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8 Physical activity Rebecca Teers
8.1.1 Background It is well established that physical activity is one of the key determinants of good health. A physically active lifestyle delivers significant physical and mental health benefits, notably helping to reduce cardiovascular disease and osteoporosis, and for some years has been the subject of public health promotion policy. The White Paper, Saving Lives: Our Healthier Nation, emphasised 'keeping physically active' as one of its 'top ten tips' for better health, encouraging greater involvement in physical activity by people of all age groups throughout the UK.1 In 1990, internationally-accepted recommendations were established, outlining the amount and type of physical activity that is beneficial for health.2 At this time, it was recommended that adults should take part in at least three occasions a week of vigorous activity lasting 20 minutes or more.3 However, by the mid-1990s it was recognised that although ideal in terms of cardiac benefit, this target was unrealistic, particularly for those who were currently inactive. Therefore, emphasis was shifted away from achieving vigorous levels of activity towards encouraging more regular moderate levels, thereby making targets attainable by a greater proportion of the population. The revised guidelines recommended that adults should take part in 30 minutes or more of moderate activity, at least five times a week.4 8.1.2 The questions asked Physical activity questions have been included regularly in the Health Survey since it began in 1991. The original questions were based on those used in the Allied Dunbar National Fitness Survey (ADNFS), which was carried out in 1989.5 Revisions have been made to these questions over the years, including changes between 1998 and 1999, the questioning being shorter in 1999 than in 1998, but the core elements of the module remaining the same. The physical activity module in the adult interview began by asking informants about the physical demands of their jobs. (Questions in the 1998 survey which asked for details of the types of physical activity carried out in the workplace were not included in 1999.) Informants were then asked about four other main types of activity:
The sequence of questions varied from topic to topic, and can be studied in detail in the questionnaire in Appendix A in Volume 2. Elements of it are discussed in the following sections of the present chapter (Sections 8.1.3, 8.1.4). 8.1.3 Classifying the 'intensity level' of physical activities Three principal measures were derived from informants' responses and
presented in the tables annexed to this chapter. All took account of
the physical intensity of activities. The following 'intensity level'
classification was intended to reflect the energy cost of each activity
undertaken:
The questions on which this classification was based differed between activity types. Physical activity at work Informants in work were asked how physically active they were in their jobs, being asked to classify themselves as 'very physically active', 'fairly physically active', 'not very physically active' and 'not at all physically active'. The coding of the intensity of levels of activity at work took account of the above responses and of the Standard Occupational Classification (SOC) code of the informant's job. Those who said that they were 'very physically active' in their job were classified as engaged in 'vigorous' activity at work if their job was one of a list of occupations,6 otherwise as 'moderate'. The activity of those who said they were 'fairly physically active' was classified as 'moderate' if the job was one of a second list of occupations, 7 otherwise as 'light'. Those who said they were not very, or not at all, physically active in their job were coded as being inactive. Although all the other activities referred to a specific period (the past four weeks), assessments of physical activity at work were based on informants' general descriptions of their jobs, as above, with no specific time reference. It was assumed that if they were full-time, they had engaged in their work activity for 20 days in the past month, and if part-time, for 12 days. Housework A list of housework activities was shown. A second list was then shown, illustrative of types of housework that were considered to impose heavy physical demands. 'Heavy housework' of this kind (examples appended in a note at the end of this chapter)8 was regarded as 'moderate' activity. Other types of housework were not taken into account. Gardening, DIY or building work A list of gardening, DIY and building activities was shown, followed by a second list of heavy manual/DIY/building activities (or other kinds of heavy manual work) that were considered to impose heavy physical demands. This heavy gardening/ DIY/ building work (referred to below, and in the tables, as 'heavy manual/DIY') was regarded as 'moderate' activity, while gardening or DIY that was not of this heavy kind was regarded as 'light' activity.9 Walking Informants were asked if they had, in the past four weeks, done a continuous walk of at least 30 minutes.10 The score allocated depended on informants' responses (on a scale provided to them) to a question about their normal walking pace. Walking at 'a fast pace (at least 4 miles an hour)' or 'a fairly brisk pace' was regarded as 'moderate'. Walking at 'a steady average pace' or 'a slow pace' was regarded as 'light'. Sports and exercise activities Different sports were treated differently. Some were always regarded as vigorous. A second group of sports were regarded as 'vigorous' if they were undertaken at a level that made informants out of breath or sweaty, but otherwise as 'moderate'. A third group were always regarded as 'moderate', while a fourth group were regarded as 'moderate' if they made informants out of breath or sweaty, otherwise 'light'. A fifth group were always classified as 'light'. The sports comprising each group are noted at the end of this chapter.11 The first derived measure (Table 8.1) is the number of days (in the past four weeks) on which informants had participated to at least a moderate level in each of the five main categories of activity (occupational work defined as vigorous or moderate, heavy housework, heavy manual/DIY, fast or brisk walking, certain types of sports/exercise), for at least 30 minutes a time. Those whose only physical activity in the past four weeks had been at a lower level appear as zero days ('None') in this table. The second measure, the 'summary activity level' (Tables 8.2-8.5), addresses the question of whether people are exercising at the level indicated in current guidelines. It is based on the number of days in the past four weeks in which informants had participated for at least 30 minutes, at a moderate level or above, in any of the five categories of activity. The grouping and labelling of responses reflects the current guidelines, which are expressed in terms of days per week. The total number of activity days each informant reported in the past four weeks was divided by four to produce an (average) weekly figure. The three summary activity level categories are: less than one day a week (low), one or more days a week but less than five (medium), and five or more days a week (high). The last of these three categories meets the current guidelines. The third measure, the 'maximum intensity scale' (Table 8.6), classifies informants on the basis of the most vigorous level of activity in which they had participated in the previous four weeks, regardless of time spent or frequency. This is the only one of the three measures in which the distinction between 'light' activity and 'inactive' is utilised, since the other two measures are concerned only with moderate activity or above. 8.2 Types of activity engaged in at moderate or vigorous level 8.2.1 Activities participated in by men Table 8.1 shows the number of days in the last four weeks on which informants had participated for at least 30 minutes at a time in physical activity classified as 'moderate' or 'vigorous': heavy housework, heavy manual/DIY, fast or brisk walking, a variety of sports/exercise activities entailing activity at moderate level or above, and occupational activity at moderate level or above. Table 8.1 also shows the mean number of days' participation in each activity (based on all informants, non-participation being counted as zero days). This mean is also shown in age-adjusted form as a ratio to the figure for the general population (separately for each sex). The inset table shows the observed (not age-adjusted) proportions of men participating within each minority ethnic group. Age-adjusted ratios of mean days' participation are shown in a subsequent table and commented on after the observed proportions.
Observed proportion of men participating in different types of activity at moderate or vigorous level
In the general population, the proportion of men participating was highest for sports and exercise (38%) and for heavy housework (36%), followed by heavy manual/DIY (30%) and walking (28%), with occupational activity in fifth place. It should be remembered that the figures are based on all men, and occupational activity would rank higher up the table if it had included only men in work. Irish men exhibited activity patterns broadly similar to those of men in the general population. Among men in all groups, sports and exercise was a widespread activity, though among Bangladeshi men the proportion engaging in sports and exercise was relatively low at 24%. It was almost double this among Black Caribbean men (47%). Men's participation in heavy housework was at about the same observed level among Indian men (34%) and Chinese men (33%) as in the general population (36%), but was lower among Pakistani men (25%) and, in particular, Bangladeshi men (16%). Men's observed levels of participation in heavy manual/DIY in all groups (except Irish men) were notably lower than the 30% for men in the general population. The proportions ranged from 5% for Bangladeshi men to 19% for Indian men. The proportion of men participating in walking (at a fast or fairly brisk pace) was as high among Black Caribbeans (28%) as among the general population (also 28%), but lower among South Asian and Chinese men, ranging from 12% to 19%. As noted above, Table 8.1 shows the estimated mean number of days' participation in each activity, and also presents these means in the form of age-standardised ratios to the general population figures, summarised in the second inset table. The pattern of differences shown is broadly similar to that described above. On this age-standardised basis, Black Caribbean men have relatively high levels of participation in heavy housework, in fast or brisk walking and in sports and exercise, but (like all the minority ethnic groups except the Irish) low levels of participation in heavy manual/DIY. South Asian men and Chinese men have lower levels of participation than the general population in almost all these activities.
Men's mean days' participation in different types of activity at moderate or vigorous level (ratios to general population)
As well as showing data for the five activities individually, Table 8.1 shows a combined figure for participation in any activity at moderate or vigorous level ('all physical activities'). It should be noted that this measure probably over-estimates the number of active days, as it assumes that each type of activity was done on a different day. Where the total number of days, aggregated over the activity types, exceeded 28 days (the total in the period) as a result of multiple activities occurring on the same day, the total was reduced to 28 for this summary measure. For men in the general population, the mean number of days' participation in all physical activities was 11.6 (out of 28). Figure 8A shows the results for each minority ethnic group relative to this, after adjusting for age. It will be seen that on this basis, the number of days of moderate or vigorous activity were about the same for Black Caribbean and Irish men as for men in the general population, but lower for Indian, Pakistani and Chinese men and lower still for Bangladeshi men. Table 8.1, Figure 8A 8.2.2 Activities participated in by women As among men, the proportions of Irish women undertaking the various activities at moderate or vigorous level were broadly similar to those of the general population, and comments below focus mainly on the other five minority ethnic groups. The participation of Black Caribbean women, like that of Irish women, was also close to that of the general population. Observed percentages of the proportion of women participating are discussed first, followed by comments on the mean number of days' participation, in the form of ratios to the general population.
Observed proportion of women participating in different types of activity at moderate or vigorous level
The activity most frequently reported by women in the general population was heavy housework (52%, this being about 11/2 times as high a proportion as the next most common activity, sports & exercise). Among Pakistani women, the proportion (51%) was about four times as high as for any other activity, among Bangladeshi women (37%) over three times as high, and among Indian women (49%) over twice as high. The proportion of women participating in sports and exercise was about as high among Black Caribbean (32%) and Chinese women (31%) as among women in the general population (33%). In South Asian groups it was considerably lower, ranging from 10% among Bangladeshi women to 20% among Indian women. As with men, the proportions of Black Caribbean, South Asian and Chinese women participating in heavy manual/DIY activity (ranging from 3% to 8%) were lower than among women in the general population (12%). The proportion of South Asian and Chinese women participating in walking ranged from 10% to 13%, well below the level of the general population (22%). The mean number of days' participation in each activity in the past
28 days was analysed for women, as for men, and full details are shown
in Table 8.1. The inset table shows the means for each group in the
form of age-standardised ratios to the population mean. It will be seen
that, on this age-standardised basis, the mean number of days in which
South Asian and Chinese women participated in these activities was generally
well below the general population level (with the exception of heavy
housework, where Indian women were at about the general population level
and Pakistani women above it). The mean numbers of days Black Caribbean
women participated in these activities were broadly similar to general
population figures, but were higher than the general population for
walking and occupational activity. Women's mean days' participation in different types of activity at moderate or vigorous level (ratios to general population)
Table 8.1 also shows the mean number of days (out of the last 28) on which women participated in any of these activities at a moderate or vigorous level. The general population mean was 9.0. Figure 8A shows the means for each minority ethnic group in the form of age-standardised ratios to this general population mean. The number of days with moderate or vigorous activity was as high, or higher, among Black Caribbean and Irish women as among those in the general population, but lower among Chinese and South Asian women, in particular Bangladeshi women, whose mean was around a third of the general population mean (the corresponding figure for men being around a half). 8.2.3 Gender differences The data discussed in this section have not been age standardised to equalise the age distributions of men and women. Men had generally higher levels of participation than women in these physical activities, except in the case of heavy housework. In all minority ethnic groups, as in the general population, the proportion of women participating in heavy housework was much higher than the corresponding proportion of men (Figure 8B). The 'gender difference' in heavy housework participation (the difference between the proportion for men and the proportion for women) was greater among Pakistanis (26% difference) and Bangladeshis (21%) than in other minority ethnic groups or in the general population (16%). Table 8.1, Figure 8B In the general population, the proportion participating in sports and exercise (Figure 8C) was higher for men (38%) than for women (33%). The gender difference among Black Caribbeans (15%) and South Asians (Indians 13%; Pakistanis 23% and Bangladeshis 14%) was larger than among the general population (5%). Table 8.1, Figure 8C The gender differences in mean number of days' participation can also be seen in Table 8.1. For participation in 'all physical activities', the means for women in the general population, and for Black Caribbean women, were about four-fifths of the means for men. For Chinese and Irish women the figure was more than four-fifths, but for South Asian women it ranged between three-fifths and three-quarters. (Table does not show these proportions.) 8.3 Participation in physical activity: days per week 8.3.1 The summary activity level The summary activity level classifies informants in a way designed to show the extent to which they were following the physical activity guidelines which recommend that adults should take part in five or more occasions a week of activity of at least moderate intensity, of 30 minutes or longer duration. All the types of activity discussed in Section 8.1.3 are included in the summary activity level. For activity at work, where the term 'occasions' is not applicable, full-time workers who were at least moderately active in their work were counted as engaging in 20 days' activity in the last four weeks, part-time workers in 12 days' activity. For other activities to be included, they had to have been participated in for at least 30 minutes at a time on each activity day. It should be noted that overall this classification, like that presented in Section 8.2.1 above, assumes that each type of activity (other than work) was done on a different day from any other activity, and so probably over-estimates the number of active days. For example, if an informant had participated in 30 minutes' heavy housework and 30 minutes' fast walking on the same day, this would be counted as two days of activity in the summary classification. Responses are initially classified in the table in five categories, which are then combined to produce a three-category classification, the summary activity level. The three categories are:
The last of these three categories (Group 3) corresponds to the current guidelines.
8.3.2 Participation in physical activities, by minority ethnic group Table 8.2 shows the number of days per week in which informants participated in moderate or vigorous activity for at least 30 minutes a time, and also shows the summary activity level. Age-standardised ratios are also presented in Table 8.2 to assist comparisons of the various minority ethnic groups with the general population. In the general population, a third of men (33%) and a fifth of women (21%) met the current physical activity guidelines (Group 3). A further 31% of men and 36% of women were in the medium activity group (Group 2). The largest proportion of both men (36%) and women (43%) in the general population were in the lowest activity group, reporting less than one occasion a week of moderate or vigorous activity lasting at least 30 minutes. The inset table shows that the proportion of men active at Group 3 level was higher than the corresponding proportion of women in all minority ethnic groups and in the general population.
Proportion active at Group 3 level: observed % and age-adjusted ratios to general population
The ratios in the inset table show substantial age-adjusted differences between minority ethnic groups as compared to the general population in the proportion active at Group 3 level. For both men and women, the highest ratios were found among Black Caribbeans (men 1.13, women 1.21) and Irish (men 0.97, women 1.15). South Asian and Chinese men and women, in contrast, had much lower proportions active at Group 3 level, all ratios being less than 0.75 except for Indian men (0.86). Table 8.2 also shows the proportion who had not, in the past four weeks, had any activity spell of 30 or more minutes at moderate or vigorous level. 23% of men in the general population had not had any activity spell of this kind. The proportion was about the same for Black Caribbean and Irish men, but higher for South Asian and Chinese men: for Bangladeshi men, it was 49%. 28% of women in the general population had not had such an activity spell, 5% higher than for men. The gender difference (not age standardised) varied by group. For Black Caribbeans and Irish, the proportions for men and women were the same or very similar. 35% of Indian women had not had such an activity spell (5% more than Indian men), 39% of Pakistani women (7% more than Pakistani men) and 54% of Bangladeshi women (5% more than Bangladeshi men). Figure 8D shows the proportion active at Group 3 level in the form of age-standardised ratios. Among men, Irish men had about the same (age-adjusted) proportion as the general population (ratio 0.97), Black Caribbean men higher (1.13), Indian men lower (0.86), and other South Asian and Chinese men considerably lower (ratios ranging from 0.55 for Bangladeshi men to 0.70 for Pakistani men). Among women, Black Caribbean and Irish women had higher age-adjusted proportions active at Group 3 level than the general population (ratios 1.21 and 1.15 respectively). Ratios were much lower for other groups, ranging from 0.74 for Chinese women down to 0.35 for Bangladeshi women. Table 8.2, Figure 8D Variations in activity levels by age Table 8.3 examines levels of overall participation by age group. As might be expected, the proportion inactive increased with age, but not always at the same rate. Of younger Black Caribbean men (aged 16-34), 9% were inactive, while of younger Bangladeshi men 32% were inactive. Inactivity rates among other young men were Pakistani 20%, Indian 16%, Chinese 17%, Irish 11%, general population 8%. At the other end of the activity scale, the proportion of young men active at Group 3 level ranged from 30% to 34% for young Bangladeshi, Chinese, Indian and Pakistani men to 42% for young Irish men, 48% for young men in the general population and 54% for young Black Caribbean men. Results for women also show large variations in the inactivity percentage among young women in different minority ethnic groups. Relatively few young Irish women were inactive (11%), whereas 44% of young Bangladeshi women were inactive. The decline in physical activity with age showed a different pattern for men and for women. For men, a notable decrease in level of activity was shown between each successive age group, but levels of activity for women tended to be similar between the lower two age groups with a larger decrease between the middle and oldest groups. However, the general tendency for both sexes was for the decline between middle and oldest groups to be larger than that between youngest and middle. 8.3.3 Socio-economic variations Variations in activity levels by social class of head of household The observed proportion of men in the general population who were active at Group 3 level differed between non-manual (26%) and manual households (41%). Some minority ethnic groups showed a difference (but much smaller) in the same direction, others showing a difference in the opposite direction. After age standardisation, the only group other than men in the general population to show a significant difference was Bangladeshi men (higher in non-manual than manual). Among women in the general population, there was less difference between the two social class groups than in the case of men. Within minority ethnic groups, none of the differences were significant. Equivalised household income Neither men nor women in the general population showed a significant difference between income tertiles in the proportion active at Group 3 level. Inspection of the ratios in Table 8.5 suggests a tendency in some minority ethnic groups, notably Black Caribbean men and women and Pakistani men, for the proportion active at Group 3 level to be higher in the highest income tertile, but the patterns in other groups are less clear, partly as a result of the small sample sizes in some income tertiles.
8.4 Maximum intensity level attained Table 8.6 presents the maximum intensity level attained by minority ethnic groups. This summary measure classifies informants according to the maximum intensity level reached in any type of activity in the last four weeks. The measure takes no account of the frequency or duration of the activity. Across all minority ethnic groups, men were considerably more likely to have engaged in vigorous activity in the past four weeks than women. In the general population the proportion was 32% for men and 24% for women: the gender difference was smaller for Irish, similar for Chinese, and greater for Black Caribbean and South Asian groups. Men Among men, Bangladeshis were the minority ethnic group who were most likely to have been inactive (22%) and the least likely to have taken part in vigorous activity (24%). Black Caribbean men, in contrast, were particularly likely (42%) to have taken part in vigorous activity. Observed figures show that the other groups had vigorous activity prevalences not very different from those of the general population, but age differences between the groups need to be taken into account by examination of the age-standardised ratios (relative to the general population) in Table 8.6, and shown graphically in Figure 8E. These confirm Black Caribbean men's high levels of participation in vigorous activity (ratio 1.17), and the low levels among Bangladeshi men (0.45). They also show that Indian and Pakistani men had low levels of vigorous activity (ratios 0.78 and 0.70 respectively) once their age profile was taken into account. The ratio for Chinese men was not as low (0.86) but nevertheless was also significantly below the general population level. The ratio for Irish men was not significantly different from the general population. Table 8.6, Figure 8E If the group of men at the opposite end of the scale, those who have been inactive, is analysed instead, then differences between the groups become still more marked. The ratios for Indian, Pakistani and Bangladeshi men were respectively 2.18, 3.71 and 4.34. Pakistani and Bangladeshi men were thus about four times as likely as the general population to be inactive. Women As in the case of men, the proportion of Bangladeshi women who had engaged in vigorous activity in the past four weeks was notably low, only 11% being vigorously active (compared with 24% in the general population). 34% had been inactive, compared with 12% in the general population. The proportion of Pakistani women active at vigorous level was equally low at 11%, though the proportion inactive was not as high (23%). The proportion of Indian women active at vigorous level was 17%, again well below the general population proportion. Age standardisation is needed to allow for age differences between women in the different minority ethnic groups. Analysis of age-standardised ratios shows that Pakistani women (ratio 0.29) and Bangladeshi women (0.27) were between three and four times less likely to have reached vigorous levels of activity than women in the general population, and less than women in all other minority ethnic groups. Indian women (ratio 0.54) and Black Caribbean women (0.86) were also significantly less likely to have engaged in vigorous activity than women in the general population. Table 8.6, Figure 8E
Like men, women in the different minority ethnic groups varied even more in the proportion inactive than in the proportion engaging in vigorous activity. Bangladeshi women (ratio 5.87) were nearly six times as likely as women in the general population to have been inactive. Inactivity ratios were 4.38 for Pakistani women, 2.43 for Indian women, 1.69 for Chinese women and 1.38 for Black Caribbean women. Irish women (ratio 0.73) were the only minority ethnic group who were significantly less likely than women in the general population to have been inactive in the past four weeks. References and notes 1 Saving Lives: Our Healthier Nation, The Stationery Office, London, 1999. 2 Killoran A et al (eds). Moving on: international perspectives on promoting physical activity, Health Education Authority, London, 1995. 3 American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in health adults, Medicine and Science in Sports and Exercise 1990; 22:265-274. 4 Blair SN, Connelly JC. How much physical activity should we do? The case for moderate amounts and intensities of physical activity in Killoran A et al (eds) ibid. 5 Allied Dunbar National Fitness Survey, Health Education Authority and Sports Council, London, 1992. 6 Those 'very physically active' at work were classified as having, in the past four weeks, been engaged in 'vigorous' activity if they were in one of the following occupations, otherwise as in 'moderate' activity: fishermen/women, furnace operators, rollermen, smiths and forge workers, faceworking coal-miners, other miners, construction workers and forestry workers. 7 Those 'fairly physically active' at work were classified as having been engaged in 'moderate' activity at work if they were in one of the following occupations, otherwise as in 'light' activity: fishermen/women, furnace operators, rollermen, smiths and forge workers, faceworking coal-miners, other miners, construction workers and forestry workers, fire service officers, metal plate workers, shipwrights, riveters, steel erectors, benders, fitters, galvanisers, tin platers, dip platers, plasterers, roofers, glaziers, general building workers, road surfacers, stevedores, dockers, goods porters, refuse collectors. 8 Examples of 'heavy' housework: walking with heavy shopping for more than 5 minutes, moving heavy furniture, spring cleaning, scrubbing floors with a scrubbing brush, cleaning windows, or other similar heavy housework. 9 Examples of 'heavy' gardening or DIY work: digging, clearing rough ground, building in stone/bricklaying, mowing large areas with a hand mower, felling trees, chopping wood, mixing/laying concrete, moving heavy loads, refitting a kitchen or bathroom or any similar heavy manual work. Examples of 'light' gardening or DIY work: hoeing, weeding, pruning, mowing with a power mower, planting flowers/seeds, decorating, minor household repairs, car washing and polishing, car repairs and maintenance. 10 An initial question asking about walks of 5 minutes or more was intended simply as a lead-in, and was not used in the analysis in this chapter. 11 Sports were grouped into five categories for the purpose of coding them on the intensity scale: Running/jogging and squash were always coded as 'vigorous'. Boxing, kick boxing, skipping, trampolining, cycling, aerobics, keep fit, gymnastics, dance for fitness, weight training, football, rugby, swimming, tennis, badminton, martial arts: were all coded as 'vigorous' if they had made the informant out of breath or sweaty, otherwise 'moderate'. Basketball, canoeing, fencing, field athletics, hockey, ice skating, lacrosse, netball, roller skating, rowing, skiing, volleyball (and a number of others) were all counted as 'moderate'. Exercise (press-ups, sit-ups), dancing were coded as 'moderate' if they had made the informant out of breath or sweaty, otherwise 'light'. Abseiling, baseball/softball, bowls, cricket, croquet, darts, fishing, golf, riding, rounders, sailing, shooting, snooker, snorkelling, softball, table tennis, yoga (and a number of others) were all coded as 'light'. 8.1 Number of days' participation in different activities in the last four weeks, by minority ethnic group 8.2 Overall participation in physical activities, by minority ethnic group 8.3 Overall participation in physical activities, by age within minority ethnic group 8.4 Overall participation in physical activities, by social class of head of household with minority ethnic group 8.5 Overall participation in physical activities, by equivalised household income tertile within minority ethnic group 8.6 Maximum intensity level attained, by minority ethnic group
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