.08; DSST, MD: 2.84; 95% CI: 0.93, 4.75; P-trend < 0.01; Stroop test, MD: −2.87; 95% CI: −4.24, −1.50; P-trend < 0.01]. Similarly, intake of fruits, except fruit juices, was significantly related to a better cognitive performance (quintile 5 compared with quintile 1—DSST, MD: 2.41; 95% CI: 0.70, 4.12; P-trend = 0.03). Conclusions This study supports the long-term benefits of VF consumption on cognitive performance, except those VF with relatively low fiber content such as potatoes and fruit juices, among the middle-aged US general population.

scholarly journals Longitudinal Associations of Midlife Accelerometer Determined Sedentary Behavior and Physical Activity With Cognitive Function: The CARDIA Study

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Kara M. Whitaker ◽  
Dong Zhang ◽  
Kelley Pettee Gabriel ◽  
Monica Ahrens ◽  
Barbara Sternfeld ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cognitive Function ◽  
Verbal Learning ◽  
Digit Symbol Substitution Test ◽  
Digit Symbol ◽  
Auditory Verbal Learning Test ◽  
Digit Symbol Substitution ◽  
Auditory Verbal Learning ◽  
Symbol Substitution ◽  
Learning Test

Background To determine if accelerometer measured sedentary behavior (SED), light‐intensity physical activity (LPA), and moderate‐to‐vigorous–intensity physical activity (MVPA) in midlife is prospectively associated with cognitive function. Methods and Results Participants were 1970 adults enrolled in the CARDIA (Coronary Artery Risk Development in Young Adults) study who wore an accelerometer in 2005 to 2006 (ages 38–50 years) and had cognitive function assessments completed 5 and/or 10 years later. SED, LPA, and MVPA were measured by an ActiGraph 7164 accelerometer. Cognitive function tests included the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop Test. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA with repeated measures of the cognitive function standardized scores. In men, statistical reallocation of 30 minutes of LPA with 30 minutes of MVPA resulted in an estimated difference of SD 0.07 (95% CI, 0.01–0.14), SD 0.09 (95% CI, 0.02–0.17), and SD −0.11 (95% CI, −0.19 to −0.04) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating better performance. Associations were similar when reallocating time in SED with MVPA, but results were less robust. Reallocation of time in SED with LPA resulted in an estimated difference of SD −0.05 (95% CI, −0.06 to −0.03), SD −0.03 (95% CI, −0.05 to −0.01), and SD 0.05 (95% CI, 0.03– 0.07) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating worse performance. Associations were largely nonsignificant among women. Conclusions Our findings support the idea that for men, higher‐intensity activities (MVPA) may be necessary in midlife to observe beneficial associations with cognition.

Abstract P400: Dietary Pattern is Associated with Better Cognitive Function: The CARDIA Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Na Zhu ◽  
David R Jacobs ◽  
Katie A Meyer ◽  
Ka He ◽  
Lenore J Launer ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Verbal Memory ◽  
Dietary Pattern ◽  
A Priori ◽  
Verbal Learning ◽  
Stroop Test ◽  
Digit Symbol Substitution Test ◽  
Middle Aged ◽  
Diet Pattern ◽  
Diet Score

Primary prevention of cognitive function decline is important for a middle-aged population, but further evidence about the influence of dietary pattern is needed. An A Priori Diet Quality Score (diet score) and cognitive function were studied in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study of black and white men and women aged 18-30 in 1985-86 (year 0, Y0). We hypothesized that a higher diet score, measured at Y0 and Y20, predicts better cognitive function measured at Y25. The diet scores incorporated 46 foods groups (each in servings/day categorized into quintiles), with higher scores indicating higher quality diets. The score was the sum of quintile ranks of foods rated healthy, 0 for foods rated neutral, and reversed quintile ranks of foods rated less healthy. Cognitive tests at Y25 measured verbal memory (Rey Auditory-Verbal Learning Test (RAVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (Stroop Test). Higher cognitive function is reflected by higher RAVLT and DSST scores and lower Stroop Test scores. For each additional 10 units of diet score at Y20, the RAVLT was 0.23 words recalled higher, the DSST was 0.87 digits higher, and the Stroop Test score was 0.69 lower. Diet score measured at Y0 was less strongly but still significantly associated with cognitive scores. In exploratory analysis, we found that education modified the relation between diet pattern and cognitive function measures, e.g. diet and DSST at Y20 were associated in less educated subjects, but not in higher educated subjects (P for interaction =0.02). In conclusion, higher diet score was associated with better cognitive function 5 years later in apparently healthy middle-aged adults. However, diet pattern was not related to some measures of cognitive function in better educated subjects, conceivably because of compensatory behaviors in better educated people that would maintain higher cognitive function scores, despite lower quality diet.

Abstract 007: Treadmill Duration Predicts Cognitive Function

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Na Zhu ◽  
David R Jacobs ◽  
Pamela J Schreiner ◽  
R. Nick Bryan ◽  
Lenore J Launer ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Verbal Learning ◽  
Stroop Test ◽  
Test Duration ◽  
Digit Symbol Substitution Test ◽  
Digit Symbol ◽  
Digit Symbol Substitution ◽  
Auditory Verbal Learning ◽  
Diabetes Status ◽  
Symbol Substitution

Evidence is scarce for an association between treadmill performance and cognitive function in healthy young and middle-aged adults. We assessed the hypothesis that duration on treadmill predicts cognitive function 25 years later. Participants were from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-center study of black and white men and women aged 18-30 at recruitment in 1985-86 (year 0). The main independent variable of interest was baseline symptom-limited maximal treadmill test duration as a measure of treadmill performance potential, including its major subcomponent cardiorespiratory fitness (CRF/TPP). Cognitive functions measured were verbal memory (with the Rey auditory-verbal learning (AVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (modified Stroop interference test, where lower is better). We analyzed 2444 participants who had y0 treadmill testing and y25 cognitive testing. For each additional SD of treadmill duration (2.8 minutes), the DSST was 2.4 digits correctly substituted higher, the AVLT was 0.36 words recalled higher, and the Stroop test time 1.7 seconds less, after accounting for race, sex, age, highest attained education level and center of clinic visit( Table ). Further adjustment for dietary pattern, physical activity, smoking, BMI, alcohol consumption, glomerular filtration rate, blood pressure, cholesterol and diabetes status yielded similar trends for these cognitive function tests. In conclusion, CRF/TPP predicts cognitive function 25 years later independently of other factors among apparently healthy adults. Prospective estimation of cognitive function by treadmill duration at baseline in minimally and fully adjusted model (see text for details), N=2444. Year 25 Digit Symbol Substitution Test: Digits correctly substituted mean±SD: 70.1±15.9 Year 25 Rey Auditory-Verbal Learning Test: Words correctly recalled mean±SD: 8.3±3.3 Year 25 Stroop Test : Seconds to correctly name colors mean±SD: 43.9±12.8 Slope * SE P Slope * SE P Slope * SE P Year 0 treadmill duration (SD) mean±SD: 10.0±2.8 minutes Minimally adjusted 2.4 0.36 <.0001 0.36 0.08 <.0001 -1.7 0.31 <.0001 Fully adjusted 2.3 0.45 <.0001 0.39 0.08 <.0001 -1.2 0.39 0.001 * “Slope” is the difference in the indicated cognitive function per SD (2.8 minutes) of treadmill duration.

Effect of Hypertension Duration and Blood Pressure Control During Early Adulthood on Cognitive Function in Middle Age

2021 ◽  
pp. 1-11
Author(s):  
Haobin Zhou ◽  
Zongyuan Zhu ◽  
Changsong Liu ◽  
Yujia Bai ◽  
Qiong Zhan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Function ◽  
Verbal Memory ◽  
Cognitive Assessment ◽  
Verbal Learning ◽  
Early Adulthood ◽  
Pressure Control ◽  
Stroop Test ◽  
Digit Symbol Substitution Test ◽  
Learning Test

Background: Elevated blood pressure (BP) is a risk factor for cognitive impairment. Objective: We aim to explore the association between the duration of hypertension in early adulthood, with cognitive function in midlife. Furthermore, we investigate whether this asssociation is altered among participants with controlled BP. Methods: This prospective study included 2,718 adults aged 18–30 years without hypertension at baseline who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Duration of hypertension was calculated based on repeat measurements of BP performed at 2, 5, 7, 10, 15, 20, and 25 years after baseline. Cognitive function was assessed at Year-25 using the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop test. Results: After multivariable adjustment, a longer hypertension duration was associated with worse verbal memory (RAVLT, p trend = 0.002) but not with processing speed (DSST, p trend = 0.112) and executive function (Stroop test, p trend = 0.975). Among subgroups of participants with controlled (BP < 140/90 mmHg) and uncontrolled (SBP≥140 mmHg or DBP≥90 mmHg) BP at the time of cognitive assessment (i.e., Year-25 BP), longer duration of hypertension was associated with worse verbal memory. Similar results were observed in subgroups with controlled and uncontrolled average BP prior to cognitive assessment. Conclusion: Longer duration of hypertension during early adulthood is associated with worse verbal memory in midlife regardless of current or long-term BP control status. The potential risk of hypertension associated cognitive decline should not be overlooked in individuals with a long duration of hypertension, even if BP levels are controlled.

scholarly journals Multi-Component Intervention Program on Habitual Physical Activity Parameters and Cognitive Function in Patients with Mild Cognitive Impairment: A Randomized Controlled Trial

2021 ◽  
Vol 18 (12) ◽  
pp. 6240
Author(s):  
Min-Ki Jeong ◽  
Kyung-Won Park ◽  
Je-Kwang Ryu ◽  
Gwon-Min Kim ◽  
Hyun-Hun Jung ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Intervention Program ◽  
Vigorous Physical Activity ◽  
Cognitive Intervention ◽  
Habitual Physical Activity ◽  
Disease Assessment ◽  
Digit Symbol Substitution Test

Age-related dementia refers to a state in which someone experiences multiple cognitive function impairment due to degenerative brain disease, and which causes difficulties in their daily life or social life. Dementia is the most common and serious obstacle in later life. Early intervention in the case of patients who are in the mild cognitive impairment (MCI) stage among the high-risk group can maintain and improve their cognitive function. The purpose of the current trial is aimed at investigating the association between a multi-component (exercise with cognitive) intervention program and habitual physical activity parameters on cognitive functions in MCI patients. Neuropsychological cognitive and depression assessments were performed by neuropsychologists according to normalized methods, including the Korean mini-mental State examination (K-MMSE) and modified Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog) and cognitive assessment tool (attention, processing speed), and the Korean version of the geriatric depression scale (SGDS-K), both at baseline and at a 12 weeks follow-up. The 12-week multi-component intervention improved cognitive function and habitual physical activity parameters in patients with MCI relative to controls. A multi-component intervention program for patients with MCI is considered to be an effective method of dementia prevention by improving global (ADAS-Cog) and frontal (trail-making test, digit symbol substitution test) cognition and habitual physical activity parameters such as moderate to vigorous physical activity and step count. In addition, it is important to encourage habitual physical activities to ensure that exercise intervention strategies are carried out at the duration and intensity required for improving physical and cognitive wellbeing and obtaining health benefits.

Accelerometry and Self-Report Are Congruent for Children’s Moderate-to-Vigorous and Higher Intensity Physical Activity

2021 ◽  
pp. 1-8
Author(s):  
Claudio R. Nigg ◽  
Xanna Burg ◽  
Barbara Lohse ◽  
Leslie Cunningham-Sabo
Keyword(s):  
Physical Activity ◽  
Repeated Measures ◽  
Vigorous Physical Activity ◽  
Fourth Grade ◽  
Assessment Method ◽  
Self Report ◽  
Upper Elementary ◽  
Upper Elementary School ◽  
Intensity Physical Activity

Purpose: This study used different analytic approaches to compare physical activity (PA) metrics from accelerometers (ACC) and a self-report questionnaire in upper elementary youth participating in the Fuel for Fun intervention. Methods: The PA questionnaire and ACC were assessed at baseline/preintervention (fall fourth grade), Follow-up 1/postintervention (spring fourth grade), and Follow-up 2 (fall fifth grade) of 564 fourth grade students from three elementary schools (50% females, 78% White, and 28% overweight or obese). Different analytic approaches identified similarities and differences between the two methods. Results: On average, self-report was higher than ACC for vigorous PA (range = 9–15 min/day), but lower than ACC for moderate PA (range = 24–30 min/day), light PA (range = 30–36 min/day), and moderate-to-vigorous physical activity (MVPA; range = 9–21 min/day). Spearman’s correlations for vigorous PA (.30, .26, and .32); moderate PA (.12, .13, and .14); and MVPA (.25, .25, and .24) were significant at each time point (all ps ≤ .01), whereas correlations for light PA were not significant (.06, .04, and .07; all ps > .05). In repeated-measures analyses, ACC and questionnaire measures were significantly different from each other across the three time points; however, change difference of the two measures over time was only 5.5 MVPA min/day. Conclusions: The PA questionnaire and ACC validated each other and can be used to assess MVPA in upper elementary school children in a similar population to the current study. However, each assessment method captures unique information, especially for light-intensity PA. Multiple PA measurement methods are recommended to be used in research and application to provide a more comprehensive understanding of children’s activity.

Abstract 035: Ideal Cardiovascular Health in Young Adulthood and Cognitive Functioning 25 Years Later: The CARDIA Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Jared P Reis ◽  
Catherine M Loria ◽  
Lenore J Launer ◽  
Stephen Sidney ◽  
Kiang Liu ◽  
...  
Keyword(s):  
Young Adulthood ◽  
Cardiovascular Health ◽  
Verbal Learning ◽  
Stroop Test ◽  
Digit Symbol Substitution Test ◽  
Ideal Cardiovascular Health ◽  
Auditory Verbal Learning ◽  
Health Factors ◽  
Symbol Substitution ◽  
Learning Test

Background: Accumulating evidence suggests the presence of cardiovascular risk factors in middle-age is associated with later adulthood cognitive dysfunction; however, the consequences of suboptimal cardiovascular health in young adulthood are unclear. Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a cohort of white and black men and women who were 18-30 years when a series of health behaviors (smoking status, body mass index, physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose) were measured during a baseline clinic examination in 1985-1986. Included in the current study were 2,577 participants who completed an examination 25 years later when a cognitive battery to assess psychomotor speed (Digit Symbol Substitution Test [DSST]), executive function (modified Stroop Test), and verbal memory (Rey Auditory Verbal Learning Test [RAVLT]) were administered. Ideal levels for each behavior and factor were defined according to the 2020 American Heart Association Goals for Cardiovascular Health. Associations were adjusted for age, sex, race, midlife educational attainment, and study center. Results: At baseline, the percentage of participants with 0-1, 2, 3, 4, 5, and 6-7 ideal health factors were 1.2%, 7.2%, 19.6%, 34.9%, 29.2%, and 7.8%, respectively. Adjusted mean DSST and RAVLT scores were higher among those with a greater number of ideal health factors ( Table ). Each additional factor at the ideal level was associated with a 0.78-point higher DSST score (95% CI: 0.28 to 1.28) and a 0.13-point higher memory score (95% CI: 0.02 to 0.25). Results did not differ by race or sex (p-interaction > 0.05). The ideal cardiovascular health score was not associated with performance on the Stroop Test. Conclusion: In this population-based sample, ideal cardiovascular health in young adulthood was independently associated with cognitive functioning in midlife. Table. Adjusted * mean (standard error) cognitive function scores at Year 25 by number of ideal health behaviors and factors at baseline: CARDIA (n=2,577). No. of Ideal Health Factors at Baseline (% of population) 0-1 (1.2%) 2 (7.2%) 3 (19.6%) 4 (34.9%) 5 (29.2%) 6-7 (7.8%) p-trend DSST 70.0 (2.5) 65.7 (1.0) 68.7 (0.6) 69.4 (0.5) 70.0 (0.5) 69.9 (1.0) 0.003 Stroop Test 21.5 (1.6) 21.2 (0.6) 21.0 (0.3) 20.6 (0.3) 20.6 (0.3) 20.4 (0.5) 0.14 RAVLT 7.4 (0.6) 7.6 (0.2) 8.0 (0.1) 8.2 (0.1) 8.3 (0.1) 8.1 (0.2) 0.02 * Adjusted for age, sex, race, midlife educational attainment, and study center. DSST=Digit Symbol Substitution Test; RAVLT=Rey Auditory Verbal Learning Test

scholarly journals Association Between Light Intensity Physical Activity And Sedentary Behavior Among Active Older Women

2018 ◽  
Vol 50 (5S) ◽  
pp. 209-210
Author(s):  
Luis Adriano Lima ◽  
Diana Carolina Gonzalez ◽  
João Pedro Silva Junior ◽  
Timóteo Leandro Araujo ◽  
Sandra Mahecha Matsudo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Light Intensity ◽  
Sedentary Behavior ◽  
Older Women ◽  
Intensity Physical Activity
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